1. Nurse retention strategies
As a Registered Nurse, I know the impact that high turnover rates can have on an individual’s lifestyle and job satisfaction. Hospitals and other healthcare facilities are also greatly affected when nurses leave for better pay or a different schedule. As future administrators, we should be concerned about retaining high quality employees for the sake of our organization as a whole and for our employees as individuals.
Elizabeth E. Pratt
O623 – Human Resources Management

2. Overview & Definitions 2
What is job retention?
How is nursing different than other professions?
Job dissatisfaction
Job opportunities
Three strategies to retain nurses:
Compensation
Job Structure
Career Growth
According to our text, retention rate is “the number of specific individuals or cohorts that enter and exit the organization” 2 (p. 225). This is different that turnover which just evaluates the overall number of individuals who move in and out of the company. It is important to realize the reasons for turnover by examining individuals and groups in order to retain the high quality staff that makes the organization exceptional.
Nursing has a high turnover rate due to job dissatisfaction. Employees experience burnout due to high stress situations, unrealistic workloads, and a lack of respect. 2
In addition, within the nursing profession, there is a larger number of jobs available due to the current nursing shortage. There are also a wide variety of positions with varying schedules and responsibilities. For this reason, nurses are able to change jobs frequently and have job security. However, in order to provide the best customer service and cultivate the most knowledgeable employees, companies must work hard to retain high quality nurses. This can be done through increased compensation, changes in job structure, and opportunities for career growth.

3. Why does it matter? 2 Safe patient care Great customer service
Preventing injury and death
Great customer service
Building trust
Financial implications
Maintaining a positive bottom line
High nurse turnover is detrimental to the nurse, patient, and organization.
According to Fried and Fottler (2008, p. 226), “nurse turnover affects communication among nurses and between nurses and other healthcare professionals, the quality of care, and care continuity.” If patient information is not transferred appropriately, patients could be injured or even die due to the errors that result from communication breakdown.
Patients are the customers of the healthcare industry. They typically follow up with the same physician on a regular basis and build a rapport with the nursing staff as well. Building trust between patients and nursing staff results in greater satisfaction by both parties. If, however, the nursing staff is constantly changing, this relationship cannot be built.
Finally, the financial implications of nurse turnover are a burden to the healthcare facility. The turnover of one nurse can cost $42,000 to $64,000. If you consider the number of nurses a hospital employs and how many leave in a given year, the cost of nurse turnover could break an organization’s bottom line.

4. How to satisfy employees 3
Poor work conditions, poor pay, lack of communication  LOW JOB SATISFACTION high turnover
Job security, good pay, tactful discipline, employee involvement, recognition and promotion  HIGH JOB SATISFACTION low turnover
Research has shown that low levels of job satisfaction are associated with high turnover rates. 3 Good pay and benefits, a good work environment, and opportunities for career growth are just a few ways to keep employees satisfied leading to greater nurse retention.

5. Strategy #1: compensation (extrinsic) 2
Pay-for-performance
Benefits
Retirement
Health insurance
Raises & bonuses
Loan forgiveness
Now let’s focus on some strategies to retain high-quality employees. I will go over several options, then we will focus on one topic in-depth.
Compensation can be intrinsic or extrinsic. 2 Intrinsic compensation is intangible and includes praise from management or promotions as we will discuss later in the presentation. Extrinsic compensation includes options listed on this slide. Those that are tangible and usually monetary.
Pay-for-performance is a way to compensate employees for good performance and behaviors. 1 This system attracts and retains above average employees and motivates them to achieve goals consistent with organizational values.
Offering benefits packages that include superior health insurance benefits and 401k options in comparison to other healthcare networks can keep nurses in their current position as well.
Finally, raises, bonuses, and loan forgiveness offered to employees would seem to cost the organization more money; however, this small investment can retain high quality employees and prevent costly turnover as discussed earlier.

