Nurse Staffing: Retirement, Turnover and Scheduling

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Nurse Staffing: Retirement, Turnover and Scheduling

By Working Nurse
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Boomer “Brain Drain”

With retirement goes institutional memory

For years, healthcare experts have warned of the “Silver Tsunami”: the potentially severe nursing shortages that may result from the mass retirement of Baby Boomer nurses coupled with an aging patient population that demands more care. For years, healthcare experts have warned of the “Silver Tsunami”: the potentially severe nursing shortages that may result from the mass retirement of Baby Boomer nurses coupled with an aging patient population that demands more care.  This perfect storm could also rob healthcare organizations of vital institutional knowledge at a time when it’s needed more than ever.

Indispensable Nurses

Most workplaces have a handful of staff members who are truly indispensable. They might not be managers, but they know their jobs — and the institution’s culture — inside and out. They’re the ones others turn to with questions, whether it’s about procedures or how to open a tricky cabinet latch.  When those staffers move on, some of their knowledge departs with them, sometimes forever. If you think about the indispensables in your workplace (and you might be one of them!), there’s a good chance most of them are older; acquiring this type of knowledge and experience takes time.  According to the California BRN, about 22 percent of the state’s current RNs are over 60 and about half of those are over 65. As these older, more experienced nurses retire, California hospitals may suffer a serious “brain drain” even if there’s no significant nursing shortage.

Knowledge Transfer

A recent article on the Health Affairs blog urges hospital administrators to take steps now to minimize the loss of institutional knowledge, before more Boomers retire.  Recruitment and succession planning are only part of the picture. Hospitals also need to develop specific strategies for transferring knowledge to younger RNs as well as incentives for older RNs willing to put off retirement for a few more years. 

Planning Ahead

o assist nursing leaders in navigating these complicated problems, the ANA’s Leadership Institute now offers a webinar in RN succession planning and the preservation of institutional knowledge. The webinar is part of a four-course “Nurse Retention Bundle” that also covers related topics like RN recruitment and employee retention.  The package costs $148.50 for ANA members, $165 for non-members, and provides 5.96 contact hours of continuing education credit. Learn more at https://learn.ana-nursingknowledge. org/products/ANA-Nurse-Retention-Bundle.


The Turnover Problem

RN turnover remains high — and expensive

While nursing shortages may still be speculative in much of the country, RN turnover is an ongoing problem for many hospitals. Two recent surveys suggest that that problem isn’t going away any time soon.

Fewer but Costlier

First, the good news: According to the 2017 National Health Care Retention & RN Staffing Report compiled by the staffing firm NSI Nursing Solutions, Inc., overall RN turnover fell from 17.2 percent in 2015 to 14.6 percent in 2016, reversing a four-year upward trend.  Nevertheless, rapid RN turnover remains a major concern. Nationwide, 48 percent of bedside nurses who left their positions in 2016 had been with their institutions for less than two years. That’s down from 50.6 percent in 2015, but still worrisome, especially considering that the average net cost of RN turnover is now $49,200 per position. That adds up to an average annual bill of almost $6.5 million per hospital. The costs are even greater for the nation’s for-profit acute care hospitals. For-profit hospitals have had significantly higher RN turnover rates that continued to climb in 2016, reaching 20.5 percent.

Here to Go

Why do so many RNs change jobs so often? It’s not usually the money. A recent survey by another healthcare staffing firm, Leaders For Today (LFT), found that fewer than 30 percent of staff RNs left their previous position for greater pay or a better opportunity. The rest, says LFT, “left for other reasons, including long work hours, frustration or burnout.” Those nurses aren’t necessarily any happier in their current jobs: 22.7 percent of staff nurses say that they plan to leave within the next two years and 62.7 percent expect to leave within five years. Almost 60 percent are looking for a new position and more than 30 percent expect to retire within the next decade.

Vicious Cycle

These trends are not limited to RNs. LFT also surveyed other healthcare workers, including staff physicians, executives and administrative staff, and found that nurses are actually the least likely to be considering an imminent exit.  Replacing so many staff members so often, the authors warn, leads to a “‘vicious cycle’ caused by understaffing and a lack of experience” that promotes even greater turnover.  


Singing the Burnout Blues

Scheduling can be a source of nurse fatigue

Why is nurse turnover so high? A new survey suggests that scheduling woes are making it harder for nurses to cope with heavy workloads and workplace stress.

Who Schedules Whom

Who makes the scheduling decisions in your workplace? According to a recent study from the human capital management company Kronos Incorporated, only about one-third of U.S. nurses (35 percent) control their own scheduling.  Most respondents aren’t happy about that lack of control, saying it contributes to fatigue and poor work-life balance. That has led 41 percent of nurses surveyed to consider leaving their current facility in the past year.

Sleep Deprivation

Fatigue is a serious issue for 85 percent of nurses surveyed. Sixty percent say their workload is a principal culprit. A related complaint is not being able to take breaks or meals while on shift, a problem for more than 40 percent of respondents. One in four say their schedules don’t allow them to get adequate sleep before needing to return to work. Would having more control over their own schedules help?  Fifty-five percent say it would mitigate fatigue and three out of five believe it would make for better work-life balance. Almost half (49 percent) say that being able to more easily swap shifts would also help to stave off exhaustion.

Chronic Overwork

The sample size of the Kronos survey (whose results you can read at was small — only 257 RNs nationwide — but its findings are consistent with those of larger-scale surveys, like the U.S. Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture. The most recent AHRQ hospital survey, released in March 2016, included 447,584 hospital staff, more than 161,000 of them RNs or LVNs. About half of those respondents say their hospitals don’t have enough staff for the workload and that the staff “work longer hours than is best for patient care.” “A fatigued employee at risk of burnout is not an engaged employee,” says Susan Reese, RN, DNP, MBA, CPHIMS, director of the Kronos healthcare practice group.  She says taking steps to alleviate fatigue at the organization level, including allowing nurses more say in their schedules, “will ultimately help nurses, patients and hospitals and health systems.” 

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