Wisdom at Work

Retaining Experienced RNs and Their Knowledge–Case Studies of Top Performing Organizations

As key caregivers in hospitals, nurses significantly influence the quality of care provided and, ultimately, treatment and patient outcomes. Consequently, hospitals’ pursuit of high quality patient care is dependent, at least in part, on their ability to retain an experienced and highly skilled nursing workforce.

Unfortunately, the health care field faces a significant nursing shortage, due in part to the graying of the nursing workforce, with large numbers of nurses retiring or approaching retirement. And despite the recent economic downturn, demographic trends portend a continuing nursing shortage, with retirement of experienced bedside nurses a major contributor. Therefore, providing additional opportunities and incentives for experienced nurses to continue to contribute their skills and knowledge is important to the functioning of our health care system. The costs of losing such workers are considerable, both monetarily with respect to hiring and training new staff and in terms of the institutional knowledge lost to hospitals and health systems.

Responding to these important issues, The Robert Wood Johnson Foundation (RWJF) is collaborating with hospitals, health systems and nursing leaders to test and build an evidence base of creative solutions that improve the retention of experienced hospital nurses and to develop “best practice” models for more widespread dissemination and uptake. In 2006, RWJF commissioned a white paper, Wisdom at Work: the Importance of the Older and Experienced Nurses in the Workplace that identified strategies intended to contribute to the retention of experienced nurses, and recommended that resources be invested to test those strategies.

The Foundation supported that recommendation in 2007 by funding the Wisdom at Work: Retaining Experienced Nurses Research Initiative. Under the 24-month initiative, grants were awarded to 13 hospitals and health systems with pre-existing programs designed to improve experienced R.N. retention to evaluate the outcomes of each initiative through the collection and analysis of performance data. The Lewin Group (Lewin) was commissioned by RWJF to serve as the programs National Coordinating Center, providing technical assistance, coordination, data analysis and evaluation services to support the initiative.

In building upon the Wisdom At Work: Retaining Experienced Nurses white paper, the Foundation demonstrated a consistent commitment to building an evidence base for retaining experienced registered nurses (RNs) in clinical practice within the nations hospitals and health systems.

However, the issue of retaining an experienced workforce is not unique to nursing. By 2010, 40 percent of the U.S. workforce will be over 50 years of age. This shifting demographic will be especially acute in knowledge-driven sectors such as healthcare, aerospace, energy and others that have become increasingly technical and complex. These new challenges create opportunities for hospitals and health systems to learn from both their own top performers and the best practices of other employment sectors.

Recognizing the relevance of this issue, in 2008 RWJF funded “Retaining Experienced Workers: Case Studies of Top Performing Organizations” under which Lewin was commissioned to develop seven illustrative case studies of top performing organizations to identify and share with the field proven and often innovative retention strategies and approaches that can be applied to the experienced workforce.

These case studies were developed through one- to two-day observational site visits to high performing organizations. While on-site, the Lewin team conducted in-depth interviews and focus groups with staff at all levels. Hosting sites included both health care and non-health care organizations that have repeatedly received widespread external recognition and awards for their commitment to experienced employees.