Recruitment and Retention Results 4

Relationships MatterEngaged Leadership Engaged Educators Engaged Managers/Directors Engaged Preceptors/Mentors Engaged Staff Engaged New Nurse

Decreased Turnover = Quality Patient CareHeather Machado RN MS

Nursing Recruitment and Retention

What is Engagement?“A heightened emotional connection that an employee feels for his or

her organization, that influences him or her to exert greater discretionary effort to his or her work.”

(Gibbons, 2006)

#3 Volunteer Discretionary Effort ConstantlyNurses who are more engaged in an organization use discretionary energy that drives an organization to top

performance (Wagner,S.E. (2006)., Nursing Management)“I would like my contributions valued”

“60 Day Hire” project group

05/01/2023 2


Relationships Matter

On average35% to 60% of new nurses will leave within

the first year of employment

(Beecroft, Kunzman,& Krozek, (2001). Journal of Nursing Administration)

05/01/2023 3


Relationships MatterStages of a New Nurse

0- 3 months – mastering material, competencies and realization of how different school is from the work environment (initial shock)

3-6 months - mastering and getting the job done6-12 months - involvement in unit based decisions, scheduling, work/life

balance, physician relationships (dissatisfaction with work schedules)• It takes 12 - 18 months for nurses to become comfortable with the

workplace environment (work schedule dissatisfaction begins to resolve) (Halfer and Graff, Nursing Economics/May-June 2006/Vol. 24/No. 3)

05/01/2023 4


Relationships MatterNew nurse hires experience stress during orientation due to:

• Lack of experience• Lack of organizational skills • Unfamiliar with new situations/skills/protocols• Wondering if their opinion is valued • Not feeling like they fit in with the team (group cohesion)

Important to feel and have:• Satisfied with job• Competent• Respected professionally• Access to information • They are part of a team• Contributions are valued, recognition, control, responsibility• Opportunities for professional development (Hatler, Kelley, Stoffers, Redding, Carr, (2011)

Nursing Economics$ )

Hatler, Kelley, Stoffers, Redding, Carr, (2011). Nursing Economics$

•

05/01/2023 5


New People, New Job, New Reality

Consider how this impacts the team

the new nurse and patient care

“I don’t feel I have time to provide the care I would like to. Sometimes I don’t even remember how I have gotten

through the day. We are pulled in so many directions.”

05/01/2023 6


Engaged Employees Increase Customer Return, Referrals, & Market Share

• 1# - Would you recommend this as a place to work = Increased patient satisfaction

• 2# Satisfaction with work - hospital departments that have higher levels of employee satisfaction provide better experiences for patients. (by four points out of 100) Satisfied employees = increased customer referrals

• Those same patients rate the quality of the care they received as higher (by three

points out of 100). Satisfied employees = perception of better care by the patient.• (Peltier, Dahl, (2009)., Forum)

05/01/2023 7


Why Engagement Matters

• Engagement has a positive correlation with individual, group, and organizational performance in areas such as productivity, retention, turnover, customer service, and loyalty (Ketter, 2008)

• Employees who are disengaged in their jobs are more likely to leave because they feel unappreciated. Employee engagement predicts job satisfaction and intent to stay (Fukuyama 1995 & Wagner, 2006)

05/01/2023 8


Employee Engagement = Quality Patient Care

• Perceived organizational support predicts both job and organization engagement. (Saks, 2006)

• Employee satisfaction has a strong relationship with the quality of care delivered and related costs

“Nurses who are satisfied with their jobs exhibit higher levels of patient safety and less medication errors which help increase patient satisfaction.” (Rathert & May, (2007)., Health care work environments, employee satisfaction, and patient safety: Care provider perspectives)

05/01/2023 9


Patient Satisfaction : Employee Satisfaction1:1 Correlation

Study:Satisfied employees were found to lead toshortened lengths of stay for patients and lowervariable costs

(Harmon,et al.,2003;Karasek 1990)

05/01/2023 10


Measuring Impact of EngagementLeadership Engagement Strategy

A Quality Improvement Initiative

We compared turnover data from

July 2011 – June 2012to

Intervention Group “60 Day Hire”July 2012 – June 2013

05/01/2023 11


New Hires Leaving by Month

u 30

1 2 3 4 5 6 7 8 9 10 11 1202468

10121416

2011- 2012

2012 -2013

6o Day Hire Group

05/01/2023 12

Month Leaving

28.2% Turnover Rate – allJuly 2012 – 2013 new hires

voluntaryinvoluntaryremaining164

61

3

Nursing Recruitment and Retention 12/7/2013


47% Turnover Rate – allJune 2011 – July 2012 new hires

voluntaryinvoluntaryremaining

89105

4

05/01/2023 14

“60 Day” Hire Group Compared to Others Who Did Not Attend Sessions 2012 -2013

u301m

os2m

os3 m

os4 m

os5 m

os6 m

os7 m

os8 m

os9 m

os

10 m

os

11 m

os

12 m

os0

4

8

12

60 DayHire All others

05/01/2023Nursing Recruitment and Retention 15


“60 Day Hire” New Nurse Hire Compared to Overall Group

• 205 eligible to attend the 60 day Hire out of 230 hires

• 89 attended = 43%

• 93 out of 230 filled out “60 Day Hire” electronic survey

• 53 attended large group session

05/01/2023 16


205 Total Eligible Nurses(230 total hired less 25 not eligible to attend)

Intervention - “60 Day Hire”

