Virtually every healthcare leadership team in the US is aware of — if not consumed by — the gestalt of staff burnout-turnover-retention-financial pressures. And with good reason. If you are a hospital or health system leader, don’t panic: there are effective countermeasures that can mitigate turnover and enhance retention, several of which are noted in recent reports by both AMN, the staffing company, and by the Association of Nursing Leadership (AONL).
Connection is Retention: Lessons from Leaders with Unusually High Nurse Retention
The AONL report presents a well researched analysis of the problem of nursing turnover, its causes and recommended solutions in "Connection is Retention: Lessons from Leaders with Unusually High Nurse Retention". I encourage every healthcare leader to read it. The report is especially persuasive in distinguishing what works and what doesn't work to retain nursing staff. For example, the frequency of "traditional" rounding by managers and leaders -- ie, how it is generally practiced in most healthcare organizations -- has no meaningful impact, indeed, is often not even noticed by front-line staff. But if the purpose and quality of rounding done by leaders — that is, if it is driven by a focus on forging a deep connection by leaders with their staff — does.
How to Improve Staff Retention and Reduce Burnout
Here are some of the recommended practices that we at Organizational Wellbeing Solutions find from our experience will reinforce and amplify the AONL findings to reduce burnout and improve staff retention:
directly engaging with and deeply listening to -- not talking at or superficially chatting with -- front-line staff, especially if done through job shadowing by senior leaders
creating, deploying, and hardwiring a sophisticated daily management system (honed to be completed within 15 minutes) that links the front-line to the c-suite
reestablishing a command center as most hospitals did during the pandemic but reframing it to monitor and address urgent staffing and workplace issues in “real time”
eliminating outdated policies and practices [(ie, getting rid of stupid stuff (GROSS)]; and,
assiduously applying one or more improvement sciences (eg, Lean, operations research, six sigma, agile, design thinking) in consultation with — and securing the direct involvement of front-line staff — to eliminate or at least markedly reduce inefficient, burdensome workflows.
AMN, the temporary healthcare staffing company, has been surveying RN’s across the country on a biennial basis since 2009. Their latest survey results, from a January 2023 survey of 800,000 RN’s (producing 18,000 completed surveys) are now available . The sobering findings warrant close attention — and concerted action — by senior hospital and health system leaders as described above. For those who remain unconvinced by the urgency of problem or who need additional encouragement to rethink their current leadership practices, here are the sobering findings from this year’s AMN national survey of RN’s:
Only 15% of nurses employed in hospitals say they will “continue working as I am” in one year.
36% of hospital nurses say they will continue working as nurses but seek a new place of employment
For nurses in all employment settings, 40% said they will “continue working as I am” in one year. That represents a 5-percentage-point drop since 2021 in the middle of the pandemic
30% of nurses say they are likely to leave their career due to the pandemic, up 7 points since 2021
18% of nurses say it is likely they will retire from nursing due to the pandemic.
Career satisfaction and related factors declined significantly since the 2021 RN Survey conducted in the middle of the pandemic.
Nurse career satisfaction has been at 80-85% for a decade; in 2023, it dropped to 71%
Likelihood of encouraging others to become a nurse is down 14 points from 2021
Only one-third of nurses say they have ideal time to spend with patients, a 10-point decrease from 2021 at 43%
The percentage of nurses who are satisfied with the quality of care they provide at their current job decreased 11 points from 2021, from 75% to 64% in 2023
Compared to older nurses, younger nurses are significantly less satisfied with their careers and jobs and are less likely to encourage others to become nurses.
Mental health and wellbeing problems for nurses have dramatically increased since the middle of the pandemic in 2021.
Four of five nurses say they experience a great deal or a lot of stress, up 16 points from 2021. Worry that their job is affecting their health is up 19 points. Often feeling emotionally drained rose 15 points.
65% of nurses participate in activities or access resources to address their mental health and wellbeing at least once a week, and 40% at least two-to-three times a week – a slight decline from 2021. Thirty- five percent of nurses never address mental health and wellbeing, approximately the same as 2021
Nurses signal dire warnings on nurse shortages.
Nearly 9 in 10 nurses say the nursing shortage is worse than 5 years ago – a 37-point increase from 2019
94% of respondents agree there is a severe or moderate shortage of nurses in their area, with half of nurses saying the shortage is sever
80% of nurses expect the shortage to get much worse or somewhat worse in the next five years with half of nurses saying the shortage will get much worse