To say the processes of attracting, hiring and retaining the best people is a challenge in the health care sector is, at its best, a colossal understatement. In “normal” times, care organizations have had to be resourceful to meet the demands of employing enough highly skilled staff to ensure quality care.

The pandemic has exposed the fragility of providing adequate staffing levels, resulting in a staffing pandemic – a cascade of compounding shortages in all health care sectors, and in all facets of care and services to clients. For many organizations, the provision of quality care has been superseded by cries for “any” care.

Signs for Optimism

In spite of the current wide-spread severity of staffing shortages, there are signs that the situation can be alleviated in the short term, and with a view to the long term, the likelihood of a similar re-occurrence greatly reduced or eliminated.

A Positive Sign

In the midst of all the turmoil, anxiety, misrepresentations and at the most extreme, deaths, there have been rare instances where Long Term Care Homes have transcended the plethora of challenges relatively unscathed.

The most common and prevailing differentiator of Homes that successfully responded to the pandemic were those in which a culture of progressive leadership practices had been in place for several years. These practices were so deeply entrenched in the culture of the Homes that even the onslaught of challenges brought on by the pandemic were not enough to substantively alter their continued success.

With respect to staffing, the response was strategic approaches to recruitment, continued and accelerated supportive environments for staff, and adaptive responses to constantly changing expectations.

Witnessing such positive outcomes leads us to…

The Second Positive Sign

When faced with seemingly unsurmountable challenges, knowing something can be done to address the obstacles, gives us reason to believe that if we change, the situation can be improved. And so it is with the long term care response to the impact of the pandemic.

For this second positive sign, we are drawing on the experiences of others to provide examples of how any Home can address the situation, by creating a culture built on progressive leadership – assuming there is a willingness and commitment to change.

The culture of any organization represents a culmination of recent, remote and distant practices. In other words, culture evolves over time, and can be impacted at any period in the time continuum. Some of the examples shared here are the result of long-standing leadership and organizational practices, while others were initiated in the moment. Regardless, they all have the potential to positively impact any Home along their evolutionary cultural journey.

For some organizations, the changes required to make a significant difference may be subtle and readily implemented. For others, a longer-term commitment to changing the culture may be warranted.

A seedling grows from the moss on a tree trunk.

Regardless of your circumstances, drawing on the familiar adage, “The best time to plant a tree was 20 years ago; the second-best time is today,” gives credence to taking action now.

This review of best practices is broken down into the categories of recruitment, hiring, onboarding, and retaining employees. Some strategies can be implemented with little adjustment, while others require a longer-term perspective in terms of time and effort before there is a payoff.


Successful recruitment today requires diversity in terms of recruitment channels and messaging.

Recruitment Channels

  • Build relationships with external potential employee sources, such as career departments and services in education
  • Connect with related education institutions with offers to speak on topics related to their curriculum
  • Continuous lobbying for student field placements and paid internships (which can result in a cost-effective way to orientate prospective new employees)
  • Offer to speak to senior elementary students about health care career opportunities in LTC
  • Utilize social media and job posting sites where millennials are likely to job search
  • For such workplace roles in dietary, housekeeping, maintenance and laundry, promote work opportunities in non-health care venues, such as the hotel conferences or publications
  • Promote openings on association job boards (albeit more challenging, given how you are competing with every other long term care Home for the same people.)
  • Church/Religious Centres sometimes offer job support programs, and may post positions

Recruitment Messaging

  • Change Your Messaging! When you are recruiting, you are “selling” your product! If you don’t like the sound of that, get over it! Or get yourself out of the recruitment role. The best recruiters are those that know people “buy” on emotion, and use logic to justify their choice. One of the best ways to connect with people at an emotional level is by sharing moving or inspiring stories from your workplace. Your Home and the experiences you have to share will resonate much more than a discussion focused on statistics, specific roles and duties, compensation and benefits. Make sure that any printed material you share communicates the same messaging.
  • Consider who you are talking to, and then communicate emotional-based messages that resonate with your audience. In other words, your messaging with a group of student nurses might be focused on how a new nurse helped a resident in need, and made a difference in the life of the resident. Conversely while talking to prospective maintenance employees, you might include a story of how a new worker identified a noisy piece of equipment, which resulted in early intervention, saving the Home money, and rewarding the employee with commendations and a bonus. Always remember, if you meet them where they are, they will be influenced at an emotional level first.
  • Full time positions or ideal shifts. If you do have full time openings, or shifts that are seen as great, you have an advantage over other potential employers. Emphasize the benefits (such as more time with family, or reduced stress as a result of the enhanced benefit package that come with full time employment.)


