CHARLOTTE, NC – With 100,000 nursing positions currently unfilled and the shortage expected to climb to 340,000 nurses by 2020, healthcare systems need a strategy to reduce nurse turnover.

Healthcare systems should shift their focus from why nurses leave to why they stay, said David Rowlee, vice president of research services for Moorehead Associates, an employee survey and research firm.

“Research confirms a strong empirical link between workforce engagement and the challenges and goals of healthcare organizations,” Rowlee told attendees in a recent webinar presentation.

Workforce engagement impacts an organization’s performance, clinical outcomes, patient safety, physician engagement, market penetration and financial performance, he noted.
Research shows that most people leave their jobs because of neutral or positive events, such as spouse relocation or unsolicited job offers, Rowlee said, adding that it is up to organizations to insulate valued employees from these events.

Rowlee thinks a “Links, Fit and Sacrifice” model can help healthcare organizations keep their employees. He said employers should make connections between a new employee and other people or groups in the organization and create a compatible and comfortable work environment for the new employee.

By providing material and psychological benefits that accumulate over time, employers create a situation in which employees won’t want to forfeit these gains by leaving the job.

Healthcare organizations should employ a detailed, streamlined on-boarding survey that measures items that have the most impact on ensuring immediate stabilization and contribution from new employees, Rowlee said.

Successful surveys include demographic coding, reasons for joining the organization, closed-ended items that predict stable contributors and open-ended items about reasons for joining the organization, feelings about the job, realistic job preview and effective orientation, he said.

One large integrated healthcare system in the West implemented a successful RN on-boarding program that used a Links and Fit strategy. Each RN received a welcome letter, had lunch with his/her manager the first week of employment and had a weekly touch-base meeting with his/her on-boarding coordinator within the first three months of joining the staff.

The healthcare system also helped coordinate the orientation checklist, provided mentoring and coaching sessions, facilitated training and development programs, and provided assistance with competencies assessment, among other things.

The average cost to fill a vacant nursing position is $62,480, according to the U.S. Bureau of Labor Statistics. Turnover negatively impacts the quality of patient care and continuity of care, lowers work unit morale, strains physician relationships and increases the patient risk, Rowlee said.

The estimated cost of nurse turnover, which is an average of 15 percent, is nearly $9.4 million. According to Rowlee, this estimate is conservative and doesn’t include loss of productivity. The potential savings by implementing a Links, Fit and Sacrifice model, which would help move nurses to high performance, is nearly $4.4 million, he insisted.

But implementing the model is not enough. Engagement goes through a “honeymoon phase” and rapidly declines before the end of the first year. It is critical therefore to measure and track early and frequently stability and contributors of workforce engagement, Rowlee said.