Nearly every physician these days is feeling at least some effect of a big problem in medicine: nurse turnover. The problem seems worst in hospitals, where about 1 in 6 nurses change jobs every year. But the challenge is universal. One study found that nurses are 5 times more likely to experience job dissatisfaction than workers in general.
In a healthy economy that translates to nurses coming and going constantly. In turn, constant turnover can breed clinical inefficiencies, lower quality of care and doctor frustrations from having to train and adapt to new clinical personnel.
What can doctors do about the nursing merry-go-round? Of course, much depends on whether you’re an employee physician in a hospital, health system or provider group, or a shareholder in, or owner of, a private practice. Either way, doctors can frequently influence human resources policies if not direct the policies themselves.
If you’re an employee physician, consider your leverage with management in how the role of nursing affects patient outcomes. Look for specific examples of increased clinical risks due to nurse turnover and draft a list of real-life instances to take to higher-ups. Better yet, you might consider enlisting physician colleagues in the writing of a formal letter.
Naturally, the task becomes a little simpler for a practice owner or shareholder. But sometimes this creates another challenge: In a small to medium-sized provider group, how much can you afford to pay to keep good nurses?
Shift your mindset to combat nurse turnover
Here’s where I suggest shifting your mindset. Recruiting and keeping good employees is not a cost – it’s an investment, regardless of where you practice medicine. The right staffing will improve clinical performance and earnings, allowing doctors to do only what they can do and therefore see more patients.
Furthermore, consider the cost of replacing a single nurse, which estimates say run anywhere from about $22,000 to $64,000. Clearly, this kind of cash can go a long way to alleviating turnover. Nonetheless, I’d like to warn you about a very common trap in management: the knee-jerk tendency to simply hand out raises to nurses like candy. Anecdotally, I’ve heard of hospitals awarding nurses in acute-care units as much as a 30-percent bonus in a healthy job market. But remember, underpayment isn’t always the main source of nurse burnout. Rather, poor management, compassion fatigue, irregular work hours and stressful work environments can be equal or larger culprits.
In this context, let’s look at complaints about poor management, which more often than not stem from two shortcomings: lack of clarity of each employee’s roles and responsibilities, and clear communications among work groups. For the former, carefully crafted organizational charts and job descriptions can go a long way in ensuring each employee knows management’s expectations. In addition, regular employee performance reviews reinforce these expectations. As for clear communications among coworkers, one of the best tools I’ve seen comes from the software world, where computer programmers hold an informal daily or semi-daily meeting called a scrum.
Counteracting common complaints
Scrums are mercifully brief – 10 to 20 minutes is typical – and are held first thing in the morning with everyone standing to keep them short. The team quickly previews the day ahead and chats about any special challenges, urgencies and trends needing attention. Usually, the small investment of time upfront more than pays for itself in avoidance of mistakes and do-overs.
Another common complaint about management is inadequate staffing. One study found that increasing the patient-to-nurse ratio in hospitals by just one patient increases the risk of nurse burnout by 23 percent and of job dissatisfaction by 15 percent. For this, I suggest researching average patient-to-nurse ratios and related nursing workloads for your clinical situation in hopes of applying a scientific baseline to staffing decisions. In addition, strive to keep nursing work schedules as regular as possible. A common grievance from nurses is over constantly changing shifts, particularly at the last minute.
Another foe in the battle for nurse retention is compassion fatigue, particularly in acute care. Some healthcare employers have made gains in this area by providing employee assistance programs and paid gym memberships for nurses, with the objective of improving health of both mind and body. Lastly, nurses often bemoan a lack of career advancement as a factor in changing jobs. A good way to counter this complaint is through designing a robust program in continuing professional education, as well as offering some form of tuition reimbursement for nurses pursing more education.
As an employer myself for many years, I know that some employee attrition is inevitable. At the same time, my own experience has taught me that even modest investments in employee satisfaction and sense of job fulfillment can go a long, long way in building – and keeping – the best team possible.