6. In contrast to longevity bonuses ________________________________
Establish performance criteria
Continuous improvement
HIGH-QUALITY STAFF
“People forget how fast you did a job –
but they remember how well you did it.”
~Howard Newton
Pay-for-Performance
Pay-for-performance is “built on the principles that good work deserves to be rewarded and that pay based on good work produces improved performance” 1 (p.298). While this term is not widely used in nursing, merit-based raises or bonuses given at time other than the yearly performance review can be seen as such. Longevity bonuses are often given on a yearly basis and do not relate to the quality of the employees’ work throughout the year. In contrast, pay-for-performance requires that management establish criteria on which rewards will be based. This allows employees to create goals and strive for continuous improvement leading to a company that is more aligned in terms of organizational goals and, thus, better able to serve it’s customers, the patients.

7. Strategy #2: Job Structure 2
Job sharing
Work environment
Nurse-patient ratios
Schedule flexibility
Autonomy
Respect
Another option to retain nurses is to structure jobs so that they create higher levels of employee satisfaction. 1
This can be done by creating job sharing options. For example, having two nurses work part-time hours to create full-time coverage to assist a physician’s practice. Some nursing positions allow for the employee to work four 10-hour shifts or three 12-hour shifts per week to allow flexibility for family and personal life.
Nurses will not care if they have a perfect schedule for their lifestyle if they do not feel they are providing safe care to patients while at work. Appropriate nurse-to-patient ratios based on patient acuity and experience of nursing staff is essential to decreasing stress in hospital settings.
In addition, fostering autonomy and respect has been shown to improve nurses job satisfaction, keeping them in their current position for longer. We will discuss the importance of the work environment more in the next slide.

8. Visibility of management
Increased involvement
Geography of workspace
Ergonomically correct
Peer relationships
Friendships & trust
Rules and procedures
Agreement with policies & allowance for autonomy
“Pleasure in the job puts perfection in the work.”
~Aristotle
Work Environment 1,2,3,5,6
Management should consider improvements in the work environment as an investment toward nurse retention. 5 Nurses want to work where they know they have the best chance to bring high-quality care to patients. The elements listed on this slide create the ideal environment for nursing staff.
In nursing it is often said that people quit their supervisor, not their job. 2 This is because nurses value supervisory staff as mentors in their field. As such, management should be interested and involved in day-to-day operations on the clinical floor. In this way they are available to answer questions, help out as needed, and provide emotional support to staff.
The layout and geography of the workspace is important for efficiency of nursing staff. 1 Efforts should be made to reduce unnecessary physical exertion when possible. 6 Updated facilities provide greater space allowance for new technological equipment. Older buildings often have narrow hallways and fewer capabilities for new technology. This can cause physical and mental strain for nursing staff. In addition, items should be easy to locate and the flow should be appropriate for the services being provided.
Trusting and friendly relationships among staff allow for greater teamwork and higher job satisfaction. 1 In a work environment that can be stressful and hectic, nurse rely on their coworkers to debrief and confide in. By carefully selecting new employees that will work well with the current employees and consistently evaluating employee relationships, management can create positive peer interactions.
Employees also value policies and procedures that are in alignment with organizational values. 3 Nurses appreciate rules that are not so rigid that they do not allow for autonomy and personal growth.

9. Strategy #3: Career Growth (intrinsic compensation) 2,5
Empowerment
Career ladder
Recognition & promotion
Because promotions to supervisory staff positions are not always available, management must empower nurses to be active in continuing education and involved in organizations and committees. As a form of intrinsic compensation, these activities provide nurses with feelings of accomplishment and belonging. 2
According to Runy (2009), “if nurses feel challenged and have the opportunity to grow in their career, they will be happy.” This includes shared-decision making, continual growth opportunities such as education or additional responsibilities, and recognition and promotion.

