Staff Retention Policies

Crush · Mar 7, 2018

, our manager stated that helping out when understaffed or census surges "is not her role".
How you like them apples?

Pitiful. I am grateful I have had some amazing managers then.

It is rare for us to have short staffing though.

RNperdiem, RN · Mar 7, 2018

The trend in the modern workplace is to look at the short to moderate term. Nursing has so many opportunities, that once people get some experience they look for a better job.

Another more recent trend in nursing is to use bedside nursing as a stepping stone to advanced practice. Sometimes I wonder that if departments want nurses who will remain at the bedside, why don't they hire ASNs?

MikeyT-c-IV · Mar 7, 2018

hospital management is FULLY aware of the steps needed to retain quality employees-no administrator could be so obtuse as to NOT know what the real core issues at hand are here.

Agree. The problem is, especially in the corporate atmosphere, even our CNO is powerless. The corporate chain of command above our CEO and CNO call the shots. I don't think they truly realize the impact of adequate nursing staff. Or, why would they care? They don't work in this building. Yet we keep hearing "improve the HCAHPS scores." Geesh. We've been dealing with these issues for years yet they refuse to take the action necessary to help the problem.

justavolunteer · Mar 9, 2018

How about having enough nurses for the type of unit + enough support staff (CNA's) for the needed help. The good news is that I'm really appreciated as a volunteer. The bad news is that there aren't enough RN's & CNA's on my unit for the work load. I think I would be appreciated anyway; no doubt I am more so because of the staffing situation.

turtlesRcool · Mar 9, 2018

People do not leave jobs. They leave managers. Your retention policy needs to include training for excellence in management, making sure that nurses who have experience are the highest paid employees on the floor and that your staffing ratios are reasonable. Period.

Oh, my goodness, yes! We're currently undergoing management transition in my hospital. Several well-regarded managers have left or are leaving.

On one floor, the manager was amazing. Kind, compassionate, willing to help out. She was an awesome "stick" and usually willing to try start difficult IVs for us. She would toilet patients, answer call lights, and engage with difficult, confused patients sitting in the hall, so we could see our other patients.

She left and the new manager is terrible.

All my interactions with the new one have been neutral or negative. She walks around "checking in" with patients...and not much else. I'm sure it's to try to get HCAPs up, but she doesn't do anything to lighten our load, even when we're understaffed and drowning. The old manager did the same, but she'd toilet a patient before she left or get some fresh water. New manager does not.

We've been on a new computer system for less than a week, and everything is at sixes and sevens. The plan was to be well staffed and have lots of superusers there to help with computer stuff. Then we had a blizzard, and call outs, so not only did we have large assignments, the superusers were pulled and given assignments, so we didn't have the expected tech help, either. And she got on my case for missing rounds (which pretty much ALL the nurses missed those days, which should tell her something). She had the gall to tell me I needed to "prioritize" in order to get there. Nope, lady, just nope. It's not time management, it's not enough time. I'm not taking lunch, not getting a pee break, and I'm still there (with half of the other nurses) still trying to chart at 5:30 (for a 7-3:30 shift). So, no, I'm not taking 40 minutes out of my morning to sit in rounds.

Totally a night and day difference on that floor. I'm in the float pool, so I try not to get sucked into floor dynamics. But I will tell you, that floor has gone from being my favorite to my least favorite, and the only thing that's changed is the manager. I know some nurses are looking to transfer to other units right now, and I have to believe she's a big part of it.

Another floor got a different new manager who is so much better. I was on her floor, too, during the new computer system roll out, and not only did that nurse manager not get on our case about rounds, she came around to each and said, "I don't expect anyone to make it to rounds, so could you just give me a quick update on your patients for me to present?" She's done things like taken a run down the pharmacy for me when I was in a jam. I feel like she has my back, and that's a huge incentive to stay there.

It's amazing the difference a good manager can make vs a bad one.

**RosesrReder, BSN, MSN, RN** · Mar 10, 2018

Everyone has good input but as an outsider, if I was new to your unit/facility and you have 'incentives' such as no floating or holidays after 10-15 years I would look at it like punishment. More like I know I am going to be royaly screwed for the next 10-15 years if I stay! No thanks

Here.I.Stand, BSN, RN · Mar 11, 2018

She had the gall to tell me I needed to "prioritize" in order to get there.[/Quote]
It sounds like you were prioritizing just fine.

