EP11EO Nurses participate in recruitment and retention assessment and planning activities.
Provide one example, with supporting evidence, of clinical nurses’ participation in nursing recruitment activities and the impact on vacancy rates. Supporting evidence must be submitted in the form for a graph with a data table that clearly displays the data.
OR
Provide on example, with supporting evidence, of clinical nurses’ participation in nursing retention activities and the impact on turnover rates. Supporting evidence must be submitted in the form for a graph with a data table that clearly displays the data.
NAME OF INITIATIVE
MS5 Staff Retention Strategies
BACKGROUND/PROBLEM
According to reports from the United States Department of Health and Human Services, the United States national nursing shortage is predicted to grow to over one million nurses by 2020. Three converging elements contribute to the shortage. These elements include: increase in nursing positions; increase nurses’ retirement and departures from the patient care field; and decrease entries into the profession. Research shows that various factors contribute to nursing vacancies and turnover, including unsupportive practice environments, long work hours, and excessive physical and psychological demands. At the present time, approximately one-third of working nurses are over the age of 50. Nurses are expected to be retiring in large numbers over the next decade. As a result, the national registered nurse job vacancy rate was 15% in 2003 and expected to be 20% by the year 2020.
Part of the 2012 Homestead Hospital strategic goal under the “People” pillar was attracting and retaining a quality workforce as evidenced by departmental attrition rates below 10. Specifically, the Patient Care Leadership Council (PCLC), consisting of chief nursing officers across the system, established a goal to keep clinical nurse turnover at or below 11% for fiscal year 2011-2013. MS5 is an adult medical-surgical/telemetry unit with 36 private beds and caters mainly to cardiac, stroke and observation patients. Their turnover rate was historically low, mostly at 0%. So, it was unusual for them to have an average turnover rate of 2% for 3 consecutive quarters (October 2011 to June 2012). The department wanted to keep their turnover rate much lower than the organizational target. MS5’s nursing leadership team was concerned that this was heralding an upward trend in their turnover rate and decided to delve into it.
GOAL STATEMENT(S)
MS5’s internal goal was to maintain clinical nurse turnover at or below 3% as measured by Human Resources (HR).
Turnover = Number of employees who resigned, retired, expired or were terminated X 100
Number of employees during the same period.
Note: Above HR definition of turnover only counted employees who left the system. Transfers were not included in the calculation.
DESCRIPTION OF THE INTERVENTION/INITIATIVE/ACTIVITY(IES)
Clinical Nurses Participation in Retention Assessment Activities
In addition to exit interviews conducted by Human Resources (HR) department, Patient Care Manager Hector Aleman, RN, also conducted one-on-one dialogues with departing nurses to ascertain reasons for leaving. He found out the main reasons were due to relocations because of spousal job opportunities and job promotion such as going into specialty areas. As part of his standing staff meeting agenda, Aleman covered under the “People” pillar new employees, departing employees and open positions. To solicit clinical nurses’ participation, he brought the information to the June 2012 staff meeting. Clinical nurses verbalized the same reasons as described above which validated the findings obtained from the exit interviews.
Clinical Nurses Participation in Retention Planning Activities
Upon further discussion in the above staff meeting, the group realized that the main reason, relocation due to nurse’s spouse transfer, is uncontrollable resignation. Uncontrollable resignation is a resignation of an employee that does not result from an issue or environmental feature or trait that is under the control of the employer. On the other hand, controllable resignations are those that result from an issue or environmental feature or trait that is under the control of the employer such as those occurring as a result of pay status, ability to advance, perceived lack of respect, or job injuries covered. The group decided to focus their attention on the controllable resignations.
MS5 clinical nurses were already involved in the hiring and on boarding activities. They participated in peer interviews which enabled them to have in an input in the final selection of the candidate for hire. This made them vested in the success of the new hire. They also participated in the orientation and preceptoring process. They had a unit-based shared governance structure called the Unit Practice Council (UPC) chaired by Clinical Nurse Joyce Jones, RN. Clinical nurses were already involved in hospital-wide councils and committees.
MS5’s culture was akin to having a large extended family. This tight-knit working environment and teamwork resonated among the staff when Aleman asked what they liked most about working in MS5. To this effect, the clinical nurses, through the UPC, aimed at strengthening this family atmosphere by beefing up their reward and recognition activities. They suggested to Aleman having staff recognition as a standing agenda item in the staff meeting. This was an opportunity to recognize new certifications, degrees, and thank you letters from customers. Another tactic which the UPC was able to implement quickly was resurrecting the birthday month celebrations in July 2012. The UPC created a taskforce that coordinated the monthly pot luck and cake. This was very well received by the staff as food was a magnet that pulled everybody together. At the same time, the UPC also reached out to their colleague, Clinical Nurse Martha Gaitan, RN, who happened to be the DAISY Subcommittee Chair to help promote the DAISY award. Gaitan spoke about it extensively during the staff meetings.
In August 2012, another initiative that the UPC worked on was improving RN-MD collegiality based on their 2012 NDNQI RN Survey. Although their score (3.46) was already above benchmark (2.99) for their bed size, they worked on this question recognizing the impact it had on nurse satisfaction and retention. They formulated an action plan in collaboration with their nurse leaders. It involved rounding with physicians; recognizing excellent physicians through e-mail and Dear Doc award nominations; inviting them to unit celebrations; and celebrating their birthdays.
PARTICIPANTS
Clinical Nurses’ Participation
Name/Credentials |
Title |
Department |
Role in the Team |
Martha Gaitan, RN |
Clinical Nurse |
MS5 |
Marketed DAISY award and Chair of DAISY Subcommittee |
Joyce Jones, RN, CMSRN |
Clinical Nurse |
MS5 |
UPC Present Chair and coordinated the retention activities |
UPC Members |
Clinical Nurses |
MS5 |
Participated in various retention activities |
Hector Aleman, MSN, RN |
Patient Care Manager |
MS5 |
Supported UPC initiatives |
OUTCOME(S)
The various tactics that the UPC implemented resulted in tangible outcomes. For example, at the end of December 2013, their clinical nurses attended 96% of hospital-wide shared governance meetings. For the past 2 years (2012-2013), 6 out of 9 nurses who were nominated won the DAISY Award. Moreover, their 2013 NDNQI score on RN-MD Collegiality increased from the previous year to 3.55, well above the national benchmark of 3.02 (bed size).
Impact on Turnover Rate
Exhibit EP11EOa: Percent of MS5 Clinical RN Turnover
Analysis: Above graph depicts an improvement in clinical RN turnover from a baseline average of 2% to 0% sustained for 5 consecutive quarters.