The Nursing Home Staffing Crisis: 3 Actionable Solutions (2023)

There exists a positive relationship between nursing home staffing and a nursing home’s quality of service. When nursing home staffing surpasses the minimum staffing standards, the quality of service for residents tends to increase. Unfortunately, nursing homes in the US currently have dangerously low staffing numbers, which result in quality problems for their residents.

There have been barriers to nursing reform in the form of the high cost of employing new nurses, industry political opposition, and lobbying. Additionally, the enforcement of existing staffing standards has been weak. As a result, some nursing homes have not kept the recommended staffing levels and are suffering as a result. “We’re still under a very old model with regulations, and they’re still punitive in some ways,” said Gretchen Brown, president and CEO of Stonehill Franciscan Services.

Brown recently joined Peter Murphy Lewis LTC Heroes podcast to discuss Employee Satisfaction and Measuring Success. You can listen below:

Here we will look at three potential solutions that nursing homes can implement to resolve the nursing home staffing crisis:

1. Fully Utilizing Job Referral and Word of Mouth

Nursing home staffing is of particular importance to nursing homes as they must follow staffing regulations. Not having enough staff violates staffing regulations, and nursing homes could be penalized for such an offense. A recent blog post from Blue Pipes states, “Professional networking is the best way for nurses to find jobs.” This is because nurses in well-established nursing homes will recommend their peers for a vacancy. Typically, nurses only recommend someone they consider competent, compassionate, and highly skilled as their reputation is also on the line.

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This can significantly benefit nursing homes as one of their trusted nurses personally recommends someone who would work well in the nursing home. Nursing is a challenging and demanding job, and nursing homes want staff who can properly take care of their residents. A job referral from one of the nursing home’s staff can help save time that human resources would otherwise spend on interviews.

As Gretchen Brown puts it, “If we have one of our own, that is referring someone that they feel is a good fit for the team, that’s a very valuable referral to get.” For the nurse, they have adequate training and have a network in the nursing home, enabling them to quickly familiarize themselves with the environment and adequately care for the nursing home residents.

Nursing homes can implement a job referral program to help them streamline their nursing home staffing process in the following manner:

a. Build referrals into your onboarding process: according to Precheck, your new hires are the best sources of referrals. This is because if the nurse was previously hired, their connections are still fresh, and they may still have friends in the organization they left. Also, they may be excited about joining your nursing home and are thus more enthusiastic during the onboarding process.

b. Train managers to seek referrals: nursing homes should train their managers as they are vital to running a successful referral program. Managers work with employees daily, and they are in a better position than HR directors to understand when a new hire is needed. In addition, managers can ask employees for referrals, and the employees are more likely to respond to the request when it’s delivered by someone they are familiar with.

c. Keep things simple: Don’t make the referral process too complicated. The guidelines should be clear and easy for employees to follow for a nursing home to get as many referrals as possible from their employees.

d. Offer a payout as an incentive: offering a payout to employees can incentivize job referral. However, it is considered best practice to pay the employee for the referral at the time of the hire.

e. Communicate quickly and effectively: email-only communication may not be the best way to ask for referrals as nurses don’t spend much time on email. Instead, it would be best for nursing homes to employ a multi-faceted approach. Text, email, posters, and even announcements during meetings are all approaches that should be used.

f. Use automation to track candidates: nursing homes should employ automation tools like Applicant Tracking Systems (ATS). The benefits of an ATS, according to Recruit Crm, include a better overview of applications, easy job postings, and improved quality of hire.

Looking for software solutions at your facility? Contact us here to test drive our user-friendly EHR.

2. Establish a National Nurse to Patient Ratio Law in Nursing Homes

A potential solution to the nursing home staffing problem is the passing and implementation of nurse to patient ratio law in nursing homes. Senior care advocates are making great headway in pushing for legislators to establish higher standards in long term care, and leaders in the industry must do their part as well.

As more of the US population ages, nurses are being asked to care for more patients at a time in nursing homes. Currently, most states in the US allow nursing homes to set their nurse to patient ratios.

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According to the National Library of Medicine, seven states – Connecticut, Illinois, Nevada, Ohio, Oregon, Texas, and Washington – have legislation in place for hospitals to implement staffing committees to develop plans for nurse staffing. In addition, California was the first state to pass a strict nurse to patient ratio law in nursing homes. In the passed California law, the standard ratio is one nurse for every five patients on average.

The Centers for Medicare and Medicaid Services provides basic information about being certified as a Medicare or Medicaid nursing home. For those curious about nursing home staffing requirements by state 2021, the Long Term Care Community Coalition publishes staffing information every quarter for all nursing homes that comply with federal staff reporting requirements in the US.

