During a conversation in a prior Post, Landon Johnes raised a critical issue that requires discussion: retention of nurses.
Turnover and Retention Are Totally Different.
Most institutions track turnover and think that if it is low, then retention must be high. Not true. One institution we studied had average nurse turnover of 12% over five years (similar to national statistics) but during the same time had net 5-year retention of 17% for nurses! This means that 83% of the nurses hired in 2000 had left by 2005. You cannot infer retention by measuring turnover.
Why Are Nurses Leaving?
We asked them. Money was virtually never the reason. By far the major dissatisfier on the job for nurses was contradictory expectations. They want to spend time with their patients. Patients expect the same. Nurses want and expect their employer to make it easier to care for patients and to be treated respectfully, as individuals each having value.
Hospitals want efficient nurses, defined as having the most patients per shift and therefore, the least time available for any one patient. Hospitals want the fewest number of nurses on the payroll because they are always the largest expense item. Hospitals simply pass onerous regulatory compliance obligations onto the nurses as well as administrative tasks for which they are not trained. And finally, they treat nurses like commodities: If we lose one, we can always get another. They are all the same.
Consequences of Low Nurse Retention
- Cost: To calculate the full cost of turnover, you need to know net retention: most do not measure it. Therefore, hospitals lose multi-millions every year due to low nurse retention and do not know it!
- Patient dissatisfaction: My nurse has no time for me, she never answers my call button, and (whispering) I doubt that she even speaks English.
- Nurse dissatisfaction: As more and more leave, those who remain begin to question why they stay. Low retention breeds lower retention.
- Errors: Who is more likely to make a mistake: a nurse who has been at the hospital for seven years or one hired last month? Turnover may consider them equivalent, but you and I do not.
- Positive – accelerating, not “good” – feedback loop: As nurses keep leaving: costs go up; errors increase; patients and the remaining nurses are less satisfied; more nurses burn out; retention keeps dropping; and morale sinks even lower.
If health care systems want to retain nurses, they must do whatever it takes to make the nurses professionally satisfied and then track nurse retention (not turnover).
For our sakes, they MUST retain nurses.
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