Keeping Both Newcomers and Seasoned Healthcare Staff
In just five years, 2016-2021, hospitals had an average turnover of 83% of their registered nurses (RNs) and 90% of their total workforce, which is an ongoing trend. According to the U.S. Bureau of Labor Statistics, the annual quit rate in healthcare rose from 21.2% in 2017 to 28.4% in 2021, over-burdening existing staff with increased workloads that bring about more staff turnover.
How Much does it Cost to Hire and Train a Nurse?
The frequent personnel changes compromise the quality of care, outcomes, and patient satisfaction, not to mention the financial cost, which according to statistics on turnover expenses, is at an average of $40,038 and up to $51,700 per bedside RN. This nurse turnover costs back the larger hospitals over $3.6 million annually.
The cost of hiring a new nurse includes recruitment fees, onboarding, training, and orienting, coping with decreased productivity in the first few months, and filling temporary vacancies.
Turnover statistics show that an alarming 17% - 30% of new nurses leave their job within the first year, and up to 56% go within the second year, whereas those with more than five years on the job account for about 14% of turnover.
Healthcare organizations are all grappling with turnover and how to retain nurses, both new and old. Turnover rates decline with age and years of service, then rise close to retirement. The loss of seasoned nurses is much more costly in terms of years of hands-on experience and knowledge, well-developed capacity, institutional savvy, rich clinical expertise, and mature stress management.
How Can Facilities Improve Employee and Nurse Retention?
The top three reasons for RNs resigning were relocation, career advancement, and retirement, and 2021 was the first year retirement hit the top three. Many nurse retention reports and studies also mention workload, burnout and stress, working conditions, salary, and lack of communication and understanding with the management.
Nurses in different stages of their careers meet distinct needs; for example, mentorship, coaching, training, and education may be most valuable for new starters, while the workforce eligible for retirement may look for flexible pension options and job redesign. Although most nursing turnover is in the first two years, the aging population naturally brings a growing number of retired nurses, just as in any other profession.
Nurse and Healthcare Worker Training and Education
Some hospitals and healthcare systems are investing significantly in on-the-job training. For example, new nurses at Houston Methodist train for the first six months in a paid nurse residency program. The hospital also facilitates pathways into specialties, providing internships combined with a residency position in the same unit, allowing a new nurse to move straight into a specialty she (or he) loves.
In New York City, the Department of Small Business Services, foundations, and employers are trying out a six-month course for unemployed and underemployed nurses with bachelor’s degrees called a transition to practice program.
Participants are paid a stipend to work at a hospital two days a week and participate in online training scenarios or practice on simulation dummies at Lehman College. This program is not tied to a specific healthcare job.
Salary
Some hospital systems can offer raises, a very effective incentive to attract and keep nurses and other staff members. But some employers can’t do that. Smaller healthcare organizations may not have the resources to raise salaries, primarily if they rely on public funding such as Medicaid. Despite limitations, they may be able to award one-time incentives for nurses, such as student loan repayments or an annual bonus for recurring commitment to the job.
However, other workable strategies exist to retain valuable healthcare staff, save at least part of the replacement costs, and slow down the spiraling turnover.
How the Work Environment and Culture Are Related to Nurse Retention
Management can forge a supportive, safe, and compassionate work environment with the following initiatives.
- Share the institution’s ideal culture in the mission, vision, and values statements. Maybe make cards with these statements, pass them around, and then ask staff how to align day-to-day operations with them.
- Involve nurses in decision-making and innovation related to patient care delivery and practice.
- Develop strong nursing leadership, comfortable access to guidance, and well-informed supervision at all levels.
- Equip, authorize, and encourage nurse managers to lead a culture of innovation, providing training and development of leadership and management capacities. Give them the authority to re-engineer processes, establish appropriate workload and staffing levels for their area, and hold them accountable for monitoring and improving workplace culture and patient outcomes.
- Support the nurses’ mental and physical health with wellness programs to help them successfully cope with high levels of stress and the threat of burnout. Read the Nursa article on “Caring for the Caregivers.”
- Upgrade security and safety at work, for example, investing in better lighting, increasing security staff, and creating a wireless panic button system to call for help. According to a recent survey, 88.9% of nursing professionals have experienced violence in the workplace.
Many organizations have created nurse retention strategies to enhance quality care, advance institutional strengthening, improve patient outcomes, foster staff well-being, and reduce the staggering costs of turnover. Reducing nurse turnover is a strategic imperative for all healthcare managers.
