Why nurse retention matters
Nurse retention is crucial for healthcare facilities, as a cohesive, experienced team can help to ensure consistent, quality patient care. Yet, nurse turnover rates, while decreasing slightly, are still higher than they were pre-pandemic, and they’re projected to increase in the coming years.
As the number of nurses entering the industry continues to decrease and the over-65 population burgeons, it’s more important than ever for facilities to implement nurse retention strategies that center their nurses' health, well-being and engagement.
Understanding nurse retention
“Nurse retention” refers to a facility’s ability to retain internal nursing staff over an extended time frame. A facility with high nurse retention rates holds onto its most tenured nurses, benefitting its patients by ensuring continuity of care and minimizing the medical errors associated with new nurses. Tenured nurses also possess organizational knowledge and can mentor junior nurses.
Conversely, high nurse turnover rates can lead to a host of problems, including excessive recruitment costs, typically between $11,000 and $90,000 per nurse. Replacing a nurse is also time-consuming: 95 days on average.
The 2024 turnover rates in long-term care are 49.5% for RNs and 52.7% for nursing staff, according to CMS. And in hospitals, according to NSI’s latest “National Health Care Retention Report,” the national vacancy rate for RNs is 15.7%. More than two-thirds of hospitals (75.4%) say their vacancy rates are in excess of 10%. High turnover can increase the burden on a facility’s team, which can lead to increased errors due to stress, exhaustion and burnout.
Factors that contribute to low nurse retention
Workload and burnout
Around the country, nurses have been going on strike to bring attention to the issues of high patient loads, workforce shortages and burnout. A 2021 study found that 54% of nurses are experiencing burnout and concluded that nurse burnout is a significant predictor of turnover. In our 2024 survey, 62% of respondents said they were currently at risk of burnout and 81% reported having experienced it previously.
Primarily what we experience in healthcare is burnout and fatigue, which doesn't come from our patient care at all. The stresses come from the corporate environment, the management environment, the staff environment.
Maryann Alexander, Ph.D., RN, FAAN and chief officer of nursing regulation at NCSBN, co-authored a study that projects one-fifth of registered nurses will leave the workforce by 2027. That study, which included 29,472 RNs and 24,061 LVNs/LPNs, also revealed that 50.8% of nurses feel emotionally drained, 56.4% feel used up, 49.7% feel fatigued and 45.1% feel burned out — anywhere from a few times a week to every day. Alexander places the future of the U.S. healthcare system at an “urgent crossroads.”
The pandemic has stressed nurses to leave the workforce and has expedited an intent to leave in the near future, which will become a greater crisis and threaten patient populations if solutions are not enacted immediately.
The U.S. Surgeon General has also dubbed burnout a public health risk.
Lack of professional development opportunities
In 1943, Abraham Maslow identified two kinds of needs: deficiency needs and growth needs. Though professional development opportunities are growth needs, they can still be categorized as inherent human needs.
The data bears that out: In an American Psychological Association study, 91% of respondents considered having learning and development opportunities somewhat or very important. Only 47% of them were able to secure those opportunities at work. On the healthcare front, a 2016 British Journal of Nursing study found that more advancement opportunities were correlated to a lower turnover rate.
Poor organizational culture and workforce morale
“Organizational culture” pertains to a set of norms, values and beliefs shared within a group. MIT Sloan Management Review reported that one in 10 employees find their company’s culture toxic. They also state that employees who feel that their culture is toxic are more likely to experience stress, anxiety and burnout.
“Workforce morale” refers to the attitudes, emotions and behaviors of an organization’s employees. It’s important to note that high-stress environments, of which healthcare is one, have been linked to low morale. A 2020 study points to a body of research that links high morale with higher-quality patient care. In the study, morale among nurses was found to be “the degree to which an employee exhibits a positive or motivated psychological state.” The study further defined it as an “attitude of confidence in the mind of the individual where they identify with a group, accept group goals and work towards achieving them collectively.”
Nurse retention strategies
A robust nurse retention plan can lower recruitment costs and help facilities cultivate a team of experienced nurses who can provide quality care, enhancing patient outcomes in the long run. It can also foster a positive work environment, leading to greater employee engagement and patient satisfaction.
