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Nursing retention

Avoid the revolving door of nursing staff turnover

BY: Eileen Williamson, MSN, RN on August 21, 2017

Good recruiting, hiring and onboarding practices can reduce costly nursing staff turnover departures.

As a healthcare professional working in talent acquisition, you’re committed to making your organization the best it can be by recruiting and retaining the best employees you can. Whether you are in recruiting, hiring, management, advertising or marketing, you need to understand the healthcare employment market and how it can affect your recruitment, retention and ultimately, your turnover rate.

Explore why staff leave

Turnover can be managed, but you need to understand its causes, how to calculate it, and how to deal with it.

The U.S. Bureau of Labor Statistics defines the turnover rate as the ratio of total employee separations to the average number of employees. Included in separations are voluntary and involuntary terminations, retirements, resignations, dismissals and layoffs. Some separations are inevitable, a few are warranted, but many are preventable.

Turnover is not always given the attention it deserves. Why is it most managers are required to set key performance indicators and goals for things like quality improvement, satisfaction rates, revenue and expense targets, but may not be tasked with tracking turnover?

Turnover is viewed differently from industry to industry. A high turnover rate at a fast-food restaurant or a furniture store may not be the same problem for management that it is in a hospital, and the difficulty involved in backfilling the vacancies are not the same. When the work at hand is patient care, high turnover can decrease care quality, jeopardize safety, lower employee morale, affect the organization’s reputation and cost a lot of money.

We’ve all heard the theory that employees leave managers, not organizations, and many believe it’s only bad managers they leave. Oftentimes, however, employees leave good managers who helped them grow and prepared them for bigger and better things elsewhere.

The impact of an employee separation is colored by whether the employee was highly skilled, difficult to replace and well-regarded, or non-productive, uncooperative and disorganized. Every separation is unique; each is not a negative event, but each one affects turnover.

Baby boomer retirement leads to job openings

There is a retirement explosion underway among baby boomers that’s affecting the healthcare workforce and causing a brain drain as many experienced nurses leave.

A 2014 blog article by Peter McMenamin on the American Nurses Association website predicted a “tsunami warning” of impending nurse retirements over the next several years. The ANA has predicted retirements will include more than 500,000 seasoned RNs by 2022, and the U.S. Bureau of Labor Statistics projects a need for 1.1 million new RNs for expansion and replacement to avoid another nursing shortage.

The economy is changing and employees are more likely to leave their jobs and move on to new positions in new organizations. As RN retirements increase, facilities will be reaching out with bigger and better offers to attract new nurses, so you’ll have to work harder than ever to retain your staff.

What you can do about staff turnover

Keep planning for the future, and do all you can to acquire new talent and hold on to the talent you have. Continually re-evaluate the effectiveness of your recruiting, hiring and onboarding practices to determine if they’re working or if changes are needed.

Maybe it’s time to reconsider your hiring stance on new grads and make plans to grow your own future leaders with education programs and new and improved orientations, residencies and mentorship programs.

Stay abreast of the new employee population. The RNs who will replace the baby boomers will be Generation X and Millennial employees, and they will have different styles, beliefs and expectations than their predecessors. They’ll look at salaries and benefits more closely, and put greater emphasis on other factors such as job flexibility, autonomy, time off and personal and family needs. Update your recruiting, hiring, orientation and onboarding practices and programs to meet their needs. Figure out what will motivate them. Make them part of your organization’s big picture; challenge and excite them about your mission and vision. Never let them get bored or discouraged.

Education is crucial. Management training programs on predicting, measuring and lessening the effects of employee separations are needed. “Onboarding,” “engaging” and “enculturating” are words we’ve all heard and worked on, but managers at all levels will need even more education and training on these topics. Help your managers focus on what will make staff love what they do and want to stay. Get them to work on making staff feel more a part of the larger organization, and more recognized and rewarded for making contributions that matter.

As talent acquisition professionals in this turbulent healthcare market, you have lived with change for a long time. It’s been happening all around you and you’ve managed it. Turnover is change, too; don’t let it take you over. You can turn it around.


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Eileen Williamson, MSN, RN

Eileen Williamson, MSN, RN, is a former senior vice president and chief nurse executive who led nursing programs and initiatives. She continues to write and act as a consultant for Before joining the company in 1998, Williamson was employed by North Shore-Long Island Jewish Health System in New York, where she held a number of leadership positions in nursing and hospital administration, including chief nurse at two of the system’s member hospitals. She holds a BSN and an MSN in administration, and is a graduate fellow of the Johnson & Johnson University of Pennsylvania Wharton School Nurse Executives program. She also is a board member and past president of the New Jersey League for Nursing, a constituent league of the National League for Nursing.