Making Inpatient Nursing Roles More Desirable

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

Nurse leaders had hoped that in 2022 they would be able to stabilize their nurse staffing. Instead, quite the opposite has happened. Nurse resignations have continued and, in many places, even increased. It is a problem that is confounding nurse leaders and one with no easy solutions. Many nurse leaders now feel sad, anxious, and unsure about the next steps. Even with a drop in COVID patients, volumes in many hospitals have not decreased, and travel contracts are still serving as a finger in the dike.

A new study released by the McKinsey group last month indicates that the nursing shortage is likely to be with us for a very long time, with inpatient nursing roles being the most impacted. Thirty-two percent of the randomized sample of direct care nurses surveyed in November of 2021 indicated that they are likely to leave their current roles – an increase of 10% from research conducted only ten months ago. Only one-third of the nurses who plan to leave will again seek employment in direct patient care. Their findings indicate that healthcare environments are getting worse from the perspective of nurses who work in them. Nurses with ten years or less experience are at the highest risk, as are nurses who feel less of a sense of purpose and less connected to their teams.

The top six reasons cited for intent to leave include the following:

Insufficient staffing
Seeking higher pay
Not feeling listened to or supported at work
The emotional toll of the past two years
The demanding nature of nursing work
Childcare and family demands

McKinsey sounds the alarm that hospitals are in serious trouble moving forward without substantive changes in work environments as inpatient units become more challenging to staff. Their study findings provide some clues about making inpatient nursing roles more desirable. Support levers that received the highest marks include embedding more breaks in the shift, recognizing nurses’ contributions, and maintaining open lines of communication. Nurses also indicated that they need more upskilling on dealing with behavioral health issues with the escalating mental health challenges in the population.

McKinsey consultants note two key areas where health systems must improve to retain staff

1. Workforce retention strategies need to be more tailored to employee needs and preferences in the health system. It is not a one size fits all approach. They suggest this could include the following

doubling down on environmental factors (for example, team dynamics, purpose or meaning of work, feeling valued by the organization), flexibility,
and professional development opportunities.
ensuring total rewards offering is aligned with organizational strategy and meets a holistic set of needs (for example, dependent care and
mental-health services)
amplifying continuing-education programs, roles, and resources that support novice clinician” and “i” need” skill sets (for example, behavioral health)
providing training and resources for leaders to support the individual needs of their team members and collective team health.

2. Workload strain needs to be minimized with strategies such as:

deploying advanced analytics to improve accuracy and timeliness of demand forecasting, workforce alignment, and real-time labor management
redesigning roles and processes (including through digitization and automation where appropriate) to reduce friction points, increase flexibility, and incorporate support to enable top-of-license practice
exploring new ways to grow the talent pipeline, including ensuring that end-to-end hiring processes are as efficient as possible and exploring partnerships and career pathway designs focused on the highest workforce needs.

As I reviewed the data in the report, it seemed very consistent with what I have been hearing during retention webinars. One organization has already started to pull a support lever mentioned in this report. They are bringing back retired nurses and young Moms who can do four or 6-hour shifts for the sole purpose of providing patient coverage during breaks. It seems small, but they have found that it has genuinely improved morale.

McKinsey is a highly respected consulting firm within the healthcare industry. Nurse leaders should share these findings with other leaders in their organizations. Nothing will change unless we get started making some small bets to make the environment healthier.

Reference

Gretchen Berlin, RN; Meredith Lapointe; and Mhoire Murphy (McKinsey and Company February 2022). Surveyed nurses consider leaving direct patient care at elevated rates Mckinsey Report 2022

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