The first defense in workforce stabilization is retention

  1. Case Study: The first defense in workforce stabilization is retention

    By Tonda Verdejo, RN, MSN, for, June 25, 2001

    It's a game of strategy being played by all healthcare providers: desperately seeking qualified, competent healthcare workers. Human resource personnel are frantically developing creative approaches to attract the brightest and the best. Participation in media marketing, direct mail and job fairs are at an all time high and are more competitive than ever. Wise recruitment strategies remain key to our survival, but are not enough in today's environment to keep the supply adequate.

    While recruitment efforts are at an all time high and dollars are being generously allocated to lure people into our ranks, we need to focus beyond recruitment and ask what it takes to keep individuals after they are hired. Recruiters are highly frustrated that turnover rates are outstripping recruitment numbers. As one seasoned recruiter stated, "It takes a lot of time and energy to recruit the right people. I don't mind, but it is disheartening to see these individuals leaving at an unprecedented rate. What is everyone else doing to retain the resources that I have worked so hard to hire?"

    This is a problem in many healthcare settings today, and the recruiter's statement bears a lot of merit. Not only is high turnover impacting the job satisfaction of the recruiter, but staff are also highly frustrated and demoralized when new people come and go quickly. "We hardly finish orienting new nurses, and the next thing we know they are gone!" states one experienced nurse. High turnover and tight nurse patient ratios add to the staff's frustration, and we often see the experienced individuals looking for "greener pastures" in response to this frustration.

    Today's more successful organizations are making retention a priority, as administrative and human resource executives grapple for solutions. Some solutions are successful, while some are failing miserably. Millions are spent annually on recruitment, but this is wasted money if recruits are leaving as quickly as they are arriving. It is evident that retention is the key to survival. Since this is true, how do we activate valid solutions for insuring a stable workforce?

    Too often we are simply guessing based on recent research or "gut reactions". We need to be brighter than that and involve our stakeholders in creating retention strategies. Our stakeholders are the staff members who know best what makes employees want to stay (or leave!) an organization.

    At New Hanover Regional Medical Center in Wilmington, N.C., we are trying a new approach to developing our workforce. Dr. Bill Atkinson, President and CEO, made a decision to aggressively address these issues by assigning a senior administrator to the task. In May of 2000, I had the privilege of moving from the position of Chief Nursing Officer to Special Assistant to the President for Workforce Development. This new role affords me the opportunity to work internally with administration, human resources and line staff. Externally, I focus my efforts on building partnerships with other hospitals, schools, colleges, community, and state and national organizations.

    Over the past year, we have experienced some very exciting internal successes related to retention. Our proudest accomplishment is the development of a very successful mentorship program for newly graduated RNs. This program was created in response to a 34% turnover rate of new graduates from the 1999 classes. Double-digit turnover of new graduates two consecutive years was unsettling and unacceptable, so we challenged ourselves to significantly decrease this number in a very short timeframe.

    A nursing committee was formed to develop the mentorship concept and set selection criteria for nurses interested in being mentors. Once the criteria were established, the program was publicized throughout the network, and applications were made available. Nurses were required to have a minimum of three years of nursing experience and two years of tenure within the network. We were seeking positive, committed role models, so each nurse applicant was required to submit two letters of endorsement - one from their immediate supervisor and one from a colleague.

    Although we felt this was a perfect opportunity for veteran nurses, we were unsure about the interest level. We were elated when 51 nurses with more than nine centuries of experience came forward to be mentors for the 59 new graduates hired. This number far surpassed our wildest dreams. More than 75% have greater than 10 years in the profession, and 43% have worked at least 10 years in our network.

    These mentors, who receive no financial compensation, provide career guidance, advice and leadership to newly graduated nurses. This is not a preceptorship, but a true mentorship where the experienced nurse serves as role model, coach, and advocate. Nearing the end of our first year of the program, we are thrilled to note that attrition in the new grad population is currently 8% - a huge drop from 34%. Feedback from these nurses reinforces that mentoring has been key to their decision to remain in our organization.

    Another successful strategy has been developing "bridging letters" that are sent to RNs who have left the organization in good standing over the past 12 months. These letters invite the nurses back and guarantee a resumption of seniority and benefits, if they return within 12 months of their resignation date. We have had an 8% return rate of highly experienced staff nurses.

    As noted earlier, administration must listen to line employees to determine what the important retention issues are. To remain connected, a Recruitment and Retention Committee has been established in our network that consists primarily of staff employees. These members are committed to reducing turnover and have worked diligently to produce internal successes. Examples are: Endorsing a change in our basic orientation program, facilitating a nursing externship for senior nursing students, supporting rewards for perfect attendance, and establishing consistency in flexible scheduling throughout the hospital. These employees feel very positive about their contribution to our retention efforts.

