The BIG word - RETENTION!!!!!

[RNPATL]

I have found that RN/LPN retention is one of the most important parts of my job as a nurse manager. I think a decent compensation package (salary and benefits) goes a long way to helping nurses stay in their job, but the single most important thing I have found has been whether a nurse feels like he/she is appreicate and valued. Over the years, I have involved nurses in the management of the unit, asking for their input on policies, scheduling and many more things, but I have found that the single most important thing for a nurse to stay is that pat on the back and a simple thanks for the hard work.

Over the last year, I have worked as a staff nurse and realized more than ever, that being appreicated is almost worth as much as getting the pay check. Hello .... please don't get me wrong, raises are very NICE (I am a single father remember), but aside from money, having the manager recoignize something that I did and provide me with a positive comment or feedback, made me feel appreciated and valued as a member of the team.

What do you do for your nurses in relationship to retention? Perhaps we can share some ideas of things that have worked for us. Also, nurses that are reading this forum might want to add a comment about what makes them want to stay at their current job. Like I said earlier .... sure money is great, but I am talking about things besides money.

[RNPATL, DNP, RN]

If you are interested I will give a couple of ideas from over this side of the ocean. TOIL is GREAT MATE:D Toil = Time Off In Leiu. Originally an invention of goverment beurocrats it crept into nursing. What it means is that I can "bank" overtime or times when I have to come in for a meeting or a lecture and use that to take time off when we are not busy.

One of the biggest retention carrots is not only in nursing but Aust wide and that is Long Service Leave. You have to put in 10 years service and then you are given an extra weeks PAID holiday leave for every year that you work - and that is cumulative. So if I work 30 years for a facility and never claim LSL I can get a payout at the end of 20 weeks holiday. Incentive - you bet:D

Everyone who asks about coming over here is amazed that we don't have recruitment bonuses - what they don't see is our retention bonuses.

Thank you .... this is the direction I really wanted the thread to go in ... we need to share these kind of ideas and perhaps nurses can take these ideas back to their management team and see what happens.

[RNPATL, DNP, RN]

Dear Pat,

How wonderful that you do these little extra's for the nurse's who help the unit in a pinch. What I would not have given, more than once, to just hear a thank you. You sound like a manager than will certainly have no trouble filling empty slots.

I agree that charting is a big issue today. I loved flow sheets, and they could be utilized in computer charting today. The program just needs to be set up right and the system needs to flow from one area to the other easily. The best flow sheets I every used were the ones that had additional information areas attached to the bottom of each section. This was used to chart those exceptions to the rule notes. Like a BS of 300 at 11:00. Nurse could make a note of steps taken and care given to address problem. Short and sweet. Computers have brains, why when a problem has been addressed in exception area could not a prompt of some kind pop up to remind the nurse to address the issue. If it is an ongoing problem she could address it. If it was an issue that was resolved, then resolve it. I hope I am making myself clear, but I really do think computer charting could be made easier.

I guess you can tell I come from the era of the "nurse is responsible for everything." I have eased up on that particular theory, but I do think we need to be aware of what is happening to our patients on our watch. I hate it when a CNA does not tell me about elevated BP's or temp's. I no longer take it for granted that they know what should be reported. I take the time to look over the VS sheet. I try to do all of my own BS's because some of the CNA's here really think that is a task only the RN should do and they are not viligant in getting them done on time. Yes, there are usually enough machines to do them, but CNA's here hate to do them. The best compliment I have gotten in the last 2 years did not come from my boss, my patient, or my coworkers. It came from an intake nurse at a speciality facility I was transferring my patient to, she thanked me for the "excellent report and tips I gave her regarding this patient, his condition, special ways of handling him and his family." She wrote a letter to the DON and HN, they did not acknowledge it to me, they just posted it on the bulletin board for some of the staff to read. If anything, the HN seemed rather put out that I spent the extra time talking to this nurse about this patients special needs. Don't mean to rant but please keep in mind that some of your nurses really need a pat on the back sometimes.

Anyway, I wish you continued success with your unit and staff.

