Healing the Healthcare HR Crisis

October 26, 2023 | 26 minute read

October, 2023

Presented in October, 2023 as a part of OLTCA’s KnowledgeBreak series, this webinar explores how senior care organizations can start healing the healthcare HR crisis by improving job satisfaction for front-line workers with simple changes in how they communicate, support, and recognize their staff.


We’re gonna talk about healing the healthcare HR crisis by enhancing employee experiences, using a tool called Niuz.

Born out of necessity during COVID, nursing homes struggled to keep in touch with all of their staff, frontline, PT, environmental, dietary people didn’t know what was going on.

It’s also hard for people without a corporate email address to find information in an intranet that they might not have access to.

Niuz is designed to solve all of those things, to help you communicate easier, to help people find
information faster, to give you the opportunity to, appreciate and show, recognition and kudos to your staff, all in the means of improving the experience.

So we’ve heard about it in the news a lot and, while the media focuses on emergency room wait times, and ridiculously long wait time for diagnostic imaging, and elective surgeries, nursing homes are still struggling.

In 2022, a report from the OLTCA staffing crisis showed that nearly all Ontario homes reported having difficulty filling shifts for RNs and RPNs.

Also in ’22, same report, more than 60% of homes had PSW staff shortages, 50% of homes lost their DOC, and 40% of homes lost their administrator.

In another report, Sherry Price, a researcher and professor from, Dalhousie School of Nursing, says that “Canada’s steady progress toward a crisis level shortage of nurses even without the pandemic was predicted more than twenty years ago today,” and yet here we are.

So why are staff leaving?

I’m sure you’ve heard about it. And if you’ve if you haven’t heard about it or you’ve, experienced it yourself, we’ve heard stories that there are agency recruiters approaching staff as they leave their shift in the parking lot offering them more money to do the same job.

No kidding?

Who wouldn’t wanna do the same job for more money?

But if you think that people are leaving just for money, I’d ask you to think again.

A number of studies from around the world show that money isn’t, in fact, the number one reason why people – even care personnel – leave their jobs.

The number one reason around the world comes from job satisfaction.

It’s not that when people leave the job, it’s not necessarily tied to money, tied to the fact that they think their job sucks.

Pardon me for saying so, but that’s what it comes down to.

I know some of you are rolling your eyes, and expect that that, you know, when I say job satisfaction, because it’s also something we’ve heard before. And anecdotally, it’s been proven to work, but there are dozens of studies that say that it actually does affect performance.

This quote, “Sometimes it’s not about the money. It’s the way you treat people and the respect that they get,” came from an administrator of a nursing home who was part of a qualitative study of staff
turnover in nursing homes.

The data and quotes collected in the study from RNs, RPNs, and PSWs all say the same thing. A pay increase would not make an undesirable work environment more attractive.

That’s not to say that pay increases isn’t gonna help them stick around. They will. They’re just gonna stick around in an undesirable work environment.

If you change the work environment, you don’t necessarily have to worry about increasing the pay because they will enjoy coming to work more.

That’s what this whole presentation is about.

According to numerous studies and surveys, the top three reasons for job dissatisfaction and creating a negative working environment in senior care: communication, support from management, and lack of recognition or appreciation.

There’s not a lot we can do to solve the challenges of verbal and physical abuse from residents or the bulk of the grunt work that the care staff have to deal with.

But we can address these three issues fairly easily.

To dig into these a bit further, using the language from the interviews in that previous study of RNs, RNs, and PSWs, for communication, care staff cite poor responsiveness from supervisors, minimal ongoing and the lack of proactive communication.

Connect early and connect often is a mantra to take with you, especially for new staff, who hold the lead position as the most likely to leave their job within the first four months of employment.

Support from management: Staff want to feel like management has their back, staff want to know that management understands their challenges and respects their needs.

Again, connect early and connect often and survey your staff.

I’ll touch on this feature a little bit later on, but if you check-in with them regularly and respond with empathy and transparency, you can get out in front of challenges from a culture perspective well before they become a problem.

