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Turning the Tide on the Great Resignation—How to Engage and Retain Nurses in an Acute Care Setting

By , SVP Clinical Services November 8, 2022 Clinical & Quality

By now, employers have all heard of the Great Resignation or the Big Quit in healthcare.  This is the ongoing trend of healthcare workers leaving their jobs for COVID-19 related reasons, including early retirement, on the job pressures and shifts in work-life balance priorities.  In the nursing field, the Big Quit is far from peaking.  A 2022 survey by the nurse recruitment and retention firm NSI Nursing Solutions found that nurses are leaving hospitals at a dramatically higher rate than in 2021.

On a positive note, people are still being drawn to nursing despite the profession’s demands, including shift workload, care complexity, burnout and stress levels.  In fact, Millennials are entering the nursing workforce at almost double the rate that Boomers once did.  A pressing issue now is preventing turnover.  An editorial in last month’s issue of Journal of Advanced Nursing (JAN) challenges healthcare leaders to “shift the nursing profession from the great resignation to the great reimagination” with retention strategies designed to make nurses feel valued and appreciated rather than taken for granted, based on the perception that many nurses feel “called” to the profession and are presumably prepared to face challenging working conditions.  CHC hospitals are at the forefront of the “great reimagination”, having recognized that devoting resources toward improving nurse engagement and job satisfaction can assist in preventing the current turnover challenge from becoming a self-perpetuating problem.

Turnover and inadequate staffing take a toll on nurses who, when spread too thin, may switch jobs or succumb to burnout.  By the same token, satisfied nurses who stay contribute to continuity and care quality, which elevates the hospital’s reputation and, in turn, gives its recruiters a competitive edge.

To recruit and retain nurses, many facilities are raising salaries and offering sign on, spot, referral and retention bonuses.  At some facilities, nurses in certain high-need units are being offered compensation that’s closer in line to a travel nurse’s earnings.  Many facilities pay their workers taking care of COVID patients more.

At CHC hospitals, monetary incentives are only a small part of the focus on retention.  We envision a multipronged strategy that includes:

  • Onboarding
  • A focus on culture
  • Flexible staffing, care models, and alternative schedules
  • Support Staff
  • Nurse Residencies
  • Trained Preceptors
  • Professional development: education and training that includes a focus on delegation, team building, and practicing to the top of license
  • Growing the nursing pipeline
  • Stay interviews
  • Support
  • Recognition

Well-structured, Engaging Onboarding
Onboarding lays the foundation for every other retention initiative.  An effective onboarding program reaffirms the decision to join hospital staff, introduces new staff to the culture of the facility, provides the necessary tools to succeed, and establishes the foundation for relationship-building with co-workers, physicians and patients.

Unfortunately, Gallup reports that only 12 percent of workers feel that their employer does a good job with onboarding, leaving 88% of employees across all industries with less than desirable initiations that are focused mostly on policy compliance and job-duty clarification.  An engaging onboarding experience streamlines that portion of the process, concentrating more on culture and connection.  This might take the form of organizing a first-day reception and ongoing brief social events; scheduling “meet and greets” with healthcare leaders as well as seasoned employees in the same role or department, or assigning a mentor or peer during the onboarding process.

Flexible Staffing, new care models, and alternative schedules
The great Resignation is driven in part by a desire for a better work-life balance.  Double shifts, erratic and inconsistent scheduling, and menial tasks can contribute to a sense of imbalance and job dissatisfaction among nurses.  Some facilities are offering temporary assignments (for “fit”) to new hires, and accommodating experienced nurses scheduling needs, including flexible hours to forestall retirement.  Telehealth positions that allow for some nursing duties to be performed remotely (such as admission interviews, discharge interviews, and medication reconciliation) are increasingly prevalent.

Many CHC hospitals have implemented different staffing models, including team nursing to their institutions.  This team based staffing model utilizes experienced RN’s, new RN’s, LVN/LPN’s, and ancillary staff with varying skill sets in working collaboratively.  By combining skills, the team can deliver quality care to a larger group of patients than one RN could do alone.  Special team training that focuses on licensure requirements, experience, patient complexity, delegation, and rounding is paramount for units that shift to this care model.  Schedules and team assignments are planned so that the care team members are practicing at the top of their license or competency.  This approach enables licensed Registered Nurses to dedicate more time to patients and tasks that require specialized skills and allows for non-skilled nursing duties to be provided by others on the team.

Professional Development Opportunities
Professional development is imperative for those with leadership aspirations but also for engaging less experienced nurses, and ancillary staff through learning opportunities and exposing them to other career-path options within the acute care setting.

Professional development includes (among other initiatives):  one-on-one mentoring or coaching, structured leadership development programs; online or group seminars, workshops and conferences; and self-directed study programs and coursework.

Support Systems and Safety Nets
Onboarding support provision is another retention strategy that starts during onboarding by fostering a sense of belonging and community, as well as making nurses feel that they can voice concerns and communicate vital information and that leaders will listen.  In most CHC facilities, there are formal leader rounding programs that enhance the visibility of all of the C-suite leadership throughout the facility. Leaders may ask key probing questions during these rounds, such as “Is there anything that you need today to do your job better” or “Do you have any concerns that you’d like to bring to my attention today?”  This “Psychological safety” is important to define the sense of assurance that an employee will not be humiliated for making suggestions, asking questions, raising questions, or reporting mistakes.  Nurses need a safety net during trying times such as COVID surges.  To help nurses cope with the hardships of the profession, hospitals might consider establishing peer support groups, helplines, and can encourage the utilization of EAP services.

Formal and Informal Recognition
Bonuses and  formal awards are two ways to formally recognize individual achievements; however, informal, day-to-day genuine displays of affection-including thank you notes, social media posts, verbal kudos, and public verbal thank you’s  are also invaluable morale boosters.  Public recognition of career progression is a good way to acknowledge employees who complete a new degree or obtain a new certification.

An effective engagement program could include celebrating birthdays and national awareness days; organizing contests with prizes for the winners, and acknowledging employees’ lives outside of work.  At CHC, we’ve encouraged engagement in many ways.  This included an open house, with prizes, for our employees’ families to see our new work environment, posting pet photos, and seasonal decorating contests.

Conclusion
As healthcare leaders work to maintain adequate staffing levels, they must acknowledge the accelerating effects that the pandemic has had on the projected nurse shortage. COVID put nurses under an extraordinary amount of pressure, and as the pandemic wore on, many nurses-reflecting society as a whole-experienced a shift in priorities and a yearning for greater meaning, balance and fulfillment. Be nimble. Try new things. Look outside the industry for some new ideas.  Ditch the things that aren’t working.  Get feedback from your staff. Right now, healthcare leaders must find ways to support and engage nurses so that they stay committed to community hospitals like yours. And, so that they stay committed to taking good care of the patients in your community.

By , SVP Clinical Services November 8, 2022 Clinical & Quality
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