I agree with you on flowsheets and making the life of the nurse a little easier with a documentation system that is simple, yet provide dcumentation proof that care was rendered. What drives me nuts are systems that take more time than they are worth and say NOTHING about the care you, as the nurse, provided for the patient. Craziness!

Thank you or the kind words regarding recognizing nurses. Sometimes I think managers need to understand that retention isn't brain surgery .... it is really common sense and kindness. Get to know the nurses, be visible and available and most of all say thanks! Pretty simple, I think. But I guess it does not come as easy to some as it does to me. Donno. :)

[VickyRN, MSN, DNP, RN]

I have never been in management, but my philosophy is simple:

Following the Golden Rule makes good business sense. Always treat people, your employees, your nurses, your patients, like you would want to be treated.

[Havin' A Party!, ASN, RN]

... treat people... like you would want to be treated.

Wouldn't it be better to treat them as they'd prefer to be treated.

[UM Review RN, ASN, RN]

I read this thread with interest and I'd like to also add something.

What's extremely important to me as a nurse is "workplace culture." For example, I am currently working in a hospital that exemplifies teamwork. We don't have to battle with other shifts or departments--we respect one another. We ask, it's done.

We nurses aren't made to feel as though we are stupid when we give report--we are coached and educated and encouraged, in an ongoing process, to fill in the gaps in our knowledge base. We are encouraged to succeed. We are like family to one another, and the goal is to provide the best patient care that we can. We support one another throughout our workday and we understand when we're crunched for time, but we still help each other out.

Workplace culture is paramount to me. I love doing my job. I've grown here, both as a nurse and as a person.

Our management doesn't just mouth buzzwords; it's just as accountable to us as we are to them. For instance, docs (and other colleagues) who have a temper problem can be very demoralizing to the nursing staff. At our hospital, no matter how brilliant and wonderful they might be to their patients, if they get written up three times for behaving badly to the staff, they're outta there.

Or suppose, for instance, that we have a problem with getting labs fast enough to be useful. We can talk to any one of several people about a need for a "process improvement," brainstorm an idea, and get it implemented quickly. The result is that our Lab people recently won an award for efficiency. Our average turnaround time for lab results is about an hour--and that's for regular labs, stats are faster. In some hospitals, this would be nothing short of miraculous. In our hospital, it's the norm.

It's this kind of teamwork interdepartmentally that keeps us coming back and keeps us happy. It's the workplace culture created by a responsive management, that helps us to provide better services to our patients, that makes all the difference.

I don't come to worked prepared to be all stressed out--I come to work interested, challenged, and engaged in doing the best job I can.

Make your workplace culture one of learning, helping, improving, teaching, respect, and you'll no longer have workers going home burned out, but you'll have a loyal, engaged, and dynamic workforce.

[VickyRN, MSN, DNP, RN]

I read this thread with interest and I'd like to also add something.

What's extremely important to me as a nurse is "workplace culture." For example, I am currently working in a hospital that exemplifies teamwork. We don't have to battle with other shifts or departments--we respect one another. We ask, it's done.

We nurses aren't made to feel as though we are stupid when we give report--we are coached and educated and encouraged, in an ongoing process, to fill in the gaps in our knowledge base. We are encouraged to succeed. We are like family to one another, and the goal is to provide the best patient care that we can. We support one another throughout our workday and we understand when we're crunched for time, but we still help each other out.

Workplace culture is paramount to me. I love doing my job. I've grown here, both as a nurse and as a person.

Our management doesn't just mouth buzzwords; it's just as accountable to us as we are to them. For instance, docs (and other colleagues) who have a temper problem can be very demoralizing to the nursing staff. At our hospital, no matter how brilliant and wonderful they might be to their patients, if they get written up three times for behaving badly to the staff, they're outta there.

Or suppose, for instance, that we have a problem with getting labs fast enough to be useful. We can talk to any one of several people about a need for a "process improvement," brainstorm an idea, and get it implemented quickly. The result is that our Lab people recently won an award for efficiency. Our average turnaround time for lab results is about an hour--and that's for regular labs, stats are faster. In some hospitals, this would be nothing short of miraculous. In our hospital, it's the norm.

It's this kind of teamwork interdepartmentally that keeps us coming back and keeps us happy. It's the workplace culture created by a responsive management, that helps us to provide better services to our patients, that makes all the difference.

