As hospitals realize the high costs financially and in outcomes associated with nurse turnover, organizations are focusing on retention efforts and allowing nurses to drive the change.
We have a robust retention program, said Joan Gabriele, MA, RN, deputy executive director for patient care services/CNO at Queens Hospital Center, part of the NYC Health and Hospitals Corporation.
That program includes a comprehensive orientation, preceptors, mentors, educational opportunities, rewards and recognition.
The hospital enjoys a 92% retention rate, up from 75% since 2006.
Satisfied nurses give better care, said Heather Smith-Dixon, BSN, RN, a staff nurse at QHC. Nursing is stressful. Having someone to encourage and nurture in a positive environment allows nurses to feel a greater sense of worth, and that spills into the care you give.
Need for retention effortsMembers of the Queens Hospital Center retention council are, front row from let, Susan Thomas, RN, chairperson, and Potriranka Queanonur, RN, along with, back row from left, Heather Smith-Dixon, RNC, and Venise Jones, RN.
Total nursing turnover nationally stands at 16.5%, resulting in a cost from $44,380 to $63,400 for replacing a bedside RN, according to a 2014 NSI Nursing Solutions survey. More than 20% of hospitals report a vacancy rate of 10% or higher.
Eighty-nine percent of responding hospitals called retention a key strategic imperative, but only 43.5% have a formal retention strategy.
Turnover is expensive, with studies showing it is costing up to a year of the nurses salary [to replace that nurse], and its disruptive to the units work groups, said Christine Kovner, PhD, RN, FAAN, professor at the New York University College of Nursing.
Her 2009 study, funded by the Robert Wood Johnson Foundation in Princeton, N.J., found that nurses perception of their working conditions, satisfaction, organizational commitment, autonomy, opportunities for promotion and fewer outside job opportunities influenced their intention to stay.
A 2014 meta-analysis about retention reported that salary was less important in reducing turnover than work conditions and job characteristics, such as having supportive leadership. Job strain, tension, work-family conflicts, control of ones practice, recognition and team cohesion all were shown to affect nurse turnover intentions.
Its not all financial; people who go into nursing are called [to the profession], said Kathryn McLay, RN, senior HR business partner at Raritan Bay Medical Center, Perth Amboy, N.J.
Turnover remains much higher for new hires than for nurses with longer tenure 25.7% for nurses within their first year of employment compared with 14.1% for those on the job 5-10 years and 17.3% for nurses with more than 10 years with that employer, according to the NSI study.
Memorial Sloan Kettering Cancer Center, Manhattan, has instituted the University HealthSystem Consortium/American Association of Colleges of Nursing Nurse Residency Program to support new graduates. Curriculum includes leadership, conflict resolution as well as pain management, ethics and end-of-life care. Every new hire is assigned a preceptor.
The residents conduct an evidence-based practice project. More than 500 nurses have completed the program since it began in 2008, said Altagracia Mota, MSN, RN, nurse residency program coordinator and the manager for the department of nursing professional development and education at the cancer center.
Mentoring new hires
Several years ago, the retention council at QHC surveyed nurses leaving the hospital and learned they felt frustrated, isolated and not adequately supported. The council decided to start a mentorship buddy program, said Reggie Atangan, RN, assistant head nurse and co-chairman of the council. Soon, the volume of exit interviews decreased, he said.
Giving a buddy empowered them to speak up, Atangan said. If you dont have a support system, you can get lost in the shuffle.
With the ED at QHC losing half of its new nurses from 2007-2012, Suja Mohan, RN, senior associate director of nursing for emergency services, knew she had to change the culture. She gives new hires a welcome package with contact numbers, a list of nearby restaurants and information about the hospitals values and strategic vision. Since changes were instituted in 2012, Mohan said all new nurses in the department have stayed.
Mohan met with new nurses and sought feedback every day until they felt comfortable.
There has been a dramatic change in terms of engagement and satisfaction, Gabriele said.
Development, retention councilsReggie Atangan, RN
Many hospitals have formed professional development councils, which also address retention issues.
It encourages nurses to get involved in making decisions, said Pia Salazar, RN, nurse recruiter, Clara Maass Medical Center, Belleville, N.J., which offers tuition reimbursement and onsite educational opportunities for nurses.
Nurses at Clara Maass create their own schedules, and the hospital offers positions with flexible hours.
Raritan Bay Medical Center also encourages nurses involvement on its professional development council, McLay said. The council fields ideas for retaining nurses and frequently implements them. The hospital recognizes nurses who earn certification and offers opportunities to prepare for career advancement, such as leadership classes.
[At this hospital] they have a place for professional development, and nurses are looking for that, McLay said. You want to keep up with the changes in healthcare.
Raritan Bay also implemented stay interviews, during which the manager sits with each employee and asks about the nurses goals and how the organization can help that person achieve those goals.
We want to invest in our people, McLay said.
Queens offers tuition reimbursement and continuing education opportunities and will adjust schedules to accommodate classes. The council holds events for staff and recognition activities of those nurses who best exemplify the characteristics of an RN. The council raises funds for Nurses Week celebrations, educational stipends, appreciation gifts and nurse of the year awards.
Supporting the staff is a challenging task, Atangan said. Working together, we try to get everyone engaged, so they feel their voice is heard, no matter how minute the issue or how small the question.
Debra Anscombe Wood, RN, is a freelance writer.