• 89 attended (43%)• 4 terminated

4.5% turnover rate

Non Intervention

• 116 did not attend (57%)• 35 terminated

30.2% turnover rate

05/01/2023 17

Monetary OutcomeNurses Saved/Nurses Lost

Intervention -“60 Day Hire”

• Projected loss without intervention an additional 23 nurses would have been lost

Total Monetary Savings $1,610,000.00

Nonintervention

• Projected savings with full participation of 116 nurses an additional 30 nurses would have been savedTotal Monetary Savings

$2,100,000.00


Total Savings if every eligible new hire attended $3,710,000.00

Short description reasons for leavingECRN form measurement

Involuntary

• Rules violation• Absenteeism• Do not hire• Incompetence• LOA• Substance• Mutual• Incompatible

Voluntary

• Home/personal• Work unsatisfactory• Other position• Mutual agreement• Leaving city or state• Employment type change• Dissatisfied• School• Incompatible• Hours • Incompetence• Illness/physical• Left without notice• Work



Cost Per Year of Turnover: New Hires Under 1 Year

• 2011-2012 = 93 = $6,510,000.00• 2012-2013 = 64 = $4,480,000.00

Total for 2 years = 157 = $10,990,000.00

• 2011-2012 another 46 left between 1-2 year mark = $3,220,000.00

• 2012-2013 = 2 leaving after 1 year mark = $140,000.00

05/01/2023 20


Top 3 Reasons Nurses are Leaving Both Years

Year 1 Year 2

#1 Hours 23 19

#2 Other position 18 12

#3 Home/personal 15 11

05/01/2023 21


Patterns and Themes from “60 Day Hire” Surveys & 90 Day Sessions

• Manager Relationship and Engagement

• Collegial and Team Relationships

• Resources and Tools to do the job

• Streamlined Orientation specific to nurses’ need and unit needs

H3W Leadership Behavior # 5 Respect & Leverage Separate Realities

05/01/2023 22


Share - Value- Act - Retain ACT

Evidence based recommendations

• The Nursing Recruitment and Retention Team and Nursing Professional Practice Council

• “60 Day Hire” Survey and Luncheon/Breakfast data• “60 Day Hire” GN project group• Research

05/01/2023 23


Strategies - Relationships MatterManager relationships• Behavior based interviewing – include staff• Meet with preceptor, nurse educator, and new hire weekly or biweekly• Demonstrate transformational leadership • Provide individual need based support • Recognize progress, accomplishments and milestones achieved• Value their input early on with unit decisions and contributions• Explain benefits, expectations, and scheduling • Ensure the team and new hire is taking breaks

“I really appreciate that she checks in with me and cares.”

05/01/2023 24


Strategies – Relationships Matter Collegial and Team support• Establish that preceptor is a good match, is consistent (2 preceptors), and

is willing and aware they are precepting ahead of time• Orient on off shifts to prepare nurse for rotation• Establish a Mentor Program on each unit• Involve new nurses in activities outside the unit• Ensure they get a break• Involve them in unit decision making – establish a committee, invite them

to join• Role model behaviors with physicians and other healthcare team members• Provide new learning opportunities to enhance skills

“Mostly everyone is supportive“

05/01/2023 25


Strategies – Relationships MatterResources and Tools to do the job• Ensure new nurse has appropriate assignment and acuity for skill set• Orient to new procedures they may not have experienced• Ensure they have the proper equipment, knowledge and online unit based

resources• Discuss adequacy of staffing to meet patient needs• Assist with technology and charting• Educator access on all shifts• Educators for each unit to meet new hire needs

“ We could use more time practicing electronic charting. Maybe a whole day of just charting. When we have 8-9 patients it doesn’t feel safe.”

05/01/2023 26

Strategies – Relationships MatterStreamline Orientation• Use an evidence based GN Residency program that demonstrates reduction in turnover• Versant Residency Program• UHCA/ACCN ( University Health System Consortium/American Assoc. of Colleges of

Nursing)• Unit specific orientation• Simulation• Practicing skills directly after content delivered during orientation• Evaluate each class after content delivered• Use evidence based surveys to monitor progress and transition into practice at 3mos, 6

mos, 12 mos, 18 mos• Casey- Fink etc.


“Simulation is great. The EKG class is great, we could use more time practicing skills right after the class to make it stick”


Results Based Accountability

Is anyone better off?What % and how many?

What is the impact?How do we sustain results?

We need you!

05/01/2023 28

Share - Value - Act - RetainTogether anything is possible

We Saved 29 Nurses overallCompared to the prior year Saving $2.03 million dollars

Patient Satisfaction:Employee Satisfaction1:1 Correlation


Congratulations!!!The “60 Day Hire”95.5% Retention RateWE SAVED 23 NURSES

$1,610,000.00 dollars savedWe saved $503.00/$1.00 invested

Relationships Matter05/01/2023Nursing Recruitment and Retention 30

Documents

Recruitment and Retention Results 4