I don't come to worked prepared to be all stressed out--I come to work interested, challenged, and engaged in doing the best job I can.

Make your workplace culture one of learning, helping, improving, teaching, respect, and you'll no longer have workers going home burned out, but you'll have a loyal, engaged, and dynamic workforce.

WOW! I'd love to come work at your facility. You are extraordinarily blessed to be able to practice in such a positive, supportive, and professional work environment.

[purplemania, BSN, RN]

we started a new service excellence program with the emphasis being on the service we provide to EACH OTHER (service to public also part of it, but we started on being nice to one another). First we sent a note to someone thanking them for whatever. It went to their home, and the facility paid for stationery and postage. When I make rounds I see these notes tacked on people's computers or walls. It is amazing how attitudes have changed now that it is expected to be civil. Little things mean a lot. After all, we see our co-workers more than family and they are our family in some regards.

[RNPATL, DNP, RN]

I read this thread with interest and I'd like to also add something.

What's extremely important to me as a nurse is "workplace culture." For example, I am currently working in a hospital that exemplifies teamwork. We don't have to battle with other shifts or departments--we respect one another. We ask, it's done.

We nurses aren't made to feel as though we are stupid when we give report--we are coached and educated and encouraged, in an ongoing process, to fill in the gaps in our knowledge base. We are encouraged to succeed. We are like family to one another, and the goal is to provide the best patient care that we can. We support one another throughout our workday and we understand when we're crunched for time, but we still help each other out.

Workplace culture is paramount to me. I love doing my job. I've grown here, both as a nurse and as a person.

Our management doesn't just mouth buzzwords; it's just as accountable to us as we are to them. For instance, docs (and other colleagues) who have a temper problem can be very demoralizing to the nursing staff. At our hospital, no matter how brilliant and wonderful they might be to their patients, if they get written up three times for behaving badly to the staff, they're outta there.

Or suppose, for instance, that we have a problem with getting labs fast enough to be useful. We can talk to any one of several people about a need for a "process improvement," brainstorm an idea, and get it implemented quickly. The result is that our Lab people recently won an award for efficiency. Our average turnaround time for lab results is about an hour--and that's for regular labs, stats are faster. In some hospitals, this would be nothing short of miraculous. In our hospital, it's the norm.

It's this kind of teamwork interdepartmentally that keeps us coming back and keeps us happy. It's the workplace culture created by a responsive management, that helps us to provide better services to our patients, that makes all the difference.

I don't come to worked prepared to be all stressed out--I come to work interested, challenged, and engaged in doing the best job I can.

Make your workplace culture one of learning, helping, improving, teaching, respect, and you'll no longer have workers going home burned out, but you'll have a loyal, engaged, and dynamic workforce.

Thank you so much for sharing this post .... I am thrilled that there is an environment like you described out there. There are several questions that I need to ask, so please bear with me:

1. How are new nurses socialized into this environment - regardless of their background ..... for example are new graduate nurses socialized into your culture differently than nurses who have worked at other places?

2. What role does your nurse manager play in creating and/or maintaining this environment? DO the staff nurses take accountability for the culture or is this something that is enforced by the nurse manager?

3. What happens if a nurse does not participate in the culture and talks badly about another shift or another nurse, how is this handled by the team or by the nurse manager?

4. I love the accountability for physicians, but how does the hospital justify losing revenue from a physician that may have a thriving practice, but met the third strike and was thrown out? While I love this, I think that the revenue lose would be so great to the hospital that administrators would be taking some pretty big heat for not making budget?

5. Finally - how do you get the "culture" started? There had to be a beginning .... share with us what ytou know about how this work place culture started. This almost sounds like utopia .... I know a work place can thrive, nurture and grow like this, but I really want to know how it all started.

6. Promise - last question - can you describe the type of unit you work on.

Thank you again for sharing your experience. Like the other posters have said, this is wonderful and is a real way to help nurses want to stay at their job. Your post actually illustrates that nurses really desire a nurturing and caring environment in which to work in. Yes, salary and benefits are very important, but aside from those being competative ... as nurses, we want to be respected, needed and most of all - recognized for the contribution we make the the health and well being of the patient.

