In September 2021, over 90% of the healthcare organizations that Nurseify supports, which includes 821 of 908 hospitals, reported their highest year-over-year increase in nurse turnover and all-employee turnover in the last 10 years (Source: Client RN turnover and all employee turnover data). The Great Resignation is real, and unfortunately, the healthcare industry is likely to experience greater attrition than most industries due to the long-term strain of COVID-19. Multiple studies have shown that healthcare workers, particularly nurses, experience depression, anxiety and chronic stress during disasters. In research conducted by Dr. Christine Kovner, PhD, RN, FAAN, Rory Meyers College of Nursing, New York University, over 27% of nurses reported experiencing anxiety and 17% reported experiencing depression after the initial COVID peaks in 2020 (Source: The psychosocial impact on frontline nurses of caring for patients with COVID-19 during the first wave of the pandemic in New York City. Nursing Outlook. April 5, 2021). Dr. Kovner’s research also found that the more that nurses cared for patients, the higher the nurses’ depression and anxiety. This does not bode well for an industry that was already on a path to a seven-figure workforce shortage. Despite the challenges, we will explore a few next generation retention strategies that organizations are executing to retain their employees.
#1: GO “ALL IN” IN PROTECTING YOUR EMPLOYEES AND #ENDNURSEABUSE
One in four nurses are abused in the workplace. Overall, the likelihood of healthcare workers being exposed to violence is higher than for prison guards or police officers. (Source: American Nurses Association #EndNurseAbuse Resource Guide. 2016). In 2020 and 2021, 65% of the organizations that included a statement in employee engagement surveys on the facility taking steps to protect employees’ physical safety at work saw a year-over-year drop in scores (Source: Client employee engagement survey results). One hospital used the feedback employees provided in their 2020 employee engagement survey to build and launch a comprehensive program to eliminate workplace violence in their facility. The hospital is also recognized as one of the Best Places to Work. A few of the steps the organization took to address workplace violence and end nurse abuse are provided below.
- Step 1: The chiefs conducted root cause analyses on every workplace violence incident over the last three years.
- Step 2: Department leaders sourced recommendations to prevent workplace violence from front-line nurses and employees during one-on-one sessions over a 60-day period.
- Step 3: The Nursing Professional Practice Council customized the recommendations included in the American Nurses Association’s #EndNurseAbuse Resource Guide to align with hospital policies and practices.
- Step 4: Human resources and marketing developed a plan to communicate the facility’s zero-tolerance policy to employees, physicians, emergency medical services (EMS), patients and family members of patients.
- Step 5: Leadership made a commitment to treat every workplace violence incident like a sentinel event and established a cross-functional team to conduct realtime root cause analyses.
Although it is too early to see the longterm effect on workplace violence incidents, the hospital saw a 12-percentage point increase in employee engagement scores for the statement, “My facility has taken steps to protect my physical safety at work.” Physical safety is next to air, water and food in Maslow’s hierarchy of needs. Organizations that do not protect the physical safety of their employees will have a difficult time retaining employees over the long run. Best practice sharing drives healthcare innovation, and organizations that solicit insights from front-line employees, nurse leaders, operators, administrators, human resources professionals, patients and family members are finding new ways to eliminate workplace violence.
#2: REWORK YOUR STAFFING PLAN TO MINIMIZE CLERICAL WORK FOR CLINICAL STAFF
As we continue to see nurses leave the bedside and the healthcare industry altogether, patient-to-nurse ratios remain at alltime highs despite declining COVID cases. The pent-up demand for elective healthcare procedures and the winter flu season will continue putting pressure on staffing levels. Before COVID, nurses in a medical-surgical unit at a hospital in Texas were typically assigned four to five patients per shift. Since January 2021, the nurses in the same medical-surgical unit are consistently caring for six to seven patients each shift due to nurse staffing shortages. The hospital developed a nurse retention strategy to address workload concerns and high patient-to-nurse ratios. The strategy includes an aggressive patient care tech (PCT) plan that doubled the number of PCTs in all inpatient units.
