Nurse Retention ideas

[CCU-Flight RN]

My unit and hospital as a whole is really struggling with nurse retention. We have two hospitals that serve a large rural area. Both are level one trauma centers, my hospital is also preparing to be a level one stroke and STEMI facility but people are leaving in droves to go to the other hospital or various other areas.

Upper management keeps saying "Money isn't everything" though most nurses are leaving for money. What are some strategies for nurse retention your facilities have offered, and please, feel free to include any monetary offers. :)

[Jules A, MSN]

Great thread and all hospitals could learn from brainstorming this topic. I work in both the inner city and a rural area so I'm familiar with the struggles of rural areas and community hospitals. The biggest thing imo that kills morale is paying crappy because there are few job opportunities in the area and the admin puts out the sentiment that they can pay dirt because they are the only game in town. It is demoralizing. To me the money is huge, sorry but thats why I go to work and I absolutely will drive my butt an hour or two away to secure what I feel is a respectable wage. Its my opinion that many of the sharpest folks will not stay and in many cases the ones left are often not the best and brightest.

The other single most important thing I have found is offering a weekend option. This is a huge staffing relief it also makes the people happy who hate weekends and secures those weekend warriors, who in my experience are similar to the overnight crew, they are lifers and rarely leave these positions.

[NurseFifty]

Your hospital should ask the nurses who resign what would have made them stay. Part of exit interview.

[dudette10, MSN, RN]

Before you come up with solutions, you have to figure out what the problem is at your particular facility. I guarantee its not all about money...

[whichone'spink, BSN, RN]

Both hospitals in my city are going through the same thing. My hospital has an incentive program where they are paying critical needs pay for extra shifts. Plus, if nurses sign up for a certain number of shifts, they get prizes. Like, if I signed up for an extra 4 hour shift above my scheduled hours, I would get a meal ticket for the cafeteria. If I signed up for 20-35 hours more than my scheduled hours in a 6 week period, I can get a prize; this month they're offering a Kindle. People are signing up and it's helping some but eventually it will get old and people will stop signing up for shifts. I know on certain floors, mandatory stays have gone up, and it's causing people to leave even more. Sad thing is, my hospital is better than the other hospital in my city, which is ten times worse. Actually, at the other hospital they are forcing people to work an extra shift each week in addition to their scheduled hours.

Here are my suggestions to retain nurses:

1) Pay us more. I live in Minnesota, and work in North Dakota. Many nurses do that, and North Dakota wages are piss poor. People leave my city all the time to go to Minneapolis, where pay is higher, cost of living is about the same as the city I live in, and there are unions.

2) Stop the mandatory overtime bulls***.

3) Offer more weekend options. You never know, some people like me will take it, and that will relieve the weekend burden on regular staff.

4) Stop rotating shifts. The majority of people work rotating shifts, meaning days, evenings and nights. Let people choose which shift they would prefer. Some people would like to work straight days, some would like to work straight nights, so on so forth.

5) Offer more tuition reimbursement options. Offering only $1000 is a drop in the bucket. People pay much more than that in tuition, whether it's undergraduate or graduate.

[Wrench Party]

1) Decent pay. People are going to up and leave if your pay sucks, especially for experienced RNs.

2) Decent management. I left my previous job because of poor management and general unresponsiveness to nurses' needs. If I feel the

need to speak up about something, you better realize it's important. I won't often repeat myself and will vote with my feet.

3) Consistent staffing. People are going to be unhappy if you rotate them excessively, give them too many weekends if not weekend option, send them home if low census, etc. I still need to pay my mortgage and feed my animals and can't do that on an inconsistent schedule.

4) Room for advancement: clinical ladders, help with certifications, opportunities for charge and manager positions, an open attitude towards internal transfers and getting more education, especially for the newer nurses. The old attitude of "bedside nursing forever" has changed and management needs to adapt. Newer nurses are encouraged and coached in school to try new things and continue their educations.

[calivianya, BSN, RN]

Gotta agree with room for advancement.

I have only worked with my organization for one year, but I still get resentful when open positions/opportunities are not openly posted. They only talk to people they like for certain things. It's like the rest of us are gum on the bottom of their shoes.

Example: a lot of people were recently selected to be trained to do charge, a few people were picked to train with rapid response, and there was some sort of study going on that several people were approached about participating in. NONE of this stuff was posted openly to every employee. I realize that seniority counts for a lot with this stuff, but they could at least pretend the positions/opportunities are open to everyone instead of making it obvious they are not. It is very demoralizing. I don't want to have to work in this place for five years before I even get looked at for anything important or interesting. I definitely don't plan on staying for that long.

[Hoosier_RN, MSN]

Your hospital should ask the nurses who resign what would have made them stay. Part of exit interview.

My facility does selective exit interviews. I asked a former coworker the other day what she said in her exit. She left over 6 mos ago and was openly unhappy. She stated that they never called or otherwise attempted. The nurse that left to go back for his FNP, and was always ok with work, was called 4 days after leaving....I think some orgs don't want to know, because then they have to deal with it. Note: I like my employer and don't have a problem, but not everyone's experience is the same based on perceptions

[noyesno, MSN, APRN, NP]

1. Uninterrupted lunch breaks occurring regularly, at a decent hour

2. Being supported by management and not feeling like you need to call a lawyer to defend you if a patient makes a complaint

3. Reasonable, consistent staffing

4. A real break room would be nice

5. Letting us use the PTO we accrue, approve our vacations far in advance

6. Knowing our schedule far in advance would be a plus

7. Decent pay

8. Lifting equipment and a culture that encourages safe lifting

9. Don't make nurses police the doctors

10. Don't make me read a script to my patients

[noyesno, MSN, APRN, NP]

One more:

FOR THE LOVE OF CHEESE, do not add any more tasks to my day without removing other tasks first. I cannot pull time out of thin air, there are only so many hours in the day.

If you add something? Take something else away or add more staff to complete the extra work. Badda-bing-badda-boom!

[KatieMI, BSN, MSN, RN]

In addition to the above, there are some other things you might want to try:

- make nurses' work comfortable. Invest in lifting devices, better EMR system, give more computers so that their days won't start from battle royal for finding one, upgrade what you have. All supplies must be up and ready. There should not be running about in search of everything.

- be your staff backbone at all times. Make them feel protected from unreasonable demands and abuse. Solve the problems with "customers" personally, and if you will have to sacrifice a little bit of "customer satisfaction", then so be it. Delve into long-standing animosities like "lab vs. ICU civil war" and solve them, so that everyone could work in peace.

- get more supporting personnel. CENAs, phlebotomy, ECG, X-ray, etc. Eliminate restrictive policies so that nurses wouldn'the have to do everyone else's job in addition to their own.

- staffing ratios, without exclusions.

- praise your nurses, they deserve it!

- eliminate every shred and trace of NETY problem. Make your place welcoming immigrants, new grads, even nurses in rehab. Make new grad residency program with guaranteed placement after finish and keep the promice.

- do not "advance" nurses as "bedside quality control" and do not create such positions. It is maddening to work being watched by people purely obsessed with every single minor problem.

[TNT_RN09, BSN, RN]

Great thread