Determining The Cause Of First-Year Nursing Turnover
The average hospital loses between five and seven million dollars a year due to nursing turnover costs. Beyond the upfront cost, we must also consider the adverse impact on patients’ quality of care that results when overworked and overstressed nurses are dealing with the increased workload. Turnover is a serious problem that needs addressing, especially when it most frequently occurs in the critical early days of a nurse’s tenure. It’s important to ensure that new RNs, especially recent graduates, are given enough support and attention so they remain and become long-term contributors to the organization.
NSI Nursing Solutions’ 2016 National Healthcare Retention and RN Staffing Report found that first-year RN turnover is at 30%. While turnover among any population is painful, it is especially difficult when it occurs within a nurse’s first year on the job. With a skilled position like nursing, the first year consists of a significant amount of training, which means that all of those costs are unrecoverable if the person departs.
In addition, RN vacancy rates are increasing. While a number of factors contribute to this shortage, the primary reason is due to a lack of RN educators to help grow and develop the next generation of nurses.
Other turnover reasons commonly found for this RN population include unhappiness with their schedules and work hours, a lack of professional development, unfavorable supervisor relationships, and the reality of their job not matching the expectations they had when they were hired. The cost of turnover is significant and healthcare organizations that want to turn the tide must make appropriate efforts to target this vulnerable population of clinical staff and support the needs of the people within it.
How to Reduce First-Year RN Turnover
One of the most effective ways to reduce RN turnover is to develop a residency program. According to the University Health System Consortium & American Association of Colleges of Nursing, first year RN retention can go up to 95.6% when residency programs are in place.
Residency programs help to fill the gap between school and practice. The goal is to continue education, mentoring, and support, so new nurses become competent, confident contributors. It doesn’t require administrators to move mountains in order to set up a residency program–the key elements are actually quite simple.
Elements Of A Nursing Residency Program
- Realistic Job Previews: Provide a clear, realistic picture of the job to RN applicants. Offering a perspective of only the positive aspects can cause someone to quickly become disengaged once they take the job and find that their expectations are not met.
- Shadowing Opportunities: Offer opportunities to shadow existing RN staff on the floor to see their workload, practices, and more. The more opportunities a resident has to see the clinical staff in action, the better the person will be able to transition into the job.
- Pre-Hire Classroom Seminars: Set up a series of seminars that give newly-hired nurses a deeper understanding of employment and of their duties. One successful seminar lineup we’ve seen used included a week each on human resources, general nursing, basic arrhythmia, and critical care.
- Clinical Orientation: Leadership at a Pennsylvania hospital required new nurses to participate in a year-long clinical orientation with a preceptor.
- Regular Evaluation: The same hospital implemented a six-month evaluation, with the nurse, their manager, and their preceptor.
A residency program requires participation and cooperation from nurse managers, doctors, and human resources professionals. It’s something that must be planned ahead of time, and phased into everyone’s workload.
Other Powerful Nursing Retention Tools
You can implement additional best practices to help the first-year nurses you have right now. Some of these include:
- Employee Surveys: Survey the existing RN population about what they wish they would have known when they started. The answers to these questions can help you take specific steps to improve your interview processes, professional development efforts, and more.
- Hiring Process: Use your current RNs in the hiring process. This allows your existing staff to answer questions, offer previews of the work, and help assess the capabilities of your applicants.
- Frequent Check-ins: Check in with new hires frequently and support their unique needs. We all know that someone with one month of tenure has different needs than someone with one year of tenure, yet both groups are often treated the same. New hires need frequent supervisor interactions and regular check-ins to make sure they are on track.
- Know Your Turnover Data: Be sure you’re analyzing the specific reasons RNs leave your own organization. While we can look at data to see common causes of nurse turnover, every healthcare firm is unique. If you don’t know the most common reasons for turnover at your organization, you can’t try to mitigate them.
It isn’t easy to deliver high-quality patient outcomes when your organization is constantly battling to hold on to its RN population. While nurses leave for many reasons, the best practices described above are essential tools for retaining new graduates. These efforts can solve several challenges, bring your RN population closer together, and create the foundation for the sustainable nursing workforce your organization needs.