The Administrator’s Guide to Retaining Nurses
The demand for nurses is rising every year. The American Nurses Association estimates that by 2022, there will be a need for 3.44 million nurses. To put that number in perspective, an additional 1.13 million nurses will be required in less than 10 years.
Unfortunately, while healthcare organizations need to hire more nurses to meet demands, they’re also struggling to retain the nurses on staff. In 2010, RN turnover was at 13.8 percent. As of 2014, RN turnover rates grew to 17.2 percent.
Surveys conducted by People Element of RNs who have left their organization reveal that the top reason for leaving is due to workload and staffing, followed by career opportunities, supervisor issues, schedule, compensation, and benefits. The issue of workload is so bad that RNs now worry how poor patient ratios might impact their licensure. Discovering these issues before it’s too late plays an important role in keeping retention numbers at bay in any healthcare organization. Improved retention rates can eliminate many pain points created by turnover such as higher costs, overworked staff, and errors in patient care.
What makes nursing retention different?
Surveys conducted by People Element indicate that RNs’ top reasons for leaving an organization are unique when compared with other healthcare employees. Therefore, administrators can’t use a “one size fits all” approach when it comes to retaining RNs and other healthcare employees. Issues and dissatisfiers are unique at every organization, as are the benefits and reasons for staying. Using your hospital’s specific reasons for leaving will be much more effective because that data is tailored to the challenges that employees perceive at that organization. Likewise, the stresses and pressures an RN feels are different than any other position within a healthcare organization. Understanding the reasons why your RNs are leaving your organization is the first step on the path to impacting nursing retention.
For example, while staffing/workload is the most common reason for leaving for nurses, it’s not as common when looking at all healthcare employees. Staffing/workload issues may be more relevant for RNs because they’re much more likely to feel overwhelmed by the amount of work they have to do compared to any other hospital employee.
Compensation and benefits is shown as the fifth most frequent cause that RNs leave; however it’s one of the top three concerns for all healthcare employees. One explanation for this difference is the amount of competition in the marketplace for successful, experienced RNs. In some healthcare organizations, the market has become so competitive that recruiters are enticing employed RNs with hefty $50,000 signing bonuses. While it might seem insurmountable to compete with incentives of this magnitude, keep in mind that to RNs who are truly engaged and feel supported, the impact of money alone might be less than one would think.
To address these unique needs, begin by identifying the key drivers of engagement for your current RN population. Then create an action plan for increasing job satisfaction around those key drivers. Improved job satisfaction positively impacts RN engagement levels which can lead to higher retention rates, fewer accidents, better patient care, and more.
Nursing-specific employment issues
People Element has conducted over 200,000 exit surveys with nurses and healthcare employees. Based on those interviews, it’s clear there are trends around why nurses aren’t happy with their jobs. Understanding these trends and addressing the reasons earlier, rather than after the fact, is important in retaining today’s top nursing talent. Exit surveys can identify why RNs are leaving; however, the action to impact turnover must be taken before people decide to leave. Once themes and hotspots are identified, companies need to get in front of the issue. For example, if RNs at an organization are saying that one of the top reasons for leaving is the immediate supervisor relationship, then action plans need to be developed for supervisors to build and develop stronger relationships with RNs early on in their tenure.
When People Element consultants spoke with RNs who were leaving, this is what nurses had to say regarding their top five reasons for leaving:
“Heavy workload wore me out to the point of exhaustion.”
“There wasn’t enough staff to handle the workload. I feared I would lose my license because of the improper staffing ratios.”
“I left due to no opportunity for advancement or growth; leadership did not value their employees.”
“No one had time to help a new graduate.”
“There was ineffective management by my immediate supervisor in the medical department. She did not care for me and it was obvious.”
“I didn’t receive enough support from my supervisor, who had inadequate supervisory skills, and often demonstrated unprofessional behavior.”
“My schedule was never consistent. Sometimes we would work 12 days straight, without one day off.”
“I needed a better schedule, something that allowed me to be around for my family.”
“In the six years I was there, I never received a raise.”
“I felt I was not at the pay scale I should have been at for my workload and experience. There was no recognition for a job well done.”
These themes and comments from RNs highlight the importance of asking questions and understanding the challenges your workforce is facing. With such a competitive job environment, it’s easy for nurses to leave and find a new job if they’re not satisfied and engaged with their existing workplace. That’s why it’s critical to monitor turnover and address issues to ensure staffing problems don’t create bigger issues when skilled RNs leave the organization.
Length of employment impact
If we look at the employee lifecycle, it’s clear that tenure also impacts what matters most to nurses. When comparing the reasons nurses cite for leaving an organization, RN reasons change between 0-3 months, 3-12 months, and more than 1 year.
