Wisdom at Work: New Study Identifies Strategies to Retain Veteran Nurses

A new study from the Robert Wood Johnson Foundation explores the impact of interventions aimed at retaining experienced nurses. Fanning the Flame was one of them, and this program at Pitt County Memorial Hospital in Greenville, N.C., is giving experienced direct care nurses the chance to renew and reframe their nursing practices.

    • August 31, 2009

Three days at the beach sounded like fun to many experienced nurses at University Health Systems of Eastern Carolina. Little did they know those three days would change the trajectory of their careers.

In 2003, Pitt County Memorial Hospital—serving a rural community as part of University Health Systems of Eastern Carolina—had a problem common to many hospitals and health care institutions around the country. Veteran nurses were leaving, taking with them valuable experience that improved patient care. But at Pitt County Memorial Hospital, a team of experts decided to do something about it.

After studying the situation, leaders learned that most nurses thought that, after ten years of service, they had taken advantage of all the educational opportunities available to them there. So Pitt County pioneered a program called Fanning the Flame, designed to give experienced direct care nurses additional opportunities and the chance to renew and reframe their nursing practices.

The program received a significant boost in 2006, when it was selected as a Robert Wood Johnson Foundation (RWJF) Wisdom at Work evaluation site.

After issuing a groundbreaking white paper in 2006, Wisdom at Work: The Importance of the Older and Experienced Nurses in the Workplace, RWJF selected 13 sites around the country to conduct research projects in 2007 and 2008 to explore the impact of interventions aimed at retaining experienced nurses. Fanning the Flame was one of them. The Wisdom at Work project was coordinated by The Lewin Group.

“We knew intuitively what was working, but we did not have evidence,” said Dianne Marshburn, R.N., Ph.D., N.E.-B.C., the project co-investigator. “The grant gave us the chance to identify the best practices in the program, and learn which components helped participants build their own professional profiles and feel more valued by the organization.”

Fanning the Flame Finds Success

Because of this research and experience accumulated over the years, leaders expanded and fine-tuned Fanning the Flame. Today, it provides nurses with three days of off-site stress relief, professional development and education opportunities—all taking place at the beach. In the early part of the program, nurses create drumming circles using sand buckets and rice-filled water bottles as drums ans shakers, fly kites, blow bubbles, and engage in similar activities. Later, they hear from patients about what nurses meant to them, and work hard to re-envision their careers. By the time they finish, they have filled notebooks with detailed plans for how to achieve the careers they have envisioned.

The results have been remarkable, says consultant Judith Kuykendall, Ed.D., R.N., the principal investigator and project director. As a result of Fanning the Flame, several nurses have completed the clinical teaching associate program, become involved in new research and community service projects, joined shared-governance councils, furthered their education, become certified in their specialties, and become mentors for younger nurses. More than 80 percent of participants say the program positively influenced their level of job satisfaction, and the institution has retained more than 97 percent of the 168 nurses who participated in Fanning the Flame.

Another important part of the program is the annual reunion, Kuykendall says, which serves as a boost for participants who come together with colleagues to continue “fanning the flame.”

After receiving queries, Fanning the Flame leaders have now created a facilitator’s manual and toolkit to help other institutions develop similar programs.

The Imperative to Keep Veteran Nurses at Patient Bedsides

Fanning the Flame is just one of the programs highlighted in the new RWJF study, Wisdom at Work: Retaining Experienced Nurses. The study finds that a number of health care organizations were able to lower turnover rates among experienced nurses by making a concerted effort to improve nurse morale and productivity.

This is especially important because 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 general population ages, creating a greater demand for hospital care, retaining veteran nurses will be even more critical.

The nursing workforce also is aging, and numerous surveys find that more than half of today’s employed nurses plan to retire in the next 15 to 20 years. Replacing those retiring nurses will be costly. The average direct cost to replace a full-time registered nurse at the 13 hospitals in the Wisdom at Work 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 because of the clinical and institutional expertise that follows retiring nurses out the door.

“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.”

Successful Strategies

The Wisdom at Work study also offers suggestions that can help health care systems address recruitment and retention issues. 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.

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.

The report also 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. These strategies include 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.

Programs Participating

These 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.

In addition to Fanning the Flame, Wisdom at Work evaluation 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, 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 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.