Nurse Turnover: Understand it, Reduce it

Franklin A. Shaffer, EdD, RN, FAAN, FFNMRCSI; Leah Curtin, ScD(h), RN, FAAN


Am Nurs Journal. 2020;15(8) 

In This Article

What can Employers do?

The 2018 Press Ganey Nursing Special Report: Optimizing the Nursing Workforce: Key Drivers of Intent to Stay for Newly Licensed and Experienced Nurses analyzed responses of nearly 250,000 nurses to identify trends in intent to stay based on age, tenure, and unit type, as well as drivers of intent to stay. In general, nurses need certain things from their jobs.

  • Good pay. How strongly pay contributes to employee satisfaction has been debated in the literature, probably because money means different things to different people. However, two truths are constant: Employees need money to live, and money is used as a measure of value by employers and employees. Pay matters.

  • Flexibility. When the Society for Human Resource Management surveyed human resources (HR) professionals about challenges they've faced, 59% responded that retaining and rewarding the best employees was their main concern. And when asked how they thought this goal could be achieved, 40% answered "providing flexible work arrangements." Almost all employees are looking for better work/life balance and are willing to be loyal to employers who provide it.

  • Respect. Employees want to know that what they think matters. They want to be treated as valuable members of the team with something meaningful to contribute. At the very least, employees don't want to be yelled at, demeaned, or humiliated by abusive managers, coworkers, or physicians.

  • Autonomy. Employees appreciate being able to fulfill their work duties in a manner that suits their standards of practice and their temperaments. Frequently, more than one way exists to achieve a goal, and nurses value the freedom to choose the way that aligns with their standards of practice. Managers who insist that low costs are superior to excellent care frustrate nurses and lead them to think about other employment options.

One of the most important conclusions of the literature on hospital employment is that the same practices that create a positive working environment for nurses also are critical to securing standards of quality patient care.

Based on this information, employers can take several steps to improve retention.

  • Improve communication between administration, management, and staff. If rudeness, lies, stonewalling, gossiping, bullying, and other forms of negative communication are tolerated, good employees will leave.

  • Hold employees accountable for fulfilling their job descriptions and standards of practice. Teach managers how to give feedback and reward them for doing it regularly and honestly.

  • Heed the adage: Hire slowly and fire quickly. Teach managers how to interview and hire employees.

  • Deal expeditiously with conflict. Competent people want to work with other competent people in organizations that value and support their talents. They'll leave if those standards aren't met.

  • Focus on fairness. Humans are wired to appreciate fairness. Employees who come to work on time and produce as expected don't like it when coworkers aren't disciplined.

Although some hospitals have moved to adopt best practices for improving recruitment and retention, too many others have moved in the opposite direction. (See Risks of mandatory overtime.)