Struggling keeping nurses in my unit

[BellaSRN]

I am a new NM in a stepdown unit and I am struggling to keep the nurses from leaving. Our unit has had some retention issues in the past. Any advice on how to keep the nurses around? I don't want to blow my budget on agency hours.

[RN1982]

I agree with the "free" charge nurse, CN without assignment. I think that would have helped a lot with the unit that I used to work on but no, the CN was expected to take 2-3 patients along with charge duty. We asked about having a charge nurse not having to take assignments and is just there to back us up when we need it but management stated we would have to give up one nurse, meaning we'd have to take 4 patients that could easily be ICU status.

[indigo girl]

I work on a tele/ICU stepdown unit, and I'll tell you why I'm thinking of leaving my job for another hospital -- the reason I'm still there is my boss won't let me move off the unit, and I'm trying to survive until the end of spring semester, and spend the summer orienting at another hospital:

1) We have a new NM, and her style is "my way or the highway."

Some of this reminds me of my current unit. The only way out is to leave the hospital. Any nurse that gives any notice to leave can expect at the very least, to be written up for something in the time left. If you think that you are lucky enough to find a job on another unit in the hospital, guess again because your transfer will be blocked, and of course, you will be written up for something.

How does the Nurse Manager get away with this? Well, her husband is a vice president at this hospital. It is downright scary. Like the Hotel California, you can check out, but you can never leave, unless you quit, hopefully with license intact. Unbelievable, but true. I keep shaking my head over this. Even if you quit, you are guaranteed to be harassed and made to feel terrible for leaving. And, if you do not say something nice about them before leaving, I guess in your exit interview, they will let you know about it. The last nurse left in tears for another hospital. The night nurse has been blocked from leaving for another unit...

[Magsulfate, BSN, RN]

My exit interview which was a form I had to fill out was long and scathing. Since my departure, my then NM left to be replaced by a tyrannt of an NM who is alienating all of the staff. She pulled out 3 months of my friend's charting to point out some very small documentation error, a reassessment of pain. Now they are very short staffed so assistant managers and the unit manager have all had to start taking assignments. Can't use agency nurses because of the budget.

And I'm in agreement, when nurses are leaving a unit in mass exodus, administration needs to be looking into "why".

Sound like the job I just quit this morning, EXCEPT the nurse managers would NEVER EVER take a patient assignment. Have seen them walk through the icu unit all happy and joking all the while knowing that we were suffering and very short staffed, then they tell everyone "have a good weekend!!" and leave.

I'm sooo glad that is over!!! I talked to my new nurse manager on the phone this morning (total 180 from my old one) and he was apologizing for not getting back to me sooner because he was on the floor taking care of pts!! Can you believe that??!

This is very good advice everyone is giving to the OP. I'm fresh (today actually) resigning from a job that was hellious like some of you have explained. They can't keep the nurses in the ICU unit. They are either fired or quit. Mostly quitting lately, and staffing is really bad.

We are quitting because:

1. Management won't listen to us. Literally. She talks over us, and the other one is a ghost, don't even know if he actually exists.

2. Our manager hires nurses with NO ICU EXPERIENCE,, even hired a nurse that has only worked in home health her whole career. Expects us to traIn her, even though we don't have adequate staff to do so. Other nurses with no icu experience have a week or two orientation,, and when they screw up, we're blamed because we didn't "have their back"... I'm not a babysitter. I have my own patients.

3. Our manager gets mad and will dig up charting from a particular nurse and write her up, and eventually making nurses quit or get fired over that.

4. Closed doors.

5. Bad staffing, and they won't come help us, even though it is to the point where THEY SHOULD BE taking patients and be right along side us... because afterall, THEY are the reason we are short staffed.

