Bedside Nurses: Undervalued, Poorly Retained and What Experts Say

Healthcare is experiencing a shrinking pool of bedside nurses. Poor work conditions, high patient ratios and inadequate pay are just a few reasons why nurses are turning away from the bedside. This article will take a look at what nurse leaders say and have implemented to retain skilled and experienced nurses.

Updated:  

Bedside Nurses: Undervalued, Poorly Retained and What Experts Say

In hospitals across the country, experienced nurses provide orientation to an ever-revolving door of new hires. The need to retain beside nurses is well known and solutions widely researched. Yet, work conditions in acute care settings are slow to improve and many nurses turn away (or run) from bedside nursing.

According to NSI Nursing Solutions, Inc., hospitals saw the highest turnover rates in 2018 when compared to the last 10 years. From 2014-2018, hospitals turned over a staggering average of 87.7% of staff. While most hospitals identify nurse retention in key strategic planning, it is not followed through in operational practice and planning. According to the report, only 43.2% of hospitals have put their strategic plan into formal retention strategies.

Do Graduate Programs Play a Role?

I recently read an editorial, authored by Maureen Kennedy, MA RN FAAN in the American Journal of Nursing, questioning if the push by colleges for students to attend graduate or doctorate nurse practitioner programs is contributing to the devaluing of bedside nurses. Research has clearly shown hospital working conditions to be the primary reason nurses are leaving the bedside. Most of us have experienced long hours, lack of flexibility and poor leadership while working in acute care at some point in our careers. And, the large need for advanced practice nurses in today’s healthcare environment, as well as the need for qualified nurse faculty, is undisputed.

Hospitals typically don’t have work environments that offer nurse autonomy or promote professional practices. Nurses may see an advanced degree as offering job opportunities that are more supportive, with greater autonomy and less stress. The editorial’s author summarized the issue by quoting a colleague:

Quote

“The narrative must be shifted to embrace the full range of roles and contributions of all nurses. Our healthcare system depends upon a well-trained, experienced workforce. The trend toward our hospitals being primarily populated with nurses with less than two years’ experience is worrisome”. If hospitals want to retain nurses long-term, workplace environments need to change and demonstrate the value of bedside nurses."

Keeping Nurses at the Bedside

Healthleaders magazine recently published an article sharing what three nurse executives did to retain RNs with the right skills and experience needed to deliver high quality care. Here are a few of the ways the executives improved their facility’s retention rates for the long haul.

Improve the Organizations Reputation

Rush Oak Park Hospital in Illinois was plagued with a negative reputation because of consistently poor quality outcomes. The hospital’s reputation bled into the work environment resulting in nurse dissatisfaction. In addition, there was a “revolving door” of chief nursing officers leading to inconsistent leadership and vision. Karen Mayer, chief nursing officer, knew the work environment needed to change and hospital leadership was up to the challenge. Over a period of years, leadership worked to improve quality indicators to improve patient care and nursing job satisfaction. After many years, turnover rates decreased from 22% to just 8.3%.

Entice Nurses Back to the Bedside

Press Ganey’s 2017 National Database of Nursing Quality Indicators RN Survey found newly licensed nurses and those who have been in practice 2-4 years at highest risk for attrition. Claire M. Zangerie, chief nursing executive at Allegheny Health Network saw the same trend within her organization. Under her direction, the RetuRN to Practice Program was created to address some of the issues leading to attrition. The program was designed to attract nurses who have stepped away from nursing and want to return to the bedside. As a result, the workload of all nursing staff was successfully lessened.

Attract nurses with flexible scheduling

RetuRN participants offer managers at least 3 hours availability at any time, on any day, day shift or night or any weekend or holiday. The nurses help ease workload in high need areas and perform “rover-type” duties, such as admissions, discharges, patient education, covering other nurses’ patients for breaks or for continuing education. Extensive on-boarding, remediation, training and support is offered to RetuRN participants to ease the transition back to the bedside.

