Lippincott Nursing Pocket Card - June 2023

Nurse Engagement and Retention Strategies

Overview

Nurse engagement and retention are important considerations for nurse leaders as staff dissatisfaction can lead to nurses leaving their place of employment, or even the nursing profession. A recent survey conducted by NSI Nursing Solutions, Inc. (2021) found the average cost of turnover for a bedside registered nurse is over $40,000 and ranges from $28,400 to $51,700. The American Nurses Association (ANA) (2019) reports “With more than 500,000 seasoned RNs anticipated to retire by 2022, the U.S. Bureau of Labor Statistics projects the need for 1.1 million new RNs for expansion and replacement of retirees, and to avoid a nursing shortage.” These startling figures demonstrate the need to prioritize nurse retention and develop ways to engage nurses in their current positions to prevent turnover.

Definitions

Nurse engagement

Nurses’ commitment to and satisfaction with their jobs
Must also consider the nurses’ commitment to the organization and to the profession

Nurse retention

Focus on prevention of turnover and keep nurses within their organization
Beneficial to quality patient care and safety, higher patient satisfaction scores, and nurse safety

Risk Factors (Tyndall et. al, 2019; Schroyer et. al, 2020)

Factors that can contribute to a lack of nurse engagement and reduced nurse retention include:

Lack of educational training, skills and knowledge
Absence of leadership support
High acuity and stressful patient workloads
Limited staffing availability/overtime
Restricted job growth
Diminished job satisfaction
Disputes with management
Unsupportive coworkers
Low salary
Aging workforce
Toxic work environment or incivility

These negative factors can lead to:

Staff turnover
Overtime hours
Prolonged unit vacancies
Poor quality of patient care
Low patient satisfaction
Higher patient ratios
Nurse burnout/distress
High costs for new nurse orientation

Millennial nurses are particularly at risk for turnover. Although they tend to be engaged, they are more likely to move onto a new role due to available opportunities. Personal attention and feedback on their work can help improve or maintain engagement and retention of this generation of nurses.

Steps and Strategies for Nursing Administrators (Tyndall et. al, 2019; Scruth et. al 2018)

Nurses who are engaged, especially new graduates, are more likely to stay with an organization longer than two years. Nurse engagement and retention should always be on the minds of those in leadership.

The following strategies should be considered to improve nurse engagement and retention:

Reimagine nursing orientation programs
- The orientation program is critical to developing positive employee attitudes and job satisfaction. Successful programs included approximately 13 weeks of orientation with an additional 2- to 3-week transition component (Kiel, 2020).
- Focus on self-directed orientation courses in combination with clinical experiences, less focus on classroom activities
- Don’t release a new graduate before they are ready.
Invest in nurse residency programs; benefits include (Knighten, 2022):
- Reduced turnover in first 2 years
- Increased competency and confidence in clinical decision-making
- Improved professional commitment and satisfaction
- Increased safety
- Increased use of evidence-based practice
- Stronger clinical leadership and critical thinking skills
- Improved quality and safety
- Improved patient experience
- Integrated organizational culture and values into practice
Provide mentorship programs and strong preceptors for new graduate nurses
- Reduced orientation costs
- Increased leadership and problem-solving skills
- Increased morale and retention
Practice and academia collaboration
- Define competencies using the AACN Essentials
- Develop practice/academic partnerships
  - Develop adjunct faculty and joint appointments for faculty in academia and practice settings
  - Increase the number of clinical sites
Flexible work hours (i.e., 12-hour shifts)
Develop workplace culture
Develop a healthy work environment
- Utilize skillful communication
- Encourage collaborative relationships
- Institute staff recognition
- Prioritize effective decision making for the unit/department
- Value leadership
- Ensure appropriate staffing levels
- Foster emotional intelligence
Increase leadership engagement and provide support to staff
Make leadership visible and available to staff on the unit
Discuss opportunities for growth within the organization
- Career ladder program
- Role transitioning
- Tuition assistance program for advancing education
Provide educational opportunities for leadership to learn more on these topics
Conduct unit staff meetings to discuss any unit issues or concerns
Implement resiliency-building tools
- Provide workforce with the basics, including food, breaks, family/childcare.
- Offer and encourage relaxation therapies, such as aromatherapy, deep breathing exercises, guided meditation, recharge rooms with massages chairs, and yoga.

Education

Collaborating with other leaders and educating one another on ways to connect with staff, being present and supportive, and ensuring that staff find meaning and purpose in their role can enhance engagement and retention. It is important to display engaging behaviors, effective communication, and promote a healthy work environment for the staff. Provide guidance, support, and resources to help staff thrive, be engaged, and successful.

References:

References:
American Nurses Association (ANA). (2019). Practice and policy workforce. Nursing World. https://www.nursingworld.org/practice-policy/workforce/.

Dempsey, C. & Reilly, B. (2016). Nurse engagement: What are the contributing factors for success? The Online Journal of Issues in Nursing, 21(1), 2. https://doi.org/10.3912/OJIN.Vol21No01Man02 .

Jones, C. & Gates, M. (2007). The costs and benefits of nurse turnover: A business case for nurse retention. The Online Journal of Issues in Nursing, 12(3). https://doi.org/10.3912/OJIN.Vol12No03Man04.

Kiel J. M. (2020). An Analysis of Restructuring Orientation to Enhance Nurse Retention. The health care manager, 39(4), 162–167. https://doi.org/10.1097/HCM.0000000000000303.

Knighten M. L. (2022). New nurse residency programs: Benefits and return on investment. Nursing Administration Quarterly, 46(2), 185–190. https://doi.org/10.1097/NAQ.0000000000000522

NSI Nursing Solutions Inc. (2021). 2021 NSI National Health Care Retention & RN Staffing Report. Nursing Solutions. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf.

Schroyer, C. C., Zellers, R., & Abraham, S. (2020). Increasing Registered Nurse Retention Using Mentors in Critical Care Services. The health care manager, 39(2), 85–99. https://doi.org/10.1097/HCM.0000000000000293.

Scruth, E., Garcia, S., & Buchner, L. (2018). Work life quality, healthy work environments, and nurse retention. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 32(3), 111-113. https://doi.org/10.1097/NUR.0000000000000376.

Tyndall, D., Scott, E., Jones, L., & Cook, K. (2019). Changing new graduate nurse profiles and retention recommendations for nurse leaders. Journal of Nursing Administration, 49(2). https://doi.org/10.1097/NNA.0000000000000716.

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Nurse Engagement and Retention Strategies