Case Study: The first defense in workforce stabilization is retention
By Tonda Verdejo, RN, MSN, for HealthLeaders.com, June 25, 2001
It's a game of strategy being played by all healthcare providers: desperately seeking qualified, competent healthcare workers. Human resource personnel are frantically developing creative approaches to attract the brightest and the best. Participation in media marketing, direct mail and job fairs are at an all time high and are more competitive than ever. Wise recruitment strategies remain key to our survival, but are not enough in today's environment to keep the supply adequate.
While recruitment efforts are at an all time high and dollars are being generously allocated to lure people into our ranks, we need to focus beyond recruitment and ask what it takes to keep individuals after they are hired. Recruiters are highly frustrated that turnover rates are outstripping recruitment numbers. As one seasoned recruiter stated, "It takes a lot of time and energy to recruit the right people. I don't mind, but it is disheartening to see these individuals leaving at an unprecedented rate. What is everyone else doing to retain the resources that I have worked so hard to hire?"
This is a problem in many healthcare settings today, and the recruiter's statement bears a lot of merit. Not only is high turnover impacting the job satisfaction of the recruiter, but staff are also highly frustrated and demoralized when new people come and go quickly. "We hardly finish orienting new nurses, and the next thing we know they are gone!" states one experienced nurse. High turnover and tight nurse patient ratios add to the staff's frustration, and we often see the experienced individuals looking for "greener pastures" in response to this frustration.
Today's more successful organizations are making retention a priority, as administrative and human resource executives grapple for solutions. Some solutions are successful, while some are failing miserably. Millions are spent annually on recruitment, but this is wasted money if recruits are leaving as quickly as they are arriving. It is evident that retention is the key to survival. Since this is true, how do we activate valid solutions for insuring a stable workforce?
Too often we are simply guessing based on recent research or "gut reactions". We need to be brighter than that and involve our stakeholders in creating retention strategies. Our stakeholders are the staff members who know best what makes employees want to stay (or leave!) an organization.
At New Hanover Regional Medical Center in Wilmington, N.C., we are trying a new approach to developing our workforce. Dr. Bill Atkinson, President and CEO, made a decision to aggressively address these issues by assigning a senior administrator to the task. In May of 2000, I had the privilege of moving from the position of Chief Nursing Officer to Special Assistant to the President for Workforce Development. This new role affords me the opportunity to work internally with administration, human resources and line staff. Externally, I focus my efforts on building partnerships with other hospitals, schools, colleges, community, and state and national organizations.
Over the past year, we have experienced some very exciting internal successes related to retention. Our proudest accomplishment is the development of a very successful mentorship program for newly graduated RNs. This program was created in response to a 34% turnover rate of new graduates from the 1999 classes. Double-digit turnover of new graduates two consecutive years was unsettling and unacceptable, so we challenged ourselves to significantly decrease this number in a very short timeframe.
A nursing committee was formed to develop the mentorship concept and set selection criteria for nurses interested in being mentors. Once the criteria were established, the program was publicized throughout the network, and applications were made available. Nurses were required to have a minimum of three years of nursing experience and two years of tenure within the network. We were seeking positive, committed role models, so each nurse applicant was required to submit two letters of endorsement - one from their immediate supervisor and one from a colleague.
Although we felt this was a perfect opportunity for veteran nurses, we were unsure about the interest level. We were elated when 51 nurses with more than nine centuries of experience came forward to be mentors for the 59 new graduates hired. This number far surpassed our wildest dreams. More than 75% have greater than 10 years in the profession, and 43% have worked at least 10 years in our network.
These mentors, who receive no financial compensation, provide career guidance, advice and leadership to newly graduated nurses. This is not a preceptorship, but a true mentorship where the experienced nurse serves as role model, coach, and advocate. Nearing the end of our first year of the program, we are thrilled to note that attrition in the new grad population is currently 8% - a huge drop from 34%. Feedback from these nurses reinforces that mentoring has been key to their decision to remain in our organization.
Another successful strategy has been developing "bridging letters" that are sent to RNs who have left the organization in good standing over the past 12 months. These letters invite the nurses back and guarantee a resumption of seniority and benefits, if they return within 12 months of their resignation date. We have had an 8% return rate of highly experienced staff nurses.
As noted earlier, administration must listen to line employees to determine what the important retention issues are. To remain connected, a Recruitment and Retention Committee has been established in our network that consists primarily of staff employees. These members are committed to reducing turnover and have worked diligently to produce internal successes. Examples are: Endorsing a change in our basic orientation program, facilitating a nursing externship for senior nursing students, supporting rewards for perfect attendance, and establishing consistency in flexible scheduling throughout the hospital. These employees feel very positive about their contribution to our retention efforts.
These are certainly not the only answers to the retention issue, nor are they necessarily the right answers for all organizations. Each setting must look inwardly, using their most valuable human resources, to identify productive strategies for their population.
Tonda Verdejo, RN, MSN, is Vice President for Workforce Development at New Hanover Regional Medical Center, a 628-bed general acute care hospital in Wilmington, N.C. (www.nhhn.org
) She has been in the nursing profession for more than 30 years and fulfilled multiple roles during her tenure, from staff nurse to leadership positions including Chief Nursing Officer, nursing educator, nursing consultant and her current position. She is active in multiple national and international organizations. She can be reached by phone at 910-343-2779 or by e-mail at firstname.lastname@example.org
Jun 30, '01
Its about time that the discussion with regards RN retention is finally getting its place in this discussion. Anyone that has taken any graduate human resources/business/administration courses was taught that the least expensive employee to attract is the one already working for you. Additionlly if retention factors aren't addressed and solved satisfactorily no recruitment strategies, either for individual employers or the profesion as a whole, will succeed in the long term. Long term problems can not be solved by short term solutions.
Last edit by OC_An Khe on Jun 30, '01