On my particular unit where I work I’ve recently noticed an outflux of staff. Many are leaving to pursue academic advancement, and others are seeking additional opportunities. It happens; especially in nursing.
I have been in my particular area for some time, and every 2-3 years I see a gentle rise in staff leaving. It’s always a bit frightening to see them go, and you wonder, will this cause patient care to suffer? After all, that’s who’s really affected by the issue of nursing retention. The patient. But thankfully, as history has shown, new staff come to fill the empty slots, and the machine of healthcare continues to chug along. Yet I wonder, what if it didn’t? What if it couldn’t?
In my specific circumstances it’s no definitive fault of the unit or the organization that causes staff to leave, but it does make one think. What can we do to retain nurses? It’s not any one individual’s responsibility, but rather the job of us all to keep staff happy. Together maybe we can help lessen the staff shortages in our area.
So how do we do that?
Pay. Increase it.
There. That’s it. End of blog. Thanks for reading along.
No, seriously, I mention pay first because it’s important, and though it’s certainly not the reason that nurses nurse it is a deciding factor in where they work.
If a nurse can travel a little over an hour away and make a considerably higher paycheck then they will likely do so. The issue of pay is a problem in rural areas. Hospitals don’t have to compete as much in these smaller towns, but when nurses see the pay of their counterparts 45 miles away they honestly become jaded. The grass (paycheck) truly becomes greener.
I’ve worked at hospitals that offer sign-on bonuses, competitive pay, and other monetary incentives, such as money for furthering your education. It helps, and it makes a nurse feel appreciated.
Perhaps pay scales should also reflect the area where you work. Pay incentives could be offered for areas where your skill level, stress level, and level of critical thinking is higher. And perhaps a nurse who stands on their feet for thirteen hours should make more than one who sits at a desk for eight, not vice versa.
Incentives are a good way to maintain retention. Aside from the fact that I love my hospital organization and my unit, I remain here due to the incentive of my particular schedule. I’m supremely blessed with it, and this schedule offered to me allows me to make a living and care for my young children, and that’s important to me. We should do this more.
Self-scheduling, clinical ladders, on-site daycare, and many other incentives that allow a nurse to know that they are valued and their personal life is important to the employer; this is what keeps staff happy.
And so does staffing adequately. It’s a must. I know this seems like a catch-22. How can I staff adequately if I don’t have the staff?! Well, I personally believe, as a frontline nurse, that when placed in an overworked, possibly unsafe environment you don’t want to stay. I mean, who wants to pull double the load? No one.
If we can build a strong, core staff, and keep them happy, they will stay. Then the key is to staff adequately so nurses don’t feel overwhelmed and under-appreciated. This is no easy task, but once an appropriate ratio of staff is obtained it should be utilized. Payroll is important to an organization’s longevity and profit, but in the long run more funds are used to repeatedly train new staff than could have been spent to pay the ones you once had but lost due to stress and exhaustion. Does this make sense?
No one needs overtime every week. Weekends off are a great thing, and this is where the incentive of weekender positions benefit everyone. They are costly, but again, it costs less in the long run if you can retain your staff. Staff builders or outside staffing agencies to supplement areas are a beautiful thing. Having a pocket of dependable prn personnel is important also.
No nurse wants to hear phrases like “suck it up” or “put on your big girl panties.” To me, I just hear, “your comfortability isn’t a priority to me.” Lawsuits are real, and no one wants to be a part of one due to unrealistic work environments.
Charge nurses can’t be expected to take a full load of very ill patients just like the other staff nurses, but then be held responsible if something goes terribly wrong on their watch. And then only get a quarter extra for their troubles.
And teamwork goes a long way on a busy unit, but that only carries you so far. After nothing but bad days a nurse can get burnt out.
It’s also important to create a motivating environment for the staff you have. Nurses love nursing. It’s why they went into the field, and what keeps them in it. Nurses love knowledge, and they enjoy the opportunity to learn new things. If new nurses are being oriented to a rotation that sits around on their phone they’re gonna wonder what they’re doing there.
New staff needs continued motivation that they are learning more and more. They need to feel like what they’re learning is needed for patient care. Preceptors need to be selected carefully, and they need to have the ability to excite and motivate new staff. Just because someone has been around a while doesn’t mean they need to be the trainers. You might be perpetuating an attitude of dissatisfaction. One bad apple ruins the barrel.
I recall having a CEO once who met with staff regularly, and he showed them how their actions were changing the culture to positively impact patient care. His words motivated his people, and I was excited to be a part of his organization. People thrive on team-building.
Create excitement over what staff contribute. Make sure they know their actions are saving lives, making a difference, and an integral part to the team. A “thank you” and “job well done” can carry a stressed out staff member even beyond what a 2% raise may do, but don’t quote me on that. We still want the raise.
In that same vein of thinking it’s important to empathize with your staff. You never want to rise so high up the corporate ladder that you forget from whence you came. That’s why it’s important to remind yourselves of what it’s like in your staff’s shoes. Come out on the floor and get your hands dirty. Often.
When the feces rolls downhill, and problems must be addressed, try to place yourself in the position of your nurses prior to the wording of your hasty emails/memos or irrational rants. Try and remember what it’s like to be in the thick of patient care, and remember how to be realistic. Unrealistic expectations will always lead to disgruntled nursing staff.
Try to whittle down to what’s important. Just like with being a parent, as a leader you must pick your battles. What ranks top with you? Is it quality, safe patient care or perfect restraint documentation? Are you placing too much emphasis on patient satisfaction surveys in the face of extremely dissatisfied staff? Just a thought.
On a personal level, I know my unit will come out on top. It’s a great place to work, and we’ll pull together and rise out of the ashes as we’ve always done. But it never hurts to realign our thinking towards improved retention. We can always improve our hiring processes and utilization of present staff.
As I said before, retention is no one person’s responsibility. It falls on all our shoulders. Our ability to retain, train, and excite the next generation of nurses is detrimental to continued, great patient care. One day we’ll be patients, and we’ll desire a dedicated healthcare team for ourselves and our family. And if that thought isn’t motivating, then I don’t know what is.