Registered Nurse Retention

Registered Nurse Retention

As a registered nurse of this organization for 5 years and an employee for 9 years, lack of nurse retention within the organization has been a major concern. Due to nurse shortages, the organization has resorted to bonus pay for those willing to pick up overtime. There is a loss of moral that can be felt throughout the facility as nurses continue to work with short staffing levels and higher patient loads. As the organization faces financial challenges with meeting the requirements of the Affordable Care Act to ensure reimbursement; nurse retention should not be compromised in the process. It may have negative impacts on the budget and quality of patient care. Prioritization and new policies must be implemented to prevent further adverse effects.

The national turnover rate if approximately 14 percent for bedside registered nurses and 28 percent for new hire nurses (Li & Jones, 2012). The cost of high nurse turnover rates can be detrimental as the cost per registered nurse is half the average salary (North, Leung, Ashton, Rasmussen, Hughes, & Flinlayson, 2012). This can range from $10,000 to $88,000 (Duffield, Roche, Homer, Buchan, & Dimitrelis, 2014). This includes cost lost through the new hire productivity and preceptor time unit that new hire is compliant. It also includes the cost of recruitment and hiring. Additional costs occur to travel nurses needed to fulfill immediate requirements. Orientation and training make up the highest costs (North et al. 2012). Studies conclude that organizations such as ours that offer more complex services such as intensive care units experience higher turnover costs due to more time and funds needed to train newly hired nurses (Li & Jones, 2012). As the organization looks for ways to cut costs, maintaining nurse retention can save a substantial amount of money.

Financial motive is a major factor in placing nursing retention at a higher priority, but quality of patient care is just as important if not more. Despite nurse staffing shortages and turnover, patient loads do not decrease. We live in a time where Baby Boomers are aging and flooding our hospitals. Patient outcomes are negatively affected, as there is an increase in the nurse-to-patient ratio, wait time, an inability for nurses to deliver proper patient care and diminishes the morale of the retaining nurses (Homburg, Van Der Heijden, & Valkenburg, 2013).

Not only is morale adversely affected, but patient mortality as well. The New England Journal of Medicine have found a correlation between lower staffing levels of registered nurses and an increase in patient mortality (Needleman, Buerhaus, Pankratz, Leibson, Stevens, & Harris, 2011). High nurse workload diminishes the nurses’ surveillance of patients and increases the risk for adverse affects (Needleman et. al. 2011). Nurses who work more that 8 hours a day; most nurses work 12 hours per day; are at an increased risk of patient mortality (Needleman et. al. 2011). In addition, low registered nurse staffing levels also negatively affects quality measures. Maintaining good standing with quality measures, adopted by the National Quality Forum, the Agency for Healthcare Research and Quality (AHRQ) and Joint Commission, are imperative now than ever before. As the Centers for Medicare and Medicaid Services (CMS) no longer reimburse healthcare institutions “for the costs associated with certain nurse-sensitive hospital-acquired “never” events, such as pressure ulcers and catheter-associated infection”, a high priority of decreasing nurse turnover needs to be addressed (Needleman et. al. 20111).

Despite the conclusions of studies related to nurse turnover, related costs and affects to organizational morale; it continues to be an outstanding issue. I am concerned there is a disconnect with the bedside nurse and nurse administrators/executives. As nurse administrators/executives are ‘removed from the day-to-day work environment they may not be the best managers to compare perceptions with staff nurses in evaluation of the organizational climate” (Gormley, 2010). When asked what issues are most important in retention of nurses to the profession, staff nurses reported professional practice, external values and beliefs about nursing, legal and employer concerns, work life/home life balance and contracts requirements (Gormley, 2010). Whereas nurse administrators/executives reported external values and beliefs about nursing, legal and employer concerns, professional practice, work life/home life balance and contract requirements (Gormley, 2010).

Hospital executives as a whole need to pay closer attention to the reasons of high nurse turnover rates. There are five reasons, in no particular order, that give nurses an intention to leave, all in which I can relate to as a bedside nurse. The first is dissatisfaction with management/supervisors and their leadership qualities. My first nurse manager was new to the position and was unable to hold accountability, implement and maintain higher standards of care within the unit. The inexperience of management was palpable as nurses, particularly new nurses such as myself left within their first and second year of hire. Pay and benefits are second. Many nurses are leaving our organization to other area hospitals because they pay higher rates as it is well known that St. Francis Hospital pays one of the lowest rate. Third is lack of job satisfaction in regard to appraisal and varying in tasks (Homburg et. al. 2013). Lack of job satisfaction is a major reason I left my first unit, as I felt unappreciated by management due to little praise. There was also a lack of being challenged by the patient population I was caring for. Work-home interference is the forth reason and personally first on my list. As my unit was from working every forth weekend to every other weekend, it has left a nasty taste of dissatisfaction in the mouths of many nurses. This change has resulted in a major nurse turnover in my unit that we are still unable to recover from. As we have to work every other holiday, working every other weekend in addition is straining our work-home balance. The fifth reason behind nurse turnover is lack of career development opportunities. There is little room for advancement for the bedside nurse. Unless high education is pursued or laboring 15-20 years at the bedside; there is little chance for advancement.

As recommended by the New England Journal of Medicine (2011), this organization needs to implement new policies to ensure there are sufficient resources for adequate nurse staffing levels. Human resources and nurse manager recruiters need to be more selective in their hiring process. In addition, the organization may need to invest in more management and leadership training skills to raise the quality of nurse managers. Although there are financial constraints, increasing nurse pay rates to a competitive level needs to be heavily considered as a substantial amount of nurses are being lost to area hospitals. Brining back weekend only nurses will help nurses in their work-home balance. Creating more jobs opportunities and involvement of the bedside nurse will help keep those retained within the organization. Tackling nurse retention rates is not only beneficial financially due to reimbursement of the CMS, savings in training, recruiting new nurses, but to the quality of patient care.

References

Duffield, C., Roche, M., Homer, C., Buchan, J., & Dimitrelis, S. (2014, June 21). A Comparitive Review of Nurse Turnover

Rates and Costs Across Countries. Informing Practice and Policy Worldwide Through Research and Scholorship , 2703-2712.

Gormley, D. (2010). Are We On the Same Page? Staff Nurse and Manager Perceptions of Work Environment, Quality of Care

and Anticipated Nurse Turnover. Journal of Nursing Management , 19, 33-40.

Homburg, V., Van Der Heijden, B., & Valkenburg, L. (2013). Why Do Nurses Change Jobs? An Empirical Study on Deterants

of Specific Nurses' Post-Extit Destinations. Journal of Nursing Management , 21, 817-826.

Li, Y., & Jones, C. (2012). A Literature Review of Nursing Turnover Costs. Journal of Nursing Management , 21, 405-418.

Needleman, J., Buerhaus, P., Pankratz, S., Leibson, C., Stevens, S., & Harris, M. (2011). Nurse Staffing and Inpatient

Mortality. The New England Journal of Medicine , 364 (11), 1037-1045.

North, N., Leung, W., Ashton, T., Rasmussen, E., Hughes, F., & Flinlayson, M. (2012). Nurse Turnover in New Zealand;

Costs and Relationships with Staffing Practices and Patient Outcomes. Journal Of Nursing Management , 21, 419-428.

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