Nurse retention strategies: Keys to empowerment, ownership and support

The following is an excerpt from an article published in the FierceHealthcare's eBook "How Hiring Right (or Wrong) Has a Direct Impact on Clinical Outcomes." Download the eBook here to read more.

With all of the effort and expense that hospitals put into hiring the right nurses, organizations must put at least as much energy into retaining those nurses and fostering continued high performance and growth.

A hospital's orientation process, therefore, must be well done to lay the groundwork for a nurse's successful career with an organization, according to Patricia Witzel, R.N., MS, MBA, chief nursing officer and associate vice president of Strong Memorial Hospital, a 739-bed facility in Rochester, New York.

Nurses hired in general units throughout Strong Memorial undergo a four- to five-month orientation period with a preceptor, and also are assigned a mentor upon orientation completion.

"Making sure their entry into the organization is a smooth one and they feel supported is very important," Witzel said. "Once they're in the organization you have to provide them opportunities to grow and lots of education."

Because of this belief system, the hospital not only offers tuition assistance and encourages nurses to use it for higher learning, but also compensates nurses for becoming certified in their clinical specialty. "We also have a clinical ladder, so as people develop expertise and skill level, they can apply for promotion to another level, which has compensation associated with it," she added.

Build nurse empowerment

A key theme among hospitals with highly engaged staff is that they nurture in their nurses a sense of empowerment to contribute ideas and make decisions that affect their units, as well as the ability to take ownership of those achievements.

For example, at Virginia Commonwealth University Health System (VCU) in Richmond, Virginia, nurses have the opportunity to take on special initiatives within their units, said Teri Kuttenkuler, MPH, R.N., VCU's human resources service line director. "Each manager will work with the new hire to find out their passions; whether it's to be involved in the retention and rewards committee or education, there are all kinds of opportunities," she said. "Then they become more engaged in not only the work they do to take care of patients but also the work they're doing to advance the unit."

Getting nurses involved in such committees also gets them excited about having the ability to shape nursing practices, said Theresa Mazzaro, R.N., supervisor of nurse recruitment and workforce planning consultant at 450-bed PeaceHealth Southwest Medical Center in Vancouver, Washington. "Through committees for safety, for wounds, for falls or shared governance, the nurses really do feel like their ideas and suggestions are heard and validated," she said.

Taking this momentum a step further, leaders at PeaceHealth also show the nurses the metrics that demonstrate the results of their projects. "We have a quality department that measures … [for instance] that by doing hourly rounding on this unit, we decreased the number of falls. Then we celebrate that," Mazzaro said. This dynamic is in stark contrast to a top-down approach to problem solving, she added. "It's from the people who are actually doing the work."

And it's worth the investment to compensate nurses for taking on such extra responsibilities, according to Witzel. So Strong Memorial pays the chairperson of its shared governance council, for example, half-time to do the extra work, while the vice chair gets 25 percent paid time for council work.

Similarly, nurses who take on roles such as "safety nurse champion" are given four to eight hours every two weeks for related tasks so they're not trying to complete them on top of a full work schedule, Witzel said. "And yes, people might say that's an added expense, but I've found that you're just rearranging how you're using your dollars," she said. "In a lot of organizations that are struggling economically, that's hard for them to justify, but once you look at your outcomes—your patient satisfaction and your quality outcomes—you can see it pays off."

To read the rest of this story and other articles, download FierceHealthcare's free eBook, "How Hiring Right (or Wrong) Has a Direct Impact on Clinical Outcomes."