    The process of hiring ideal candidates is fraught with challenges. While it is tempting to use the vapour test method of hiring during extreme staff shortages (place a mirror under the person’s nose, and if there is a vapour, they are hired!), the results are seldom positive. Even the best interviewers cannot guarantee a “good fit” when a final selection is made.

    However, a quick summary of some approaches might help to increase the likelihood of finding more people that work out in the long run.

    Asking good questions is important. Rather than the “What would you do if…” type of question, ask questions that require them to provide examples of what they actually did.

    • Tell us about a time when you were confronted by…
    • Provide an example of when you went above and beyond your employer’s (or teacher’s) expectations.
    • Describe how you clean a resident room, when the resident is there.
    • What do you see as the key challenges in this job?
    • Share your knowledge of…

    Finally, make the person’s demeanour and attitude the primary factor in hiring. Skills can be taught. Who the person is won’t change. Organizations that pay special attention to how the prospective employee responds to others (staff and residents) while they sit in the hallway waiting to be interviewed often gain valuable insight into the real person behind the interviewing mask.


    Group of employees gather in a circle
    Copyright Chernetskaya |

    Now that the person has been hired, the transition to successful employment has just begun. Most Homes have experienced the frustration of finally recruiting new employee(s), only to have them leave within a few days or weeks. While a great onboarding process doesn’t guarantee positive outcomes, it substantially reduces the likelihood of such turnover. Here are some strategies (some simple, and some requiring more planning!) that increase the likelihood that your Home will be seen as the place to be employed!

    • First Connections. When someone is hired, connect with them first in their home. Sending a hand written note from their new manager congratulating them on their decision, and thanking them for joining the team, resonates that you care about people. If you send more “official” documents prior to their start, send them separately, and include a message saying that if they have time and find it helpful to go over them before coming to work, great, but otherwise you will provide time for them to review the documents once they start working. Otherwise, you are asking them to start working for you – on THEIR time!
    • Send Out the Alert! Once a new hire is confirmed, send out notices, and a brief orientation about the new hire, and their start date, to their new team members. Encourage everyone to mentally rehearse the new hire’s name, so when they are first introduced, the welcome is all the more meaningful.
    • The First Day…or The Worst Day. You have one day to create a good first impression. Unfortunately, all too often, the first day of orientation is one of the worst days people will experience on the job. They are confronted by legal documents, signing all over the place, and then loaded up with reams of policies and procedures to review. When we ask employees what they remember from all that inundation of information on their first day or two at work, the typical response is along the lines of “I remember nothing from everything I had to read, but I do remember feeling overwhelmed!” Consider the first day on the job as a “Threshold Moment” – a day more important than any other – that you are acknowledging the presence of a new person, marking this moment as special. One of our favourite stories comes from Daniel Coyle (The Culture Code, Bantam Books, 2018), recounting how new basketball players are orientated to the Oklahoma City Thunder team. The first thing that happens is they are taken to the Oklahoma City National Memorial, which honours the victims of the Oklahoma City bombing that killed 168 people. After simply walking around the reflecting pool and the sculpture of 168 chairs, the players are reminded to look into the stands during games and to remember that many of the fans were personally affected by the tragedy. As Coyle says, it sends a powerful belonging cue – that resonates emotionally. Imagine the impact of walking down a hallway in your Home with a new hire, focusing on one or two photos of residents in your Home (current or past), and sharing stories about their life accomplishments, or how what they did in your Home that was so special. You have hundreds of stories in your Home – focus on these stories – make the person’s first day in your Home an inspiring Threshold Moment.
    • The Essentials. The first day must include a tour of the essentials for the new hire’s experience – where and how to navigate to the staff room, the lunch area and the bathrooms, and their primary work area. As the new hire is orientated to these areas, be sure they have a copy of the floor plan(s), so they can be shown where they are at any given moment of this first day tour.
    • Mentors/Buddies. A mentor or buddy program, utilizing an employee peer is an excellent way to help the new hire gain confidence on the job. Ideally the period of support remains in place for 60 – 90 days. The selection, training and guidance you provide to the mentor or buddy should be commensurate with importance of this role. If you want to bring out the best in the new hire, make sure they are well guided by the best.
    • The Head Honcho Moment. Regardless of their position, the new hire should be introduced to the most senior manager in the Home, such as the administrator or CEO. This person should be made aware of the new hire’s name and some personal details (such as family, children, birthdate, etc.) in advance, so that in these few moments, they can make the welcome all the more personal and meaningful.
    • Orientation Program. The amount of orientation time provided to new employees does communicate a message. In recent years of staff shortages, Homes have tended to expand orientation time, giving new hires more time to adjust to the work routines, in the hope that people will not become frustrated and leave. These changes in approach do appear to be having more positive outcomes in terms of new hire retention. While this does add costs to the orientation process, the added cost of repeated staff replacement makes a more extensive orientation program more acceptable – and communicates a more positive message to both the new hire, and to established staff (new hires are not seen as such a burden).