In our pre-webinar questionnaire, one of the questions was how often do you survey your staff?

A lot of you are doing it just annually once a year.

Some of you aren’t doing it at all.

Huge opportunity to make sure that you’re checking and keeping a finger on the pulse of your staff is through a very quick and easy survey.

It’s something we can really quickly and easily send in Niuz, and, we’ll show you how later.

And then recognition and appreciation: When asked, what would keep care staff in their roles, again,
in that same report, yes, money came up, but in the context of staff recognition and appreciation, not as additional compensation.

As we said earlier, no amount of bonus is gonna make an undesirable work environment more attractive, change the work environment by engaging with your staff by recognizing their efforts, no matter how small, and showing appreciation for the work that they do, that is going to make their work feel like it sucks less.

So the vicious cycle of senior care staffing starts with the communication, support, and recognition.

If I’m not feeling supported at my job and in the recognition of the work that I’m doing, if I’m not getting the answers that I need, it’s going to lead to confusion, frustration, and disappointment That’s going to lead me to caring less about my job. I’m not gonna put as much effort into it, which then translates into a reduced quality of care, increased falls, increased hospitalizations…

Your reputation management is then at risk.

Your occupancy is probably gonna fall because the care suffers. The residents suffer.

As this happens and continues to happen, staff get burnt out and they leave. They’re done. I don’t
wanna do this anymore.

The remaining staff then have to pick up the slack, then they’re gonna get overworked and burnt out, then they’re going to leave because they don’t feel supported. They’re not getting the recognition. They’re not hearing the communication.

And when staff leave what does that look like for us?

Well, like I just said, remaining staff are going to be completely overworked. The ones that are doing more work are going to be asked to do even more work that’s going to lead to more burnout. It’s going to lead to inconsistency of care, and then it leads to you having to lean into agency to support this. We need staff – I don’t have staff. I have to go to agency to support that. My bottom line is going to suffer a lot because staffing through agency is costing me a lot more than it probably should.

How do we keep the staff that we have?

We’ve talked about this a little bit, but let’s go through what you can actually do about this.

Employee engagement is the key to this whole thing.

And I can almost hear the eye rolls. I was expecting that.

Employee engagement has been a business buzzword for years now. Everyone’s a guru or an expert on this, that, the other thing.

We’re not claiming to be experts in solving all of your problems. What we have done at Niuz, is we have done a lot of research. We’ve done a lot of studies. We’ve done a lot of reporting. We’ve done a lot of asking of our customers and in the industry to see what it is that we could do, what you need.

Let’s go through that now.

Employee engagement is the involvement and enthusiasm of employees in their workplace.

The key to this is involvement and enthusiasm.

I really like analogies and sports analogies. So let’s use one to sort of better describe this.

Tim Hortons sponsors kids hockey teams across the country. And on kids hockey teams, you get a variety of different types of players.

The first group of which, some kids just don’t want to be there. They they kinda go through the motion. They do it because their parents make them do it. They show up, but they don’t do a lot. They they like to lie down on on the ice and they’re not really engaged.

Second group of kids though are the more engaged kids. They’re the ones that are more involved. They go through the motions. They do the job. They do the drills. But they’re not raving fans, but they represent the bulk of the community. They’re the ones that are coming in just getting their work done.


These kids – the fanatics – are the ones that really raise the bar. They’re the ones that are denting their garage door throughout the summer with road hockey slap shot practices. And they’re the ones first on, first off. They’re the ones that are helping the rest of the team do drills and run things and they do a better job.

They bring more of themselves to the ice.

They raise the average for the rest of the team, which is great. You raise the average for the rest of the team, it’s like a rising tide lifts all boats.

If everyone gets involved in this, more energy creates more energy. If you feed it, it will grow.

So what does this look like for us?

When we communicate better, when we, as management, engage more with our staff, when we show appreciation and respect for teams, things will change.

You’ll see more staff who go above and beyond to build relationships with residents and families.

Who actively engage with other team members.