[UM Review RN, ASN, RN]

thank you so much for sharing this post .... i am thrilled that there is an environment like you described out there. there are several questions that i need to ask, so please bear with me:

1. how are new nurses socialized into this environment - regardless of their background ..... for example are new graduate nurses socialized into your culture differently than nurses who have worked at other places?

our new nurses are "coached" and "precepted" by staff. they gradually increase responsibilities as they learn and improve their skills. the more experienced nurses are all very approachable, open, and friendly. procedures are streamlined enough so that any nurse can answer most questions, and if not, they know who to call. orientation can last as long as the orientee feels he/she needs it. we try to include the new folks in social activities and conversations. of course, we always help one another--it isn't just the new folks helping the more experienced folks--we all just pitch in with everything. it helps to foster a can-do attitude and a sincere, patient-based focus.

2. what role does your nurse manager play in creating and/or maintaining this environment? do the staff nurses take accountability for the culture or is this something that is enforced by the nurse manager?

in my opinion, you can't legislate feelings. we are just as friendly, helpful, and supportive with our fellow coworkers as we are of our patients. some of that you can be taught to do. one thing i notice an absence of is critical complainers. we all pretty much agree that it's useless to complain, and counterproductive to argue.

[color=#4b0082]there is a specific coaching program for our nurse managers at my hospital. we also use a model similar to that described in "from novice to expert," by patricia benner.

3. what happens if a nurse does not participate in the culture and talks badly about another shift or another nurse, how is this handled by the team or by the nurse manager?

we usually listen, because to not listen would be to possibly reject a valid concern. we usually keep things upbeat, and we'll joke about "grumpy" or "cranky" people. when it gets really busy, we all have our little "mantra" that helps us laugh it off and keep going. mostly, our attitudes are that we like to work. we don't like to be overwhelmed all the time, but we recognize that it comes with the territory, and somehow, the shift always gets finished, regardless of how you get there. so you might as well smile and help one another; at least you're not dealing with everything by yourself.

[color=#4b0082]i personally think that a lot of nurses are so stressed out because they're driven by fear--fear of losing a patient, fear of being sued, fear of being written up, fear of making a mistake, fear, fear, fear. nurses have a real culture of fear ingrained into them from nursing school on.

[color=#4b0082]therefore, to have a great workplace culture, you don't want or need to threaten--the fear is already there so much that some nurses simply wake up one day and can't go to work, ever again. fear. it ruins the joy that we take in our job.

[color=#4b0082]you don't threaten--you encourage. you stop a negative behavior and show them the positive behavior. you stress that their success is important, that you--the entire team--wants them to succeed.

4. i love the accountability for physicians, but how does the hospital justify losing revenue from a physician that may have a thriving practice, but met the third strike and was thrown out? while i love this, i think that the revenue lose would be so great to the hospital that administrators would be taking some pretty big heat for not making budget?

i have no idea, but it's happened. i've written up two docs for getting nasty with me, and they lost the attitude problem pronto, so admin must have backed the threat up at some point.

5. finally - how do you get the "culture" started? there had to be a beginning .... share with us what ytou know about how this work place culture started. this almost sounds like utopia .... i know a work place can thrive, nurture and grow like this, but i really want to know how it all started.

i believe that my manager simply allowed the chronic complainers and bad attitude people to weed themselves out. those types really do have an effect on team morale. we strive to build up, they're too busy looking at the dark side to have fun at their job.

[color=#4b0082]oh, and that reminds me--see the phish film! that pretty much sums up how it can be at work. here's the link:

[color=#4b0082]

http://www.charthouse.com/charthouse/vidtlr_fish.asp?

