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Keeping Nurses: Strategies for Nurse Retention

According to a report released in 2014 by NSI Nursing Solutions, Inc., the national average turnover rate for bedside registered nurses rose to 14.2% in 2013, an increase from 2012’s rate of 13.1%. As the economy improves, the potential for related increases in RN turnover poses a challenge for hospital administrators and may indicate a nursing shortage is looming, the report said.

The high costs of turnover – estimated to range between $44,380 and $63,400 for each nurse who leaves – can seriously impact a hospital’s bottom line. In fact, NSI reports that average hospitals lose between $4 million and $6 million due to turnover, yet fewer than half of hospitals have a retention strategy.

Additionally, when RN turnover is high, morale, patient care and recruitment suffer. On the other hand, retaining experienced nurses leads to stronger teams, better morale, improved care and significant cost savings.

Strategies to Retain Nurses

The first step to develop a retention strategy is identifying the factors that motivate nurses to stay. Among these are a positive working environment, high standards for quality care, respect for each employee and opportunities for professional growth.

Two problems, floating and scheduling issues, are frequent causes for dissatisfaction among nurses, but solutions can be found to reduce those problems.

While full-time specialty nurses may prefer not to float, it can be done successfully, resulting in engaged, confident nurses and consistent patient care. Here are some tips:

  • Place new hires on other units during orientation so they become familiar with how those units function.
  • Make floating easier by providing a manual that outlines procedures and what to expect when working on different units.
  • Create a floating pool of nurses who are cross-trained to work in a number of units. This option can be attractive to nurses who wish to learn a variety of specialty areas or who want to work part-time.

Launching a well-run float pool is a way for hospitals to manage the variances in patient volumes and staff availability.

Use of self-scheduling is another nurse retention strategy that allows nurses to choose the day and shift they’ll work. Self-scheduling demonstrates to nurses that the hospital administration understands their needs. It solves the problem of arranging schedules around requests for days off and vacations. Plus, it can motivate nurses to stay on the job longer, while attracting new employees.

When nurses have more involvement in their schedules, the entire process becomes less stressful. However, self-scheduling comes with its own challenges. To avoid problems, a solid plan is necessary, along with short- and long-term goals such as nurse retention and improved recruitment and clear rules and processes.

Additional strategies for boosting morale and keeping nurses on the job include:

  • Recognize great work: Demonstrate appreciation for excellent work by recognizing the efforts of outstanding nurses.
  • Be available: Administrators should get out of the office and walk the units to observe what’s going on, and to show nurses that supervisors are there for them when needed.
  • Reward loyalty and mentorship: Offer monetary incentives for longevity, as well as for experienced nurses who provide mentorship to new hires.
  • Focus on orientation: Consider extending the length of orientation and personalizing it to meet the individual needs of new nurses. Take extra time with new hires to help them adjust and feel comfortable.
  • Encourage career development: Provide tuition reimbursement to nurses who wish to pursue advanced degrees, such as LPN-to-RN or RN-to-BSN.

RN Retention Case Studies

A hospital’s success depends largely on its ability to retain an experienced workforce of skilled RNs. This is a look at how three top-performing hospitals instituted creative solutions to the problem of nurse turnover with successful retention programs designed to keep experienced nurses on the job longer.

Bon Secours Richmond Health System

Bon Secours is known for retaining experienced nurses, with nearly 25% of its RN staff age 50 and over. Employees are encouraged to keep working as long as they are able, and the company has received several “Best Employers for Workers over 50” awards. This is one result of an effort to learn more about the interests and challenges of workers over 50, and developing programs that encourage them to keep working. Experienced workers are appreciated for their knowledge, which creates an attractive environment for skilled nurses.

Bon Secours also focuses on newly hired nurses with a strong long-term retention strategy. The hospital provides a high level of mentoring and support for the first two years of a nurse’s career, along with development opportunities from then on. Flexible work scheduling and improvements to the physical side of nursing, including ergonomic programs, provide incentives for nurses to stay. As a result, turnover rates for experienced RNs at Bon Secours averaged 11% to 12%.

Monongalia General Hospital

This Morgantown, West Virginia-based hospital built a strong culture of patient care where nurses are appreciated. For example, the hospital invited experienced nurses to help design a new patient tower, including room and floor design and equipment selection. One result of nurse involvement was a more ergonomic design that improved patient care and nurse satisfaction.

Nurses choose to work at Monongalia for its personal atmosphere. The open-door policy promotes communication and problem solving. Consistent employee engagement leads to higher satisfaction and long-term retention. The hospital also utilizes advanced technology to leverage nurses’ skills, and promotes staff development and education.

Scripps Health

Scripps Health is based in San Diego, one of the country’s most competitive healthcare markets. After several years of financial losses, plans were implemented for improvements from the ground up. Retaining nurses was a major focus. Scripps invites nursing leaders to participate in high-level meetings to ensure their voices were heard. The facility instituted an open-door policy with senior management, and regularly seeks employee feedback. Scripps also focused on talent development as a retention strategy.

The Nurse Mentor Program was developed to better prepare new nurses for bedside work. This allows experienced nurses to take on a leadership role without moving into management, while newly hired nurses get needed support.

Scripps also pays higher salaries to nurses with more experience and additional certifications, and instituted a “Life Cycle” approach to retention, which manages nursing talent through five stages:

  1. Entering the workforce
  2. Growing with your family
  3. In the middle of everything
  4. Thinking about retirement
  5. Retirement 
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