Who aren’t afraid to suggest new approaches to things with management, who advocate for what’s best, and who genuinely care about what they do, where they do it, and who they do it with and for.

Let’s get down to brass tacks, and we all know employee engagement is a thing, sure, and we’ve heard that it can help, but can we quantify how it helps?

Yes. We can.

So employee engagement’s tied to better care. This example from a study from Argentum and The Great Place to Work in 2019, showed that, one provider measured employee engagement and resident satisfaction in alternating years. And although it’s difficult to prove causation, many companies see employee engagement and resident satisfaction move in tandem.

Residents enjoy and thrive with consistency among staff who work in their communities and care settings. You engage with your staff more frequently, they will stick around longer.

People build stronger relationships and benefits the residents in the long term. That just makes sense.

Staff engagement is tied to turnover.

Same study looked at a trust index score. What they measured then was, engagement and culture inside of organizations. Each dot here represents a specific senior care facility in the states. And while looking at the the left side measures the percentage of turnover from one year perspective, the trust index down at the bottom is how much trust does that employee have towards their organization.

Well, this doesn’t show us, like, oh my god. Yes. You’re getting way more trust and way less turnover.

If you look at the median line, it’s clear that the more trust the employee has with the organization, the less likely they are to turnover.

But how do you build that trust?

The trust has to come from communication. It has to come from recognition and appreciation. It has to come from the response from management to the challenges that you’re sacrificing. And, obviously, employee engagement can save you money.

As I talked about before, according to a 2023 report, from AdvantAge Ontario, of a hundred homes who’ve been using staffing agencies, homes are forced to pay an average $88 per hour for a temp RN. That’s more than twice their typical wage of $43 an hour.

One agency charged $150 dollars per hour for the same position, a 249% increase over their typical rate.

On top of these high wages, homes are paying agency fees about the 35% for short notice premiums and rural homes have a 30% increase because they’re hard to get to.

Lisa Levin, the CEO of AdvantAge Ontario said “Our members are spending tens of millions of dollars on temp staff rather than permanent care.”

The only way to sidestep this is to start keeping the staff that we have.

It’s not all doom and gloom.

We’re here to talk about the three tenets of employee engagement, and how Niuz can help you achieve these or at least overcome some of the challenges that you’re facing.

Communication, support, and recognition.

I am going to emphasize this all comes down to habitual change management from all of us on this call.

We as leaders in this space need to change the way that we do things in order to affect the change that we wanna see.

Apps are just tools, apps are not the panacea to solve all ailments.

An app won’t solve your problems for you.

It’s just a way for you to better approach something.

There’s a quote I like to use that goes “It’s a poor musician who blames this instrument,” which is applicable, unless you’re talking about recorders, those things are the worst.

Communication then, first up. Today, how do you reach everyone on staff and not just management, not just the people with the corporate email address? That’s easy. That’s cheating. I mean, everyone, PSW’s, environmental, food service, therapists, all those people who come to work in your building that don’t have a ShadyAcres.com email address.

We’ve got COVID preparedness plans coming from the ministry any day now, and if that means masking and or PPE mandates return, God forbid, that’s going to be awful, but you’re going to keep everyone on staff updated.

And if you have God forbid have an outbreak and have to start limiting access again, and that happens on an overnight shift, your day staff needs to be prepared.

If you’re using PointClickCare, like almost all of you are, you’ve got the communications tab inside of PointClickCare to reach out to people, but that’s just for clinical staff that doesn’t reach everybody.

To reach the rest of the staff that are coming in, you’re probably using one of these apps: Gmail or Outlook, if you have their email address and you don’t, it’s messaging, it’s school messenger, it’s WhatsApp. It’s another communication tool like that.

I will just caveat that WhatsApp is owned by Meta, which owns Facebook and Instagram and Messenger. And while Meta and WhatsApp provide as much security as possible, it’s still a public facing social media platform that is under constant cyber attack, and I’m not throwing shade at Meta whatsoever. I’m just making sure that everyone is aware that massive public social media companies like meta, like Facebook, like Instagram, are under constant attack. Fortunately, we don’t hear anything in the news about any breaches, but Is it just a matter of time?


