Nurse Retention

[XNavyCorpsman]

Tele Nurse at a very small hospital. Our turnover rate is bad, very bad. Out length of stay for Nurses is less than 1.4 years experience. I am working on improving work schedule and the way they do assignments but that is going to be a very long process. My request to this forum is what can I recommend to management to improve nurse morale? I recommended to management to do something for our aides and they did but I need something for our nurses. What can be done to show us nurses that we appreciate what we do?

[emtb2rn, BSN, RN, EMT-B]

Nothing says we appreciate you more than adequate staffing. Nothing.

[quazar]

Nothing says we appreciate you more than adequate staffing. Nothing.

Yep. Skip the transient and toothless gestures like thank you notes or movie passes or other "nurse appreciation" stuff like that. Appreciate nurses by giving them the staff they need to do their job safely and without feeling like they're running their legs off.

[amoLucia]

What about limiting the actual number of shifts worked in a row to some MAX level??? Like no more than 4 or 5 regular shifts in a row? There would have to be at least ONE 24 hr day off before starting to work a string of shifts again.

Don't know how well this would go over for everyone as I just responded to another thread re a limit. (Can't please all the people all the time ... )

I would venture that's there's EB research out there that recommends shortened work schedules as a means to reduce OJT fatigue (and decrease workplace errors/injuries). Also to reduce employee absenteeism?

Employees would have the administrative ASSURANCE that they would have at least 1 day all to themselves (take the dog to the vet, get the car serviced, etc). Everybody in all capacities (employee and mgt) would have to ABSOLUTELY follow the in-house rule - NO EXCEPTIONS.

???

[realnursealso/LPN, LPN]

You say it's a small place, have you looked into how long time employees treat new comers? I worked at a small hospital at the beginning of my career. There definitely was a small core group of nurses/cna's who had been there forever. Some were kind and helpful, some were not. Some were rather clickish. If you have tried everything else, you might want to look into that.

[llg, PhD, RN]

Before you can make a good decision about how to fix a problem, you have to understand what is causing the problem. You can't just pull interventions of you a hat. Do an assessment ... diagnose what the causes of poor morale are on that particular unit ... then (and only then) will you be in a position to select an appropriate intervention to try.

[XNavyCorpsman]

I already know what the long-term solutions is but change is going to take a while (I have been working on it for over 6 months now). I wanted some gestures that may make the nurses feel like their appreciated. Back to the solutions. Scheduling is a biggie here and so is assignments by acuity. I have been gathering research papers and studies on both of these. I am going to make a presentation where they can't ignore facts. I have talked to every nurse that quit and the ones that are still there.

[Rexie]

A few things that come to mind:

I strongly agree with those who said adequate staffing. I've worked floors where I did nothing but run for my whole shift - meds, assessments, call lights, bedpans, bed alarms, family members, and so on. I'd leave at the end of the day completely exhausted and feeling very discouraged because my patients did not get the care I felt they deserved. I've also worked on floors where there was good staffing and it is such a joy to leave at the end of a long shift tired, but not completely spent, knowing that the patients were well cared for.

Taking good care of your staff is important. I recently worked on a floor where the manger was answering call lights and willing to take care of the patient's needs instead of coming to find the nurse.

My current manager has a reputation for having our backs. I'm sure if there were something serious wrong, there would be repercussions but when petty stuff comes up (and it does...) she doesn't throw us under the bus. If we have an issue with another department and bring it to her attention, she has a knack for getting to the bottom of it in a way that doesn't seem to ruffle feathers. If staff needs time off, especially due to family issues, she will accommodate us, if she can. Knowing these things goes a long, long way in keeping me off the job searching sites.

As another poster mentioned, the culture of the floor is important. Is there back biting? Are there mean girls (of guys)? Do the support staff do their jobs? When you get attitude from the secretary (who is surfing the web) and have to hunt down the CNA (who is texting in the the back room) it is frustrating and discouraging. There needs to be enough support staff so they're not overwhelmed either, but when there is enough and they do their jobs, patient care goes so much more smoothly.

And then there is money. There, I said it. Everybody I know, no matter how much they feel that nursing is their calling, works for money. If I were going to do it for free, I'd go do charity work. You can get away with paying a little bit less if working conditions and benefits are very good. Most people will see the worth of a pleasant workplace. However, I can't be alone in that I'm always open to an opportunity to earn more. If your floor is not paying market rates, many nurses will feel the need to follow the money.

Another thing that comes to mind is making sure the staff has the equipment they need to do their jobs. Nothing lowers morale like having CNAs fight over dynamaps or RNs compete over IV pumps. If something is broken, have it fixed. Personally, it makes me feel disrespected and not valued as an employee if I have to take time out to search high and low to beg, borrow, or steal equipment.

Anything you can do to make the job run smoothly and the staff to feel valued will go a long way.

[thekidisback]

Definitely adequate staffing. I work on a tele/med-surg unit and the days we don't have staff are the busiest and make you want to quit nursing all together!But the days we have enough staff with a 1:4 1:5 ratio and 2 aides and a secretary..those are the best days and you feel like you can do your job right and leave work like you did everything.