Millennial and Generation Z nurses are leaving the workforce at a high rate, with up to 30% percent of graduate nurses exiting within the first year due to lack of support.
While this figure is discouraging, hospitals and health systems are regrouping to form innovative partnerships and programs that better prepare new nurses for practice and address multigenerational workforce needs, said a nurse leadership panel during the HealthLeaders Healthcare Workforce NOW summit.
The panel “Securing Nursing’s Future by Engaging the Multigenerational Workforce,” sponsored by Lippincott Solutions—part of Wolters Kluwer—examined the top reasons nurse graduates leave the profession early in their careers and important actions health systems and academia can take. Following, is a summary of this conversation.
Nurse graduate turnover: Where do we stand?
The turnover rate for graduate nurses in the second year is often higher than the first year “which results in a large number of new graduate nurses leaving our profession,” said Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, chief nurse at Wolters Kluwer, Health, Learning, Research and Practice.
Nurse panelists also indicated that turnover trends varied during the pandemic. “While we did have a big bump up in turnover after the first surge back in 2020, 2021 seemed to stabilize a little bit, and now we're seeing an increase in our ability to hire new graduates and other nurses,” said Maureen Swick, PhD, RN, NEA-BC, senior vice president, nursing and pharmacy, enterprise nurse executive, at Atrium Health
In addition to leaving to work as travel nurses, nurses moved out of acute care settings to work in other specialty areas such as ambulatory care, said Dabrow Woods. “The other thing that we're seeing is an uptick in the number of nurses who are moving out of the staff nurse role into the advanced practice role.”
Launette Woolforde, EdD, DNP, NPD-BC, NEA-BC, FAAN, chief nursing officer at Northwell Health, added “We saw the same exodus of nurses and welcomed them back.” She agreed with Dabrow Woods in that younger nurses are looking for more rapid career advancements while more experienced nurses are seeking roles that are less physically demanding.
Three best practices for attracting and retaining younger nurses
Healthcare organizations are reevaluating everything from nurse residencies to academic partnerships in an effort to improve new nurse retention and meet the changing needs of its multigenerational workforce. The nurse leadership panel explored the following success strategies.
1. Create new opportunities and more impactful residencies
Both Woolforde and Swick said their organizations offer accredited nurse residency programs, which have been successful in preparing new nurses for practice. “We have maintained a 90% retention rate with our new grads within a year,” said Swick. “These residency programs and the dedicated professional staff that we have to support them have been an incredible asset allowing us to keep newer nurses and support them with their needs.”
Woolforde said Northwell Health’s nurse residency program has undergone key changes since its 2019 launch, including adding new skills sessions and regrouping with preceptors to level expectations of incoming nurse residents who may have less experience due to the impact of COVID-19. She added that Northwell Health also provides nurses more opportunities to move within the system. “That way they don't have to make such a drastic decision as to leave the profession.”
2. Form robust partnerships with academia
Panelists also agreed that what’s old is new again as healthcare organizations revisit academic/practice partnerships to adequately prepare nurses for practice. “It’s important to open up more opportunities to bring nursing students into our healthcare organizations to learn and to achieve their clinical hours,” said Dabrow Woods. “It’s refreshing to see that we're coming back to that.”
To that point, Woolforde said Northwell Health is relaunching a new approach with some of its academic partners by making advanced job offers to nursing students during their final semester to assure a smooth transition to practice. Swick added that Atrium Health is also partnering with academic institutions to increase the number of adjunct faculty. “This partnership “is going be critically important,” in building a pipeline and helping preceptors and faculty help nurses transition to practice when they graduate,” she said.
3. Adopt new solutions for the multigenerational workforce
Panelists are also implementing numerous approaches to successfully manage their multigenerational workforces, including shared governance programs that embrace a multigenerational perspective and virtual nurse roles and mentoring relationships that tap older workers’ knowledge and experience. They are also addressing different learning and technology preferences. “The healthcare systems we found to be the most successful are the ones that understand that the way that we teach people has to change,” said Dabrow Woods.
The panelists stressed that now, more than ever, there must be more flexibility to meet the needs of the evolving nurse workforce. In addition, organizations can improve retention by staying on top of burnout and work-life balance and ensuring adequate, competent staffing, wellbeing support, and robust employee assistance programs.
