Bedside Nurses: Undervalued, Poorly Retained and What Experts Say

[J.Adderton]

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?

[MSO4foru, ADN]

Apologies for misspelling Munro. Several yrs ago, I applied for a manager position at my workplace and was told " to be a good manager you have to be able to talk out of both sides of your mouth convincingly... just don't think you can do that" . To date this is one of the highest compliments I have ever received- because I am a terrible liar.

[Secretperson]

9 hours ago, MSO4foru said:

Apologies for misspelling Munro. Several yrs ago, I applied for a manager position at my workplace and was told " to be a good manager you have to be able to talk out of both sides of your mouth convincingly... just don't think you can do that" . To date this is one of the highest compliments I have ever received- because I am a terrible liar.

I’m not even mad about this;)

[MunoRN, RN]

22 hours ago, Secretperson said:

So you are arguing that research directly relating to this is wrong...all of it? You are suggesting that the last few hours of a 12/hr shift actually has a decrease in possible errors? Yeah ok.....

However, You cannot argue that it is NOT cost effective for the organization to continue with 12's. The reason you cannot argue this based on two things:

1. You are staff and have never assumed a multi-million dollar budget for your units.

2. You have not sat in ELT meeting debating the need for improved staff morale and engagement by improving staffing ratios and reducing dependence on 12's and every other weekend staffing. Then subsequently being destroyed for having to increase your budget by 25%, so you go back to your staff and continue to crack the whip.

Something tells me you are the nurse who knows so much more than your leadership...wait till you get there, your tone will change.

I'm not sure where you're getting that I said all of the research relating to shift length is wrong.

There isn't research available on the risk of errors specific to each hour of a shift, but there is data on another concomitant factor of fatigue, employee injuries, based on each hour of a shift. And you're correct, there is an increased risk of injury, and presumably fatigue, in hours 9 through 12 of a 12 hour shift. However there is an even larger increase based on consecutive days worked, so the increase in consecutive days worked in a 8-hour shift system produce more measurable fatigue than do the additional length but fewer days worked of a 12-hour shift system.

I'm also not sure where you're getting that I agree with the theory that 8 hour shifts can reduce employer costs, I've pointed out a couple of times that employers are unlikely to realize the cost savings of the fewer nurses required with 8-hour shifts mainly because nurses are unlikely to work the same FTE as they would when working 12 hour shifts.

Prior to going into my second career (or maybe technically third or fourth) of nursing, I was a director of a department with a 7 figure budget, although I'm not sure what you feel that has to do with the ability to understand the shift length debate.

[Secretperson]

3 minutes ago, MunoRN said:

I'm not sure where you're getting that I said all of the research relating to shift length is wrong.

There isn't research available on the risk of errors specific to each hour of a shift, but there is data on another concomitant factor of fatigue, employee injuries, based on each hour of a shift. And you're correct, there is an increased risk of injury, and presumably fatigue, in hours 9 through 12 of a 12 hour shift. However there is an even larger increase based on consecutive days worked, so the increase in consecutive days worked in a 8-hour shift system produce more measurable fatigue than do the additional length but fewer days worked of a 12-hour shift system.

I'm also not sure where you're getting that I agree with the theory that 8 hour shifts can reduce employer costs, I've pointed out a couple of times that employers are unlikely to realize the cost savings of the fewer nurses required with 8-hour shifts mainly because nurses are unlikely to work the same FTE as they would when working 12 hour shifts.

Prior to going into my second career (or maybe technically third or fourth) of nursing, I was a director of a department with a 7 figure budget, although I'm not sure what you feel that has to do with the ability to understand the shift length debate.

8’s increase cost exponentially, my point is just that. Understanding the budget is my reasoning behind bringing up managing said budget.

Some of us fight daily for resources to improve morale and engagement, which is the point of this thread. Offering three shifts and a weekend duty option is expensive, and is nurse and patient centric. Very few HCO’s will fund this as nursing is still often viewed as an expense as they bring no discernible revenue.

I’m on your side, i’m just looking at things from a higher altitude.

[MSO4foru, ADN]

Ummmm .... what ' resources for improving morale/ enagement are you working toward?

[Nurse SMS, MSN, RN]

I left bedside because of sheer exhaustion. There was no such thing as an easy day. If a day aligned to be too easy staff got sent home and boom - hard again. I had PTSD dreams, anxious thoughts and my legs hurt for 36 hours after my shifts ended. When I got an anorexic patient that refused to be turned and my primary thought was concern over being written up for their decubitus I knew it was time to go. I had been on the floor for only 5 years. Staffing has to improve.

[CKPM2RN, ASN, EMT-P]

On 9/23/2019 at 2:25 PM, MunoRN said:

... but in general 12 hour shift staffing has been shown to reduce fatigue, errors, burnout, etc.

I think this would be a study that was commissioned to show the preferred results. Paid for by the 12 hour shift proponents of management and sold to the staff.

[raemcclain]

Can't say it any better than what is written above! I, too, had over 3 decades in nursing of all sorts. I loved it. I was so proud of what I had accomplished.
I was forced to obtain a BSN, on-line....biggest waste of money! And I will
be paying it off until after I die. Yes- a good diploma nurse, who learned
about nursing by being on her feet and having instructors that knew more
than just textbooks, is what is needed. Along with nursing CEO's, managers,
whatever, that will risk THEIR JOB to fight for their staff! If hospital management does not listen, then nursing heads roll!

[Subee2, BSN, MSN, CRNA]

There is no management left to speak for us. Once the DON became a corporate "vice-president", representation for nursing staff ceased to exist.

[winniewoman9060ret]

Nursing has changed over my 41 years as an RN. I did 12 hour shifts but learned my body was better suited to 8 hours. Now we say do self care, but do we? I am having issues with chronic back pain. I’ve had 2 surgeries maybe heading to three. All the lifting,turning patients alone working with the bed too low dose every other job we do takes a toll on our bodies. I have loved bedside nursing but am getting done in nursing. My hearts not in it, poor staffing, lack of management support, sicker patients, being a waitress to the family. It’s time to go.

One more stressors for new grad in NY state. You have to have your BSN within 10 years of graduating. Ugh. I never say now to education but this is going to be a tough one.

[Leader25, ASN, BSN, RN]

On 9/20/2019 at 9:48 AM, MrNurse(x2) said:

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

100% agree,and do not let that "manager" come near me.The head nurse had real experience,these managers do not.They spend the day in meetings,manage the unit very poorly ,lacking in skills and sensitivity,play favorites.I have seen nurses given awards and the staff not even made aware of the event ,nor given the option to enter the contest or whatever they call it. Administration humiliated nurses even more by coming to units to reward only those "mentioned" in a survey ,while ignoring the rest,especially in a unit where everyone works as a team.

Then they separate nurses by title BSN or Not, creating an even more toxic work environment.

[Leader25, ASN, BSN, RN]

On 9/24/2019 at 6:40 PM, Secretperson said:

8’s increase cost exponentially, my point is just that. Understanding the budget is my reasoning behind bringing up managing said budget.

This is not known by my hospital , funny,...if so much savings in 8s why did we have to threaten a strike to become 12's----because our hospital kept saying 12's are more expensive,especially with sick time and having to replace a 12.

23 hours ago, winniewoman9060 said:

Nursing has changed over my 41 years as an RN. I did 12 hour shifts but learned my body was better suited to 8 hours. Now we say do self care, but do we? I am having issues with chronic back

And thank you for your service.