The cost of nursing turnover is exorbitant for healthcare organizations.
Replacing just one staff nurse can range in cost from $36,900 to $57,300, according to our continuing education module Keeping Colleagues: Nurse Retention Is Everyone’s Responsibility.
And if you’re replacing a nurse from a specialty area such as intensive care or labor and delivery, the cost can be even higher — jumping to double the amount of that nurse’s annual salary, said Blake Ingram, senior vice president of business development at OnCourse Learning Healthcare, a Relias Company.
The issue of high nursing turnover is so important that we recently hosted a free webinar for recruiters and other healthcare industry and nursing professionals titled, “Reduce Nurse Turnover. Recruit Better. Retain Longer” and published a nursing turnover whitepaper to offer insight on why nurses leave their jobs and strategies to help recruiters, administrators and managers turn the tide to reduce turnover and its associated costs.
One of the featured speakers for our webinar was Lori Burt, vice president of talent management at the University of Maryland Medical System.
“Reducing nursing turnover and improving nurse retention is a complex topic, but one that is fraught with opportunities to change the trajectory and improve retention,” she said.
“It’s important to recognize that there is no one magic bullet to reducing nursing turnover,” Burt continued. “You need to look at how you recruit nurses, how you onboard them and how you treat them once they’re on the job.”
Healthcare organizations also need to brand themselves as great employers and ensure that what they’re selling during the recruitment process is what their nurses are going to experience once they come on the job, Burt said.
Better recruiting alone will not necessarily stop all turnover – you need a partnership and effective communication between recruiters and nurse managers, said Burt. “It’s more than just hiring someone with a license. Savvy recruiters and managers will want to consider if the person is a good fit for the organization and the unit’s culture. Some ways to assess this are to use online pre-employment assessment tools, and bringing in any candidates they’re strongly considering hiring for a peer interview with the unit’s staff,” she said.
Staff members who participate in a peer interview, who like the candidate and advocate for their hiring, will want to help that person succeed once they’re hired, Burt said.
“Once a new hire is on the unit, they should be given a mentor or buddy, someone who can serve as a resource and provide support,” she said. “This will help the new hire feel they’re receiving the training they need and help them fit in.”
She also said once nurses are in the door and working for an organization, if the experience is not good they will leave.
“And when they leave, in addition to the cost of hiring someone new, organizations have to pay premium pay rates for overtime and travelers to fill the void,” she said.
Take a holistic, broad scope approach
The second featured speaker of our webinar, Ingram said the holistic approach in nurse recruiting and retention requires examining the continuity and effectiveness of recruiting and advertising in several key areas during the hiring phase and after, which include:
- The interview process
- Use of appropriate assessment tools
- Providing a formal residency and preceptor
- Offering ongoing education
- Good leadership and management
- Shared governance
“Hospitals are now looking at the ‘patient experience’ and assessing how patients view their stay at a particular hospital and assigning staff titles and roles to oversee this, such as patient experience directors or managers,” Ingram said. “However, they don’t generally examine what the ‘employee experience’ is and how it impacts nurse recruitment and retention.”
Communicating your brand to prospective candidates
Most healthcare organizations don’t realize that branding their organization is an important part of the recruitment and hiring process, Ingram said.
“An organization’s brand is something that’s not usually well-defined,” he said. “What’s your culture, mission and values as an organization? It’s important to communicate these so employees know and understand the organization.”
Something for recruiters, administrators and managers to consider is what the employee value proposition is that you are pitching to your prospective and current employees, Ingram said.
“An employee value proposition (known as EVP) describes what you’re offering them as an organization such as the work and organizational culture, the pay, benefits and professional growth opportunities,” he said. “You’re telling them, this is what you can expect when you work for us – in detail.”
The key to branding and communicating your value proposition when recruiting and advertising to potential new hires is: “What you’re describing needs to match the reality of what you’re offering – not the aspiration. If your EVP is not your reality, it could lead to turnover,” said Ingram.
If you know your organization is a challenging, yet rewarding, place to work – say it, said Ingram. “Being up front with your EVP when recruiting will lead to some potential hires moving on and looking elsewhere, but some won’t. The ones who choose to stay with the process may be more of a match to your organizational culture.”
Another featured webinar speaker was Lance Pine, senior vice president of recruitment and advertising solutions at OnCourse Learning Healthcare, a Relias company, who said the cost of nursing turnover is approximately $4 to $7 million annually.
“It’s important to get the right people in the door who fit an organization. This will help reduce turnover later,” Pine said. “When starting the recruitment process, it involves four steps to create what is known as a candidate lead funnel.”
- Prospecting – reaching out and identifying prospective candidates
- Screening of initial prospects (typically phone calls)
- Deciding which candidates you want to bring in for in-person interviews
- Acceptance – the last stage, some candidates will accept the job and some won’t
“If your candidate lead funnel is too large with too many people to process, find ways to create a smaller funnel with fewer candidates so you can handle the volume,” Pine said. “Getting more prospects is not always the answer – you want the right people with the right skills who’ll fit the work culture.”
Other strategies to help you identify and hire the right people:
Use assessments: One insightful tool to use with job candidates are online assessment exams. “These can be used either pre- or post-hire to assess interpersonal (soft) skills as well as knowledge and skills about the job and specific role (hard) skills, Pine said.
Understand your candidate’s motivation: Find out what is motivating your candidate to consider working with your organization, Pine said. “Some examples of motivating factors are organizational mission, patient population, salary, potential for career growth and schedule. These can help you interact at a more personal level to match your goals with theirs,” he said.
Determine the candidate’s level of emotional investment: Does your candidate appear emotionally invested in your organization and the job, or apathetic? “It takes skill to read candidates in this way,” Pine said. “Those who are emotionally invested will likely stay longer once hired.”
Ways to keep a nurse on the job
In addition to hiring the right people, it’s important to keep them happy once they’re on the job. A way to do this is to have good managers and administrators, who:
- Connect with and support their staff
- Provide opportunities for career growth
- Offer flexibility with scheduling to promote work-life balance
- Provide a respectful work environment
- Reduce bullying
- Provide competitive compensation and benefits packages
“Employees generally leave their managers not an organization, so having good managers is one of the keys to reducing turnover,” Pine said. “Good managers will want to help their great employees achieve success at work and at home.”