6. Coming into the unit and raising all kinds of heck, being loud, about something they were told by Upper upper management that their nurses were doing wrong... so they feel like they should make a scene in front of everyone to straighten all the nurses out. (this is crazy, and stupid)

7. Going out to clubs with some of their nurses, and giving special treatment to those nurses at work,, and inviting them in front of everyone to go out clubbing again tonight.... (stupid also)

8. Acting like your nurses owe you something just because you do your job.

I guess I could keep going,, but these are just a few... :)

I think that the OP is a good manager, just for the fact that she is on here asking for advice!!

[indigo girl]

OP, you sound like a great person to work for simply by caring, and questioning why staff are leaving. So refreshing that you even care. Bless your heart, your staff will eventually stabilize and rally around you just for that.

[Ruby Vee, BSN]

like most of those who have written, i suspect that i know more about what makes a bad nurse manager than what makes a good one, and more about reasons to leave a job than reasons to stay. but i'll try.

staff nurses appreciate fair managers who will listen to them and, if needed, stand up for them. i've had precious few managers who would stand up for me when i needed it, but the ones who did earned my loyalty forever! if the x-ray tech, pt, patient family member or physician is complaining to you about one of your nurses, make sure you hear your nurse's side of the story before you take sides, and if at all possible, side with your nurse, at least publicly. i had a surgical fellow complain vociferously about me because "and she titrated the dobutamine drip rather than start milrinone." the nm called me into the office and chewed me out up one side and down the other -- even though i pointed out that the orders i had -- and i showed them to her in black and white -- dictated titrating dobutamine and said nothing at all about milrinone. furthermore, my charting reflected multiple attempts to contact that fellow, but no response on his part. her efforts would have been better served backing me to the physician and telling him that if he wanted milrinone, he should have ordered milrinone and if he doesn't answer his pages and we have to go up the chain, he shouldn't be complaining that the orders we get aren't the ones he would have wanted. years later she apologized, but by then i wasn't working for her anymore and her stock as a manager had plummeted.

staff nurses appeciate managers who are fair. we all know that our managers like some staff members better than others, and we're painfully aware when we're not one of the better-liked staff. but your management policies should be fair and even handed, and as a staff nurse i shouldn't know that sally sue is really your favorite. there's nothing like being cheated out of something that you've earned or was your turn to have because the manager gave it to her favorite instead. i've worked in places where seniority was the way we earned a day shift slot, a shot at christmas off, a charge nurse position, etc. there's nothing like going on vacation for two weeks and having management post (for the required two weeks) the day shift slot you're next in line for the day you leave on vacation, and award it to her favorite the day before you get back "because sally sue was the most senior person to sign up."

staff nurses appreciate managers who take the time to know them and know their work before counseling them. i've always been well known for the completeness of my charting. but one manager pulled me into her office at the beginning of her shift, waving a page of my patient's chart at me and telling me "this is inadequate and substandard charting." what she had in her hand was the rhythm strip i had posted, analyzed and signed at the beginning of the shift, three hours ago. i hadn't yet started to write a note. rather than listen to me try to tell her that, she continued to harangue me -- until the assistant nurse manager intervened by saying "remember those complete nurse's notes i was telling you about that saved us when x patient tried to sue? those were ruby's notes." years later she apologized, but by then she had lost her management job and was working prn when she wasn't in rehab for her addiction to painkillers.

staff nurses also appreciate managers who don't mess with their schedules or their compensation. one manager new to 12 hour shifts tried to tell me that i couldn't take 8 days off by "stacking" my shifts without using vacation time. "you're required to work three shifts every week," she told me and no amount of pointing out that "sunday, monday and tuesday this week and thursday, friday and saturday next week not only fulfills my weekend obligation but is three shifts a week" made no impression on her. only when she sat down and plotted it out on paper with a copy of our staffing rules in front of her did she "get it." she conceded with grace and never took a stand without knowing exactly where she stood again. she became one of my favorite managers!

exit interviews are a good idea, but i think a better idea is some sort of anonymous survey asking pointed questions about management support, fairness and other issues will give you a good handle on why your turnover is so great. good luck!