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Strategies for Nurse Retention

A high nurse turnover rate is an expensive problem for any healthcare facility.

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Anyone newly licensed or newly employed in a nursing position, especially in a healthcare- related facility, generally experiences either a warm welcome or become bullied from the start.

This wide-ranging display of mixed acceptance typically is either caused by uneasiness from thoughts of job jeopardy or, by contrast, genuine gratitude for the extra help in getting the job completed.

Resistance to change has been a long time issue at my hospital. As I was once the nurse educator and am now charge nurse of a male adolescent behavioral health unit, I have firsthand knowledge of this issue. I still see it today when newly-hired employees are shadowing other personnel in the same position.

This article will explore this issue of nurse retention and what strategies can be used to improve it.

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Issues at Hand

As the nurse educator in charge of all nursing personnel during their orientation period, I was responsible for training new employees, especially nurses, in all aspects of the hospital's policies and procedures.

Part of the educator's duties was to have the newly-hired nurse shadow a more experienced seasoned worker. I would have the new nurse trained in the classroom first with the information so they can practice it on the units with the seasoned worker.

This buddy-up system would work with certain personnel and not with others.

The issue at hand was more seasoned nurses felt ti was an imposition for them. Their reasoning was they did not have time to do it; a not-my-job attitude; or, "What does the educator do with them all day in the classroom?!"

After new staff completed their orientation period, however, there was no ongoing support for them. I felt this to be a serious issue. I would see the newly-hired nurses were stressed, and felt alone and unsupported by their own peers.

I used to let the new employees come to my office for support and much needed venting.

On one occasion, I even had to talk a nurse out of quitting. Her reasoning was that her co-workers were rude and not helpful to her or ignored her when she asked a question. She wound up quitting after she finished revealing her plight.

Costs & Benefits

Training new employees due to high turnover rates is expensive for any healthcare facility. Some of these costs are dependent upon the nurse's experience and education.

Direct costs of the nurse turnover includes advertising and recruitment; orientation and training; and vacancy cost to fill the position with overtime.

Some of the other costs to consider are when there is workplace bullying leading to an increase in absenteeism, low morale and low productivity with an increase in absenteeism that also increases the overtime allotted for the department due to the missing staff worker.

While the new employee is trained on the unit, there also is the expense incurred of paying the preceptor and scheduling staff in place of the regular staff.

There are benefits to nurse turnover, however, including newer employees being paid sometimes at a much lower rate.

The newly-hired nurse can also bring fresh ideas to the organization while poor performers are eliminated.

Retention Strategies

There are numerous strategies than can be utilized for nurse retention.

In an article written by Lee Ann Runy, (2006) she states that you should assess first what motivates new employees to stay. You must provide a good working environment and a safe one with room for personal development.1

Following are some strategies I've used during my 25 years at the same facility:

Stay In-Touch I believe in managing by walking around on the units to have the staff see you and assess for yourself what is going on. Incorporate weekly meetings with the new employees to help them adjust and deal with any issues at hand.

Reward Longevity & Preceptors Monetary incentives for longevity, or for being a preceptor to a new employee, will help to retain employees because they will feel appreciated for their loyalty to the hospital. The preceptor can form a relationship with the new nurse and can experience a special bond over the years. This has happened to me with two of my new employees and they still come to me for questions. This makes me proud that they feel comfortable to still inquire to me for information.

Individualize Orientation
Another strategy for retention is to extend the orientation program for newly hired-nurses by weeks and possibly longer on an individual basis. The 4 weeks I believe are enough for a more seasoned nurse to learn the inner workings of the hospital. Sometimes a newly-graduated nurse needs more time with a preceptor to learn a position. This should possibly last for three months with their preceptor on the same shift for support.

Recognize Quality
Another incentive for retention is a "nurse excellence award" with nurses nominating a peer who they feel is worthy of this award.

Encourage Career Development
Increase tuition reimbursement to help LPNs and ADNs become RNs, and RNs to further their education.

Use 'Floating' Wisely
Lastly, when a new nurse that was trained in a specialty area has to float to another area of the hospital to work, due to staffing issues, there should be a manual that helps the nurse to know what specific duties are expected to be accomplished on that unit. Also, as part of the orientation, the nurse should be placed on other units to be enlightened to the inner workings of the other units in case of staffing issues. By utilizing floating and the other strategies above, I believe we can alleviate the bullying and negativity toward new employees and improve our retention rate.

Career Development

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Importance of Preceptors

Preceptors should be of the highest level in training, maturity and experience, but also possess a willingness to train other nurses.

The preceptor needs to be knowledgeable in aspects of leadership and hospital policies, and foster open communication with teamwork to help the newcomer to overcome fear of a new job.

According to Laura Stokowski (2011), the preceptor should educate the new employee in other skills utilizing evidence-based practice, sensitivity to cultural diversity and being active in the promotion of good health.2 These are things nurses cannot learn in the classroom alone.

Preceptors should have ample access to resource of personnel within the hospital and an educational program ready to help preceptors and new employees work through any issues that may arise.

The educational program should cover all topics needed for success of working at the organization. Checklists and competencies are monitored by the preceptor and the education coordinator to help the new employee cover all the stated areas of the hospital policies and procedures.

A high turnover of nurses and the retention rate correlates with a decrease in the quality of care, lack of preceptor's training and patient safety. Utilizing these experienced nurses as preceptors will help the new employees to gain knowledge and assimilate to the hospital's policies and procedures.

Having all staff on the same page of knowledge in caring for the patients brings about a better continuity of higher quality care and an increase in positive outcomes.

References for this article can be accessed here.

Lorraine Mercado is charge nurse of a male adolescent behavioral health unit in New York.

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Well, there went my morale. All that extra work to go from LVN to RN after 13 years just to feel that my ADN is not a "real" RN. And you are in charge of retention?

Gina October 14, 2012

Good article but I take exception of labeling ADNs as not RN. I was , am, and will be an RN though I was an ADN for multiple years during which I went on to obtain other degrees and only recently obtained "advanced" degrees, which do little or nothing for my practice.

Margaret ,  RN, RCNP, CON, CNM, CLNC, SANEOctober 11, 2012

Pay attention to MJM. She just let us know what seasoned nurses are really thinking and feeling. The best strategy seems to be to match nurses who are only about 2 to 5 years in the profession to new graduate orientees. Save the 10+ year veterans for transfers and seasoned-nurse hires, special teaching duties, bedside research, and yes, promotion.

Alice Peterson, RN, MPH, CHES, CMSRN,  Clinical Education SpecialistOctober 11, 2012
Lakeland, FL

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