**RosesrReder, BSN, MSN, RN** · Mar 11, 2018

This problem won't be solved the way you are coming at it.
In what other every-day relationship in life can we successfully treat people as a means to an end or a subject to be controlled? None. We wouldn't succeed by treating a spouse/partner that way, nor raising a child, nor maintaining a friendship. Human beings do not work that way. We either care about the people we want to have an ongoing relationship with, or we don't. If we don't care, we won't have an ongoing relationship. Some may say this is different because it's business. Well, I think it holds true, I think I'm right, and the proof is right there for anyone who wants to look at it.
The thing that some people don't understand is that nurses have always worked in situations where we didn't have endless resources to perform our duties. Nothing new there. The thing that has changed is the idea that all of this is somehow our fault. There have been endless times in my career where patients keep coming in the doors, multiple things are needed at once, patient conditions change rapidly, and we are ROAO the entire shift - but it used to be that someone eventually said, "well done," and "take the best care of the patient that you can and we'll worry about the rest later." There was such an incredible sense of teamwork, belonging, and accomplishment in successfully handling these situations! But I think I would fall over dead if I heard either one of these two things in our current environment. In other words, there was moral support for our efforts. Moral support has currently left the building and been thoroughtly replaced with shame and blame.
No professional is going to put up with that for very long. Nor should we. Working one less Christmas or floating two less times per year (after 15 years of service???) is not going to endear people to the idea of being repeatedly scapegoated and treated like a thorn in everyone's side.
If a business can't afford to speak with, treat, and consider adult human beings in a manner consistent with the idea of maintaining an ongoing, mutually-beneficial relationship, then one won't be had. It's that simple.
As a matter of fact, I believe they very well know this already, which is why they have plans in place knowing they will churn through employees. I personally could not be happier that their careful calculations and accommodations for treating people like sh*t aren't panning out.
Over time, you cannot pay (most) people enough or throw enough half-hearted "rewards" their way to have them agree to be treated poorly every day, day in, day out. That only works for a time and then you'll simply again be faced with your refusal to have a real relationship.
ETA: This is the same reason why the "patient satisfaction" game won't be won. There is a difference between treating people well because you care about them and doing things to try to make them feel like you care as a means to an end.

I wish I could like this a million times over. This has made my entire week. It's such a relief to read someone with common sense and actually gets it!

I want to just e-hugs you. Thanks for this.

LoveJRenee, BSN, RN · Mar 12, 2018

Maybe a good place to start would be doing a unit survey. You could first yourself identify some areas that may be causing a problem then ask the nursing staff what they perceive their biggest problems to be. You can include a range of items ( understaffing, lack of relationship, underpaid, holidays, etc). Maybe you only want to include things that you have the power to change..this way people don't have unrealistic expectations of your power. Maybe your survey ask 1 question: why do nurses leave THIS unit/ floor.. leaving it open ended may get answers you didn't expect.

Once you have a better idea you know you are fixing problems that are valuable to the staff.. not random problems that no one on YOUR staff cares about. Then you can use all the great advice people have posted.

Leader25, ASN, BSN, RN · Mar 13, 2018

merit based pay raises,

these are more correctly called My best friend and my favorites pay raise!!!

allstressedout1 · Mar 13, 2018

Christmas bonus! That would be nice.

brandy1017, ASN, RN · Mar 13, 2018

I left my management after three decades. Why? I had it with the condescending seniority remarks. Had a patient admitted with GI bleed that turned out to be a basilar skull fracture, that I caught, not the docs. I was told that was expected because of my experience. Two docs dismissed this man's chest pains, I stuck on it until he made it to the cath lab, once again, expected. Meanwhile a new nurse gets recognized hospital wide for dealing with a screaming patient who was heard throughout the whole unit when he occluded his fem-pop. I was not the only multi decade nurse to leave, half of our experienced nurses left. I now work a facility that listens to what I have to say and treats me as an adult.

Your experience reminds me of a CNO pitching what she wanted in nurses to fill the new hospital they had just built. She made it clear she didn't value the experienced nurses and was only going to hire experienced nurses, some at least, out of necessity not desire. She much preferred "cheer leader" like employees, happy, rah, rah but accepted that idealistic new grads didn't have the necessary experience to open a new hospital. She downplayed the knowledge base that experienced nurses carry as it was simply expected, nothing special. I found the article and her attitude condescending. Ironically after a year she was let go and replaced with someone else. I guess her knowledge and experience wasn't worth much either. I wonder how she felt about that. Takes one to know one!