Strategies for Reducing Nurse Turnover

A healthcare economist's prescription for retaining RNs includes creating mentorship positions for older nurses and investing in employee development programs.

High turnover is undesirable in any department, but the pain can be especially when nurses leave. It's the nurse at the bedside that the patient remembers, and nurses often bring with them decades of versatile experience and wisdom that follow them out the door when they depart.

Since the beginning of the recession in 2008, nurse hiring has been a buyers' market with hospitals being able to demand higher credentials and more experience from nurse job candidates, says Peter McMenamin, PhD, senior policy fellow and healthcare economist with the American Nurses Association in Silver Spring, MD—but that's about to change.

"You used to see ads [for nursing positions] that said 'new graduates need not apply.' You don't see them as often anymore," says McMenamin. This is because 40% of practicing nurses are over the age of 55, with many reaching retirement age. Many of these nurses have been delaying retirement, but they can't hold off on retiring forever.

While the market seems to be in the process of correcting itself with more students graduating from nursing programs annually over the last few years, it will take time for those nurses to come up to speed and gain experience. In the meantime, there is a nurse shortage that will get worse before it gets better, and hospitals need to try hard to retain good nurses.

McMenamin has an unusual prescription for doing this.

"Although many hospitals have very narrow or negative margins, the hospital industry banks $15 billion per quarter because revenues are that much higher than expenses. That money is put into a financial reserve, and is often spent on acquisitions or building projects. I think a good idea is to consider many hospitals setting up a human capital reserves," he says.

Here are some areas to consider investing both financial and human capital in to cut back on turnover and improve retention.

Invest in Employee Development

Nurse retention is highest in hospitals that focus on developing nursing staff, McMenamin says; internal training and investing in employee education are sure-fire ways to keep employees engaged.

Employee development programs have gained popularity in recent years as increasing numbers of healthcare employers have realized the benefits of growing a nursing staff internally and the high cost of education has made college unreachable for more fulltime workers.

Another benefit of an internal program is that it's safe to say workers are a good cultural fit for the organization—plus, on-the-job investment in employee education is a strong mechanism for keeping staff on-board.

Create Mentorships

As older nurses leave, they take decades of nursing experience with them. Their replacements may have technical knowledge and book smarts, but lack hands-on, clinical experience. But there's are strategies for developing experienced nursing teams, says McMenamin.

He suggests that HR departments hire a few more newly-minted nurse graduates than they normally would. At the same time, nurses that are preparing for retirement should shift into roles that primarily focus on mentoring.

"This will extend some nurses' careers. They might not do as much at bedside, but they will still be valuable to your organization. As you hire on slightly more new grads 'than appropriate,' allow the older nurses to mentor them and pass their experience along. In just a few years, you will grow an experienced workforce."

Focus on Staffing Ratios

"If I feel beat up at end of shift, I won't feel good about myself, my job or my employer," says McMenamin. Staffing ratios are still an area of contention between nurses and hospital administration: some states, such as California, have passed laws ensuring a higher nurse-to-patient ratio, but many others allow this to hospital management's discretion.

For McMenamin, the choice is obvious.

"Better hospital staffing gets better results," says McMenamin. "Studies show higher nurse-to-patient ratio numbers have better results, fewer fines from CMS, lower readmissions, and hospital mortality goes down. There are statistically significant differences showing that more nurses equal better results. But, more pertinent to this topic, it also leads to higher levels of job satisfaction among the nurses."

Many nurses who work in environments with lower staffing ratios say they feel regret over not being able to better care for patients because they had too many, he says. "They often say they feel they could have done more," he explains. Conversely, when the staffing ratios are more appropriate, they report that they feel respected and engaged at work.

Of course, hospitals must weigh the benefits McMenamin mentions against the risks. Data shows that under mandated nurse-patient staffing ratios, patient safety benefits have not been clearly demonstrated. In California, where a similar law has been in effect for 11 years, hospital operating expenses have risen.

Ultimately, the key to hanging on to these in-demand employees is for HR departments is to make sure nurses feel valued, says McMenamin. "That kind of treatment will make a nurse want to work at that specific organization."