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Are Your Staff Preparing to Leave?

How to keep nursing staff on board as the economy improves - or even if it doesn't.

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For now, suggests a recent Accenture study, although many employees indicate they are unhappy in their current jobs, the have no plans to leave.

The study, "The Path Forward," found more than half (57 percent of the women and 59 percent of the men) respondents indicated they were dissatisfied with their jobs.1

Yet, more than two-thirds said they have no plans to leave their current employers.

But, the situation is likely to change once jobs start opening up and, in the area of healthcare, that may already be happening, according to the study, which has been conducted the past 8 years in conjunction with International Women's Day.

One reason why people may be staying in place despite their unhappiness in a position is likely related to the economy, said Kay Kapoor, managing director and chief executive of Accenture's U.S. Federal Practice. 

"As the economy turns and opportunities present themselves, we will see more attrition in those environments where people are unhappy long term," she said.

For nurse managers and healthcare administrators, now is the time to begin paving the way to ensure that valuable human resources don't walk out the door as the economy improves - or even if it doesn't.

Engagement Always Matters

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Resolving Workplace Conflict

Conflict interferes with successful clinical outcomes, as well as with personal and professional satisfaction.

While the current economy can serve to keep some employees connected to companies and jobs they don't necessarily value, other employees always have some flexibility, noted Eric Chen, JD-MBA, an associate professor of business administration at Saint Joseph College in West Hartford, CT.

"The funny thing about this is that, for good, qualified, top performers, the market is always there," noted Chen.

"Top performers will always be in demand, no matter what the environment. With respect to nurses, there is a well-established debate as to whether or not there is truly a nursing shortage. Nonetheless, the top performers usually find a good home."

Chen teaches management, human resources and organizational behavior courses at the undergraduate level, and healthcare law and management courses at the graduate level.

"The Path Forward dynamic reveals a powerful mistrust between employer and employee," says Chen. "Indeed, both sides have a lot to lose if they share an unproductive environment. Employers spend a lot of time and resources to train and develop an employee.

"According to the Robert Wood Johnson Foundation, a number of national studies estimate the average cost of replacing an RN to be anywhere from about $22,000 to more than $64,000. These efforts are lost when the employee leaves and the employer is forced to start the cycle once more."

With the stakes so high, said Chen, "it behooves both employer and employee to collaborate effectively."

Dawn Bazarko, DNP, MPH, RN, agrees. Bazarko is senior vice president of UnitedHealth Group's Center for Nursing Advancement in Minneapolis, and a leader in the nursing field with more than 25 years of experience in both clinical and business settings.

Bazarko said "The Path Forward" report resonates with her experience and reflects much of what the Center for Nursing Advancement has attempted to do with its staff of more than 10,000 nurses. For instance:

  • flexible scheduling and telecommuting opportunities;

  • a mentoring program;

  • creating a sense of community within the organization; and

  • supporting transitions in practice.

In addition to the risks they may face as the economy shifts, Bazarko noted that healthcare organizations are also at risk from the impending retirements that are likely to occur within an aging nurse workforce. Many nurses have stayed on board and delayed retirement, but that may be changing, she said. Organizations should be preparing now to address these impending shifts.

"If you're in that situation where you have a lot of retirement risk, there may be ways you can keep your older nurses in nursing either by offering mentorships or on a per-diem basis," said Bazarko, who points out that many nurses simply enjoy their work and do not necessarily want to stop contributing entirely.

The key is keeping them engaged.

Building a Positive Environment

While many organizations struggle to maintain loyal ties with employees, successful engagement is not rocket science, suggested Tom Armour with High Return Selection in the Toronto area.

"We continually interact with professionals and business leaders and in our experience the answers are common sense and not too difficult to implement," he said.

Armour noted he has found that more than 80 percent of professionals today ask for the same things.

"They want a positive work environment that offers challenge and development, providing good leadership and a company culture that respects and values its employees."

However as common sense as this may be, many organizations fall short.

"Surprisingly, many once great organizations have lost the respect of their employees as a result of poor leadership, continual layoffs and outsourcing," noted Armour. These are the companies that are in jeopardy of losing their people once employment improves, he said. What can organizations do? Armour offers a number of suggestions:

  • Build a positive work environment.

  • Make sure your organization has leaders who are able to engage people,
    demonstrate respect and integrity, and get the job done.

  • Don't be afraid to challenge and grow your employees. Good employees want to experience new things and continually learn.

  • Establish a very strong employer brand and a social media recruiting process.

It's important to recognize, said Armour, that it's not all about compensation. "We find 80 percent of professionals indicate they would take less money if they could find a rewarding workplace," he said.

