Losing Nurses!

rn/writer, RN · Jul 17, 2005

Have you done any exit interviews with the nurses who have left? The exodus might not have anything to do with you or the unit itself. If you hadn't implemented the things you have, you might have lost even more. Then again, maybe there are problems that a nurse with nothing to lose anymore will be able to fill you in on.

Also, ask the current staff what is important to them. Try not to sound too desperate or they might exploit your willingness to accommodate, but if you tell them you are asking merely to take matters into consideration, you might find out what motivates them.

It sounds like you have tried to implement some good changes and foster cameraderie. If all managers were as caring and concerned, the health care world would be a better place.

Good luck,

Miranda

**canoehead, BSN, RN** · Jul 17, 2005

Have a brainstorming during a staff meeting about retention of nurses and how to make the unit better. they might have some good ideas. I bet they would welcome a break from training new staff too.

UM Review RN, ASN, RN · Jul 17, 2005

Well, think about it--ICU has a different patient load than tele, better pay, less burden to the nurse, correct?

After preceptoring and having to take as many as 12 patients, doing Charge for not a whole lot more money (yet being responsible to all those patients, my staff, and staffing for the next shift), I could see why they'd leave.

Not enough compensation for more headaches, more responsibilities. I didn't become a nurse so that I could see my patients for a total of one hour and spend six charting, nor did I become a nurse so I could interrupt a med pass to deal with a late call-off. And all of that so I could go home still wondering like a new grad, what I might've missed.

Sorry this post kinda turned into a rant, but throughout hospital managements, the more experienced bedside nurses are simply not valued and there is no incentive to stay, but plenty to leave that bedside.

UnewmeB4 · Jul 17, 2005

I sometimes think that it is because they just use the tele unit to get their feet wet before progressing to ICU. Once they are comfortable with all the heart treatments, meds,rhythms,etc. they feel confidant enough to go to ICU. Some are looking for the challenge, some are looking for respect, some for only 2 pts/nurse, some for sicker pts who are on the vent and can't complain and less visiting hours to interrupt their work.

mydesygn · Jul 17, 2005

I sometimes think that it is because they just use the tele unit to get their feet wet before progressing to ICU. Once they are comfortable with all the heart treatments, meds,rhythms,etc. they feel confidant enough to go to ICU. Some are looking for the challenge, some are looking for respect, some for only 2 pts/nurse, some for sicker pts who are on the vent and can't complain and less visiting hours to interrupt their work.

It is becoming rare to find a unit with a lot of long term nurses. Sometimes there is very little you can do. You can work at a nursing positon for many years and the job you do is no different than a new grad. You get to a point where you need to find new challenges or very your routine or advancement. I agree with the previous poster related to ICU but I do beleive in general, there is not much value placed on seniority. You still work weekends, don't make that much more than new grads, mangement considers nurses pretty exchangeable. In all honesty, most people don't spend a lifetime with a single employer (2-5 years is about avg for an exceptional unit).

llg, PhD, RN · Jul 17, 2005

Great thread ... great responses....

It illustrates some of the complexities of the "nursing shortage." As the OP has shown, people don't just leave because the unit managers are evil, lazy tyrants as some people like to suggest. Nurses have other reasons for leaving that are often beyond the control of the frontline unit manager.

It might help the OP to re-think the role of her unit within the hospital system. We have such a unit at my hospital -- a general med-surg unit to which new grads often come to get good experience before moving on to a more specialized unit and/or ICU. Rather than bemoan that phenomenon, the unit embraced that identity and even began to market itself as such. They re-organized their care-delivery model to better fit having a high percentage of new grads ... they used nurses with 1 year of experience or more as immediate resources for those new grads, giving those 1-year nurses a good introduction to precepting. They emphasized the importance of precepting and mentoring for their senior nurses and tried to recognize and reward them for taking on those roles. etc. etc.

In other words, the unit leadership knew which battles it could win and which ones it couldn't. They kney they would always have a lot of new grads coming and leaving after a relatively short time. Rather than beat their heads against a wall trying to change something they couldn't change ... they re-built their unit in a way that would take that fact into consideration. They invested heavilty in educational programs, in providing support for new nurses, and in recognizing and rewarding the preceptor role.

It's not a perfect unit ... but it IS working. By marketing themselves as the place where a new grad can get that "year or two of good experience" they usually hire enough new grads to keep themselves reasonably staffed. A few of those stay longer than a year or two. By acknowledging that they will always have a "young staff," they have been able to secure the resources and set up the systems to provide good care in spite of the turnover.

It's a thought ...

llg

SmilingBluEyes · Jul 17, 2005

Well, think about it--ICU has a different patient load than tele, better pay, less burden to the nurse, correct?
After preceptoring and having to take as many as 12 patients, doing Charge for not a whole lot more money (yet being responsible to all those patients, my staff, and staffing for the next shift), I could see why they'd leave.
Not enough compensation for more headaches, more responsibilities. I didn't become a nurse so that I could see my patients for a total of one hour and spend six charting, nor did I become a nurse so I could interrupt a med pass to deal with a late call-off. And all of that so I could go home still wondering like a new grad, what I might've missed.
Sorry this post kinda turned into a rant, but throughout hospital managements, the more experienced bedside nurses are simply not valued and there is no incentive to stay, but plenty to leave that bedside.