6. promise - last question - can you describe the type of unit you work on.

i work progressive care. our patient/staff ratios are doable, our pay is ok, but as i said, it's the staff that makes the difference. i hope this helps.

thank you again for sharing your experience. like the other posters have said, this is wonderful and is a real way to help nurses want to stay at their job. your post actually illustrates that nurses really desire a nurturing and caring environment in which to work in. yes, salary and benefits are very important, but aside from those being competative ... as nurses, we want to be respected, needed and most of all - recognized for the contribution we make the the health and well being of the patient.

well said, pat. i hope i've passed on a little piece of our workplace culture. it can only improve our profession in the long run. :)

[RNPATL, DNP, RN]

our new nurses are "coached" and "precepted" by staff. they gradually increase responsibilities as they learn and improve their skills. the more experienced nurses are all very approachable, open, and friendly. procedures are streamlined enough so that any nurse can answer most questions, and if not, they know who to call. orientation can last as long as the orientee feels he/she needs it. we try to include the new folks in social activities and conversations. of course, we always help one another--it isn't just the new folks helping the more experienced folks--we all just pitch in with everything. it helps to foster a can-do attitude and a sincere, patient-based focus.

in my opinion, you can't legislate feelings. we are just as friendly, helpful, and supportive with our fellow coworkers as we are of our patients. some of that you can be taught to do. one thing i notice an absence of is critical complainers. we all pretty much agree that it's useless to complain, and counterproductive to argue.

[color=#4b0082]there is a specific coaching program for our nurse managers at my hospital. we also use a model similar to that described in "from novice to expert," by patricia benner.

we usually listen, because to not listen would be to possibly reject a valid concern. we usually keep things upbeat, and we'll joke about "grumpy" or "cranky" people. when it gets really busy, we all have our little "mantra" that helps us laugh it off and keep going. mostly, our attitudes are that we like to work. we don't like to be overwhelmed all the time, but we recognize that it comes with the territory, and somehow, the shift always gets finished, regardless of how you get there. so you might as well smile and help one another; at least you're not dealing with everything by yourself.

[color=#4b0082]i personally think that a lot of nurses are so stressed out because they're driven by fear--fear of losing a patient, fear of being sued, fear of being written up, fear of making a mistake, fear, fear, fear. nurses have a real culture of fear ingrained into them from nursing school on.

[color=#4b0082]therefore, to have a great workplace culture, you don't want or need to threaten--the fear is already there so much that some nurses simply wake up one day and can't go to work, ever again. fear. it ruins the joy that we take in our job.

[color=#4b0082]you don't threaten--you encourage. you stop a negative behavior and show them the positive behavior. you stress that their success is important, that you--the entire team--wants them to succeed.

i have no idea, but it's happened. i've written up two docs for getting nasty with me, and they lost the attitude problem pronto, so admin must have backed the threat up at some point.

i believe that my manager simply allowed the chronic complainers and bad attitude people to weed themselves out. those types really do have an effect on team morale. we strive to build up, they're too busy looking at the dark side to have fun at their job.

[color=#4b0082]oh, and that reminds me--see the phish film! that pretty much sums up how it can be at work. here's the link:

[color=#4b0082]

http://www.charthouse.com/charthouse/vidtlr_fish.asp?

i work progressive care. our patient/staff ratios are doable, our pay is ok, but as i said, it's the staff that makes the difference. i hope this helps.

well said, pat. i hope i've passed on a little piece of our workplace culture. it can only improve our profession in the long run. :)

thank you again for sharing your experiences with us. it is so helpful to know that there are places that do indeed nurture nurses and make a work environment a place that people want to come to day after day. i love the accountability factor, but more importantly, i really love the idea of no fear. success is coached! i have often said on the units that i have run and managed, that i did not believe in throw away nurses ... every nurse (well most anyway) want to do a good job and want to learn and grow. you have certainly shown that there are places where this culture exists and it is working!

thanks again for a wonderful exchange of information.

[Hellllllo Nurse, BSN, RN]

Yesterday, I had been busting my butt for 12 hrs, and my immediate supevisor came in to the unit and had a fit about something miniscule and stupid (I had a pack of gum on the counter at the nurses' station) it really burst my bubble and made all of us that were there feel like we were fools for working our butts off for such a short-sighted, nit-picky boss.

Bosses- don't sweat the small stuff.

[OC_An Khe]

To over simplify the answer, treat professionals as professionals. And not with lip service. Treat all nurses equally especially with scheduling. Don't favor one because they work extra. Some people would like to work extra butcan't because of other commitments. There others ways of rewarding those that work extra without "punishing" those who can't.