The key to retention success

Shari Dingle Costantini, Avant Healthcare Professionals - Print  | 

A study in the current issue of Policy, Politics & Nursing Practice reveals that an estimated 17.5 percent of newly licensed RNs leave their first nursing job within the first year, and one in three (about 33 percent) leave within two years.

According to Dick Finnegan, author of The Power of Stay Interviews for Engagement and Retention, the primary reason people stay or leave a position is their manager. If you assumed money – and most people do – you may be surprised that is one of the least effective tools for influencing retention.

Do nurse retention programs really work?

With no end to the nurse shortage in sight, nurse retention programs are gaining in popularity. But if the Human Resources (HR) department is the sole driver and advocate of these programs in your hospital, your results are likely mixed, if not failing entirely, for two key reasons:

1. Successful retention is not a program. It is a core philosophy on employee value that begins at recruitment, extends through management and integrates into corporate goals.
2. It needs to be woven into day-to-day business activities, and with that type of commitment, you can reverse even an avalanche of resignations, including those from retirement, which may be deferred by truly contented employees.

Interviewing for long-term retention

A client once asked me what is the single most important thing that she could do to improve retention at her hospital. I said, “Find out the single most important thing to every employee you have. Of course, that will be multiple ‘single most important things’ because we are all individuals.”

Most employees don’t leave because their managers treated them badly, but because their managers didn’t take a personal interest in them. They never asked the right questions:

• What is most important to your job satisfaction here?
• What are your career goals?
• How can I help you achieve them?
• What type of recognition do you like to receive?
• What is one thing I can do today to make your work more enjoyable?

An effective leader begins these discussions in the job interview. If there is alignment between your interviewee’s and hospital’s goals, the relationship will be long lasting. Nurses often want to make a difference and be part of a team, but not all do, so ask.

Be clear about how your candidate will fit within the organizational culture and on your floor. Hire for attitude, teamwork, collaboration, drive and problem solving. These are often more important to long-term success than clinical skills. Skills change and improve. Personalities rarely do.

The key to retention success

Since most employees leave a job because of their manager, you possess a powerful tool for succeeding in the recruitment battle — you! That responsibility may seem daunting, but your employees will guide you, if you listen.

Empower those who want and are ready for autonomy, and support others who need more of your attention. And always let your staff know you will go to bat for them when needed. Make sure you understand the obstacles your nurses face and what they need from you to overcome them. Intervene where necessary. If your nurses are confident that you have their best interest at heart, they will return the loyalty.

Supporting your staff also means preparing them for what’s ahead. Many nurse leaders view the need for training as episodic, requiring a heavy upfront investment for new nurses, but then trailing off to near nothing, outside clinical and hospital requirements, for long-term, experienced staff. This approach may have worked in the past, but today, healthcare is changing too rapidly. Technology is spurring new treatments; destination medical centers are increasing competition; insurance providers are exerting greater influence over healthcare decisions, and patient expectations are rising. Without sufficient support and training, frustration can mount and retention might suffer.

Provide small, ongoing opportunities for your nurses to learn and keep pace. This will help them maintain confidence and prepare for larger changes ahead. It also facilitates an efficient treatment environment in which patient decisions are made at the point of care.

I prefer to view training as continuous learning. It can be formal and structured, such as a preceptor program, or highly informal: best practices shared over coffee, self-initiated mentor/mentee relationships or employee libraries. Encourage continuous learning. Make it part of your culture, so that your nurses are resilient, engaged and capable of seeing themselves in their jobs for a long time. Whether it is day 1 or day 5001 on the job, continuous learning contributes to long-term staff retention.

Despite your best efforts, people will leave. When that happens, it’s time to do an inventory. Ask yourself if you could have done anything differently. Or better yet, ask the departing employee. Share that you only want to improve as a leader and understand how you can create a work environment that supports greater retention. Ask if they can think of anything that will help you do that.

Retention: whose problem is it anyway?

Nurse leaders across the country are engaging with their HR departments to address staff shortages, burnout and turnover. That engagement is crucial to finding effective solutions. Finnegan believes that department managers must ultimately take responsibility for solving the problem. He encourages hospital executives to quantify employee turnover into monetary terms. Identifying the financial loss associated with turnover elevates the importance of the issue to the entire organization. Once quantified, retention goals can be established for nurse leaders and other managers. In Finnegan’s model, each leader receives an individual goal, reflecting the department’s unique trends and challenges. Regularly measuring and reporting help keep everyone on track. It generates greater buy in from managers and builds stronger support throughout the hospital.

As a nurse leader, you are the key to retention success on your floor. You have the opportunity and ability, but a little help will go a long way.

Shari Dingle Costantini is an experienced healthcare-staffing executive with 29 years of experience in strategic leadership, nursing, and international nurse recruitment and placement. She has recruited and hired internationally trained nurses in more than 60 countries, and specializes in nurse retention and diversity strategies to build strong, cohesive workforces. She can be reached at

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