Retaining Staff and Reducing Turnover

Health Care Staff Turnover

Staff retaining and Reducing Turnover is a managerial skill for staff retention.

Reducing turnover

    Reducing turnover and retaining staff begins with recruitment and selection. Additionally, the overall shortage of nurses is expected to worsen (American Association of Colleges of Nursing, 2007; Joint Commission, 2007). An aging workforce coupled with an aging population and the spiraling cost of health care exacerbate the problem of too few nurses to care for many more patients. It behooves the nurse manager to make every effort to enhance the environment so that the best nurses remain.

Retaining Staff
Healthy Work Environment

    Gilmore (2007) suggests that a healthy work environment increases nurse job satisfaction, a necessary condition for retaining nurses. In contrast, unhealthy work environments lead to turnover and poor patient care (Barden & Distrito, 2005). Miracle (2008) positives that both nurse satisfaction and excellent nursing care is the product of a healthy work environment.The American Association of Critical Care Nurses (AACN, 2005) established six criteria for a healthy work environment to "foster. excellence in patient care" (p. These criteria are:

Skilled communication-as important as clinical skills

• True collaboration-between and among nurses and other health care professionals' Effective decision making-involved as partners in making policy and leading organizations
• Appropriate staffing effective match between patient needs and nurse competencies Meaningful recognition-for value of work Authentic leadership-leaders embrace, live, and engage others in it
• Authentic leadership is required for a healthy work environment, according to Shirley (2006).

    Where nurses practice and what mix of nursing staff is required to adequately care for tomorrow's patients continue to shift (eg, ambulatory care, home care). Regardless of the setting, reducing turnover, the number of staff members who vacate a position, is essential for the health care organization to thrive.

Management Strategies to Retain Staff

    In addition to the work environment, managers can use several strategies to help retain a valued employee in the organization. These include:

• Provide a realistic job preview to new hires
• Facilitate movement within the organization
• Improve the work environment
• Coordinate with other managers to influence organizational policy
• Adapt to turnover rate
• Provide Realistic Job Preview and Follow-up

    Drenkard (2004) suggests that new graduates' unmet expectations about the practice setting is the cause of the high rate of turnover (Price Waterhouse Cooper, 2007). Children's Memorial Hospital in Chicago reduced turnover among new graduates from 29.5 percent to 12.3 percent after implementing a multifaceted orientation program (Halfer, 2007). Providing a real job preview, orienting the new graduate to the practice setting, and monitoring the new graduate's adaptation can help prevent these early withdrawals (Parrish, 2006).

    You may recall the example in which the manager included unit staff in peer interviews with applicants in order to provide realistic job previews. Another manager followed with a new nurse in the up next example.

    Trina Prescott, RN, joined the pediatric oncology unit of a large university teaching hospital. Her nurse manager, Lily Yuen, scheduled a lunch with Trina 30 days after she started. Lily had a relaxed conversation with Trina about the first 30 days of her employment. Trina expressed how much she enjoyed her new job, but still felt uncomfortable accessing implanted vascular ports without assistance from her mentor. Lily makes a note to schedule one-on-one teaching for Trina with a nurse from the IV team. Scheduling a lunch with new employees approximately 30-days and 60-days into their employment has improved new employee retention and increased open communication between Lily and her staff.

Facilitate intra-organizational movement

    If a staff nurse is "burned out" from working on an oncology floor, one option is to allow a transfer to another service area in the organization (eg, home care). Unfortunately, some managers hinder or even prohibit such a transfer (particularly if the potential transferee is an excellent performer), not wanting to lose a good nurse. However, this perspective is short-sighted. If the staff nurse cannot transfer to another area (intra-organizational mobility), she or he may leave the organization entirely (inter-organizational mobility).

• Improve Management Practice Some suggestions for managers to use are:
• Enrich or redesign the staff nurse's job Facilitate upward and downward communication
• Link rewards with performance (see next section on pay for performance)

    The temptation is to look for a quick fix in dealing with turnover, is seldom In fact, what appears to be a simple change (eg, trying to enrich the whether of a high-performing nurse) may not be. For example, providing additional duties to enrich a nurse's job may lead to complaints of favoritism from other nurses, or the human resources department may worry about as signing duties that are not included in the job description.

    Such potential difficulties should not cause a nurse manager to revert back to status quo behavior Rather, anticipate such potential problems and deal with them (eg, be able to justify the differential treatment through the use of performance appraisal data, have the affected nurse agree to the additional duties in writing). One nurse manager decreased voluntary turnover on her unit without incurring additional costs

Coordinate with Other Managers to Influence Organizational Policy

    A manager wants to do everything possible to lessen the problem of turnover. Sometimes this involves coordinating efforts with other managers to change organizational policy. One example is changing an organization's policy concerning work schedules.

    Work scheduling (self-scheduling, fixed versus rotating shifts, flexible work hours, job sharing) is a particularly important area not only because of its relationship to voluntary turnover but also because of its frequent linkage to unionization attempts. It should not be surprising that working conditions that lead to turnover also can motivate interest in unionization Two key causes of turnover-related strategies for the temptation is to look for a quick fix in dealing with turnover, is seldom In fact, what appears to be a simple change (eg, trying to enrich the whether of a high-performing nurse) may not be. 

    For example, providing additional duties to enrich a nurse's job may lead to complaints of favoritism from other nurses, or the human resources department may worry about as signing duties that are not included in the job description.Such potential difficulties should not cause a nurse manager to revert back to status quo behavior Rather, anticipate such potential problems and deal with them (eg, be able to justify the differential treatment through the use of performance appraisal data, have the affected nurse agree to the additional duties in writing). One nurse manager decreased voluntary turnover on her unit without incurring additional costs.