Skip to Content

How to Staff a Nursing Home [10 Smart Tips]

Do you about hiring employees for your nursing home? If YES, here is everything you need to know about staffing a nursing home.

US nursing homes are mandated to have adequate nursing staff with the appropriate competencies to assure resident safety and attain or maintain the highest practicable level of physical, mental, and psychosocial well-being of each resident.

Minimum nurse staffing levels have been identified in research studies and recommended by experts. Beyond the minimum levels, nursing homes are expected to take into account the resident acuity to assure they have adequate staffing levels to meet the needs of residents.

Federal law mandates Medicare and Medicaid certified nursing homes to have a registered nurse (RN) on duty at least 8 hours a day, 7 days a week; and a licensed nurse (RN or LPN) on duty 24 hours a day. However, there are no minimum staffing levels for nurse’s aides, who offer most of the day-to-day care.

In the United States, nursing homes are also expected to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident. In addition, nursing homes must provide a minimum of 75 hours of training for the aides.

Note that the important factor in improving the quality of care is the amount of nurse time each patient receives. If a nursing home only attains the federal nurse staffing requirements described above, a resident would receive 20 minutes of nurse time per day.

Some years back, the Centers for Medicare and Medicaid Services (CMS) noted that the preferred minimum staffing level was when nursing home residents received three hours of total staff time per day – two hours of nursing assistant time and one hour of licensed nurse time.

The optimum staffing level, according to the CMS, is one hour of licensed nurse time and three hours of nursing assistant time.

However, most states have standards that are higher than the federal requirements but still fall short of the levels recommended by the CMS. According to reports, the key to improving nursing home staffing levels is increasing state standards.

Have it in mind that insufficient nursing staff can negatively impact all residents in a nursing home. Various studies of nursing homes show a strong positive relationship between the number of nursing home staff who provide direct care to residents on a daily basis and the quality of care and quality of life of residents.

Types of Nursing Home Employees

A well-staffed nursing home has  different types of employees. A good number of these employees must have undergone specialized training for their roles and responsibilities.

While there are some employees such as personal care attendants and registered nurses who are often seen in the hallways and walking into rooms, there are also specialized support staff that are not often seen by residents or their families.

These staff members help with accounting and other important internal tasks but don’t directly care for the elderly. Here are basic nursing home employees;

  1. Direct Care Employees

Direct care employees are better known as those staff members who provide personal care and attention to the residents of the nursing home. As opposed to other employees, these staff members relate and are in contact with residents on a daily basis.

Direct care employees include: registered nurses, licensed vocational nurses, licensed practical nurses, physical therapists, and certified nursing assistants.

  1. Nurses

Registered nurses, also called RNs, tend to offer a lot of the medical care in nursing homes. It is their task to assess every need of the residents and create personal care plans for each person. Registered nurses may work with licensed vocational nurses and licensed practical nurses when planning and implementing personalized care.

Also, note that these nurses will be in charge of daily monitoring of the health and care of residents. If a resident is undergoing a new plan for care and treatment, the nurse should be assessing how that plan is addressing the patient’s needs.

All nurses who work in nursing homes are expected to be licensed by the state. RNs have nursing degrees and usually between two and six years of nursing education. Licensed vocational nurses and licensed practical nurses usually only have one or two years of nursing education.

  1. Nursing Assistants

Certified nursing assistants are known to work under the supervision of the licensed nurses. While they are certified, they do not have the same medical training or knowledge as licensed nurses. Notably, nursing assistants provide assistance to residents with daily tasks such as eating, hygiene, dressing, and using the bathroom.

Note that to work full time as a certified nursing assistant, a person is expected to complete training and an evaluation program to become certified. Certified nursing assistants have to participate in continuing education courses every year in order to stay certified.

  1. Qualified Dietician

According to federal regulations regarding nursing homes, every nursing home is expected to have a qualified dietician. The dietician can work full time, part time, or as a consultant. But to be recognized as qualified by the government, a dietician will have to register with the American Dietetic Association’s Commission on Dietetic Registration.

