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Nurse Retention and Workforce Planning: Hold on to your Staff!


Where is your organization in the race to retain nurses? Are you prepared with specific information on what is working and what isn't? Most healthcare organizations have no data or tracking of retention or recruitment activities. There is no organizational infrastructure to support nursing recruitment, or more importantly, retention. There is no link between business development of new programs and nursing workforce planning. In some facilities, it is unclear owns the process for nurse recruitment and retention and how the dollars are spent. There may be some overlap between nursing and human resource functions for nurse retention and recruitment, but usually no evidence of what practices are successful. There is no tracking of nursing hires using advertisements, career fairs or web sites such as Monster.com.

To effectively manage their workforce, organizations must have hard data to determine how to best spend nursing retention and recruitment dollars. They also need benchmarking to monitor and track their successes. Managers must be able to link business development and expansion strategies with the provision of adequate nursing resources to support new programs.

There are plenty of innovative retention strategies being suggested by nursing executives, school directors and faculty. Nursing retention is the responsibility of every employee in a healthcare facility. There are different answers for different regions of the country, but everyone needs to focus on the same goal-retention of nursing staff through workforce planning.

Nurse staffing ratios and a deepening nursing shortage require solutions and strategies different than those used in the past. Expanding educational capacity will force enhanced retention efforts at healthcare facilities.   Facilities must be prepared to deal with retention and planning for their nursing workforce in addition to dealing with the nursing shortage.

Organizations need to commit to several strategies simultaneously to assist with reversing the nursing shortage in their geographic region. Effective strategies include the implementation of magnet characteristics as outlined in The Magnet Recognition Program ® . This program was developed by the American Nurses Credentialing Center to recognize health care organizations that provide the very best in nursing care and uphold the tradition within nursing of professional nursing practice.

Offering RN Residencies to new graduate nurses upon hiring has been demonstrated as the best retention strategy by far (2004). Other focuses include expanding compressed salary grids, offering retention bonuses instead of sign on/recruitment bonuses. It has been demonstrated by several research studies that facilities that provide formal education and compensation of nurse preceptors and mentors have more satisfied employees and higher retention rates.

Retention strategies also must be specifically cultivated for the "Boomer nurses." As they enter their fifties, many Baby Boom-era nurses can no longer cope with clinical bedside care. Creating and offering other employment opportunities within hospitals for nurses no longer able to manage the physical demands of bedside clinical nursing would go a long way to keeping "boomer nurses" working instead of retiring.

Hospitals can also provide pre-retirement information sessions to discuss reassignment options. These non-clinical options could include case management, patient advocacy, education, quality improvement or mentoring.   Keeping older nurses in patient care setting as mentors is a valuable resource to less experienced nurses and increases retention of both older and newer nurses. Healthcare systems may want to evaluate the feasibility of utilizing a deferred pension fund jointly with employment, as public service agencies have done throughout the country. Police and fire services facing massive retirements as those hired after the Vietnam War were ready to retire, developed deferred retirement options and plans. These plans, called D.R.O.P. programs, allowed police and firefighters to retire from their positions if they had twenty or more years of service. They could then reapply for their same job, earning both a salary and pension at the same time. This strategy encouraged many police and firefighters to remain in the workforce instead of retiring. Most D.R.O.P. programs have a maximum enrollment time of five years, but that still helps with retention of important public service staff (2001)

Facilities may want to hire older nurses as RN Retention Specialists. Their roles/responsibilities could include meeting with aging nurses, facilitating problem solving and being empathetic listeners. They would serve as a mediator and mentor resources. In addition, nurses in this role could try to get nurses back into facilities that have left by attempting to resolve personal concerns and creating innovative solutions for older nurses.   This type of role could have a significant impact and can save registered nurses while limiting vacancies. The aging nurses remain employed and the hospital improves staffing with experienced nurses.

Healthcare facilities also need to remember how important having effective and competent nurse managers is to retention. 50% of employee satisfaction comes from their relationship with their boss (Kaye & Jordan-Evans). Research shows that the quality of the relationship between a boss and subordinate is a primary predictor of intentions to remain in a job or facility (Thomas). An investment in strengthening an organization's leaders- from senior executives to middle managers to team leaders-pays off in all sorts of ways, but particularly in attracting and retaining employees.(Buckingham et al)   Those hospitals that had measures in place to hold managers accountable for retention tended to experience lower turnover rates.

Healthcare Facilities must now link business development and expansion plans with projected nursing resources. If staffing is not planned for, new program success can be jeopardized. Use the workforce planning tool to assess and evaluate how effectively your facility is managing recruitment and retention strategies as well as workforce planning. The answers will help you create an organization-wide workforce plan to use for the future.

The bottom line is that retention and workforce planning must be the new emphasis in healthcare facilities. Recruitment strategies must continue, but not to the exclusion of retaining competent nurses who want to keep working. Nurses must be seen as what they truly are-a precious resource that is the mainstay of hospital care and programs.


Turner Workforce Planning Assessment Tool©

Organizational Focus

  • How do you link your business development and expansion plans with your nursing resources? How does your recruitment strategy intersect with your business development and strategic planning e.g. how will you have the nurses you need to implement a new program?
  • What methods are you using to benchmark and monitor what is working for nursing retention and recruitment?
  • Do you have a retention and/or recruitment dashboard?
  • What is your infrastructure in the organization for retention and recruitment?
  • What piece of nursing retention do nurse managers own? HR? Nursing administration?
  • Do you track units where nurses transfer to/from?
  • Do you track nursing resignations?
  • Do exit interviews with those nurses?
  • Is your facility a magnet hospital? Are you planning to start the Magnet Hospital process?
  • Do you use a shared governance model in your nursing organization?
  • Who owns the retention and recruitment processes?
  • Where is the data on these processes?
  • Who owns the dollars used on these processes?
  • How much of your patient population is cared for by registry/travelers?
  • Which units use the most registry/travelers?
  • If you are unionized, what are the labor union efforts toward retention?
  • What do you offer aging RNs who are no longer able to perform bedside nursing?
  • Do you have a formal pension plan besides individual 401 Ks? A DROP plan?
  • Do you have a 2 year and 5 year recruitment strategic plan?
  • If you are part of a hospital system, do you have a corporate retention strategy?

