Improving Nurse Retention

Six Strategies to Reduce RN Turnover

A nurse is smiling seated at a desk and shaking the hand of another nurse who is standing in front of her

When I started my nursing career almost 15 years ago, I remember my colleagues telling me, “Good luck on night shifts — you’ll be there a while.”

They weren’t kidding: I was on nights for 10 years, waiting for someone to leave so that I could move to another area.

Today, hospital turnover is so high that I often see nurses landing their first day shift spots in less than two years — sometimes in less than a year. My hospital and specialty area are not unique. Nurse turnover and retention are nationwide problems.

Why is Nurse Turnover a Problem?

According to a 2019 staffing report compiled by the recruitment firm NSI Nursing Solutions, Inc., 2018 saw the highest hospital turnover rates in over a decade. Bedside RN turnover reached 17.2 percent in 2018, with an average vacancy rate of 8.0 percent. Between 2014 and 2018, the average hospital turned over 87.8 percent of its entire workforce!

This revolving door is expensive. NSI reports that the average cost of bedside RN turnover in 2018 was $52,100 per position. On average, each percentage point increase in RN turnover costs a hospital an extra $328,400! High rates of resignations and new hires can quickly make a healthcare business unsustainable. There are also significant non-financial downsides, such as unit disruption and the loss of institutional knowledge and experience.

A 2017 Forbes article noted that Millennials often leave jobs within two to five years. Recently, the RN Work Project found that 17 percent of newly licensed RNs change jobs within one year. Thirty-three percent of them move on after two years. Within eight years, 60 percent of new RNs have left their jobs. Retirement of older, more experienced nurses is also a growing concern.

Reasons to Stay

Given the high cost of turnover, hospital administrators, educators, and healthcare teams are all looking for ways to better support nurses and encourage them to stay with their current institution. There’s no one answer, but here are six strategies that go a long way towards addressing the problem:

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Hire the Right People

The interview process is the first step in determining if someone is the right fit for your unit — and if your unit is the right fit for them. (It has to be a two-way street!) It’s also your opportunity to set clear expectations for prospective employees.Try asking open-ended behavioral interview questions that go beyond clinical skills.

These areas include:

  • Communication
  • Teamwork and collaboration
  • Problem-solving
  • Leadership
  • Time management
  • Responses to challenges, stress or pressure.

Asking the right questions during the interview process can help you select candidates who are more likely to stick around (as well as identifying future leaders of your group).

Offer Meaningful Benefits

People want to work for an organization that works for them. Look at other hospitals around your area, check out their compensation packages and see if they are in line with what your hospital is currently offering. Are you competitive?

If you’re a manager, you may not have any control over “big-ticket” items like salary or health insurance plans, but if you think outside the box, you might find other ways to make your unit a more attractive workplace.

  • Their birthday as paid time off each year?
  • Less on-call time if they need it?
  • Flexibility to tackle some work (and continuing ed) at home?
  • Free education conference days?
Recognize Your Staff

Take time to recognize the great things that your nurses are doing every day. Hold a huddle before each shift to compliment staff members who received positive patient feedback, address any updates on unit improvements, and share other motivating and positive news. Be sure to give your nurses a voice in the hiring and onboarding process.This helps you select the right candidate, make the newcomers feel welcome and build unit cohesion.

Nursing Education

Experienced nurses can answer questions that a new employee may be too nervous to ask their manager or HR representative.

Provide a Welcome Package

When you first go to a new salon or attend the grand opening of a store or restaurant, they often distribute coupons or little promotional tokens like pens or magnets. Do the same for new employees to welcome them to the team. Giving new hires small gifts like official hospital bags, coffee mugs or lanyards is a nice, thoughtful gesture. Be creative!

Leaders Need a Personal Touch

Managers should get to know the nursing team as individuals. Take time out of your day to ask how they are doing. Inquire about their spouses, kids and personal lives, and follow up later to emphasize that you’re paying attention.

Use conversation-starters like:

  • “How’s Zachary doing at baseball this year?”
  • “Did you end up buying that car?”
  • “Ready for the holidays?”

A manager’s personal touch goes a long way. People want to feel like they matter to their leaders. Checking in with them about their lives helps to make this possible.

How Can You Help?

If you’re a manager, you should walk around the unit and ask how you can help your nurses to be exceptional today. Teamwork helps create a trusting environment for staff. Preparing new IVs, fixing a broken piece of equipment or figuring out staffing for the next shift are easy places to start, but you can also ask the nurses on the floor what else you can do to help.

If your unit is plagued by high turnover, that’s not going to change overnight. However, taking these six steps will help create a positive culture, and build a strong team of nurses who are happy and fulfilled in their work.

JANINE KELBACH, RNC-OB, BSN, is a writer and podcast host with experience in bedside nursing, management and education. She owns WriteRN.net and hosts The Savvy Scribe Podcast. She has a husband, two boys and two Great Danes.

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