Support Professional Development and Work Environment

Kelly Johnson, vice president, patient care services and chief nursing officer at Stanford Children’s Health understands a healthy work environment and professional development programs are critical to retaining nurses. Therefore, Johnson developed and implemented several programs to support nurses in various stages of their career. Nurses have opportunities to continue growing through personal success plans, a succession planning development program, certificate and advanced degree programs.

The organization has also committed to creating a healthy work environment and culture. This includes initiatives embracing HeartMath concepts that empower employees to “self regulate emotions and behaviors to reduce stress, increase resilience, and unlock their natural intuitive guidance for making more effective choices”. The goal is to create a work environment that is caring and healing, where nurses care for each other and themselves.

What programs or initiatives have you experienced that improved the work environment of bedside nurses?

Additional Resources

NSI Nursing Solutions 2019 National Healthcare Retention Report

Want to Keep Nurses at the Bedside? Here’s How

Nurses at the Bedside - Who Will Be Left To Care?

6
Up Vote Up Vote ×
J.Adderton

About J.Adderton, BSN, MSN

(Columnist)

J. Adderton MSN has over 20 years experience in clinical leadership, staff development, project management and nursing education.

121 Articles   502 Posts

Share this post

Share on other sites
Specializes in IMC, school nursing.

After three decades in bedside nursing I have seen it change immensely. My experience has seen better staffing ratios, but sicker patients. The biggest change I have seen is in managerial support. I come from Head Nurse era, where a nurse worked up from floor nurse to LEAD the unit. The semantics of head nurse and manager are very important. Head nurse implies a nurse who is at the front of them all, someone who can do the job alongside the others, a leader. Managers probably have limited experience working next to their staff, they took a managerial tract to get there, and if there is any floor experience, it can be counted in months compared to years. I have found the "professional push" for nursing in the last 20 years to be detrimental to the patients and staff, alike. BSNs come out ready to lead and ill prepared to work, their experience poorly lacking. When I am laying in that bed, give me a diploma nurse over any nurse with lots of letters behind their name. This is why people are leaving. Poor management and ill equipped support from coworkers.

39
Up Vote Up Vote ×

Personally, I don't really care what the Nursing 'experts' have to say on this subject and most others. In my experience, they (Nursing experts) are usually the nurses that have minimal clinical experience and have gone on to obtain graduate degrees so that they could escape the unpleasantness of bedside nursing. I much more value the opinions of the workaday nurses who are in the trenches and fight these battles every day. Also my opinion, but I feel that many of our so called nurse leaders have sold out to corporate healthcare-HCA et. al, and are now the puppets of senior management-but that's a whole other story.

30
Up Vote Up Vote ×
Specializes in Emergency.

Why has every unit gone to the 12 hour staffing model? It is sold to the staff as a way to have more days off and pursue other things. What really happens is you burn out faster, spend the first day or two inert and by the time you're refreshed its back to doing it all over again. Who really benefits from 12 hour shifts? I would guess management does. Less nurses to hire, hour blocks that are fixed and only two shifts to staff.

I'm looking for non-12s. My friend who became a RN the same time I did told me last night that he is going to start classes for his NP to get away from the 12-hour sprint that he lives in CCU. I don't blame him.

18
Up Vote Up Vote ×
Specializes in Nursing Professional Development.
3 minutes ago, CKPM2RN said:

Why has every unit gone to the 12 hour staffing model? It is sold to the staff as a way to have more days off and pursue other things. What really happens is you burn out faster, spend the first day or two inert and by the time you're refreshed its back to doing it all over again. Who really benefits from 12 hour shifts? I would guess management does. Less nurses to hire, hour blocks that are fixed and only two shifts to staff.

I'm looking for non-12s. My friend who became a RN the same time I did told me last night that he is going to start classes for his NP to get away from the 12-hour sprint that he lives in CCU. I don't blame him.