1. Create a positive work culture
- Hold senior leadership accountable and implement coaching programs. Recognize that senior leadership shapes culture, whether the leader is the CEO or a manager. Coaching is proven to correct some toxic behaviors. Encourage teamwork and collaboration. Teamwork has been correlated with higher job satisfaction, which, in turn, has been correlated to improved nurse retention rates and patient safety, along with higher quality of care.
- Recognize and reward accomplishments. Recognition is one of the most effective non-incentive nurse retention strategies. It doesn’t have to be public to be effective — private verbal and written feedback ranked second and third for preferred forms of recognition. Monetary rewards are also favored, so most facilities will need to strike a balance between financial incentives and recognition programs
- Promote work-life balance. When nurses can take time off and choose whether or not to work overtime, they can create better work-life balance. Strategically using PRN shifts to maintain adequate workforce levels can help reduce reliance on mandated overtime, and the strategic use of PRN shifts has enabled facilities to increase census (and revenue) while providing team members with more flexibility.
Foster open, transparent communication with management. Up to 68% of nurses have had negative experiences with their managers, but knowing which subcultures are toxic is hard unless employees can provide safe, anonymous feedback. However, if these relationships are positive — meaning that they’re respectful, supportive, encouraging and empowering —they reduce burnout and emotional exhaustion.
2. Enhance professional development
In implementing a learning and development strategy, organizations should first consider their business and talent goals. For example, if an organization needs more RNs, it could assist CNAs and LPNs in becoming nurses. If it aims to train junior nurses, it could implement a mentorship program.
- Continuing education programs. In some states, continuing education is mandatory; in others, it’s voluntary. Mandatory or not, when companies take an active, supportive role in continuing education, nurses report feeling more valued, especially when program participation is built into the nursing schedule.
- Leadership development initiatives. More than 50% of nurse managers and other administrators intend to leave within the next five years due to a lack of advancement opportunities or job dissatisfaction. Offering a clear career development path can help. Additionally, providing management training to clinicians who have been promoted to management may help them to succeed in their new roles.
Mentoring programs. Inexperienced nurses are far more likely to leave the industry than experienced nurses due to burnout. Mentors help ease the transition from school to the workforce, and they can also help new nurses adjust to organizational culture. Mentorship programs benefit experienced nurses as well and may reinvigorate their passion for nursing or desire for leadership opportunities.
3. Promote work-life balance
To decrease turnover and increase nurse retention, organizations need to reduce burnout. Supporting nurses in finding work-life balance can help.
- Implement nurse-friendly scheduling practices, such as limiting 12-hour shifts to three consecutive days and not rotating shifts within 24 hours.
- Offer flexible scheduling. Allowing nurses to schedule themselves and trade shifts as needed gives them more autonomy, one of the biggest predictors of work-life balance. With flexible hours, nurses gain more flexibility, another predictor of work-life balance. Facilities can use PRN shifts strategically to offer employees more flexibility and scheduling apps like OnShift Schedule X to provide them with more autonomy.
- Provide adequate rest periods. Although rest breaks have been shown to significantly lower acute fatigue, 35% of nurses report that they don’t take them. Without recovery, acute fatigue can lead to chronic fatigue. Some nurses feel guilty about taking breaks because they don’t know how patients and residents will get care if they do. (Some organizations have implemented shorter “lunch shifts” that ensure nurses feel good about taking their breaks.)
- Offer employee assistance programs. Investing in wellness programs, such as organizational-sponsored gym memberships, mental health services or even fitness or meditation apps, can go a long way in supporting nurses’ mental health.
- Support self-care initiatives. Self-care initiatives range from in-depth mental wellness programs to unlimited PTO to care packages. Surveys can help administrators decide which employee assistance and self-care programs are most important to their nurses.
Solve workforce shortages. The workforce shortage is potentially the most critical issue facing healthcare organizations today. Shortages affect not only nurse retention rates but also patient outcomes. To truly solve workforce issues, facilities need to be able to increase coverage on demand without relying on employees who are already at risk of burnout.
How organizations use ShiftKey to improve nurse retention and reduce burnout
Among the strategies discussed for improving nurse retention rates, overcoming workforce challenges and helping nurses find better work-life balance are critical. Fortunately, ShiftKey can help.
More than 6,000 facilities use ShiftKey to connect directly with licensed, independent professionals who are ready to work as needed, enabling them to offer their employees more flexible schedules and a better work-life balance. Some are even using PRN shifts as part of a comprehensive growth strategy.
