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7 Nurse Retention Strategies

April 1, 2021
April 1, 2021

The nurse retention strategies that worked in the past cannot dampen the kind of turnover that healthcare is facing. Healthcare organizations that want to retain employees need to implement stronger, evidence-based strategies.

It’s estimated that over 260,000 nurses leave the profession annually and are not being replaced as quickly as they leave. In turn, new academic nurses do not have the same experience level as more mature nurses. For skilled nursing, the median turnover rate is 43.9. Each percentage change costs about $379,000 on average, which means an average loss for a hospital of about $5 to $8 million annually, not to mention the erosion in quality of care.

It’s time to act on the problem. Organizations with lower turnover have found these 7 actions to be vital to boosting retention:

  1. Engage from the first touch in recruiting and hiring
  2. Establish a hiring standard
  3. Put science in your selection
  4. Adopt a structured competency nurse residency program
  5. Actively support career development
  6. Support clinical decision making at the point of care
  7. Foster a culture of learning and competency
  1. Engagement begins with recruiting

    Start by focusing on the candidate experience in your recruiting process. Remember that selection is a two-way street and that first impressions matter. Make the process efficient. Consider the use of job preview videos to help you present the best aspects of the job and highlight it realistically. Also, utilize healthcare-specific behavioral assessments and then track the candidate reaction data.

  2. Establish a hiring standard for behavior competencies

    The focus has shifted away from clinical and technical skills to behavioral competencies. All of the research points to the fact that non-clinical skills like positive attitude, teamwork, collaboration, drive, and initiative impact both performance and retention. Be sure to align your mission and values with your candidates, but don’t forget a thorough job analysis where specific behavioral competencies are detailed.

  3. Put science in the selection

    Motivational fit is a huge part of what predicts your job success and retention. Is the fit right? Look at factors like pace, autonomy level, collaboration, and work environment. The research shows that if any one of these is out of balance, the result is higher turnover. Because let’s face it, with so many job openings, candidates can easily leave to find a better fit. Why not find the right fit right away?

    The generic resume/interview process is non-predictive and has not been useful in the current climate. You need a structured, behavioral interview where you look for specific attributes and the correct motivational fit. This is one of the best ways you will increase the odds of hiring an employee who stays. Think of it like building a layered selection system from the ground up. Define what you want and determine where in the process you will evaluate each competency.  Be deliberate and consistent. Remember to increase your odds of success by using a health-care specific behavior assessment tool. 

  4. Adopt a nurse residency program

    The nursing expertise gap is a key factor contributing to turnover.  Nursing school deans who were surveyed said their graduate nurses were 90% ready, but hospital leaders surveyed said that nursing graduates were only 10% ready. Creating a 80 percent gap in view of readiness! Facilities needs to take action to support nurse transition through a nurse residency program, innovative onboarding and support of new nurses.

     A survey found first year turnover for nurses fell from 25% to 12-14.7% when structured onboarding was used in lieu of traditional. Also, structured programs yielded measurable improvements in patient errors, negative safety practices, new nurse competence, work related stress, and increased job satisfaction. Develop a way to standardize and structure onboarding so that you transition academic nurses to clinical nurses

  5. Actively support career development
    According to the IOM Future of Nursing report, we must prepare nurses to lead the charge to advance healthcare. We must prepare the current workforce to assume leadership positions at all levels. Decision makers should ensure that leadership positions are available and filled by nurses.  

  6. Support clinical decision making at the point of care

    A key reason nurses say that they leave the industry is due to “emotional distress related to patient care.” Unfortunately, healthcare technology can factor into that stress. More than 75% of nurses report that medical devices cause stress. Help prevent that stress and provide support at the bedside. 

    A 2014 study by the Rockburn Institute found use of evidence-based clinical support and clinical procedural improvement software and systems positively correlated to higher performance scores. A metrics driven, evidence-based program cross-pollinates success and improves conditions creating increased retention. 

  7. Foster a culture of learning
    Ensure that your nurses engage in lifelong learning, not just safety or regulatory training but the real development that they need. In a recent 2-year study by Bournes & Ferguson-Pare, two departments offered training to employees. One department offered status quo, traditional training and the other offered more electives and nontraditional classes. The department with the nontraditional training had lower turnover, a budget surplus, less employee sick time, and shorter patient stays.  When you invest in your employees, they will invest back. So take this quiz to see how your organization rates in reducing turnover. How many of the following statements can you affirm?

  1. We engage our employees with a recruitment process that makes them want to work here
  2. We have established a hiring standard
  3. We are using science in selection
  4. We have a structured competency nurse residency program
  5. We  support career development
  6. We provide clinical decision making at the point of care
  7. We have a culture of learning and competency
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