In addition, a dietician is expected to complete training, so that they can properly identify dietary needs, plan dietary programs, and implement those programs. Note that if a nursing home does not employ a dietician full time, they will be expected to ensure that their director of food services regularly consults with their dietician.

  1. Administration and Support Employees

Administration and maintenance employees do not play a large role in the daily activities of nursing home residents. Notably, the size of a nursing home’s administration team depends on the size of the nursing home. Most times, the administration team made up of a few employees.

In bigger nursing homes, the staff may consist of dozens of employees in separate departments such as human resources, accounting, and the like. Furthermore, support employees include those such as maintenance employees, custodians, and groundskeepers.

These types of nursing home employees are tasked with maintaining the functioning and appearance of the nursing home. Support employees may also include activities directors or coordinators. These nursing home employees may plan events and social activities within the nursing home.

10 Best Practices for Staffing a Nursing Home

With the competition mounting and the tight labor market showing no immediate sign of lessening, nursing homes understand that effective recruiting is the key to their success.  Many are adopting a more flexible and diverse approach to their recruitment practices to meet these challenges. Nonetheless, here are best practices for actively staffing a nursing home.

  1. Develop an Employee Referral Program

Employee referrals are indeed the number one source of quality candidates for the most successful organizations. Ensure to educate current employees on the positive impact of referrals and set up an appropriate incentive structure for referring candidates.

  1. Revisit Low-Hanging Fruit

You can also leverage a tracking system to manage each and every candidate. Create a call schedule to reach out to quality candidates, who, for whatever reason, didn’t join your team initially.

  1. Implement the 80/20 rule

Spend 80% of your time actively recruiting employees and 20% of your time interviewing them. Note that the best way to reach this goal is to mark off one day on your calendar every week dedicated to interviewing and on boarding. Utilize the other days to plan and implement active recruiting strategies.

  1. Poll Current Clients

Ask each client, “Can you tell me about your favorite care provider to date?” Ask if they remember the individual’s name, and do your best to reach out to that person via LinkedIn or a quick Google search.

  1. Host an Out-Of-The-Box Job Fair

No one says that a job fair must occur at the office! Instead, host a casual event at a coffee shop, favorite lunch spot, or nearby park. Invite current employees to bring friends interested in open positions.

  1. Create a Recruitment Video

Remember to include employee testimonials, discuss the home’s mission and goals, and add glimpses into the unique benefits your nursing home offers.

  1. Request Feedback

Conduct a survey of each new hire. Request for immediate feedback related to your recruitment and hiring practices.

  1. Schedule Off-Hour Interviews

In a typical nursing home, caregivers and clinical candidates may work odd hours. To accommodate these individuals, consider offering weekend or evening interview sessions once a month.

  1. Get Social

Consider starting with LinkedIn. Add current staff to your network and start to mine their contacts for potential new hires. Reach out with a personalized invitation to connect.

  1. Consider a Pay Differential For Weekend And Second-Shift Employment Openings

You can start by presenting your most current team members with the opportunity to accept this work. If they accept the position, it entails a pay raise for that staff member, the most challenging shift is filled, and your focus turns to fill the easier employment gap.

If no one is interested, current staff will be more understanding of you offering a pay differential and looking outside the company to hire for these shifts.

  1. Contact Local Churches, Synagogues, And Places Of Worship

Note that these tight-knit communities often know of members looking for employment. Ask if you may leverage their newsletters, bulletins, etc. to advertise open positions. Offer free refreshments after one of their services and present your employment opportunities to attendees.

  1. Reach Out To High Schools, Community Colleges, CAN/Nursing Schools And Universities

Consider contacting the career coordinator at each school. Offer to do a résumé-building or interview skill-building presentation on-site for their students. You can spend five minutes at the end of the presentation discussing open opportunities and providing details on how to apply.


Inadequate staffing levels can have devastating consequences and is not consistent with the 2016 federal regulations that require sufficient nursing staff with appropriate competencies to assure resident safety and attain or maintain the highest practicable level of resident well-being.

Nursing homes are responsible for assuring adequate nurse staffing levels and for complying with federal nursing home requirements.