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
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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)
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Nursing Recruitment and Retention
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)
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Nursing Recruitment and Retention
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$
•
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Nursing Recruitment and Retention
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.”
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Nursing Recruitment and Retention
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)
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Nursing Recruitment and Retention
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)
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Nursing Recruitment and Retention
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)
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Nursing Recruitment and Retention
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)
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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
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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
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Month Leaving
28.2% Turnover Rate – allJuly 2012 – 2013 new hires
voluntaryinvoluntaryremaining164
61
3
Nursing Recruitment and Retention 12/7/2013
Nursing Recruitment and Retention
47% Turnover Rate – allJune 2011 – July 2012 new hires
voluntaryinvoluntaryremaining
89105
4
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“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
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Nursing Recruitment and Retention
“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
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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
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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
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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
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Nursing Recruitment and Retention
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
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Nursing Recruitment and Retention
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
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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
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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
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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.”
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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“
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Nursing Recruitment and Retention
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.”
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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.
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“Simulation is great. The EKG class is great, we could use more time practicing skills right after the class to make it stick”
Nursing Recruitment and Retention
Results Based Accountability
Is anyone better off?What % and how many?
What is the impact?How do we sustain results?
We need you!
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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
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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