At a time of significant instability and uncertainty in 21st-century healthcare, holding onto valuable nursing staff could not be a smarter focus for organizations that want to stay ahead of the game. If nurse attrition is an arch-enemy of high-quality patient care, how can prudent facilities ensure their nurses stick around?
According to the 2023 NSI National Health Care Retention & RN Staffing Report published by NSI Nursing Solutions, a hospital-based RN turnover rate of 22.5% is our reality, with nurses employed in pediatrics, surgical services, and women’s health showing the lowest rate of attrition, and those working in telemetry, step down, and med-surg being the most likely to leave.
“In a competitive market where nurses can easily become well-paid travelers or find a better compensation package and more positive workplace culture down the street or across state lines, healthcare organizations can’t be lazy,” states Sharon M. Weinstein, MS, BSN, RN, CRNI-R, CVP, CSP, FACW, FAAN, a certified coach, speaking professional, and consultant to healthcare organizations. “Nurses are valuable, and those employers that reflect their knowledge of that value will be much more likely to reap the rewards of nurse retention.”
If the average cost of turning over an RN position is $52,350, as NSI reports, inspiring nurses’ sense of workplace loyalty should be top of mind for healthcare administrators, managers, and executives who are watching their profit margins shrink. A constantly revolving door isn’t healthy for any unit, let alone the facility of which it’s a part.
While free pizza, a tote bag, or a new thermal coffee cup can provide a few feel-good moments and a full stomach for a hard-working nurse, these initiatives fall flat when it comes to long-term nurse retention. Pizza and coffee cups don’t put money in nurses’ pockets or decrease their workload, so these shallow band-aids are not central to any retention strategy.
When considering the need to create a workplace environment where nurse retention is a direct result, we’ve already established that pizza and tote bags should not be your go-to. So, where do we look beyond such simplistic would-be incentives?
According to Weinstein, things have changed. “The pandemic brought a perfect storm of challenges for healthcare providers with a disruptive impact on practice and process; one thing that did not change was our commitment to the profession.”
“This is the time for wellbeing to prevail as a core retention strategy,” Weinstein admonishes healthcare leaders. “We must be attuned to nurses’ needs for active listening, respect for their mental health, and the constant threat of burnout. We must offer a stress-free, psychologically safe work environment and reinforce that there is joy in the journey. We want their place of work to be the focus of that joy.”
Compensation: Nurses want and deserve proper compensation, and they’ll vote with their feet when they know certain facilities or employers pay more. Sign-on bonuses, money for relocation, tuition reimbursement, childcare, generous health insurance, and other benefits are all incentives for nurses to come on board and remain loyal.
Positive work environment/workplace culture: Flowery words on the company website are nice, but creating a positive workplace culture takes work. Work-life balance initiatives, zero tolerance for bullying and incivility, a culture of appreciation and camaraderie, and an atmosphere encouraging kindness and rejecting negative behaviors don’t just happen organically. There must be a commitment from the top. When it comes to a positive workplace environment, safe staffing is at the top of most nurses’ agendas — we can’t practice safely if we’re asked to do too much in too little time with too few resources.
Professional growth and development: Generous tuition reimbursement (as mentioned above) is a good start. Ongoing in-house training and educational opportunities are essential, as are pathways for career advancement. Nurses interested in professional growth should be aware of a leadership funnel and/or clinical ladder in which they can participate. Mentorship programs can also be part of a culture that encourages professional growth. A culture of learning is a dynamic and healthy culture.
Engage staff in the organization’s life: Weinstein suggests employers can engage their staff in organizational development. “Offer diagnostic design thinking to your teams in small group workshops, and have them think differently about themselves, their roles, and their futures.” These experiences can enhance a sense of “ownership” of the process by both staff and leaders.
Recognition and rewards: Like any other strategy, employee recognition programs are just one of many ways to give back to hard-working staff. Performance-based rewards, promotions, financial incentives for specific achievements, and celebrating professional milestones can all contribute to employee satisfaction. From her experience as a consultant, Weinstein knows what works: “Offer meaningful recognition — recognize and reward your nurses.”
Flexible scheduling: Flexible work schedules must also include understanding and consideration for the needs of nurses and their families. Smart employers make allowances for employees with young children and disabled or elderly family members to care for. “Nurses have lives beyond the clinical space,” states Weinstein, “and they need to engage in flexible scheduling and comprehensive benefits packages to get a life and enjoy it!”
Health and wellness benefits: Employee Assistance Programs (EAPs) and anonymous mental health and counseling services for employees are a must in this day and age. Stress management programs, financial wellness support, and other programs that show employees that they’re cared about make nurses feel appreciated and seen.
There is no silver bullet in nurse retention, but organizations that approach this crucial issue with a thoughtful, intelligent, and well-planned strategy will engender more loyalty and positive regard from their nursing staff than organizations that rely on the tired pizza-and-tote-bag approach. Nurses are valuable, and those employers that reflect their knowledge of that value will be much more likely to reap the rewards of nurse retention.
“Turning attrition to attraction begins with the relationship you build with your team, concludes Weinstein. “An organization with top talent can navigate change, mitigate uncertainty, exceed staff and patient expectations, and soar to success. It can create loyalty and reignite passion, even in unprecedented times.”