Knowledge Article

Staff Retention: What Every Nursing Manager and Executive Should Know.

The hot topic “dejour” is employee retention. It is on the radar screen for all CEO and Nurse Executives across the country. Recruitment is barely able to stay ahead (if at all) over the turnover of staff nurses. Recruitment boasts vacancy fill rates appearing stellar to industry standards, yet staff nurses still feel stretched thin. Overtime and outside registry usage skyrocket to all time highs. Staff nurses are unable to see the results of recruitment successes and do not believe there is a light at the end of the tunnel. WHY?

One of the reasons is that organizations are not looking at net growth to the nursing workforce. How many budgeted RNs are leaving the organization compared to the number of budgeted RNs entering the workforce? Many HR Recruitment departments report vacancy fills including both the number of budgeted and casuals hires made on an annual basis. Looking at true percentages of budgeted vs. non-budgeted RNs hired may reflect a higher percentage of casual hires (usually 50-60% of total RNs hired.) Factoring out the number of casual hires, and comparing true budgeted hires to the number of budgeted RNs leaving the organization results in an accurate view of net RN growth to the organization.

As you plan for future staff recruitment and retention, take your individual RN hire numbers from the three previous years and look for any trends in the net growth. Historic projections would indicate net growth is shrinking with each successive year. Now, if you are truly daring, go to your payroll and request retirement eligibility by year by department beginning with the current year through the next ten years.

If you are like most organizations benchmarked, you will note that approximately 50% of your nursing workforce will become retirement eligible within this time period. Now, go back to the net growth trends you reviewed for the past 3 years and project that trend over the retirement eligibility for the next decade. This will cause new heartburn and palpitations, if you have now experienced them already.

The fascinating component to all of this “retention talk” is the lack of knowledge for the detail and infrastructure surrounding this goal. I speak and meet with healthcare leadership across the country and ask them what retention means to them. Overwhelmingly, responses fall into the following categories:

• Potlucks
• In-service meetings
• “I have an Open Door policy”
• Annual Service Award Banquets

True “Retention Planning” committees organize themselves in a format familiar to all. Assess, Plan, Implement, Budget, Evaluate.

The Assessment component to Retention Planning consists of performing an environmental assessment to establish baselines for trending data related to:

• Local, State and National Nursing Workforce statistics
• “Cost of Turnover” using the Nursing Executive Center’s methodology and formula
• Unit based facility turnover
• Vacancy statistics
• Retention interview survey data
• Exit interview data
• Recruitment decline log data
• Employee demographics
• Ratio of full-time staff to supplemental staff
• Retirement eligibility of budgeted RN staff
• Community supply pool
• Student supply pool
• Aging faculty of local nursing schools
• Diversity of community and staff
• Evaluation of department and facility communication vehicles and pathways

The Retention Plan is built upon information and trends realized from the assessment data, and are categorized in the following areas:

• Incentive development
• Pre-hire (activities)
• Orientation (quality and follow-up)
• Preceptor (quality and support)
• New Hire follow-up
• Quality of work life for managers and exempt staff
• Quality of work life for staff RNs
• Staff Development at all levels
• Staff recognition
• Academic relations
• Community relations
• Recruitment
• Metrics

Budget to fund programs supporting the Retention Committee Plan would be negotiated with Senior Leadership resulting from reduced turnover with its associated cost savings.

Evaluation would be performed quarterly measuring outcomes to goals and metrics defined from the assessment phase.

Retention begins from the moment a new hire walks through our doors, and continues throughout the career of that individual. It is focused on meeting the developmental and personal needs through each stage of each individual’s professional career. Instead of placing focus on “sign on bonuses” for new hires, let’s invest in our current and future workforce!!

This article was written by Cross Country Staffing and originally appeared in the Journal of Clinical Systems and Management.

© 2003 Cross Country Staffing