New Study Identifies Strategies to Retain Experienced Nurses As Nursing Shortage Looms and Nation's Health Care Needs Grow

Improving morale, utilizing innovative staffing approaches among keys to success.

    • July 29, 2009

Experienced nurses provide quick and accurate assessments of patient health and well-being, mentor less experienced staff, maintain institutional memory, and perform numerous other vital functions. As the population ages, creating a greater demand for hospital care, retaining veteran nurses will be even more critical. But today’s nursing workforce is also aging, and numerous surveys find that more than half of today’s employed nurses plan to retire in the next 15 to 20 years. There are solutions; hospitals, medical centers and other health care organizations can initiate activities that help to keep more veteran nurses at patient bedsides, according to a new study supported by the Robert Wood Johnson Foundation (RWJF) and coordinated by The Lewin Group.

The study, “Wisdom at Work: Retaining Experienced Nurses,” finds that a number of health care organizations lowered turnover rates among experienced nurses by making a concerted effort to improve nurse morale and productivity. Successful strategies included innovative approaches to staffing; employee health and wellness programs; and training and development opportunities for veteran nurses. Ergonomic initiatives, such as teams and equipment to help nurses lift patients and other heavy items, did not contribute to an overall drop in turnover among experienced nurses; however, they did improve morale and cut expenses associated with work-related injuries, the study finds.

“We know that there is no quick fix to the crisis in health care,” said Susan B. Hassmiller, Ph.D., R.N., F.A.A.N., RWJF senior adviser for nursing. “But the approaches explored in our ‘Wisdom at Work’ initiative are pieces of a larger puzzle that will help health care organizations keep experienced nurses from walking out the door—and taking their expertise with them—just when we need them most.” 

The new study includes seven in-depth case studies examining strategies used by health care and non-health care institutions that have received recognition for their success in retaining experienced workers, as well as findings from 13 separate research projects conducted from January 2007 to December 2008 to explore the impact of interventions aimed at retaining experienced nurses in hospitals. It is a follow-up to the groundbreaking white paper, Wisdom at Work: The Importance of the Older and Experienced Nurses in the Workplace, commissioned by RWJF in 2006.

The new “Wisdom at Work” report finds that companies that have successfully retained older workers cite the following reasons for their success: sustained commitments by corporate leadership; corporate cultures that value aging; and compensation packages that cater to older workers, offering benefits such as phased retirement options and flexible work arrangements. 

“At a time when managers everywhere are looking hard at their bottom lines, the ‘Wisdom at Work’ evaluations demonstrate that there are ways to retain experienced nurses that ultimately are cost-effective,” Hassmiller added. “With our nation’s population aging and health care needs growing, we need to encourage more veteran nurses to stay in their jobs so we can benefit from the knowledge and wisdom they have gained over the years. We do that by creating better working environments for employees of all ages and experience levels.”

The average direct cost to replace a full-time registered nurse at the 13 hospitals in the study totaled $36,567, a sum reflecting expenses associated with termination payouts, filling temporary vacancies, additional overtime costs, and hiring and training new staff. The loss of experienced nurses is especially costly.

Strategies in the “Wisdom at Work” study offer suggestions to help health care systems address the issue. Although no single initiative lowered turnover rates at all of the health care organizations evaluated in the study, several hospitals and medical centers improved nurse retention rates with programs that met nursing needs at their individual institutions. In one example, Carondelet Health Network in Arizona improved retention by offering an on-site BSN education program that nurses requested when asked what the health network could do to retain them. Later, it signed an exclusive contract with Grand Canyon University to offer its nurses an MSN program, offered on a part-time schedule over 25 months. “How could I leave Carondelet after they have given me this opportunity?” one nurse asked.

The “Wisdom at Work” in-depth case studies of recognized top performing companies identified among the reasons for their success: a sustained commitment by company leaders to retain older workers; corporate cultures that value the experience of older employees; ongoing data collection and analysis to address concerns of senior employees; opportunities for older employees to transfer to less demanding roles; compensation packages that reward longevity; and benefits catering to older employees such as phased retirement options, flexible work arrangements and opportunities to receive in-home care for parents and spouses.  

The strong practices at these companies include:

  • building a “culture of aging” at Bon Secours health system in Richmond, Va., with flexible work and retirement arrangements, mentoring, and ergonomic programs;
  • a “snow bird” program at Carondelet Health Network in Tucson, Ariz., that makes it easier for Carondelet to offer temporary R.N. assignments to licensed nurses from other Nurse Licensure Compact states; and 
  • comprehensive retention programs at Scripps Health in San Diego that include interactions with employees through trainings, orientations and communication that aim to consistently engage employees and provide them with relevant information.

“Wisdom at Work” also showcases successful retention initiatives at a number of health care systems including: Centra Health in Lynchburg, Va.; Mary Imogene Bassett Hospital in Cooperstown, N.Y.; Edward Hospital in Naperville, Ill.; and Hillcrest Memorial Hospital in Greenville, S.C.

The 13 “Wisdom at Work” research projects were conducted in:

  • Los Angeles, Calif.: Impact of Reducing Physical Practice Burdens on Retention of Experienced Nurses at Cedars-Sinai Medical Center
  • Ft .Collins, Colo.: Impact of the Base Staffing Model on Retention of Experienced Nurses at Poudre Valley Health System
  • Tampa, Fla.: Impact of a Lift Team on the Recruitment and Retention of Experienced Nurses at Florida Health Science Center
  • Atlanta, Ga.: The “Smooth Moves” Initiative to Retain Experienced Nurses at the Bedside at Saint Joseph’s Hospital
  • Aurora, Ill.: Impact of the ACT Nurse Program on Experienced Nurse Retention at Rush-Copley Medical Center
  • Naperville, Ill.: Impact of the Wellness at Work Lifestyle Change Initiative on Retention of Experienced Nurses at Edward Hospital and Health Services
  • Cooperstown, N.Y.: Impact of the Admission Nurse Initiative on Recruiting and Retaining Wisdom at Mary Imogene Bassett Hospital
  • Rochester, N.Y.: The Minimum Lift Program Initiative to Reduce Lost Staff Time Due to Patient-Related Injuries at Strong Memorial Hospital at The University of Rochester Medical Center
  • Greenville, N.C.: Fanning the Flame: A Retention Initiative for Experienced Nurses at University Health System of Eastern Carolina
  • Greenville, S.C.: Addressing Retention of Experienced Nurses While Promoting Safe Patient Handling at Greenville Hospital System
  • Nashville, Tenn.: A Comprehensive Evaluation of the “Smooth Moves” Safe Handling Program at Vanderbilt University Medical Center
  • Lynchburg, Va.: Implementing a Closed Staffing Model as a Nursing Retention Strategy at Centra Health at Lynchburg General Hospital
  • Milwaukee, Wis.: The Virtual Intensive Care Unit as an Alternative Environment for Critical Care Practice and Experienced RN Retention at Froedtert Hospital

The seven case studies examined: Bon Secours Richmond Health System; Scripps Health; Carondelet Health Network; Monongalia County General Hospital; Mitre Corporation; L.L. Bean; and First Horizon National Corporation.

The Lewin Group served as the National Coordinating Center for this initiative and provided coordination, technical support and data collection and analysis for the “Wisdom at Work” evaluation. The Lewin Group also developed the seven in-depth case studies of high performing organizations. To view both, visit www.rwjf.org/goto/wisdomatwork.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, we work with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years we’ve brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and health care of those we serve. When it comes to helping Americans lead healthier lives and get the care they need, we expect to make a difference in your lifetime.

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