Nursing Leaders must engage the newest team members

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 their young?

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. 

Another nursing 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 they recommended.

1)     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.

2)     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.

3)     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.

4)     Make new/existing people feel they part of the team. 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.

5)     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.

6)     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.

7)     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 frat house.

8)     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.

9)     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.

10)  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 performance.

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.

4 responses
Thank you very much for your candid and helpful insights. I couldn't help but to notice the comment about 'even the grouchy ones', relating to nurses. It's time we talked about why we allow 'grouchy' people to take care of sick people. Perhaps that is part of the problem. Grouchy nurses are grouchy to patients and co-workers alike. Nursing teams can immediately name who the 'grouch' on their unit is. And we tolerate it. In some instances we esteem them. Anytime we say things like, (insert name) is clinically great BUT..." and then go on to say something negative of their attitude, we have identified what may be referred to as the BUT NURSE. Keep in mind that other industries such as those that serve coffee, chicken, and provide amusement would not tolerate a 'grouchy employee'. It is way too costly for them in so many ways. Yet, in healthcare, we do it on a consistent basis. We need to rid healthcare organizations of those who do not welcome, nurture and mentor those who are new to nursing (and one day will take care of us).
Thanks for the helpful insights and like Colleen I feel that we do keep "grouchy\difficult"nurses in Healthcare and this really results in young nurses leaving the field and causing a loss of Revenue.
An informative an reflective read. I see too often this happening. It would be interesting to see if there was a difference in experience between bachelor and diploma nurses. My experience is that bachelor nurses are provided with more formal support and there is a general acceptance that they are new and inexperienced. Diploma nurses however are expected to hit the floor running. Add in a high workload in areas such as aged care and the experience of this being their first real job- has lead to some very stressed and disillusioned staff
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