    These are certainly not the only answers to the retention issue, nor are they necessarily the right answers for all organizations. Each setting must look inwardly, using their most valuable human resources, to identify productive strategies for their population.

    Tonda Verdejo, RN, MSN, is Vice President for Workforce Development at New Hanover Regional Medical Center, a 628-bed general acute care hospital in Wilmington, N.C. ( She has been in the nursing profession for more than 30 years and fulfilled multiple roles during her tenure, from staff nurse to leadership positions including Chief Nursing Officer, nursing educator, nursing consultant and her current position. She is active in multiple national and international organizations. She can be reached by phone at 910-343-2779 or by e-mail at
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  3. by   Mijourney
    Hi. It is sooo important that those entering the nursing profession get a realistic picture of what will possibly be expected of them. So many nurses come out with unrealistic expectations and get frustrated immediately when they realize the rigor involved in practicing as a nurse. I think the strategies that you have included in your post from an article are excellent opportunites for nurses to learn how to make a career out of their choice. Unfortunately, there is no consistency from employer to employer on using quality programs to recruit and retain nurses. Also, once in practice, nurses frequently seem to stay in competition with one another preventing any mentoring or advocacy from taking place.
  4. by   oramar
    I read this article on HealthLeaders site and corresponded with the author Tonda Verdejo. I told her I admired her attempts at retention and liked the article but that I thought that part about nurses acting as mentors without compensation was not anything to be bragging about. She actually responded to me and repeated her postition and I repeated mine. I also told about my ideas for getting older nurses back into the field by promissing lighter work loads. She has not replied to me on that yet and of course I do not know if she will. I was impressed that she responded to my first email.
  5. by   natalie
    I remember it was less than a year ago that healthcare facilities were denying there was a compromise in patient care and there was no nursing shortage at their particular facility.

    Fast forward a few months and they are stating, there is indeed a shortage.

    Fast forward a few months and many are claiming it's reaching critical mass. They state the cause is the demographics.

    Fast forward a few months, and there are legislative bills sprouting up to recruit new nurses with loan forgiveness.

    Now, finally NOW, they are talking retention. We ARE getting somewhere. These past few weeks I have come across articles re: working conditions. Mandatory overtime bills are being initiated in many states. This is a great time to be a nurse and witness the evolution of the public becoming informed.

    I'm psyched! (Or maybe it's just because I have a few days off and don't feel beaten down. )
  6. by   natalie

    AHA chairman urges collaboration to solve nursing shortage

    AHA Board Chairman Gary Mecklenburg recommended a collaborative effort of all stakeholders to address the nation's nursing shortage in testimony before Congress today. Mecklenburg, CEO of Northwestern Memorial Healthcare, Chicago, also recommended restoring all remaining Medicare and Medicaid payment reductions, greater government support of rural hospitals and establishing innovative nursing education initiatives. His remarks came at a Senate oversight of government management subcommittee hearing on nurse retention. Citing mandatory overtime and unsafe conditions, American Nurses Association and union witnesses said unsatisfactory workplace environments are the root cause for the shortage. However, Mecklenburg said, federal reimbursement methodologies don't reflect the costs of safer workplace technology and don't allow for nurse salary increases at the same rate as the national average. He said failure to reimburse hospitals at the full market-basket level by using 1992 payment models "just doesn't make it anymore." An audio playback of today's hearing is available at
  7. by   natalie
    Work conditions talk.
    Pa. legislators address nursing shortage

    By Anne Danahy

    A state senator has introduced legislation that would prohibit mandatory overtime for Pennsylvania nurses, and a state representative is expected to do the same this fall.

    Health-care providers in Centre County and across Pennsylvania are feeling the squeeze of the ongoing nursing shortage. These bills and a separate action by state Rep. Kerry Benninghoff, R-Bellefonte, are designed to address the issue.

    Benninghoff has asked the governor to use money from Pennsylvania's share of the tobacco settlement to provide grants for students who enroll in programs to become licensed practical nurses or nursing assistants.

    There are currently no regulations that limit the number of hours a health-care provider may work, according to Jeff Hunsicker, political program coordinator with the Centre Community Hospital Chapter of District 1199P/SEIU. The union represents about 450 health-care workers at Centre Community Hospital.

    "One of the reasons (health-care facilities) don't have enough staff is mandatory overtime. One in four nurses is no longer working in health care. What we're doing is driving nurses and others out of the field," said Hunsicker.

    The union is supporting legislation prohibiting mandatory overtime that state Rep. Dan A. Surra, D-DuBois, will probably introduce this fall. Sen. Mary Jo White, R-Venango, already introduced a similar bill that would prohibit overtime for nurses.