Nursing Recruitment

  • Is there a nurse recruiter?
  • Is the recruiter proactively targeting RNs or simply processing nursing applicants?
  • What is your net recruitment number (nurses hired vs. nurses resigned/retired?)
  • Are you tracking how and where you recruit nurses?
  • How are you spending your nursing recruitment dollars? Ads? Career fairs? Giveaways? New grad events? Recruit-a-friend campaign s ? Sign on bonuses?
  • How many nurses have you recruited from each method?
  • Where are you advertising? Journals? On line? Newspapers? Radio? TV?
  • How many RNs are you recruiting from each strategy?
  • Do you have a new grad orientation program?
  • Do you have an RN residency?
  • Are you visiting local nursing schools?
  • Do you host a new grad event for recruitment?
  • Do you have a n employment web site?
  • Who is responsible to monitor it and how often?
  • Who follows up with contacts or emails from the web site ?
  • How many nurses have you hired from that site?
  • Do you advertise on other sites e.g. Monster.com?
  • How many RNs have you hired from those sites ?
  • Do you have an on-the-spot interview strategy for experienced nurses who apply/appear?
  • Do you have a defined and tracked procedure for getting back to and hiring interested applicants?
  • How many dollars have you spent to hire per nurse you have hired?
  • How many nurses have you hired?
  • Do you have a nursing school partnership?
  • Do you put your employees through nursing programs e.g. grow your own nurses?
  • How much do you spend per employee?
  • How many graduate the program? How many quit the program? Why did they leave the program?
  • How long do they stay after they complete the program?
  • How many more nurses will you need? How and where will you find them?
  • Do you have a program to recruit successful registry and travelers as employees?
  • Do you have a plan to recruit/train staff for specialty areas that have aging nurses?

Nursing Retention

  • Do nursing units self schedule?
  • Do you use employee satisfaction surveys?
  • How do you disseminate the results of the survey?
  • How do nurses get workplace complaint issues resolved?
  • Do you have formal leadership training for managers?
  • Do you use 360 degree evaluations for managers?
  • Do you have formal preceptors or a preceptor program?
  • Do you train preceptors?
  • Do you pay for preceptors?
  • Do you have a formal mentor program?
  • Do you pay mentors?
  • Do you train mentors?
  • Do you use clinical staff as clinical faculty for nursing students?
  • What kind of arrangement s do you have with your nursing schools for providing faculty? Skills labs? Classrooms? Equipment?
  • Do you hire nursing faculty as per diem clinical nursing staff?
  • Do you pay experienced nurses to oversee students? New staff?
  • Do you offer split or short shifts for older nurses?
  • Do you have hot spotters? Resource nurses for crisis management?   Break nurses?
  • What units have the oldest nurses? What is their average age?
  • What are your plans to replace those nurses when they retire?
  • What is the average age of your nurses hired in the past 5 years?
  • What is your RN turnover for all nurses?
  • What is your RN turnover for new grads at 12 months, 24 months after graduation?
  • Do you have an RN residency?
  • What is your formal nursing and general orientation length?
  • How long is your new grad program/orientation?
  • Do you use mentors/buddies for new nurses?
  • How long does a new staff member have a buddy?
  • Do you use buddies for RNs who transfer to new departments?
  • Do you have an in house float pool? In house registry?
  • What is the percentage of usage of registry and travelers of your total nursing budget?
  • Do you have a retention coordinator who meets with nurses who resign or retire to try to keep them employed?


References

1. Bradley, Carol (2002, March). The nursing shortage: Facilitating partnerships between service and education. CACN Fall Conference, Garden Grove, CA. Data from Deans and Directors Survey

2. LA Times "Itinerant Nurses fill Growing Shortages at State's Hospitals" Sunday, October 27, 2002

3.  California Strategic Planning Committee for Nursing, Phase 3 Final Report, September 2002

4.  Florida Hospital Association Survey, RN Recruitment/Retention, August, 2001.

5. Lee, B. (2001). Keep your nurses and healthcare plain professionals for life. Calgary, Canada: Mastery Publishing Co.,p.34

6. AONE. (2002, Sept.). Say what? What California nurses say about working , Nurseweek/AONE Study

7. Kaye, B.L., Jordan-Evan, S. (2002). Love 'em or lose 'em: Getting good people to stay. San Francisco, CA. Benett-Koehler Publishers.

8. Abrams, M (2002, March). Employee retention and turnover: Holding managers accountable. Trustee. Chicago, 55 (3), T1.

9. Turner, Susan Odegaard,"Staying Power" Nurseweek, June 20, 2004

10. Hill, J, (2003, December 15). System allows nurses to bid for pay, shifts online . Nurseweek, p.3 www.nurseweek.com

11. ANA Nursing Call to Action presented by Foley, Mary, California Nursing Summit, 9/13/02, Sacramento

12. McClure and Hinshaw, Magnet hospitals Revisited , American Academy of Nursing, Summer 2002 p.1

13. Olson, Jan, "A Tool for Attracting Nurses" Contemporary Long Term Care, October, 2002 p 42-44.

14. Los Angeles City Fire Department Deferred Retirement Option Plan, brochure, 2001.


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