Am I trying to be alarmist there?

Maybe? But it’s a problem that we all face, and we need to do better at this.

This is probably your default method of communication within your buildings. This and posting printouts all over the place. Now I covered up the organization’s name just so, you know, to avoid public shaming, but this is by and large – this plus printed pages – are the status quo.

And this method doesn’t really support communicate often communicate early.

David and I were visiting a client site a couple of months ago, and I asked their staff development coordinator if they felt that their posting of notices around the building was effective.

When they finished laughing, they said that their staff seemed surprised when an internal event came up around Pride week, even though they’ve been advertising it using this for well over a month.

The problem with billboards and bulletin boards is they just become part of the furniture.
They’re just part of the scenery.

It’s just something on the wall I don’t see it anymore. I look at it a few times, and then it’s just it doesn’t stand out enough.

There’s nothing there, no matter how much stuff you replace on this, there’s nothing there that makes me want to stop and read it because I’m just used to seeing it in the background.

It’s a picture on the wall.

The better way to do this is to push it into an app because that’s what we know to go to for news and for updates on things. It’s just I’m trained now to look down for some information, not up.

Using an app is going to help get information to people faster and easier.

And what about new staff and onboarding?

A perfect use case for this sort of thing is we see large organizations acquiring buildings and communities all the time – how nice would it be for all of those people in the pre-existing community to now know who to reach out to in thenew community, in the new building, or in the new office.

How do I know who my ED is?
How do I know who my RDO is?
How do I know who to reach out to with questions?
Who’s in charge of HR now?
Where do I go to find information that I need? Like, links out to my scheduling app or links to my payroll or links to my EAP, all those things can be pushed into an Intranet.

BUT if I don’t have access to your intranet because I don’t have a corporate email address, I’m kind of stuck asking who about what.

Getting in front of this and giving people what they need early and making sure that it’s available for them right on day one, solve the problem of the PSWs who are the leaders of leaving your job within the first four months because they’re new and they don’t know what to do.

This is going to help you solve that problem.

Easy way to do that is just to sort of do something like this, adding a social post into an app like Niuz. You can either take a quick photo of your new executive director, RDO, share that out with everyone just to put a face to the name.

You can take pictures of new management, send them out as well, sharing it through a social media experience, you can welcome new staff and remind them where to go to find things like this inside
this app. You don’t need an intranet. You can go here and get everything you need.

It’s just giving them what they need to help them feel comfortable in their position right from day one.


ugh… I can’t believe it’s coming back again. It’s ridiculous. But with cold and flu season upon us, we know something’s going to happen. It’s it’s inevitable. Something’s going to happen. There’s going to be an outbreak going to be closure if there’s going to be quarantines, heaven forbid, but what if all that happens Wednesday night? And then Thursday shift shows up, and they didn’t know that there’s an outbreak on the second floor.

They didn’t know that there’s new PPE mandates put in place. They Whatever the case may be, if it happens overnight, you have the opportunity to give this to them information-wise, then and there.

Into a format that they’re used to looking at in a device that they’re used to looking at in a very easy, simple way, just to keep everybody up to date.

What about when God forbid, we do have an outbreak.

How do you keep people up to date on that?

Chances are right now, you’re probably leveraging email and messaging and printed notes and shift meetings and everything else, but consolidating all that, putting it in one spot, giving people updates regularly from the top down, super, super simple thing to do using an app like Niuz, and it gets in front of everybody instantly.

You can know who’s read this because we have read receipts attached to it.

Like, it’s done. No one can then say to you, “I didn’t know this was happening. I didn’t expect that. I never heard about this.” Yes, you did.”

What about job postings?

When people are looking for new roles or new jobs, what about an opportunity for advancement?

Host that in a place where people can see it. Don’t print it out on a piece of paper and stick it in the bulletin board in the lunchroom. People likely aren’t going to look at that. And if they are, it’s printed. You’ve got to update that in regular.

