HealthNovember 08, 2022

New approaches to nurse retention

New and experienced nurses are essential to the profession’s future, but keeping them in clinical practice continues to be a challenge. Nurse turnover is a known issue, especially among recent graduates — up to 30% leave within their first year, and up to 57% leave by the end of their second. Health systems and nurse leaders are committed to understanding the reasons why, and what can be done to retain them.

A recent HealthLeaders Healthcare Workforce NOW summit panel, “Securing Nursing’s Future by Engaging the Multigenerational Workforce,” sponsored by Wolters Kluwer, explored what drives nurses to leave the workforce and provided practical approaches to improve nurse retention.

The panel consisted of top nursing experts from some of the most prestigious health systems. The HealthLeaders panel was led by Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse of Wolters Kluwer, Health, Learning, Research and Practice, and critical care nurse practitioner at Penn Medicine Health System. She was joined by Launette Woolforde, EdD, DNP, NPD-BC, NEA-BC, FAAN, Chief Nursing Officer, Northwell Health, Manhattan properties, Lenox Hill Hospital, Lenox Health Greenwich Village and Manhattan EET; and Maureen Swick, PhD, RN, NEA-BC, Senior Vice President, Nursing and Pharmacy, Enterprise Nurse Executive, Atrium Health.

Reevaluating values post-pandemic

The COVID-19 pandemic prompted hospital leadership to revisit what matters most for the nursing workforce. Work-life balance became non-negotiable, as nurses prioritized family needs and mental health. Many opted to work as travel nurses or seek opportunities outside of the acute care setting.

Today, experienced nurses who either prefer remote positions or desire a less physically demanding role are pursuing remote work opportunities. Less experienced nurses have placed an emphasis on career development, with many seeking rapid promotions and advanced practice positions. However, nearly one-third of graduate nurses leave the bedside due to a lack of support.

The following are a few of the approaches presented by the panelists that have improved nurse retention within their respective organizations.

Provide career flexibility for nurses

The panelists noted that nurses don’t need to leave their healthcare organization in order to further their career. “We talk with them about other opportunities in the health system…that might align better with where they want to be. That way they don’t have to make a drastic decision such as to leave the profession,” said Launette Woolforde, EdD, DNP, NPD-BC, NEA-BC, FAAN, Chief Nursing Officer, Northwell Health.

Telehealth is an effective way to keep experienced nurses - and their wisdom - in the workforce. “Our more experienced nurses are looking for other ways to leverage their talents…and stay in the workforce but without having to commit to the physical demands,” said Woolforde.

Increasing the use of float pools and moving from unit-based to continuum-based hiring offers nurses an additional layer of flexibility. “Millennial nurses and the next generation nurses really loved the ability to be able to work in adjacent areas and have that flexibility, and also a lot of times the float pool gives them more flexibility in their schedules,” explained Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse, Wolters Kluwer, Health, Learning, Research and Practice. The ability to rotate within different areas also helps nurses maintain competency, she noted.

Boost competence and confidence with nurse residencies

A key theme that emerged during the session was the importance of supporting new nurses before and after their transition from classroom to exam room. Nurses in their senior year of school can benefit from hands-on training programs that help prepare them for clinical practice. “We've created a nurse extern program where we can have them come and work alongside a preceptor prior to graduation, one on one, so I think that also adds a bit of security and training and gives them a little bit more confidence,” said Maureen Swick, PhD, RN, NEA-BC, Senior Vice President, nursing and pharmacy, Enterprise Nurse Executive, Atrium Health.

For new graduates, nurse residency programs help improve competency, and have a significant impact on nurse retention. Dabrow Woods stated, “We know that in hospital systems that have nurse residency programs, they're able to decrease their attrition rate down to about 6% to 10%, which is a huge improvement over the 30% that would be leaving.”

Foster inclusivity through shared governance

Ensuring all voices are heard is a critical part of managing a multigenerational workforce, according to the panel. Shared governance allows new and experienced nurses to come together and compare insights and experiences in a way that is mutually beneficial.

“Our shared governance model brings forth our frontline nurses from all backgrounds, all generations, into one forum where we're able to hear and share together what an experience is like, what everyone wants the workplace to look like, and how we can get there together,” said Woolforde.

Visibility of leadership is also crucial, especially during night and weekend shifts. This helps the workforce feel seen, supported, and valued. As Swick noted, “I think we can never underestimate the importance of leader rounding and leader presence.”

To hear more from the panel, watch “Securing Nursing’s Future by Engaging the Multigenerational Workforce.”

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