Increasing turnover among U.S. nurses has prompted hospitals and health systems to consider programmatic and cultural changes to mitigate, address and prevent its pervasive effects. These effects include poor provider wellness, reduced productivity, high job burnout, early retirement and reduced quality of care.
Nurse satisfaction, burnout and retention are prevalent topics that are receiving increased attention in peer-reviewed medical journals as well as the popular media. In fact, the U.S. health care workforce has a higher rate of burnout than any other profession. Burnout often occurs simultaneously with work-related stress, job dissatisfaction, and physical exhaustion. Burnout not only has serious effects on nurse well-being and mental health but also undermines health systems’ productivity and compromises patient outcomes.
The high cost of dissatisfaction
Clinical staff satisfaction correlates to patient outcomes, patient adherence to treatment and staff turnover rates. In addition, the cost of losing a high-value employee is significant. Aside from direct costs of recruiting, hiring and training a new nurse, losing experienced nurses can hurt morale in a nursing unit and decrease patient satisfaction. Furthermore, the knowledge gap between experienced and new nurses is widening due to the increasing number of experienced nurses entering retirement, with one-third of the nursing workforce expected to retire over the next 10 years.
The aging population and increasing acuity of hospital care drive demand for nurses and further underscore the importance of nurse retention strategies. With the average cost of turnover for a bedside RN at $52,100, professional and personal nurse satisfaction is critical to stemming turnover and maintaining a well-functioning, high-quality medical environment. As organizations find themselves competing for an experienced workforce, aggressive recruitment and retention plans are becoming increasingly necessary.
Strategies for combating nursing turnover
Reducing turnover and overcoming burnout require a deliberate shift in organizational thinking, which involves rejecting the passive acceptance that turnover is the price of doing business. Internal, organization-specific team inefficiencies and cultural concerns also impact turnover rates. Unsupportive leadership, lack of autonomy and shared decision-making, overwork, absence of work-life balance, and regulatory and liability concerns also significantly affect nurse satisfaction. Success is contingent on identifying and understanding pain points for providers, allowing for timely professional development, and on limiting tasks that require more generalized skill sets, e.g. data entry.
Experts at Sg2 suggest hospitals begin by surveying nurses about areas of dissatisfaction and work-related stress. Doing so will not only help administrators understand what is making nurses unhappy but also help to identify deeper problems in the institution, such as poor communication among staff and overly taxing or superfluous paperwork. Armed with this information, hospital administrators can tailor provider satisfaction programs to their staff’s needs. Frequently the top two issues necessitating a culture shift are the prevalence of burnout and lack of professional development.
Strategic considerations to improve retention
Health systems should prioritize the retention of satisfied, valuable employees as the health care delivery landscape continues to evolve. As hospitals compete to offer the highest quality care to the patient, the soft-touch advantages resulting from satisfied nurses positively interacting with patients are increasingly important. Be sure to utilize select quality and operational metrics to determine whether interventions to combat turnover are successful.
To reduce turnover and improve retention, consider the following strategies:
- Identify current workforce challenges
- Determine the leading causes of turnover at your institution through a survey or interviews. Individuals may have unique reasons for experiencing burnout, including fatigue, lack of meaningful relationships with colleagues or time spent on administrative tasks.
- Prioritize major pain points such as work-life balance and nurse morale through alternative clinical structures or supplemental staffing support
- Leverage health system leadership to build internal support
- Evaluate institutional support for specific approaches, such as resilience training, empathy classes, visual thinking strategies and narrative medicine
- Determine whether adding scribes or medical assistants to the care team might alleviate turnover due to the electronic environment and demanding coverage duties
- Leverage authentic leaders who champion provider well-being and allow nurses a stake in decision-making processes, creating value before capturing value
- Support ongoing professional development
- Identify opportunities for ongoing feedback and recognition
- Establish nurse fellowship or mentorship programs to enhance career growth opportunities and ensure long-term success and retention
Comprehensive, effective solutions can be elusive, but hospitals and health systems looking to address turnover and retain nurses can develop organization-directed, systemwide and multipronged initiatives to combat this growing issue.