Are Your Staff Net Promoters?

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Healthcare systems are spending millions of dollars to recruit and retain staff. But what if some of those efforts are undermined by your staff? Consider the following story that a nurse leader shared with me:

I was at the gym and overheard two nurses talking about their hospital – our local competitor. In loud voices, they were trash-talking the organization and its leaders. It made me wonder whether we may have nurses doing the same thing. 

This leader made such a great point. As leaders, we know that our staff can be our best recruiters. One leader recently talked with me about a young nurse who earned $50,000 last year in referral bonuses. She is a fantastic recruiter with her TicTok videos touting her organization and has found a lucrative side hustle that is a win-win for both her and the health system. But what if the opposite is true and staff not only don’t promote the organization but also discourage others from applying? How would you know if that is true?

One way to do this is to measure the net promoter scores of your staff as one organization is doing. They measure this metric quarterly via a pulse survey. When you think about it – it makes sense. Younger nurses regularly use online ratings to make decisions about products and services. They are more likely to value a rating or recommendation from a friend about an excellent place to work versus outreach from your recruiting staff.

Net Promoter or Net Promoter Scores are a widely used market research metric that typically takes the form of a survey question asking respondents to rate the likelihood that they would recommend a company, product, or service to a friend or colleague. It is also part of the HCAHPS patient satisfaction assessment.

A net promoter score for nurse recruitment can be done organization-wide or at the unit level by asking how likely you are to recommend nursing employment on this unit (or in this organization) to your friends and colleagues. The question should be asked using a Likert Scale of 1-10 from very unlikely to very likely, and the NPS is evaluated in the following way:

Promoters (9-10) – these are your most engaged and satisfied nurses who promote employment in your organization.

Neutral (7-8) – these nurses may be content to stay themselves but are not likely to promote the organization to their colleagues or friends.

Detractors (1-6) – these nurses are unhappy and disengaged. They won’t recommend employment to other nurses and may even discourage others from applying, as those nurses in the gym story above.

We can use the example of a critical care unit with high nurse turnover. If I were the manager, I could do a net promoter assessment (which should be anonymous), giving me an average score for the unit and breaking down the number of nurses in each group. I would then calculate employee net promoter scores by deducting % of detractors from your % of promoters. You ignore those who score 7-8, otherwise known as your ‘passives.’ Your result is measured on a scale from –100 to 100. If 30% of my ICU staff are promoters and 20% are detractors – my net promoter baseline is 10%. I now have a baseline to design a plan to improve it. I would share the data with staff and seek ideas about areas for improvement.

Although an Employee NPS can measure success, it’s only significant compared to a previous score or another organization’s results. On its own, it can’t tell you much. But it is a good place to start. Nurses listen to other nurses, especially in the current environment. If your staff is not promoting your organization, the most expensive recruitment strategies will not likely work.