New-Nurse Turnover is Common. A Nurse Leader at Indiana University Health is Working to Change That.

Regular 1:1 meetings with new nurses foster engagement and solve problems before they arise.

With newly licensed RN turnover rates ranging between 17% and 30% their first year, and 30% to 57% by their second year, according to different studies, one nurse leader has taken a vigorous approach to handling her nurses' concerns long before they become disenchanted enough to leave.

Brigitte Nastally, MSN, RN, clinical operations manager for Indiana University Health, schedules regular and frequent one-to-one meetings with first-year nurses, going beyond the number of meetings recommended by the health system's human resources (HR) department.

The regular meetings serve to counteract factors that contribute to increased turnover. Among those factors are feelings of vulnerability, limited support from their healthcare organization, and a stressful working environment  factors, according to a research article in the American Journal of Nursing Research.

Many newly graduated RNs not only have trouble organizing, prioritizing, and delegating their nursing work, but they report feeling poorly prepared and frustrated that the work environment does not match their expectations, the research article says. As a result, they feel incompetent, stressed, and overwhelmed.

For those reasons, Nastally implemented the frequent one-to-one meetings.

"During the tumultuous year of 2020, I anticipated that new nurses may need ongoing support, coaching, and development conversations," she says. "Beginning at orientation, we set up a meeting schedule between the new nurse, clinical educator, and unit manager."

The roll-out to schedule monthly one-to-one meetings with each first-year nurse was tricky, because patient needs were so great, Nastally says.  

"However, I made an effort to touch base as frequently as possible to ensure new nurses were adapting to the needs of patients during COVID surges," she says. "I also made sure to keep an eye on each nurse to check on their own well-being and overall mental health."

Those one-to-ones have become more regular as working conditions begin to return to normal.

IU Health's HR department's onboarding roadmap includes 30-, 60-, and 90-day meetings with managers in addition to other touchpoints along the employee's first year, says Nastally.

Nastally does much more than that with her new nurses. She extends that onboarding roadmap out to four, five, and six months, and beyond, and follows annual performance reviews with additional post-reviews at three months and six months, she says.

She uses a conversation guide supplied by HR for those discussions, but the chats are informal, she says.

"We often have unstructured conversations where I ask about what is going on in the new nurse’s home life, what struggles or successes they have had," she says, "and I try to find opportunities for continued learning and development."

Costs of turnover

Nurse turnover is costly on several levels. The average time to recruit an experienced RN ranges from 66 to 126 days, depending on specialty, according to the 2021 NSI National Health Care Retention & RN Staffing Report, and turnover has a profound impact on diminishing hospital margins.

Cost of turnover for a bedside RN ranges from $38,300 to $61,100 per nurse—an average of $44,400—which can result in the average hospital losing $4.4 million–$7 million annually, according to 2018 Press Ganey Nursing Special Report Optimizing the Nursing Workforce: Key Drivers of Intent to Stay for Newly Licensed and Experienced Nurses.

That includes vacancy costs, such as overtime, paying for agency nurses, closed beds, advertising and recruitment, orientation and training, and decreased productivity.

Based on these estimates, each percent change in nurse turnover is worth $337,500 in either direction, the report says.

Turnover's patient care costs are also high.

Hospitals with low turnover rates, ranging between 4% and 12%, had lower risk-adjusted mortality and lower patient lengths of stay than organizations with moderate (12% to 22%) or high (22% to 44%) turnover rates, according to an article in the The Online Journal of Issues in Nursing.

Furthermore, nurse turnover creates negative effects in illness exacerbation, medications management, communications, and follow-up, the article states.

One-to-ones are 'priorities'

For her part, Nastally is working to decrease turnover at her health system by making the time to maintain close contact with 21 first-year team members, including those who may be less vocal.

"We schedule these meetings as priorities in my calendar," she says. "These are not 'extra' meetings in my mind, as it's so important to get to know my team and their strengths."

If a meeting must be canceled, rescheduling is imperative, Nastally says.

"We have to be flexible to the ever-changing needs of the patients and the hospital, so if we don’t get the opportunity to meet on the scheduled day, then I do my best to reschedule or at least have an informal touchpoint," she says.

From these one-to-one meetings, Nastally has forged meaningful relationships with her newest nurses, gaining insight about their career aspirations, impactful moments with their patients, accomplishments, and work struggles.

She has also learned the names of their children, spouses, and family members, how they like to spend their time away from work, and their important life events.

Measurable results of Nastally's one-to-one meetings with first-year nurses may not reveal themselves in data numbers, aside from her belief that it helped to reduce departures during COVID-19 surges, but she knows, as a leader, that the effort is working.

"While we did not measure the metrics of these meetings, the benefits of these practices went beyond metrics," she says. "I’ve developed positive, strong relationships with my team members and benefited from hearing about the valuable relationships our team members have developed with their patients."