Sadly, this is all-too-common. It's enough to make many leave not only a unit, but nursing----forever.

SmilingBluEyes · Jul 17, 2005

Just a thought; what is your organization doing to RETAIN nurses, (or not) that say, the competition has not thought to do----(or maybe IS).

Seems hospitals are GREAT at recruiting people-----few give as near much effort to their retention. Stupid, if you ask me.

Works2xs · Jul 17, 2005

Just Seems hospitals are GREAT at recruiting people-----few give as near much effort to their retention. Stupid, if you ask me.

Especially if you compare the costs of retention programs vs. recruitment. Just the admin burden of advertising, paying recruiters, signing bonuses, conducting interviews, etc. is considerable. Then throw in the extras for orientation periods, overtime, temp hires, etc. Seems that the funds you could use for improving morale (seminars, longevity bonuses, other incentives) would be relatively smaller. I wouldn't be surprised if some manager/administrator is looking at different pots of money instead of the total cost, i.e., don't have a "retention" budget so they can't do it versus having a "fat" recruiting budget. If they could just look at the aggregate costs to the unit....

ShayRN · Jul 17, 2005

Just a thought; what is your organization doing to RETAIN nurses, (or not) that say, the competition has not thought to do----(or maybe IS).
Seems hospitals are GREAT at recruiting people-----few give as near much effort to their retention. Stupid, if you ask me.

Thanks for all your great replys!

At our hospital we are doing numerous things to retain our nurses. We have a yearly bonus program in place that is based on attendance, education, committees worked, continuing education (if you are an AD going for a BSN for example,) and extra shifts worked. We also offer money towards that education. If a certain GPA is maintained they get reimbursed for a percentage of their tuition. We also have two pay structures in place right now for picking up shifts. One is called Premium pay, that is for units like our that are consistantly in need of nurses. If a nurse picks up a shift that is not scheduled she gets paid 35.00/hour. Another plan in place is called incentive pay, this is through out the hospital. That is 4.00/hr on the week and 8/hour on the weekend in addition to the shift differential and the premium pay. For example if I want to pick up a Friday and it is over my contracted hours I would get 35.00/hr + 4.00/hr + 1.00/hr for the shift. If it is overtime I get my 1/2 time rate in addition to that rate. We are also a Magnet hospital. The perks for our more senior people are that they don't really have to work off shifts. We are so short nurses that the ones who have been there awhile do the majority of days. When doing the schedule, if I have 8 nurses on Evenings and call for 7 the most senior of those get bumped to days. Nobody seems to have a problem with that... We even have a lot of our girls that leave come back to pick up shifts on our unit. They say it is because they miss us (yeah, right, lol) but I am sure that the money is also involved.

As far as an intensive unit being less stress because of less patients, I am sorry I just don't see it. You take care of fewer people for a reason, THEY ARE SICK! But I do see how that can be the preception.

UnewmeB4 · Jul 17, 2005

Great thread ... great responses....
It illustrates some of the complexities of the "nursing shortage." As the OP has shown, people don't just leave because the unit managers are evil, lazy tyrants as some people like to suggest. Nurses have other reasons for leaving that are often beyond the control of the frontline unit manager.
It might help the OP to re-think the role of her unit within the hospital system. We have such a unit at my hospital -- a general med-surg unit to which new grads often come to get good experience before moving on to a more specialized unit and/or ICU. Rather than bemoan that phenomenon, the unit embraced that identity and even began to market itself as such. They re-organized their care-delivery model to better fit having a high percentage of new grads ... they used nurses with 1 year of experience or more as immediate resources for those new grads, giving those 1-year nurses a good introduction to precepting. They emphasized the importance of precepting and mentoring for their senior nurses and tried to recognize and reward them for taking on those roles. etc. etc.
In other words, the unit leadership knew which battles it could win and which ones it couldn't. They kney they would always have a lot of new grads coming and leaving after a relatively short time. Rather than beat their heads against a wall trying to change something they couldn't change ... they re-built their unit in a way that would take that fact into consideration. They invested heavilty in educational programs, in providing support for new nurses, and in recognizing and rewarding the preceptor role.
It's not a perfect unit ... but it IS working. By marketing themselves as the place where a new grad can get that "year or two of good experience" they usually hire enough new grads to keep themselves reasonably staffed. A few of those stay longer than a year or two. By acknowledging that they will always have a "young staff," they have been able to secure the resources and set up the systems to provide good care in spite of the turnover.
It's a thought ...
llg

GREAT POST!

I always learn something new here, and hopefully can share it with someone who can use it!