Nursing Turnover - A Growing Concern

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

After almost of decade of low nursing turnover rates, many health systems are once again experiencing high rates of nursing turnover. In a NationalHealthcareRNRetentionReport2016compiled by NSI solutions, the national turnover was reported at 17.2% for 2015. This summer, the Missouri Hospital Association reported that turnover in that state had risen to 17.9% a year for nurses working in hospitals. With an improved economy, many Baby Boomers who had put off retirement are now leaving. Newer staff are finding many more employment options and are willing to leave if dissatisfied. A recent report by AMN Healthcare also indicates that nurses under 40 are or are planning to return to graduate school in record numbers to become advanced practice nurses. When they do this, they often either reduce their hours or stop working completely.

Some turnover is to be expected but when it climbs above 10%, there are high costs in salary replacement, training of new staff and potential quality issues. Depending on the specialty area, the cost of a RN loss can reach $82,000. If you have 500 RN FTE and 17.9% leave each year – you could experience a revenue loss of as much as 7.4 million dollars a year. For some health systems, these increased costs are coming at a time when they are already struggling with reduced reimbursement. In a 2015 Hospitals and Health Networks article, Karlene Kerfoot, the Chief Nursing Officer for GE Healthcare offered the following 4 strategies to reduce nurse turnover:

Reduce Overtime – mandatory overtime or on call requirements are huge dissatisfiers especially for Millennial nurses who value their time off. Unfortunately once staffing problems start, it can be a viscious cycle as leaders try to safely staff units by requiring staff to work more hours.
Practice Shared Governance – Lack of empowerment and involvement in decision making leads to disengagement. Shared governance is one strategy to try to keep staff involved in decision making. This also requires nurse leaders who value shared governance and practice at the unit level. Leadership research consistently shows that the quality of relationship that a nurse has with his/her manager is a strong predictor of retention.
Implement Data Driven Staffing – Inadequate staffing is a frequently cited reason why nurses are leaving employers today. With skill mixes trending toward less experienced nurses, this is especially important to provide the level of support that is needed. Nurses may be more likely to leave if they are placed in patient care situations that they are not equipped to handle.
Develop Quality of Life Initiatives – The current healthcare environment is complex and often chaotic. Healthcare staff are at high risk for burnout as expectations of patients and employers continue to increase. Quality of life initiatives that promote resiliency are essential today. This could include support for learning meditation and mindfulness, quiet rooms, gym memberships, onsite childcare, yoga and more time off for family and friends. Actively promoting friendships at work matters because Gallup has considerable data to support that having a best friend at work is linked to retention and engagement.

It has been a very long time since we have seen nurse turnover widely discussed as a leadership challenge. Leaders will need to carefully watch this trend and search for new, innovative solutions.