Nursing is a tough job. Nurses juggle it all — sick patients, worried families and stressed doctors. They log long hours, often going to the hospital when it is still dark outside and leaving when it is dark again. It is not unusual for nurses to be floated to hospital departments where they feel that they haven't received adequate training and are expected to take on the workload of a 20-year veteran.
As a nurse for many years in patient care administration and clinical practice, I have experienced firsthand the huge commitment the job requires — mentally, physically and emotionally. Nurses' work can be grueling at times, with high patient volumes and insufficient nursing staff to manage the cases. They often spend their shifts on foot and lift heavy loads. Eight in 10 nurses said in an American Nurses Association safety survey that they frequently experience muscle and joint pain. Some nurses also experience compassion fatigue, a form of burnout that can affect people who work in the health care industry.
These factors and more are contributing to the ongoing shortage in available nursing staff. In fact, the Robert Wood Johnson Foundation reported that nearly one in five nurses drop out of the profession in their first year on the job, and one in three leave within two years.
The Price of Turnover
Why are nurse satisfaction and dropout so important for health care providers? According to the Journal of Nursing Administration, it costs roughly $82,000 to replace a nurse. That cost covers vacancy, orientation and training, the lowered productivity of a newly hired nurse, and advertising and recruiting.
With nurse turnover averaging 14 percent, the typical turnover expense for a 300-bed hospital approaches $4.4 million annually, as revealed in a KPMG study. Not only is turnover detrimental to a hospital's bottom line, it also results in a huge loss of intellectual capital for the provider, and it dampens employee morale.
The good news is that health care leaders across the country are searching for answers on how to improve nurse retention and satisfaction. However, more effort is needed.
Here are some proactive measures that health care executives can think about and implement to improve their nurses' job satisfaction.
Reduce overtime. A Health Affairs study found that nurses who work more than 12 hours in a shift and 40 hours in a week are more prone to turnover and job dissatisfaction. The same study concluded that nurses who work shifts longer than 12 hours are 1.45 times more likely to leave their jobs within a year.
In my experience, reducing a health organization's staff overtime is easier said than done. However, hospitals can make this happen by driving a fundamental culture change from overtime being the "rule" to overtime being the exception. If hospitals implement measures to reduce shift and workweek length, and set guidelines for what is an acceptable amount of overtime, nurses will not feel obligated to tack on extra hours.
Practice shared governance programs. Approximately 13 percent of nurses are dissatisfied with their work schedule and lack of independence, according to Health Affairs. Shared governance can include self-staffing, which empowers nurses by letting them select shifts based on availability and interests. Shared governance programs can go a long way toward making nurses feel as though they have ownership over their unit and are not just renters.
Implement data-driven staffing. Nurses may be more likely to leave if they are placed in patient care situations that they are not equipped to handle. Harnessing workforce data analytics to gain a deeper understanding of patient needs and matching the right type and number of staff to meet those needs is key. Not all nurses have the same experience; every patient is different and needs a customized care delivery model. Data-driven staffing, or using tools like acuity-based staffing, has the potential to reduce labor costs, provide equitable staffing and improve the organization's ability to deliver high-quality patient care.
Anderson Regional Medical Center in Meridian, Miss., implemented a data-driven workforce management solution. Anderson provided managers and clinicians with digital tools to staff the hospital based on patient needs. As a result, Anderson realized a cost savings of more than $2.5 million during an eight-month period, compared with the same period the prior year.
Develop quality-of-life initiatives. Just like all of us, nurses have responsibilities that extend beyond the hospital or clinic door. They also need to care for significant others, family members and themselves. Implementing quality-of-life initiatives for nursing staff significantly can improve their morale and enhance loyalty.
Health care executives can offer varying shift lengths and staggered start times to give nurses the flexibility to choose what's best for their personal obligations. Being able to plan around a child's soccer game or school talent show can help greatly. In addition, health care providers can offer on-site programs, such as child care centers or gyms.
In today's value-based health care environment, industry executives are responsible for demonstrating value to their patients and employees alike. Nurses are the backbone of this workforce and most often the closest point of patient interface. We must focus greater attention on initiatives that promote their wellness and satisfaction.
Karlene Kerfoot, R.N., Ph.D., is the chief clinical integration officer at API Healthcare in Hartford, Wis.