PRE-COVID
- Medical-surgical beds = 40
- Medical-surgical RNs per shift = 10 (Every RN is assigned four patients)
- Medical-surgical PCTs per shift = 4 (Every PCT is assigned 10 patients)
- Medical-surgical RNs & PCTs per shift = 14
POST-COVID
- Medical-surgical beds = 40
- Medical-surgical RNs per shift = 6 (Four RNs are assigned seven patients, and two RNs are assigned six patients)
- Medical-surgical PCTs per shift = 4 (Every PCT is assigned 10 patients)
- Medical-surgical RNs & PCTs per shift = 10
AGGRESSIVE PCT PLAN (Q3-2021)
- Medical-surgical beds = 40
- Medical-surgical RNs per shift = 6 (Four RNs are assigned seven patients, and two RNs are assigned six patients)
- Medical-surgical PCTs per shift = 8 (Every PCT is assigned five patients)
- Medical-surgical RNs & PCTs per shift = 14
Prior to executing the aggressive PCT plan, nurse leaders worked with bedside nurses to identify clerical work being performed by nurses and reworked the PCT job descriptions to transition as much clerical work as possible to PCTs. The hospital revamped its PCT orientation and onboarding program to provide specific training on the new PCT roles and responsibilities. The human resources team partnered with community colleges and local high schools to promote the new PCT opportunities to students completing their certification. Thirty-two new PCTs were hired over a 4-week period. Nurse leaders and recruiters also partnered with two local nursing schools to bring on nursing students to work as seasonal PCTs during the summer.
The aggressive PCT plan does NOT replace the hospital’s long-term plan to increase the number of full-time and part-time nurses. The PCT plan is providing short-term relief to nurses that have been carrying high patient loads for nearly a year. By giving nurses the opportunity to provide insight on the solution, the hospital also gave nurses a voice. In the Q4-2021 employee engagement survey, the hospital’s inpatient units saw a 20-percentage point increase on the statement, “I have access to the resources I need to do my job effectively,” and a 24-percentage point increase on the statement, “I receive support from my supervisor to help balance my work and personal life.”
The nursing shortage is not going away anytime soon. Rethinking the way care is provided and modifying roles and responsibilities are essential to addressing workload concerns. Organizations must develop shortterm and long-term strategies to retain employees.
#3: TREAT NURSE MENTAL HEALTH AND WELLNESS LIKE ANNUAL CODE OF CONDUCT TRAINING
Earlier, we discussed the effects disasters have on the mental health of nurses. Every day, nurses and nurse leaders are asked to do more with less. Between July 1 and September 30, 2021, we asked 1,100 nurses to provide one word that best describes how they are feeling. The top three words were overwhelmed (22%), exhausted (17%) and tired (15%). On a positive note, most healthcare organizations are engaging in dialogue on the mental health and wellness of their workforce. Unfortunately, we continue hearing disappointment from nurses and nurse leaders that organizations are not taking more action.
One hospital in Florida decided to treat nurse wellness like annual code of conduct training and make it mandatory. The hospital has a long history of ensuring all employees complete code of conduct training every year. Systems and processes are in place to ensure every employee reviews the organization’s code of conduct policy and expectations. Mandatory can be a polarizing word, but the chief nursing officer and chief human resources officer believed the best way to drive participation in a wellness program was to make the program mandatory.
The hospital partnered with an organization to provide one-on-one wellness coaching sessions to 90 nurses. The wellness coach, who is a certified mental health nurse practitioner, conducted two rounds of one-on-one coaching sessions over a 12-week period. Significant effort was put into planning the one-on-one coaching sessions, and the hospital did an amazing job addressing issues that could have prevented nurses from participating in the program. For example, nurses attended sessions during their normal shifts instead of coming in early or staying late. To ensure nursing departments were not left short-handed, relief nurses were brought in to backfill the nurses that participated in the one-on-one coaching sessions throughout the day.
The feedback from nurses and nurse leaders has been overwhelmingly positive. In the Q3-2021 employee engagement survey, the hospital saw a 25-percentage point increase on the statement, “The behavior of our senior leaders is consistent with this company’s values.” Nurses appreciate the commitment the organization made to support their mental health and wellness.
Retaining employees in today’s environment is a monumental task. We all play a part in supporting our colleagues and creating a healthy workplace environment. Despite facing unprecedented challenges, leaders that act are seeing positive results. We encourage you to keep up the good fight and share your next generation employee retention strategies.
, MBA, is the CEO/Founder of Nurseify, Inc. He also is a current member of the CMSA editorial board. You can reach Benjamin via email at [email protected].