    Obviously, the true nature and culture of working in your organization becomes apparent to all employees within a matter of weeks or months of their employment. Ongoing and consistent progressive leadership practices are key to fostering a culture that reinforces ongoing employee engagement.

    Our focus here is on essential leadership practices that impact the more recent hires, and their decisions to stay with the Home.

    • First Formal Follow-up. While the new hire is encouraged to come forth with questions and concerns immediately, also schedule and confirm a follow-up touch-base meeting time – ideally within two weeks of the start date. They will have experienced enough by that point to have questions, and it shows that you care and are supportive. Be prepared to ask questions, such as “What do you like most about your work so far? What do you find most challenging? What can we do to help you in your work? How could we have better prepared you in our orientation program?”
    • Second Formal Follow-up. Having a second scheduled meeting (at least 6-8 weeks after their start) helps to draw attention to deeper concerns and needs that the new hire may be experiencing. Some research suggests that the primary stressors experienced by health care workers are personal debt, medical issues and mental health. Carefully listen to the new hire’s comments, which may prompt you to offer much appreciated support and direction. Asking about their aspirations, what do they see as possible new opportunities in your Home in the future, and reinforce any educational opportunities or support you are able to provide.
    • What We Do For Everyone – All The Time. Looking to retain people, beyond the new hire process we are focusing on here, requires a diverse approach in order to appeal to the many different needs, interests and abilities of employees. The options are endless, including such initiatives as celebrations of achievement (both personal and Home-wide), personalized acknowledgements (birthday cards, anniversaries, etc.), announcements (newsletter, media releases, etc.), and celebrations and acknowledgment of diversity (cultural, ethnic, age, etc.) Reinforcing and encouraging ongoing personal and professional growth and development of employees is also highly corelated with employee retention. Rather than waiting for employees to come forward looking for support, progressive leadership is characterized by a desire to “grow” people – encouraging people to take advantage of training and development opportunities. This serves to expand people’s scope and ability to take on new challenges and opportunities, and when positions are filled from within, it reinforces for everyone that the organization is committed to its employees.


    Successful recruitment, hiring, onboarding, and retaining employees is a direct outcome of progressive leadership. Where practices such as these have not been employed, the pandemic has served to further undermine many organizations ability to fully staff and provide the level of care they aspire to achieve. The planting of trees metaphor noted earlier reinforces that for Homes that are struggling, the need to get on with it, to take action now, is imperative.

    The full impact of changing the culture of the Home through progressive leadership will require time and effort on the part of the entire leadership team. This leads to one more metaphor. Just as dieting for many results in only temporary weight loss, applying a few simple strategies will not change the culture of the Home, nor solve the staffing issues. Instead of a fad diet of strategies, a balanced and sustainable approach of progressive leadership is required to develop a healthy organizational culture of engaged and committed employees.