Financial impact of recruitment and retention

Financial Impact of Recruitment and Retention

Recruitment and retention of nurses: Strategies for improvement

Careers in the health care field can prove to be taxing upon the constitution of both seasoned professionals and new recruits. Nursing in particular is physically, mentally, and emotionally challenging. The statistics speak for themselves, fully 35% to 69% of newly hired graduate nurses leave their place of employment within the first year, and nurse turnover rates range from approximately 55% to 61% nationwide (Persaud 2008, p.1173). Retention is critical in assuring patients of quality and consistency in treatment, and such widespread mobility suggests that institutions must do more to improve job satisfaction for nurses.

Hospitals are attempting to increase retention rates. A "recent study found an inverse correlation of nurse education with acute care mortality and morbidity, a troubling finding if baccalaureate nurses leave acute care prematurely. Patient safety, advocacy, and flexibility in a changing health care system underscore the importance of having experienced, well-educated nurses at the bedside. Ultimately, the well-publicized nursing shortage may not only be a shortage of numbers, but a shortage of highly educated nurses with acute care expertise and career longevity. Rapid turnover and loss of experienced RNs significantly impede leadership development and the development of practice expertise in high-acuity patient care areas. Retention of baccalaureate nurses is a central issue to patient safety" (Hodges 2008, p.80). "A 2004 economic analysis published in the Journal of Nursing Administration estimated that the dollar cost of turnover per registered nurse at one 600-bed acute care hospital is $62,100 to $67,100" (Poynton 2007, p.396). If action is not taken quickly, the entire healthcare profession will suffer. "A staggering number of registered nurses are leaving the profession due to feelings of stress, inadequacy, anxiety, oppression and disempowerment" (Persaud 2008, p.1173).

From the hospital's perspective, "typically, nurse salaries and benefits represent either the first or the second largest line item in a hospital's budget. Nurse retention, therefore, can have significant financial implications for hospitals, as well as quality of care implications. A well-trained, experienced nurse represents an extremely valuable source of knowledge and skills that hospitals can ill afford to lose" (Miller 2008, p.18). Saint Anthony Medical Center of Rockford, Illinois believed that one of the critical problems in its retention system was the fact that so many new nurses were overwhelmed, early on in their careers in the or. While the practice of hiring a new nurse to work in the or was unheard-of at the facility, now it is a necessity, meaning that nurses were being called upon to serve in more stressful capacities earlier in their careers at the hospital. Saint Anthony implemented a mentorship program as a way of changing new nurses' outlook from one of surviving to thriving. Establishing a single mentor to anchor the new nurse through rotations was the hospital's most successful retention strategy. "Between January and June of 2006, five new graduate nurses and two experienced nurses were hired. All new hires completed the surgical nurse residency program and participated in the or mentorship program" (Persaud 2008, p.1179).

One common protest is that smaller, rural hospitals do not have the funds or staff to house such mentorship programs. However, the Rural Wisconsin Health Cooperative in Sauk City has found ways to creatively incorporate mentorship into their training program. "Nurses drive to the cooperative to attend 12 monthly, daylong programs. These plans include achieving expertise in various areas of care. The retention statistics for the first and second years of the program are impressive. Eighteen months after the program ended its first year retention was at 89% for 19 nurses. For the second year 87% of the 31 nurses in the program were retained" (Thrall 2004, 24). Nurses were willing to undergo long commutes simply for the additional mentorship, which is itself testimony to the importance of such programs. There is a strong correlation between positive mentoring and retention: "I had to learn to ask questions. I felt that they would perceive me as not very knowledgeable if I asked a lot of questions. but...they told us we were not to know everything as a new graduate.... not even an experienced nurse knows everything...and that it's okay to ask questions....I need(ed) a lot of reassurance. Had I gone to a unit where they put me with a preceptor who really didn't care about educating...I think I would have struggled big time....[but] they never treated me like I was stupid," are common responses of new nurses in mentoring programs (Hodges 2008, p.83). Mentors provided advice on psychologically coping with the emotional demands of nursing, time management, accuracy, and striking a balance between work and professional life.

Mentoring programs are especially important for nurses given that "developing an ability to thrive in unpredictable health care environments is crucial to all nurses, but particularly to practice in acute care settings" (Hodges 2008, p.80). All healthcare settings draw upon a nurses' ability "to recover quickly or adjust to adversity is commonly known as resilience. The capacity for resilience allows one to reframe, adapt, balance, persist, and grow in the face of adversity and hardship, but requires both suffering and perseverance in the struggle to work through emerging difficulties and to integrate experiences of crisis into a sense of well-being" (Hodges 2008, p.80). "The new nurse is faced with overwhelming questions: Do I really want to be a nurse? Am I cut out for the nursing profession? Do I want to stay?" And a positive role model is critical in generating positive answers from the nurse (Hodges 2008, p.85).

Showing respect for the stresses nurses undergo is also a vital component in increasing job satisfaction and retention. The McGill University Health Center (MUHC) in Montreal gives individuals with more than five years service, an additional week off a year, as well as three scheduled personal days for all staff. "While the improvements have led to greater retention of staff, initially there was skepticism from senior management" (Harder 2009, p.12). "Ironically, since nurse retention is often considered to be everyone's priority at a hospital, it often becomes no one's priority. A dedicated retention specialist takes ownership of this function and provides both continuous retention improvement and accountability" (Miller 2008, p.18).