Initially, RNs are concerned about training and orientation to the organization and role, but as time goes on, they’re less concerned with training. The career ladder for RNs typically includes continuing education, so once a nurse has been in their position for a while, they’ll most likely be looking to advance by earning a degree, certificate, or some other form of continuing education. It seems that around the one year mark, RNs are feeling more confident about their position and skills and are looking for next steps in their careers.
Similarly, at one year or later, compensation and benefits become more critical. When RNs are new these are less critical, but after a year or more of employment, 12 percent of RNs said this was a top reason why they left. This could be due to benefits becoming a greater concern as nurses begin raising families and the desire for better compensation comes as an RN’s level of experience and expertise increases. Another reason is that with some tenure under their belts, RNs begin to realize just how hard the job actually is and believe that the work that they signed up for is worth more compensation than what they accepted.
Regardless of whether an RN has been on the job for three months or a year, workload remains a primary concern and the top reason for leaving. For healthcare organizations looking to retain a broad tenure of RNs, these two areas (workload and supervisory skills) might provide a good place to focus initial retention efforts.
Suggestions for how to retain nurses
Bottom line: nursing is a difficult job. Nurses work long hours, float to various departments, and interact with people who are sick, as well as patients’ families, and the doctors who are treating them.
It might seem like a futile task to retain nurses who want to leave…but it’s not. The cost of turnover for RNs is quite high, and if action can be taken that will affect RNs’ levels of satisfaction and engagement within their organization, it’s possible to change someone’s mind about wanting to leave. Of course, there are sometimes people who are not a good fit and who shouldn’t stay, but often there are good RNs who would do great things for the organization if just a thing or two were different. The consultants at People Element have suggestions for ways to address the top reasons why RNs leave.
Address workload issues
Administrators probably wouldn’t hesitate to hire more nurses if they could, and if their budgets allowed it. But sometimes there are other ways an administrator can address the perception that there’s a staffing issue.
“I like to ask what administrators can control in regards to staffing,” says one consultant. “Something such as out-of-date technology can add unnecessary time to a nurse’s day and give them less time with patients, which makes them feel understaffed.”
In that case, an administrator might be able to secure funds for a technology update that will positively impact job satisfaction for current nurses, and better prepare the healthcare organization to address future staffing needs as well.
Provide training and development
Once a nurse is hired, stay committed to providing ongoing training and development opportunities. Training should help RNs succeed in a new role, but as time goes on, RNs will also be looking for professional development to help them advance their career.
Training and development opportunities are not limited to workshops or online courses. Development can—and should—be part of the conversations managers are regularly having with their team.
“I’ve seen this in clients’ data when looking at comparisons between those who have reported having a developmental conversation with their manager in the past year, compared to those who’ve not. There’s always a large difference between the two. Developmental conversations improve career growth as well as perceptions about supervisors.”
Improve supervisor interactions
Regardless of role or industry, most employees want to have a positive connection with their manager. Creating those connections requires time and communication. While on shift at a busy hospital, nurse supervisors don’t have a lot of extra time for meetings or one-on-one discussions. When managers do rounding “with a purpose”, and conduct occasional skip level meetings, they’re able to maintain and improve working relationships with their team. And, any issues or concerns can be addressed in the moment, before they become bigger problems.
In some cases it’s necessary to provide managers with resources—and possibly training—to learn how to communicate properly with their employees. Experts suggest looking at the behaviors of top-performing managers and developing a training program to help grow those behaviors in other managers.
Collect employee feedback data
It’s difficult–if not impossible—to retain nurses if you don’t know what they’re experiencing. In order to gain a better understanding of what’s making nurses leave, you must ask for and gather their feedback.
Engagement surveys for current employees and exit surveys for former employees both provide excellent sources of data that can be analyzed to understand and identify significant issues. It’s important that the data you collect is high quality and actionable so you can more easily respond to—and address—issues. Using third parties is an effective way to get high quality data due to responses being confidential.
“We’ve had clients who, after a few years, have decided to gather feedback themselves. In those cases, they’ve come back within a year to ask us to conduct the interviews for them. What they find is that they’re not able to get the same quality of data because they aren’t a third party,” says Keri Schmidt, People Element data collection supervisor.
Healthcare organizations that use engagement surveys and exit interviews to understand the specific needs of their RN workforce are prepared to tackle the issue of nurse retention. The deeper understanding gained from these surveys allows organizations to address the real reasons nurses are leaving and provides them with tools to re-engage RNs, while reducing burnout and decreasing vacancy and turnover rates. At the same time, organizations with more engaged employees enjoy increased satisfaction and retention rates.
An engaged team of nurses will contribute to the success of any healthcare organization. Addressing job satisfaction issues early on will help engage nurses and keep turnover at bay. Don’t let your RNs leave simply because you didn’t take the time to understand and listen to their needs. Nurses are the backbone of healthcare organizations, and with a greater focus on RN satisfaction and retention, the entire organization will benefit.