    The union supports Surra's legislation, Hunsicker said, because it would apply to all health-care workers, not just nurses.

    More and more people may start to feel the effects of a nursing shortage, particularly as baby boomers age, nurses retire and fewer people move into the field to replace them.

    The average age of nurses is 47, and the number of people going into the field does not keep up with the number leaving. In addition, many nurses say that changes to national reimbursement for Medicare and Medicaid patients that were part of the Balanced Budget Act of 1997 are leaving hospitals and health-care facilities strapped for money -- which translates into fewer nurses doing more work and getting paid less.

    Because registered nurses, licensed practical nurses and nursing assistants can be far and few between, many care facilities have become dependent on nurse-staffing agencies -- the equivalent of temp work for a nurse -- which again translates into higher costs.

    A registered nurse might earn $15 to $20 an hour in a full-time position, but could earn $30 an hour working for a staffing agency. In addition, the health-care facility must pay an additional fee to the agency that places the nurse.

    The mandatory overtime legislation would not directly address these issues, but some believe that not being required to work overtime will translate into greater job satisfaction and higher retention rates for nurses.

    "There are facilities choosing on their own to not use mandatory overtime. One hospital in Butler County stopped using mandatory overtime and has come up with other solutions," said Lori Anne Artz, communications director of Pennsylvania State Nurses Association, which supports the legislation introduced by White.

    Others are hoping that Benninghoff's proposal to spend money from the tobacco settlement to support students enrolled in nursing school will help address the problem in the long run.

    Sharon Bressler, coordinator of practical nursing at the Central Pennsylvania Institute of Science and Technology, said that while this fall she will have the first full class of nursing students in years, last year 50 percent of her students dropped out because of a lack of financial support.

    "I'm terrified," said Bressler. "We have a wonderful application pool to pull from, but whether or not these students can complete the program is a different story."
  8. by   OC_An Khe
    Its about time that the discussion with regards RN retention is finally getting its place in this discussion. Anyone that has taken any graduate human resources/business/administration courses was taught that the least expensive employee to attract is the one already working for you. Additionlly if retention factors aren't addressed and solved satisfactorily no recruitment strategies, either for individual employers or the profesion as a whole, will succeed in the long term. Long term problems can not be solved by short term solutions.
    Last edit by OC_An Khe on Jun 30, '01
  9. by   Norbert Holz
    "It's a game of strategy being played by all healthcare providers: desperately seeking qualified, competent healthcare workers"

    What does the word "qualified" mean? Already did the job somewhere else was trained there? Have MSN, BSN, Young, cute, blond; Or licensed to pratice (work)?

    Does competent mean never made a mistake? Never devieated from being a good little company employee.

    Does this mean to fire them for trivial reasons is ok in the game?

    The only desprately seeking recrutement action I've encountered has been to travel far away from my daughter and home to earn a moderately livable wage. Recruters here have lost my applications or returned a nice letter saying that they do not need me, they have already hired a "more qualified" applicant, my qualifications do not match, I do not have enough experience.

    Ok so I've only been a RN for 6 years, I am male, I can't speak tagalog, I can't work every other weekend, I need to be able to take my daughter to her IV therapy (she has juvenile dermatomyositis).

    Retention, Ha! Here in Tampa Florida you'll be lucky to find a job at all. Then after finding a job ANY EXCUSE FOR A REASON WILL BE USED TO DISMISS YOU or put you on a do not use list!
  10. by   -jt
    <Retention, Ha! Here in Tampa Florida you'll be lucky to find a job at all. Then after finding a job ANY EXCUSE FOR A REASON WILL BE USED TO DISMISS YOU or put you on a do not use list!>

    I know an RN in Tampa who was just as disgusted as you are. She solved her problem by quitting her job, signing on with a travel nurse agency but instead of traveling, took assignments at the same hospital she was working in right there in Tampa.... for more money than she made as a staff RN there - plus benefits. She had no benefits when she worked as staff at the hospital because she took the option of having more in her paycheck. Yet her "travel" position earns her more AND gives her benefits. When she finished at that hospital, she chose not to extend the assignment & just went to another one in Tampa. Shes living in her own home, in her own city, working in her own town & the agency is even giving her a housing allowance that pays her rent because she didnt need them to find her an apt. One other thing......... she is not working "at will". She has a contract & the hospital is bound by the terms agreed to in it. She does not have to endure the abuses that staff RNs are subjected to because her contract protects against them. She negotiated which days & shifts she will work, if & where she will float to, and whether or not she will work w/e & how many. And she didnt even have to leave her town to be on a travel assignment.