Don’t take low nurse turnover rates for granted

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Alexandra Wilson Pecci, for HealthLeaders Media, March 27, 2012

The nursing shortage is over and a survey published in the American Journal of Nursing shows that nurses have a greater commitment to their employers than they did just a few years ago.

That's great news for hospitals, right?

"When turnover slows down, when the vacancy rates drop, nurse managers and leaders always breathe a sigh of relief," one of the study authors, Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing at the University at Buffalo, tells HealthLeaders Media.

But digging into the study results tells a more complex story, Brewer suggests.

The research examined two surveys of new RNs in 15 states. The first was conducted in 2006 prior to the recession and the second was conducted in 2009 during the recession.

The two groups were demographically similar, but the second group of nurses reported significantly better health status, fewer injuries, working fewer hours, better nurse-physician relationships, and a better work environment. They also reported a higher level of intent to stay in their current jobs.

Despite all this, their incomes and their job satisfaction levels hadn't changed much. They were also more likely to be searching for a new job, and perceived fewer job opportunities than the earlier group.

Work environment hasn't changed; perception has
Brewer suspects that nurses' commitment to their employers has less to do with the employers themselves and more to do with the market for nursing jobs. In other words, in a rough economy where there are plenty of nurses to go around, nurses who are employed may just feel lucky to have a job. Their work environment hasn't changed; their perception of it has.

"They're looking around, and they're saying, ‘you know, I'm ok right now,'" Brewer says. "Possibly because I have no other alternatives right now."

In addition, the recession has prompted many older RNs to delay retirement or to return to nursing. As the economy improves, many of those nurses will retire, creating greater demand for new graduates.

Prepare now the next nursing shortage
"At some point, nurses are going to retire," Brewer tells HealthLeaders, and when they do, there's going to be a need to replace them. "All we can do is watch and try to anticipate these factors."

A study published in the New England Journal of Medicine last week predicts the next nursing shortage will come in 2020, when older nurses retire en masse.

"That's just the nature of the beast," Brewer says. "You have to think ahead to the next shortage."

"Make your place the best place to work," Brewer says. "So when they look around, they're going to stay with you. You want to keep them. You don't want them to jump ship the minute the market heats up."

Nurses want overtime, and autonomy
There are lots of ways to do improve nurses' work environments. Brewer points to other research regarding mandatory overtime, which she calls a "dissatisfier" that can be a factor in high turnover rates. Instead, nurses want autonomy and the ability to control when they work overtime.

"It's not that nurses don't want to do overtime, because they quite evidently do. But they want control over the overtime," Brewer told HealthLeaders in January. "Having control over your work hours is a satisfier; it's something that nurses need to have to be satisfied in their job."

Autonomy was also a key issue in the column I wrote last week about a hospital using a self-scheduling program that lets nurses set their own schedules.

Those are just a couple of ways hospitals can make working conditions better for nurses. But whatever strategy they choose to use, nurse leaders should strive to retain their nurses because the job market will inevitably improve.

"For leaders, you cannot tread water. You have to make your environment the best you can because…when that market tilts and we head into the net shortage, you want to be positioned to keep your nurse," Brewer says. "You can't ever stop trying to make your work environment better or you will lose out."

Source: HealthLeaders Media