The Leader's Circle of Influence in Managing Turnover

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

Nurse retention has become a priority leadership concern nationwide. We lack real-time national data, but anecdotal evidence suggests that current turnover in many settings may far exceed the 19% reported at the end of 2020. Hiring experienced staff to replace them is extremely difficult. The use of agency and travel nurses to fill core positions is widespread, albeit expensive.

Workforce instability and turnover post-COVID is not unique to nursing. At the 2021 Gallup Work conference, it was noted that 51% of employees globally are looking for new jobs. After a lifequake experience, it is not unusual for people to rethink all aspects of their lives and work. This rethinking sometimes leads to seeking different employment and/or relocation to another part of the country.

Without current national data on these changes in the nursing workforce, nurse leaders are often on the defensive in their organizations to explain turnover in their settings. One nurse leader recently told me that her CEO had a two-year-old study that reported an oversupply of nurses. She tried to explain with limited success that the current nursing workforce post-COVID is vastly different from 2019.

In this era of instability, it is important to go back to the basics – what is in the nurse manager’s circle of influence relative to the retention of staff versus their circle of concern where they have less impact.

The Nurse Manager’s Circle of Concern

Organizational pay/benefits package
Competitor sign-on bonuses
Staffing ratios/acuity guidelines
Health system recruiting practices
Health system onboarding programs
Internal transfer policies
Organizational communication transparency
Admission/transfer and discharge practices
Organizational tuition reimbursement/loan repayment programs
Organizational/Union contract work rules

The Nurse Manager’s Circle of Influence – (Your Greatest Opportunities to Impact Retention)

Unit/team culture
Unit recruitment practices
Team inclusion/psychological safety
Leadership communication
Leader responsiveness/a bias for action to fix problems
Unit-based onboarding of new staff
Nurse recognition
Career coaching
Strategic offboarding of valued staff

There are aspects of staff turnover that leaders have no control over, BUT there are some key areas outlined above where leaders can make a difference in whether staff leave or stay. In today’s chaotic environment, my advice is, to begin with, those opportunities in your circle of influence. This is where you, as a leader, will have the most control and impact.

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