Why is the nurse to patient ratio of a nursing home so important?

  • Nurses with fewer patients to care for show higher levels of satisfaction: According to the National Library of Medicine, the job satisfaction of nurses plays a crucial role in an organization’s success. Nurses who feel they have a reasonable workload tend to take care of residents in nursing homes better. This is, of course, is in the best interest of the nursing home and the residents.
  • The quality of patient care decreases as the number of patients in a single nurse’s care increases: Patient Engagement Hit talks about how nurse to patient staffing ratios affect a patient’s safety and access to care. For example, when a nurse is in charge of too many patients, they may become stressed, and there is an increased risk of them making a medical mistake. Additionally, the nurse may fail to provide adequate comfort and emotional support to residents as they don’t have time.
  • Employing more nurses is cost-effective: As strange as it sounds, when healthcare facilities hire more nurses, they reduce their overall costs. Hiring more nurses will result in better care and attention for residents as well as fewer unexpected health emergencies, which pays off in the long run.

Nursing Center discusses how a study found that when healthcare facilities (such as hospitals) have a lower nurse to patient ratio, the patients tend to have shorter stays. Such economic benefits are particularly important in an industry with razor-thin profit margins. Brown stated that 50 percent of her facilities’ residents are served by Medicaid, which means they only receive about 50 percent reimbursement from the CMS for what it costs us to care for residents.

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More states are now recognizing the link between nursing home staffing levels and higher quality of care. As a result, there has been increased public and private support for state and federally mandated nursing standards in nursing home staffing in recent years. In addition, more nursing homes are utilizing job referral to make up for their nursing home staffing problem. How do job referrals work? Essentially, the better the work environment, the more staff members will want to share their contentment with others. As was previously mentioned, managers, current employees, and new employees are the best sources of referrals for nursing homes.

3. Adjust And Revamp Nursing Home Staffing Models and Schedules

Nursing home staffing shortages will likely continue to be a problem, especially as the COVID-19 pandemic continues and new variants of COVID begin to appear. Therefore, nursing homes need to plan and communicate with staff members about ways to navigate their schedules and interactions with residents safely. “We’ve collaborated so wonderfully during COVID to help each other out. And I think that’s a little different,” explained Brown when asked how the COVID-19 outbreak affected their staff and day-to-day operations.

The CDC suggests strategies that nursing homes and other healthcare facilities can employ to deal with their staffing shortages, and these strategies are to:

  • Cancel all non-essential procedures and visits: The staff that worked in these areas can instead focus on more critical, understaffed areas.
  • Address factors that may prevent staff from getting to work: If the staff used to use public transportation to commute, a nursing home may need to consider providing transport (private van) to pick up staff from their homes. This should especially be considered for staff caring for residents with underlying medical conditions.
  • Request that staff members postpone their time off: This is a request that nursing homes will need to make to their staff while still being considerate of the mental health and well-being of staff as well. If a nursing home is facing a staffing shortage due to COVID-19, they may need to consider asking them to delay their time off for a bit. But they should not take this too far; time-off for staff is an essential part of providing excellent service to residents. Med Page Today talks about how nurses need to “chill out” and that vacations are a perfect tool for managing stress and preventing burnout. Without it, nursing home staff would struggle with anxiety at work, have a higher turnover, and likely make medical errors.


The nursing home staffing crisis continues to plague American nursing homes. However, there is compelling evidence to support the claim that a lower nurse to patient ratio results in better care for residents, reduced costs for the nursing home, and overall job satisfaction.

Lawmakers should consider political solutions to the problem and contemplate the ramifications of the potential variations of nurse to patient ratio law in nursing homes. Nursing homes, meanwhile, should consider economical solutions (job referral, adjusting and revamping nursing home staffing models and schedules). For Brown, the most important factor is ensuring fair compensation. “We can stay competitive in wages,” she said. “And to me, that’s the first step in then really attracting people to our industry.”

For more on recent trends in long term care, read our blog and subscribe to the LTC Heroes podcast.

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Elijah Oling Wanga

Elijah Oling is an experienced writer and editor who has improved the visibility of corporate websites by publishing on the topics of digital marketing, business growth, personal development, and software services. Most recently, he began researching and developing content in healthcare and has made an impact by raising questions and exploring solutions both on Experience.Care and on the dedicated sites of long-term care organizations. In his free time, Elijah enjoys reading non-fiction books, hiking and camping.

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