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Nurse Leaders: Is Retention Keeping You Up at Night?

Sleep … it’s a beautiful thing. The body needs it to function. It was somewhere around my first child when I realized it was something I would probably never have a lot of again. As a nurse working in the acute care setting, if my kids didn’t interrupt my sleep, it was often interrupted by calls from my place of employment. "Bonnie called in today, we need someone to cover." “We have had ten admissions overnight and need another set of hands." "Jennifer put in her two weeks and now we are short this weekend and are looking for someone." The list goes on and on. No one ever told me my job as a nurse, no matter what role, would disrupt my sleep. I am going to say it … staffing can be a NIGHTMARE (as if you didn't know that) and this is true no matter what end of the spectrum you are on. If you are the nurse leader, staffing is keeping you up at night because you are trying to come up with solutions to fix problems, and if you are the bedside nurse, your sleep is constantly interrupted because you are frequently being asked to help fix the problem by working. Why is staffing so hard? Many reasons! One of which is a little thing called turnover – the coming and going of staff in and out of facilities, departments, and units. We know from our previous blogs that millennials are entering nursing in record-setting numbers, but we also learned that their voluntary turnover rates are nothing to brag about. We have a lot of fresh blood, but many aren't staying put for very long. I have spent some time reflecting on why this might be. My conclusion is that what attracts millennials to the profession is also the reason for our retention headaches and sleepless nights. In our previous post, we found out that millennials are being attracted to nursing because they can change and grow frequently, but also because they can do it from anywhere life takes them. So, if that is the case, the question then is … how do we fix this? Is it something that needs to be fixed? Is it a matter of getting our retention efforts to align with the values of this millennial generation? Or, is coming to terms with and learning to accept the reality of what nursing is, as hard as that may be?

Honestly, I am not sure if there is one solution that fits all organizations. Sure … let's align our retention efforts with our pool of eligible employees, but we also need to accept the fact that the possibilities of what you can do with a nursing degree are endless, and because of that, there will always be the constant fluctuations.

When you look up the definition of retention in Merriam-Webster Dictionary, it is defined as ‘the state of being retained’. Hmmm … that’s not very helpful! When you look up retain, it is defined as ‘to keep in possession or use and to keep in one's service’. Now that is a little more helpful!  How do you measure retention? Should retention only be counted in terms of new hires staying in the job they were hired for? Knowing what we know about the nursing profession and those entering, do we need to look at retention in another way? Should retention be counted in terms of the new hire staying at the organization? Or, broader yet...retaining them in the nursing profession? That is a tough one, right?  I mean, as a nurse leader it is your budget dollars that are going into the training and orientation of these new hires.

Let me introduce you to Nurse Nicole. Nicole is a new nurse that is hired onto the MedSurg unit. Nicole is an awesome nurse (how could she not be with a name like that!) She is very eager and shows a great deal of passion for her work. During her first year of employment, she transitioned to the role of preceptor and then charge nurse. She always had the desire to work in the ED and since she put in the year of MedSurg that was recommended, she thought she would throw in her name for the ED opening that had recently come available. After only 16 months on MedSurg, guess what? She got the job and transferred to the ED! In many organizations, this would be counted as turnover. Nicole was no longer in the role she was hired for and so she would be counted against the MedSurg department on their turnover rates. Nicole spent some time getting oriented to the ED and continued to work there for just about a year and a half before she had her first child and decided that the hours of the ED just were not going to work for her family. At that time, she applied for a job within the Home Health Department at the same organization. That worked out great for a few more years until her husband took a sales job that required travel, and the on-call hours required by Home Health just didn't work because she had young kids at home. Finally, Nicole transferred back to the hospital and took a job in the Quality Department.

Within six years, Nicole had changed positions four times. If you can imagine, Nicole's commitment was being questioned by the HR department... and maybe even some of the nurse managers at the organization, but do you consider Nicole's journey at the facility a bad one? Sure, Nicole moved around and tried different things, but she also had acquired so much knowledge, experience, and expertise - AND stayed with the same organization to do it all. Instead of considering Nicole a 'headache', maybe we should consider Nicole's journey a WIN!

Some nurse leaders think retaining staff to units should be the ultimate goal because it makes staffing easier, reduces orientation costs, and maintains a good mix of experienced and novice nurses. While this is ideal, is that really our reality? It really isn’t when you consider everything we have explored in these last few blogs. Reality is that we are going to continue to get a large influx of millennials that are attracted to nursing because of the opportunities for change and growth. Not all will want this, but a good portion will. Instead of putting effort into trying to change them, (it will never happen and just frustrate those trying) or trying to fight against reality, what if we instead embraced it and looked for ways to function and maybe even flourish despite our new reality? What could that look like for you?

I think there are many possibilities. Possibly as nurse leaders, we set up pathways to encourage growth and development of those that want to grow and develop. A new nurse is hired on MedSurg and has a passion to deliver babies? Instead of trying to make him/her love MedSurg or be stressed each time the OB Department posts an opening, maybe a pathway should be provided to the new nurse so they know everything that will need to happen for them to get to where they want to go. If you work in a rural facility that requires nurses work in all areas, develop a clear process on how that will happen to provide enough training, orientation, and experience in each area to make them comfortable and retain their skills. Or how about this...a new nurse is hired to a unit and it doesn't take long to figure out that they are not a good "fit" for the unit, but shows great potential. Instead of torturing everyone in the department because of strict HR rules, which may prevent moving within the first six months of hire and potentially losing the nurse altogether to another facility, move them to a unit that is a better fit. How else could you embrace this new reality?

Don't get me wrong, new nurses coming into the facility need to learn the basics and maybe even do some 'time', but they should also have a clear idea of what they need to do in order to get where they ultimately want to go. Sure, there are things nurse leaders can do to attract and retain millennials to a specific unit. Not all new nurses are out to climb the ranks quickly and try many areas of nursing. Believe it or not, some are content to stay put, but let’s consider this.  Instead of constantly agonizing over retention numbers (they are important, but not the end all be all) spend some time reflecting on how you can cost-effectively provide the education and training nurses need, to do the work you need them to do, at the level you need them to do it,  for as long as you can keep them  and if you happen to have nurses who are meant to grow and develop and move on to the next opportunity that you accept the reality and support that growth and development with the idea that at least they are still retained at the organization level.

Simply put, with this new reality we just cannot put all our eggs in one basket when it comes to cost-benefit analysis of training and education. Professional development and growth is important and can be a very valuable outcome of many of the programs that are put in place to support and retain staff. A nurse who has purpose and passion can be one of the greatest assets to any organization - and one that is unhappy and working in an area that is not a good fit can be a huge liability. If we don't just focus on retention and turnover, how else will we be able to show the return on investment for the programs that are put in place to support and keep our staff?   

Join us next time as we explore going beyond retention. 

Nicole Weathers
Program Manager, IONRP

Posted On: 
Dec 14th, 2018