There’s printing cost. There’s just it’s antiquated process.

Stop doing it.

Put it somewhere that makes it easy for people to access, makes it easy for people to share, and it saves you a lot of time and effort using an app.

If this is how your you sharing opportunities like that. It’s it’s just gonna get missed.

Bulletin boards, we all have them. We need them. Do we?

We’ve had them for so long.

Again, what we’re talking about is change management.

If we change the approaches that we take towards communicating and sharing information, we can make things more streamlined, we can actually have a positive impact.

The most expensive seven words in business, “We have always done it that way.” Yeah. It’s true.

If you don’t advance, if you don’t improve, if you don’t move forward with things, you’re going to get stuck left behind using bulletin boards.

It’s just, we can do better. We can do better.

So support for management, this is a tricky one because it’s so subjectively measured. But focusing on showing understanding and listening with the intent to help and providing tools and resources to help staff deal with the challenges of work are critical.

According to surveys and reports from across the country, support from management really
boils down to three main categories for care staff.

Training and professional development, emotional and mental health, and support and recognition and appreciation. And as I said earlier, recognition appreciation is one of the main reasons why people have dissatisfaction with their jobs.

So training and development, you’re probably using a tool like Surge Learning.

You’re probably using another LMS tool to give people the opportunity to learn new procedures, new protocols.

There’s always some upskilling that is required.

Another client that David and I visited this year, we bumped into their staff development coordinator in the hallway. She was carrying a monstrous stack of papers. And it was mandatory training for the PSWs.

And we laughed and said, “That’s for all PSWs?” And she said, “No. This is one package for a PSW.” It was about sixty pages, and she had to go and print and make copies of this for 35-40 people.

And both David and I went, “Wow. That’s crazy.”

The amount of paper that was being used just to make sure that people are signing off on this sort of stuff.

Put it in an app. You get read receipts. They can sign things digitally. It’s it’s done. It’s easier. There’s no printing. There’s no storage.

I know you’re wondering too, though, if I do that, I then don’t have a paper copy to show from compliance perspective, compliance will accept digital signatures.

Nobody wants to print ten thousand pages of training, knowing that they’re not even going to be read or just be thrown out.

Digitizing it, it’s already digital. You’re printing it, it’s already a digital copy, push that through an app. It’s going to be much easier from a cost perspective.

I’m sure you run in-house training sessions all the time, either hosted by your EDC or your iPAC administrator. If those are part of a series leading to certification, that can help staff earn more money later, could you run those once instead of multiple times and record the session for those who weren’t scheduled to work when you were running the session?

And then make that available, and all related paperwork in an app so they can view it later and add a read receipt to that.

We’re just just streamlining things, consolidating it.

It’s the way to move forward. It’s the way we’re going to get better at this.

And this is not a bulletin board. Like, don’t don’t bulletin board anymore.

Using Niuz, you could easily post upcoming training sessions, and information for everyone and give them access to every training session, every guide or PDF, every online LMS, all the training resources you’re currently printing and emailing around.

It all goes into Niuz and it’s available 24/7 for everybody, not just those with a corporate email address.

You can govern who gets access to what inside the app as well.

But this also becomes your onboarding process, showing new staff how to self-help: where to go for information, how to find their logins for things, who to go to for questions, who to go to, where to look for new procedures, protocols, documentation, maps, it can all exist in an app.

Second thing, emotional and mental health.

Aside from promoting a healthy work-life balance, I mean, I I don’t know what that is anymore. I don’t think anybody does.

There’s no such thing as work-life balance. But the best way to provide support is through regular check-ins and responding to challenges.

This gets back to our pre-webinar questionnaire about are you running employee surveys?

If you’re not and you’re doing it maybe regularly, huge missed opportunity to show some empathy, to show some transparency and support for your staff.

The most important part of asking is answering.

It’s hard to do that, though, when you’ve got dozens of staff across dozens of shifts and and trying to schedule one-on-one time. It’s almost impossible to do that.