As hospitals and health systems regain solid ground after two years of constant pressure and overwhelm, nursing quality and safety are top of mind.
Nurse leaders from leading health systems convened to discuss these topics at the recent HealthLeaders Nursing NOW summit panel “Rebuilding Quality and a Culture of Safety in the Wake of the Pandemic,” sponsored by Lippincott Solutions—part of Wolters Kluwer. The panel, led by HealthLeaders Nursing Editor Carol Davis, offered an unveiled look at top challenges, including extreme burnout, workforce shortages, and the pressing need for more competent bedside nurses. Below is a summary of their discussion.
Innovating through monumental challenges
It’s no surprise that the ongoing worker shortage was cited as one of the most debilitating challenges. The entire healthcare system is “facing, a workforce challenge—whether it's finding enough people or retaining the people that we have,” said Phyllis Doulaveris, DNP, RN, NEA-BC, CPHQ, SVP of patient care services and chief nursing officer at Banner Health. She noted that in addition to leaning on academic partnerships to find more nurses and other key workers, the organization is also “thinking differently around models of care and top of license practice.”
Panelists are also troubled by caregivers continued moral distress due to trauma and the overwhelm of not being able to provide the care they want to provide due to high patient numbers. Solutions range from adding agency nurses and new nurses to changing care models and onboarding philosophies, said Shannon Pengel, MSN, RN, NE-BC, chief nursing officer with Cleveland Clinic. “Embracing this new workforce and knowing that you have to onboard and train differently is incredibly important.”
“We're fighting for workforce wellbeing and finding joy again in what we do as nurses,” agreed Anne Dabrow Woods, DNP, RN, chief nurse of Wolters Kluwer, Health, Learning, Research, and Practice. Dabrow Woods is also a critical care nurse practitioner at Penn Medicine health system. “The way to do that is we need to fix the staffing issue.” She added that a recent research project showed that leaders want scheduling programs with additional components that address patient acuity and nursing competency on each shift, as well as the ability to offer flexible work hours.
The other panelists agreed that scheduling flexibility and providing more balance in the workday are essential. “Our response has been to offer serenity rooms and engage people in dialogue about what's going on in their work and personal life,” said David Marshall, JD, DNP, RN, FAAN, senior vice president and chief nursing executive at Cedars Sinai.
Boosting quality and safety
During the pandemic hospitals stepped up to meet different safety challenges through innovation and collaboration, including addressing the lack of PPE and switching to multidisciplinary care models to address the nursing shortage. However, panelists agreed that the pandemic has impacted quality metrics. “We saw increases in most of our nursing sensitive indicators such as CLABSI and CAUTI and hospital acquired pressure, injuries” said Marshall at Cedars Sinai. “Many of the hospital acquired pressure injuries were a result of proning” he added, noting that best practices were created, putting the organization in a better position than before the pandemic.
According to Dabrow Woods with Wolters Kluwer, research prior to the pandemic clearly shows that nurse education and experience impact quality metrics. “Organizations that invest in continuing professional development for their staff actually have better retention than those hospital systems that don't because it shows that they truly value the nurse and what that nurse can achieve.” To this point, panelists are addressing education needs more creatively. “We have a robust program to support any of our nurses who want to get a BSN, degree,” including automatic approval for tuition reimbursement and a new policy that reimburses nurses up front,” said Doulaveris with Banner Health.
Healing from COVID-19
While COVID 19 infections and hospitalizations have scaled back to manageable numbers, the pandemic’s toll on nurses’ mental health requires short and long-term solutions. Both Cleveland Clinic and Banner Health offer onsite counseling. Cleveland Clinic also offers moral distress debriefs led by a nurse ethicist that focuses on how nurses are feeling and dealing with the pandemic, while Banner Health also has a program that helps people debrief after a difficult event. Moving into the future, the panelists agreed it will be critical in to continue to establish a culture of safety and high reliability. “It’s important now more than ever that we hear from our frontline caregivers and embrace shared governance so that issues can be addressed,” concluded Pengel.
To watch the entire panel discussion and to hear more of what the panelists had to say, click here!