10. Recognition & Promotion 4,5,6
Commendations
Verbal or written
Leadership Involvement
Committees
Continuing Education
"The rung of a ladder was never meant to rest upon, but only to hold a man's foot long enough to enable him to put the other somewhat higher."
~Thomas Henry Huxley
Recognition & Promotion 4,5,6
Recognition and promotion can come in many forms. The ultimate goal is that the nurse will gain autonomy, be recognized for his or her efforts, and progress toward leadership positions in the future.
Written or verbal commendations build confidence in employees, giving them strength to build on their talents and move forward and upward into leadership positions. Commendations in conjunction with continuing education opportunities such as conferences, online training, or pursuit of higher education provide employees with the necessary background and confidence to participate in committees and make decisions for the department. Hopefully, this empowerment will create strong future leaders for the profession of nursing.

11. Summary Retention and turnover are…
Retention of nurses important because…
Nurses are satisfied when…
Three strategies to retain nurses are…
Retention rates are the specific individuals or groups of individuals who enter and leave an organization. Turnover is a more general summary of the number of people who move in and out of the organization.
Retaining nurses is important to provide safe patient care, good customer service, and maintain the finances of the organization.
Nurses are most satisfied when they have job security, good pay, appropriate discipline, and are recognized for their work.
Three strategies to retain nurses include special attention to compensation, appropriate job structure, and opportunities for career growth. Continually evaluating retention strategies can prevent turnover that is costly to the nurse, patient, and organization.

12. Self-Assessment & Questions
Why is turnover more detrimental to the nursing profession than other professions?
What are some factors that lead to high turnover?
What are some strategies for retaining nurses?
Give a specific example of how your previous or current employer worked to increase employee satisfaction. Did this work? Did this prevent employee turnover? What could have been done to improve this situation?
Any questions?
Please use these questions to facilitate any discussion that you may have thought of during the course of the presentation. Are there any comments, questions, or concerns?

13. Annotated Bibliography
Christmas, K. (2008). How work environment impacts retention. Nursing Economics, 26(5),
This article is written by a registered nurse who currently serves as vice president of the Bernard Hodes Group Healthcare Division in New York, NY. She writes this article for nurse managers to outline the impact changes in the workplace can have on nurse turnover and the effects that turnover has on patients and nursing staff.
Fried, B.J. & Fottler, M.D. (2008). Human resources in healthcare: Managing for success (3rd Ed.). Chicago: Health Administration Press.
Written by professors of public health and healthcare administration, this book provides guidelines for healthcare administrators of all types. It elaborates upon concepts related to managing employees including employee retention and turnover in the healthcare industry and in nursing specifically.

14. Annotated Bibliography (cont.)
Rad, A.M.M. & De Moraes, A. (2009). Factors effecting employees’ job satisfaction in public hospitals. Journal of General Management, 34(4),
This article, written by doctoral researchers in public services management, reviewed their study conducted to identify factors associated with job satisfaction. Identified were factors associated with low job satisfaction and motivating factors in a healthcare setting.
Roberge, C. (2009). Who stays in rural nursing practice? An international review of the literature on factors influencing rural nurse retention. Online Journal of Rural Nursing and Healthcare, 9(1),
This article, written by a professor of community health sciences, describes factors that affect nurse retention, specifically in rural areas. While the author discusses factors related to job satisfaction in depth, she also recognizes that personal characteristics which affect turnover have yet to be researched further.

15. Annotated Bibliography (cont.)
Runy, L.A. (2009). Nurse retention. Retrieved on November 7, from
This author, a senior editor for publications for the American Hospital Association, describes the most effective retention strategies for nurses with a focus on leadership opportunities. Specific case examples are a strength of this article.
Val Palumbo, M., McIntosh, B., Rambur, B., & Naud, S. (2009). Retaining an aging nursing workforce: Perceptions of human resource practices. Nursing Economics, 27(4),
The authors of this article include professors of nursing and biostatistics. They examine indicators of job satisfaction specifically in nurses over 45 years of age. They acknowledge that this group is the largest cohort of nurses and recognize the importance of job retention in this group.