My experience (which may not be universal) is that it has staff nurses who want the 12-hour shift. When I was young, almost everyone worked 8-hour shifts. But gradually, over a period of a few years, things shifted to the 12-hour shift as the norm. I have been through 2 votes (in 2 different hospitals) asking staff to vote for either 8's or 12's. Management was willing to go either way. Both times, the staffs voted for 12's. They preferred having to work only 3 days per week to be considered full time instead of 5 days per week. People with kids didn't want to pay for child care 5 days per week. Students wanted more days off to go to focus on schoolwork, etc.

People chose to work harder/longer for 3 days a week rather than have a shorter workday, but have to work 5 days. Those votes were actually several years ago. I wonder how they would go if there was a vote today. I suspect most would still choose 12-hour shifts for the same reason.

10
Up Vote Up Vote ×

First, more staff.

15
Up Vote Up Vote ×
Specializes in Critical care.

Our hospital is pretty comical in regards to retention. All of the other acute care hospitals in the area have post-retirement health care, and a pension of some sort. When we bring this up we are told …. but you get free parking. In their strategy meetings they feel that because our hospital has received numerous awards that nurses work here because of that. I am not sure how insanely more out of touch with reality anyone could possibly be.

16
Up Vote Up Vote ×
Specializes in corrections and LTC.

I started nursing back when it was 8 hour shifts, within the first few years we went to a mix of 8's and 12's. Now you can't hardly find a job where it is 8 hour shifts other than an office job (even they are not 8's). What I see is not that nurses are enjoying their days off, but that they are picking up extra shifts or a second job since they have '4 days off'. I see more burnout, more mistakes, less compassion. It isn't only the extra days that nurses are working, but the higher acuity and in some areas, the shortage of nurses and CNAs. I know that not everyone believes in the nursing shortage, and I can only speak for the region that I live in. Wyoming and surrounding rural states have a huge lack of nursing and CNA staff. Honestly, the jobs are killing us.

10
Up Vote Up Vote ×
Specializes in Mental health, substance abuse, geriatrics, PCU.

Poor staffing, inconsiderate management, unrealistic demands, ever growing list of tasks (mostly documentation), increased verbal/physical abuse from patients and families, minimal pay raises, poor retirement, expensive insurance, denied vacations, 3 sick days a year, who wouldn't want to get away from that?

29
Up Vote Up Vote ×
18 hours ago, J.Adderton said:
10 hours ago, ocean.baby said:

It isn't only the extra days that nurses are working, but the higher acuity and in some areas, the shortage of nurses and CNAs. I know that not everyone believes in the nursing shortage, and I can only speak for the region that I live in. Wyoming and surrounding rural states have a huge lack of nursing and CNA staff. Honestly, the jobs are killing us.

Nurses or CNA's can't enjoy their jobs anymore. It's not 5 patients. It's 50.

4
Up Vote Up Vote ×
Specializes in Cardiology.
18 hours ago, CKPM2RN said:

Why has every unit gone to the 12 hour staffing model? It is sold to the staff as a way to have more days off and pursue other things. What really happens is you burn out faster, spend the first day or two inert and by the time you're refreshed its back to doing it all over again. Who really benefits from 12 hour shifts? I would guess management does. Less nurses to hire, hour blocks that are fixed and only two shifts to staff.

I'm looking for non-12s. My friend who became a RN the same time I did told me last night that he is going to start classes for his NP to get away from the 12-hour sprint that he lives in CCU. I don't blame him.

I am now scheduling 3 12's in a row less because after 4 years I am spent. It isn't worth it where Im at. My previous job it was but not now. I even volunteered to do 2 12's and 2 8's.

1
Up Vote Up Vote ×
Specializes in Cardiology.

These so called "experts" are the ones responsible for what is going on now. I dont know how many times Ive seen yearly surveys that ask about staffing and every time nothing is done to combat the burn out. Im getting so sick of upper management asking "What can we do to retain staff?". You damn well know what it is but refuse to spend the money.

20
Up Vote Up Vote ×
+ Add a Comment