What can employers do to increase nurse retention? Takeaways:
Nurses work in a fast-paced environment, providing patient care, reassuring family members, and keeping up with evidence-based practices and procedures. That level of stress can leave many healthcare organizations with a high nurse turnover rate. Fundamentally, though, turnover is a reaction to every leadership decision, so managing it is a process, not an event that’s concluded with a quarterly or annual review. Managing turnover requires mindfully creating a workplace culture that supports high performers financially, intellectually, and psychologically while also efficiently and fairly weeding out poor performers. What does nurse turnover cost?Costs associated with nurse turnover can have a huge impact on a hospital’s profit margin. According to the 2019 National Healthcare Retention & RN Staffing Report, published by Nursing Solutions, Inc., each percent change in nurse turnover will cost (or save) the average hospital an additional $328,400. The turnover rate for hospitals’ bedside nurses grew to 17.2%. The average turnover costs result in hospitals losing $4.4 million to $6.9 million each year. The report also found that the average time it takes to fill a staff nursing position is 85 days (3 months or more for a specialized nursing position), costing about $82,000 (not counting the costs associated with overtime work by other nurses and time to onboard and train the new nurse). In March 2016, Streamline Verify ranked healthcare as one of the top three professions with high turnover rates. It also found that 43% of newly licensed nurses who work in hospitals leave their jobs within 3 years, another 33.5% resign after 2 years, and 17.5% work for only 1 year. (To view an infographic of this data, visit streamlineverify.com/nurse-turnover-rate.) Why do nurses leave?When surveyed, nurses give the following reasons for leaving their current positions: moving, personal matters, promotion, salary, retirement, and burnout. They also leave because they’re dissatisfied with their jobs, they’re given little independence or respect, staffing and scheduling don’t meet their needs, physician/nurse relationships aren’t collegial, they want to return to school, or their healthcare facility closed. Many hospitals have addressed these problems, but turnover continues to rise. Healthcare organizations might do well to learn from business as well as from other hospitals. Research by John Kotter and James Heskett, published in the book Corporate Culture and Performance, reveals some surprising statistics for firms (12 with a performance-enhancing culture and 20 without) they followed for 11 years. Firms with a performance-enhancing culture experienced:
Firms without a performance-enhancing culture experienced:
Simply put, companies that intentionally manage their cultures significantly outperform those that don’t. The original research behind the American Nurses Credentialing Center Magnet Recognition Program®, conducted by an American Academy of Nursing group headed by Margaret McClure, EdD, RN, FAAN, was an attempt to determine why nurses stayed at some facilities and left others. The results indicated that nurses stayed at hospitals where excellent patient care was the norm. Risks of mandatory overtime
One troubling staffing solution that is being used is mandatory overtime. Presumably, hospital administrators believe that mandatory overtime (which is almost universally banned by hospitals that have achieved American Nurses Credentialing Center Magnet® recognition) will save money by limiting recruitment and benefit expenses. However, several studies show that it’s one of the worst practices to emerge from the era of downsizing and managed care. Mandatory overtime:
What can employers do?The 2018 Press Ganey Nursing Special Report: Optimizing the Nursing Workforce: Key Drivers of Intent to Stay for Newly Licensed and Experienced Nurses analyzed responses of nearly 250,000 nurses to identify trends in intent to stay based on age, tenure, and unit type, as well as drivers of intent to stay. In general, nurses need certain things from their jobs.
One of the most important conclusions of the literature on hospital employment is that the same practices that create a positive working environment for nurses also are critical to securing standards of quality patient care. Based on this information, employers can take several steps to improve retention.
Although some hospitals have moved to adopt best practices for improving recruitment and retention, too many others have moved in the opposite direction. (See Risks of mandatory overtime.) Finding a balanceIdentifying the most effective balance of guidelines to improve nurse retention requires employers to better understand their workforce, to develop policies and procedures based on nurses’ work experiences and motivations, and to appreciate nursing staff needs. When management and staff collaborate, they benefit the organization, the workforce, and patients. Franklin A. Shaffer is the president and chief executive officer at CGFNS International, Inc. in Philadelphia, Pennsylvania. Leah Curtin is executive editor, professional outreach, for American Nurse Journal. ReferencesAmerican Federation of State, County and Municipal Employees. Solving the nursing shortage: The cost of failure. 2016. https://www.coursehero.com/file/44849991/The-Cost-of-Failurepdf/ Eubanks B. The hidden cost of nursing turnover. People element. peopleelement.com/the-hidden-cost-of-nursing-turnover Jones CB, Gates M. The costs and benefits of nurse turnover: A business case for nurse retention. OJIN: The Online Journal of Issues in Nursing. 2007;12(3). ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NurseRetention.html Kotter JP, Heskett JL. Corporate Culture and Performance. New York, NY: The Free Press; 2011. Leonard B. SHRM poll: HR’s top challenges in 10 years have a familiar ring. Society for Human Resource Management. November 6, 2012. https://www.shrm.org/hr-today/news/hr-news/pages/2022-poll-challenges.aspx Press Ganey. 2018 Press Ganey Nursing Special Report: Optimizing the Nursing Workforce: Key Drivers of Intent to Stay for Newly Licensed and Experienced Nurses. images.healthcare.pressganey.com/Web/PressGaneyAssociatesInc/%7Baab37da7-cf32-4fdd-8f8e-a4a27d4f2f53%7D_2018_PG_Nursing_Special_Report.pdf?elqTrack=true Trossman U. Better prepared workforce, better retention: Programs illustrate the value of mentoring. Am Nurse. 2013;45(4):1,12. Witkoski Stimpfel A, Sloane DM, Aiken LH. The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Aff. 2012;31(11):2501-9. |