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Five reasons nurses want to leave your hospital


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Rebecca Hendren, for HealthLeaders Media, August 9, 2011

Your nurses have one eye on the door if you do any of the following.

Although economic woes abound, nurses are planning their exit strategies and will make a move when things improve. A recent survey from healthcare recruiters AMN Healthcare found that one-quarter of the 1,002 registered nurses surveyed say they will look for a new place to work as the economy recovers.

Are your nurses engaged, committed employees? Or are they biding their time until they can go somewhere better? To predict whether you face an exodus, take a look at the following five reasons why your nurses want out.

1. Mandatory overtime

Nurses work 12-hour shifts that always end up longer than 12 hours due to paperwork and proper handoffs. At the end, they are physically, mentally, and emotionally exhausted. Forcing them to stay longer is as bad for morale as it is for patient safety.

Some overtime is acceptable. People get sick, take vacations, or have unexpected car trouble and holes in the shift must be filled to ensure safe staffing. Nurses are used to picking up the slack, taking overtime, and pitching in. In fact, overtime is an expected and appreciated part of being a nurse. Many use it to help make ends meet. Mandatory overtime, however, is a different matter. Routinely understaffed units that rely on mandatory overtime as the only way to provide safe patient care destroy motivation and morale.

Take a look at the last couple of years' news stories about RN picket lines. Most include complaints about mandatory overtime.

2. Floating nurses to other units

One nurse is not the same as another. Plugging a hole in a geriatric med-surg unit by bringing in a nurse from the pediatric floor results in an experienced, competent nurse suddenly becoming an unskilled newbie. A quick orientation won't solve those problems. Forced floating is usually indicative of larger staffing problems, but even so, its routine use is dissatisfying and compromises patient safety.

Instead, create a dedicated float pool staffed by nurses who volunteer and who can be prepared and cross-trained. Institute float pool guidelines that nurses float to like units. For example, critical care nurses find a step-down unit an easier transition than pediatrics.

Float pool shifts open up options for nurses who need more flexibility and offering a higher rate means you'll never be short of volunteers.

3. Non-nursing tasks

Nurses are already understaffed and overworked. Hospitals with too few assistants rub salt on the wounds. RNs shouldn't have to take time from critical patient care activities to clean a room or collect supplies. Gary Sculli, RN, MSN, ATP, patient safety expert and crew resource management author, offers a vivid analogy. Imagine if half way through a flight you saw the pilot come down the aisle handing out drinks because the plane was short staffed.  It just wouldn't happen.

Yes, cleaning a room is important, but don't force nurses' attention away from their patients. Distractions are dangerous and compromise patient safety.

4. Bullying and toxic behavior

Bored of hearing about this topic? So am I. So are nurses. Nothing makes nurses want to walk out the door more than toxic colleagues—whether physicians, nurses, or anyone else—who are allowed to behave badly.

It's not enough to have a zero tolerance policy. Enforce it. Preach it. Talk about the importance of respectful behavior. Explain expectations, not just at orientation but at multiple times through the year. Send information via emails, hold continuing education classes, and have the topic as a standing item on meeting agendas.

Give managers the tools to confront problem employees and back them up when they do. Have a plan in place to educate offenders. If the behavior continues after that, fire them. Support managers through this work. Nurses would rather work a nurse short than keep a disruptive employee who sabotages the morale and cohesiveness of the others.

5. Bad managers

You've heard it before: People don't leave companies, they leave managers. Yet hospitals still don't pay enough attention to leadership skills for nurse managers. Bad nurse managers who don't know how to lead are retention nightmares. Skilled managers are retention magnets.

Some hospitals have good managers who are stretched so thin they become bad ones. How can anyone focus on the professional development of their staff if they're overseeing several units with umpteen nurses across all shifts? Annual performance reviews shouldn't be the only time the manager and nurse engage in conversation. Nurse managers must help staff reflect on growth and plan for the future.

These five reasons affect every aspect of nursing workload and contribute to fatigue and burnout. Don't forget that nurses always know when their colleagues at the hospital across town are happier.

Source: HealthLeaders Media