Chen agrees. "When people are asked why they want a particular job, they seldom list compensation as the number one factor. According to certain parts of motivation theory in management, people strive to be the best that they can be. I believe in this."

Trust is a critical part of the equation, said Chen. Within an environment of mutual trust management, he noted, "managers need to be creative about using techniques and solutions that don't necessarily cost the company anything while delivering positive outcomes." These can be seemingly simple things like allowing opportunity for input into decisions that impact them, providing positive feedback and recognition, even offering a sincere "thank you" for contributions.

Creating Trust

While HR certainly plays a role, for employees it is the individual, personalized connections that really matter, Kapoor pointed out. HR programs or broad-scale initiatives will not be enough to create engagement, she said.

"I'm a fundamental believer that success should be tailored to the individual. The fabric of the workforce today is very much what I call 'mosaiced.' We have more diversity than ever before, not only in terms of race and ethnicity, but also diversity of thought, diversity of lifestyle."

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Steve Gavatorta, CPVA, CPBA, is the author of The Reach Out Approach: A Communication Process for Initiating, Developing & Leveraging Mutually Rewarding Relationships (Advantage Media Group, 2009) and a certified professional behavioral analyst, consultant, trainer, coach and speaker, based in the Tampa, FL, area.

Communication is critical in any work environment, but particularly in healthcare, noted Gavatorta, who points out conflict is a key issue that must be addressed.

"One of the biggest issues in a hospital is conflict among the nursing staff," he said. "A big reason for this is the multiple educational dynamics that exist with staff - you can have nurses with associate degrees, baccalaureate degrees and master's degrees all at the same level. Add in the fact that Gen Y is entering the workforce and you have yet another dimension. This is often leads to conflict and, when that occurs, it makes for a poor work environment."

This conflict is related to the different expectations and perspectives these generations bring to the workplace.

A 2011 Society for Human Resources Management study indicated that 47 percent of younger workers complained their older managers were resistant to change and had a tendency toward micromanagement. Among the older respondents, about 33 percent complained younger workers lack of respect for authority, informality and need for supervision were areas of concern.2

Nurse managers must be adept at conflict management, Gavatorta said, and recommends training on conflict resolution. "This type of training can give the nurse staff practical skills to deal with tough workplace issues."

Another key factor in building a trusting environment is communication. "Communicate with your staff on a regular basis," recommended Gavatorta.

"Be a great communicator with your team so you have a pulse on the dynamics of the team as well as patient status. If you communicate on a consistent basis, managers can be on top of problems and opportunities with the staff - ultimately driving better patient outcomes and improved patient safety."

References for this article can be accessed here.

Lin Grensing-Pophal is a frequent contributor to ADVANCE.


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I agree with much of what is said in the article. I have been a nurse for over 20 years and I love everything about my job. I have worked in many different hospitals over the years as a registry nurse and recently took a career position 7 years ago. Sadly, nurses themselves are a major problem contributing to the dissatisfaction nurses feel at work. I have been blessed with having the best manager ever. Despite her efforts, she was unable to change the culture of a group of nurses that have worked together, taken short cuts, put themselves before the patient, and then covered for each other. Although I am an experienced, "old" nurse, I stay up on the latest technology and practice. We will never retain our new nurses if there is not a major culture change and we embrace what they have to offer while at the same time mentoring them in a job that is very hard for the 12 hours we spend at work.

@Rashida...if you have 8-10 patients at an acute care hospital in California, that is a problem as I am sure you are well aware of the mandated staffing ratios, your hospital will be fined for the nurses being out of ratio. Do you really take care of 8-10 patients??? And with the attitude you seem to have come across in your comment, that is a problem. Patients always come first and they should always feel as if they are the only person we are taking care of. Obviously we have other patients and each patient knows that deep down, sometimes only a gentle reminder that you are with another patient and will be there a s soon as you can is all that it takes.

Cheryl ,  RNNovember 14, 2012
Orange, CA



I agree 100% with the above people, especially Rachel Woods. I couldn't have said it better. These are the main reasons I'm no longer working in an Inpatient setting and am looking for other options. I would not recommend the job as a profession either, if you truly cae about patient care in the hospital setting.

Becky ,  RN, BSNNovember 14, 2012
CA



Racheal Woods..... You hit the nail right on the head!!!! Most of the time I am running around like a chicken with my head cut off and we never have charges to help when a patient is dumping or help when families are upset that we can't run to their every beck and call because we have 8-10 patients. And they tell us to just run to them whenever they call, although we have other patients that may need out attention right then. And we don't get raises. As long as these and other conditions do not change, the nursing burn out will be tremendous and they will always be short staffed. As soon as I can leave.............

Rashida Lee,  RNNovember 13, 2012
Chino Hills, CA



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