|
Twenty-five Percent of Your Nurses Will Quit This Year
Why this will hurt your safety and quality and four things you can do about it.
By Steve Harden
 | | 25% of Your Nurses Will Quit This Year |
Twenty-five percent of registered nurses (RNs) will seek a new place of employment in 2011 because of job dissatisfaction, according to survey results released this month by AMN Healthcare.
This is an increase of 15% from last year.
Why This Will Hurt Your Safety and Quality
Nurses are at the core of quality care in our nation's delivery system. If nurses change jobs in large numbers-as they say they will in the survey--experts believe the exodus will dramatically increase nurse vacancies and put heavy stress on staffing resources. That, in turn, will impact patient care and outcomes.
Research has shown that hospitals with lower nurse turnover have lower risk-adjusted mortality and lower patient lengths- -of-stay than organizations with moderate (12%-22%) or high (22%-44%) turnover rates. Another study has shown that nurse turnover creates:
- Communication errors (the number-one cause of adverse events)
- Medication errors
- Compromised follow-up
- Patient disengagement
- And prolonged patient illness.
 Replacing nurses also costs money, about $25,000 per nurse, on average. If you have 1000 nurses in your facility and you must replace 25%, or 250 of them, your organization is going to spend $6.25 million dollars on recruiting, hiring, and training new nurses. This is a huge investment of financial resources that won't be spent on patient safety and quality initiatives.
Why not keep the nurses you have?
The Four Things You Can Do About Nurse Turnover:
- Conduct interdisciplinary teamwork and communication training (interdisciplinary, because your physicians must train alongside your nurses). Training together breaks down the barriers and creates a collegial atmosphere promoting job satisfaction.
- Create and implement user-created standardized processes (e.g. checklists, communications scripting, protocols, handoffs, etc.). Insisting that your nurses and physicians jointly create their own standardized work tools creates buy-in and a shared investment in success. Implementing an agreed-upon and standardized way to work together eliminates conflict and frustration and improves employee satisfaction.
- Implement a "Chain of Command" policy that makes it crystal clear who a nurse will call to get immediate supervisory action and support when other team members refuse to follow standardized processes. Answer the phone or page when they call. Go to the bedside and support the "stop-the-line" behavior.
- Celebrate loudly and often those nurses who speak up and stop the line to protect a patient's safety or quality of care. Send them handwritten "thank you" notes. Put a laudatory written report into their personnel file. Let them know you care.
Will This Work?
Absolutely. Where these steps and others like them were put in place in a surgical services unit in a large hospital in Tennessee, nurse turnover dropped from 14% to 2%. Teams who work well together tend to stay together. In this same department, job satisfaction as measured by an employee satisfaction survey was statistically significantly higher than in other departments that hadn't implemented these steps.
In Illinois, a community hospital followed this blueprint and was able to decrease nursing turnover in the ICU from 19% to just over 4%. With great stability among the ICU team, both mortality and length of stay in the ICU decreased as well.
Implementing these four steps, a 300-nurse unit in a hospital in New Mexico reduced the number of positions that had to be filled by travelers and agency nurses from 60 to virtually zero. Mandatory overtime was completely eliminated. Not surprisingly, when turnover stabilized, patient-harming errors and sentinel events were totally eliminated as well.
Nursing turnover and the subsequent negative impact on safety and quality is not inevitable. A small investment in training and processes will stop the exodus and allow you to keep your great nurses so critical to the quality of your care.
Did you miss last month's newsletter? Watch this video about 7 1/2 Tips to Turbo-charge your Checklists:
 | | Turbo-Charge Your Checklists |
| 
