Tuesday, January 1, 2019

It’s summertime now, and like many, I have spent several nights at the fields watching the kids play ball. While it is not my preferred pastime, I have a daughter who just loves it. She wants to play it, she wants to watch it, and then she wants to play it some more. As I was watching the neighbor girl pitch my daughter the ball for what seemed like the millionth time this summer, my mind began to wander back to the topic of retention that we have been discussing in the past few blogs.  I was thinking that success in softball is as much about the batter as it is the quality of the pitch and the ball coming at the batter.  When we think about retention, we must not just consider what we are doing at the facility to attract and retain new nurses, but also about the quality and fit of the applicants coming to us.  In the way described, job applicants are a lot like softball pitches. Some are low and way too far outside to even consider, some are a little high but hittable, and every once in a while, you get one that is right down the middle.  I have spent several years of my career in the role of onboarding new hires. Where I came from, it was a one-man-show, meaning I did a lot of the hospital-wide orientation, the unit/department-specific tasks, and the ongoing mentoring and support.   While I wasn't in on the interview process, because of my role, I often had the opportunity to hear about many of the applicants and their interviews as we were looking to hire on new nurses. On one day, in particular, my nurse manager came into my office and she was so excited about their latest interview. This is how the conversation went…

Manager: "I think we got one!"

Nicole:  "We got one what?"

Manager:  “We had a really great interview this afternoon. She seems really smart, well-rounded, compassionate, and best of all she is a farmer's fiancé!"

Nicole: "What do you mean a farmer's fiancé?"

Manager: "She is marrying a farmer that lives just outside of town. I hope she wants to come work here because she sounds like she will be a great fit and since she is marrying a farmer, we know she won't be going anywhere soon."

While I had never heard that phrase used before, it made perfect sense. Nurse leaders in rural hospitals know exactly what I am talking about!  Farmers don't leave their family, and community roots are deep. They don't pack up their families and move for better job opportunities ... because farming their land is their life. It is tradition, and, in many cases, it is forever. Farm businesses are passed down from generation to generation and rarely are they sold to outsiders -- at least in my area of the country. What this means is that if you have a nurse marrying into a farm family, you know they will hopefully be in the community for a very long time and will establish roots of their own in the area. The nurse my manager was talking about not only had all the great attributes of a good nurse, but she was also going to be a part of the community for years to come. We might even call it the perfect pitch!

As I was cleaning out my 'Read Later' folder in my email the other day, I just so happened to come across an article that caught my eye. A New Perspective on Nursing Retention: Job Embeddedness in Acute Care Nurses - that title really grabbed my attention. I mean, retention is a hot topic and I feel like I have read it all, so could there possibly be a new perspective? I had to click to learn more. In this article, they explored the concept of “job embeddedness”, or the reasons employees stay at their job.  I found it very interesting that the authors chose to focus on the positive (what keeps employees around) versus the negative (what might make employees leave). I am not sure if their findings were surprising or not, but they found that the more involved a nurse was in the organization AND in the community, the more likely they were to be retained long-term. The first thing I thought of was the 'farmer's fiancé'! All this time, it might be the key to long-term retention. Could it be? I encourage you to check out the article for yourself, but it really got me thinking. How can we as nurse leaders make every one of our hires a farmer's fiancé, or perfect pitch?   

What can we do as nurse leaders to focus on this other angle of retention - what keeps employees in their job? My first thought was making an account on “farmersonly.com” a prerequisite to hire for all the single ladies and gents, but I am sure all the HR departments would shoot that down pretty quickly (only joking!). But seriously, with the rate at which our new generation is traveling the globe, how can we at least slow them down? Let's consider how to improve their involvement in the organization.

Ideas for establishing nurses in the organization:

  • Focus on professional development & growth – Make sure they feel you have vested interest in their growth and development. They need to know leaders care about their success and care about their development as an individual.
  • Get them involved – More than once this article talks about the more committees and councils the nurse was on, the greater the correlation to retention. Get them involved and do it early!  Help them identify their strengths and capitalize on it!
  • Help them build peer connections – Ensure teambuilding activities are part of your education process.  It is not just about what nurses know, but how well they work together. The article showed that the more connected to peers nurses are, the more likely they are to be retained. Not only having a mentor that helps them assimilate to the nursing profession, but a facility as well will likely be beneficial. 

So that all sounds good, but what can we do to help them in the community? I mean, is it really the responsibility of the employer to do something with that piece? Maybe ... maybe not ... but this article shows the more embedded in the community, the greater the long-term retention.

Ideas for establishing nurses in the community:

In a city, the opportunity to get involved in the community can be very diverse. There are many community groups, churches, and other organizations in which employees that are new to the area can find their niche. In the rural areas, however, opportunities are much more limited. If you are onboarding a person who is new to the community and is not the “farmer’s fiancé”, it might be a good idea to help them get involved and find their niche in your community. Groups are smaller and tighter-knit. It is likely difficult for an outsider to come in and feel a part of it all, however, here are some ideas to consider.

  1. Opportunity to get involved in the community – You as an organization likely do a lot for your community, but is it the same person that gets involved each time? Spread the wealth and help your nurses discover how they can play a part in your community involvement.
  2. Help new hires build community connections – What would a welcome package look like at your organization? Could you include information on different community groups and organizations that they could get involved in outside of your facility?  Sometimes people need help in establishing their roots. 
  3. Consider a community mentor - What would a community mentor look like? Possibly someone affiliated with the hospital whose role is to mentor the new person and help them find their niche in the community? I am sure this may be happening somewhere, but it is a pretty novel idea, isn't it? Considering what we know about the importance of roots in the community, it might be the next hot idea for nurse leaders to consider.

While this is just one research article and as always, more research in this area is needed, it does give nurse leaders a different perspective to consider regarding their retention efforts. It's not always about what we can give in the form of perks, benefits, and titles. It is about acknowledging that people who feel like they belong, whether it is at the organization or the community, oftentimes want to stay. You might find a lot of great nurses applying for jobs at your facility and the only thing keeping them from being a home run is their lack of roots. What can you do to help nurses to become embedded in your organization AND community?   

Nicole Weathers
Program Manager, IONRP

Resources: Hopson, M., Petri, L., and Kufera, J.  (2018) A new perspective on nursing retention: Job embeddedness in acute care nurses. Journal of Nursing Professional Development 34(1), 31-37.