Ten big ideas to engage,
love and retain your nurses.
Insights and suggestions
from nursing leaders
The lifeblood of any organization is its ability to attract great team members, including young, fresh-out-of-school beginners. What happens to the quality of care in healthcare, when that very group of new team members begins to feel alienated?
Recently we examined our aggregated data on nursing
engagement, and to our surprise we found that the least happy nurses with their
life at work were nurses with less than five years of service. This was by a very wide margin--greater than
15%. So we shared these results with a set of nursing leaders. We also asked them for a set of concrete strategies
that could be used to improve the engagement among the newest members of the healthcare
team. In this post, we will share why they believe this occurs and how you as a
nurse leader can combat it.
Newest member treatment: Do nurses really eat
One Director of
Nursing said that “they had seen more mature nurses really beat up on new
nurses. More importantly, she had been asked not to hire new nurses onto the
team. However, she said that “we have to remember that we were all were new
nurses at one point”. And with the average age of nurses being in the 50s, clearly
nursing leadership needs to figure out how to successfully and consistently
retain and engage new nurses.
leader told us about a University of West Texas study that said 14% of
attrition among nurses is a direct result of poorly-engaging younger nurses. She continued that many studies have been
published on the verbal abuse, hostility in the workplace, and the impact of
this behavior on patient outcomes. She
said “we know that the greatest attrition occurs among healthcare workers whose
length of employment is less than 5 years.” The Joint Commission, the ISMP, the
IHI have each spoken out on this subject.
Worse yet, the
cost of RN turnover can have a profound and tracable direct impact on hospital
margins. According to a March, 2013 NSI report, the average cost of turnover
for a bedside RN ranges from $36,000 to $48,000 resulting in the average
hospital losing $3.7 – $5M per year. Each 1 percent increase in RN turnover costs
the average hospital $300k. While an overwhelming majority of organizations
view retention as a “key strategic imperative” it is often not put into
practice says one of our nursing leaders. Hear that sucking sound? It's the sound of care quality and revenue dollars going down the drain due to unnecessary RN turnover.
There clearly many
factors that contribute to poor engagement of young nurses, but one healthcare
leader said that one that is often overlooked is that healthcare is one of the
most highly emotional industries and the people who are providing care don’t
always know how to manage this factor.
Our nursing leaders
had ten ideas for improving things at your hospital. Here are just a few that
Nuture young nurses. Make sure you take strong steps to nurture
your young nurses. Teach new nurses and treat them as your own. This can
include having veterans take new nurses under their wing. They often are a good
judge of their co-workers and can help you figure out where the rookies’
strengths and shortcomings are. The fact is that most employees that are new to
healthcare are seeking a mentor.
Care for the whole person.
Health care leaders should involve
bedside nurses in models that focus on the mental, as well as the physical
aspects of patient healing and employee care. Caring for the
"whole-person" benefits nurses and patients alike, and health systems
can ultimately improve efficiency, patient satisfaction, readmission rates, and
cost savings if bedside nurses are involved in this type of dual mindfulness.
Create a culture of safety
. Use tools related to Culture of Safety to
understand the issues impacting the patient. Nurses (even the grouchy ones) are often startled
when they begin to recognize how their nurse-to-nurse behaviors can create a
negative outcome for the patient.
Make new/existing people feel they part of
. Make new people
feel that they are a part of the healthcare team in a way that enables them to know
their contribution is valued.
Creating a supportive and just culture
. Create a supportive and just culture, encouraging
learning and ensuring Immediate inclusion into the social structure of the team.
Make it okay to ask “stupid questions”
. Any behavior not supportive of asking
"stupid" questions, identifying and speaking out regarding risk in
the environment, and not enforcing "see one, do one, teach one" ,
should be addressed immediately.
Create standards of behavior
. Create standards of behavior and a
"commitment to coworkers” protocol. Embed this into orientation and
performance evaluation tools. Do internal customer service surveys often to
identify by department how you are doing in treating each other as important
customers. Weed out detrimental behavior, similar to "hazing" in a
Make it okay for nurses to seek care
. All the "caring" is spent on
the patients often leaves the individuals bereft of the ability to self-care
and to care for each other. Even “Super-Nurse” isn't always truly caring for
herself. Make sure to be clear that
"caring" doesn’t only apply to the patients and is imbedded into the
total organizational culture.
Managers protect employees from actions
that don’t reflect a caring culture
. Managers have to fiercely protect staff from any organizational behaviors
that are not reflective of "caring". Your staff needs to know that
you truly care for them. The synergy of
a caregiver team increases exponentially and patients know they are being cared
for in a truly authentically caring environment.
Creating an experience mix
. The ideal experience mix is that of
older RNs, medium-timers RNs and inexperienced RNs blended together. This sets
up what Pat Benner describes a learning situation where the senior RNs have
responsibility to share their knowledge with the younger RNs. The younger RNs
can bring their enthusiasm and energy to the workplace and that with the
sharing of experience will both benefit the team and it's growth and
In summary, nursing leaders need to make sure that younger
nurses are integrated into the team quickly and are treated in a supportive
manner. Only in this way can nursing leaders make real progress to engage, grow
and retain the next wave of caregiver team members.
These are just 10 great ideas from healthcare leaders. You probably have 100 more. Please share in
the comment section below and follow the conversation on twitter or Facebook.
Bonus: here's a link to the 10 perks nurses love most! How many does your healthcare organization offer? Enjoy!!
if you want to join the discussion on healthcare employee engagement and how to improve it, please join us at our LinkedIn group.