But a simple survey using a tool like Niuz, something you can send to staff in seconds can really help track the pulse of your team.

Weekly satisfaction surveys with open ended question, like, “Please share the way why you feel this way.” It gives you invaluable insight into what’s going on inside the home.

Making those surveys anonymous and making sure that everyone knows that the surveys are anonymous allows for a much more open dialogue. People will be much more transparent.

Is there going to be a lot of complaining? Absolutely.

If you don’t hear the complaints, you don’t know what to fix. But doing it this way in a closed anonymous survey means that, there’s no commiseration. It’s not going to be a gang up on management.

It is a single person offering their views expressing their viewpoint. And you can then respond to them directly either through a, an everyone-text or taking action. There’s an opportunity.

Employee assistance programs and benefits.

There are dozens of things you’re probably spending money on that aren’t being used because they’re hard to find.

You can use Niuz as an intranet replacement. For things like EAP programs and wellness resources or links to payroll and benefits and financial resources and scheduling tools… All of those things can be put in here – discount codes and work perks.

I don’t know about you, but we’ve heard a lot of staff asking for, especially in the summer, “I’ve heard there was a discount code for Canada’s wonderland. Where do I find that?”

It’s it’s here. You can make this, again, part of your ongoing communication is, “Hey, everyone. Halloween’s coming just to say thanks. Make sure you get your PSL. Here’s five dollar off coupon. We’ve arranged with…” whoever, like, you can put all this stuff into Niuz and make it easily accessible for everybody.

Recognition and appreciation is the the last one.

This is by far the easiest problem to solve. Change management, yes, but it is so easy to do because it takes so little effort.

As we said earlier too, when we were asked what would make work better, the majority of care staff indicated that staff recognition and appreciation were the top metric for that, and this is in lieu of having a bonus or salary increase, put the money towards recognizing the staff.

Simply acknowledging the efforts of your staff will have immediate positive impact This doesn’t have to come with any remuneration, just showing them that you see them, you appreciate the work they do. You value the impact they’re having on the health and well-being of your residents, and your community can mean all the difference in the world.

We all know that PSWs do a ton of grunt work, and it’s not the most glorious of jobs. Nor does it come with a very lucrative salary, but it’s critical to our seniors.

Using an app like Niuz gives you that closed social media platform where you can very easily thank specific individuals on team or overnight staff or entire groups to show them that you appreciate the work that they do.

What it’d be better to is posting a thank you to a staff member and giving them $25 gift cards. $20 for Tim’s, a $20 indigo gift card. You could turn it into a competition, a recognition competition so that across your organization, who’s been recognized more. Sales teams do this all the time. Sales teams reward their top sellers for beating their quota.

Do the same thing. It’s like a nominal reward, instead of giving them a bonus or a pay raise, nominal ongoing rewards will pay off in dividends.

And that could literally be a couple of hundred dollars a month for you. It could mean the world for your staff.

So we’re gonna recap then.

So job satisfaction is the big thing that we need to focus on in order to help keep the staff that we have.

How do we do that?

We need to solve the problems of communication, of support from management, and recognition and appreciation of our staff.

This is where Niuz can help you.

We can help you improve your communication.

We can help give visible support from management to your staff.

And we can make recognition and appreciation an effortless part of your day.

Niuz is both a mobile app as well as a web app.

We have a dashboard that allows you to see into how often people are using the app, how much are they posting from an executive position. This allows you to see which homes are using the tool more often. It gives you the ability to look into the pulse of your staff to make sure that culture is actually improving versus deteriorating.

There’s a lot of other things we can do inside the app, but I’m not going to get into that right now.

If you guys want to see anything more about Niuz, you can scan the QR code on the screen right here.

It’ll take you to our website.

We have some more information on there about how the app actually works. Who it works
for and why we’ve designed it.

If you need to get ahold of either David or myself or emails are here on the screen.

Thank you very much for your time.

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Build a stronger culture by improving the ability to communicate across your entire organization.