How To Attract And Retain Great Nurses
INSTALLMENT 2 of 2
In Installment 1 of this 2-part blog series, we shared with you the challenging state of affairs in U.S. employment and, specifically, in the nursing corps. Not all nurses are created alike. Some see their career as a calling and a passion while others do it for a paycheck [and often not much more]. So how do you find more of the former and fewer of the latter? I believe I have the answer for you …
By JEFF LITTLE
Partner
[March 14, 2024] – If you’ve stepped inside a grocery store, restaurant, big-box store or home improvement center in the past few years – and we all have – it’s no secret to anyone that managers continue to face stiff headwinds when it comes to identifying, hiring, training and retaining high-quality team members. This painful reality isn’t limited to retail outlets, either. It slashes across the entire industrial spectrum.
Hospitals and other healthcare facilities are no exception, particularly as it relates to fielding full teams of competent, dedicated Registered Nurses [RNs].
An April 2023 article in Becker’s Hospital Review summarized findings from the most recent NSI National Healthcare Retention & RN Staffing Report. Even with the staff RN turnover rate declining 4.6% in 2022, the national average remains a troubling 22.5%. The study also found that 51% of hospitals in the U.S. had RN vacancy rates greater than 15%, and only 5% of the 273 hospitals in 35 states surveyed reported an RN vacancy rate below 5%.
That turnover comes at a steep price, too. The cost of turnover for a bedside RN ranges from $40,200 to $64,500 with an average of $52,350. Each percent change in RN turnover will cost — or save the hospital if it chooses not to fill the open position — an average of $380,600 annually. Further, filling open positions isn’t an overnight process. The RN Recruitment Difficulty Index ranges from 61-120 days. In other words, it takes 2-4 months to fill a vacated position with an experienced nurse.
As for who’s leaving and who’s staying, over the past five years, RNs in Step Down, Emergency Services, Behavioral Health, and Telemetry were the most likely to seek greener pastures or exit the profession outright with a cumulative turnover rate ranging from 108.7% to 115.2%. Think about that. Those departments will turn over their entire RN staff in less than five years. Ouch!
On the flipside, RNs in Surgical Services, Pediatrics, and Women’s Health were far less mobile with 2022 turnover rates at just 16%, 17.1% and 17.2%, respectively, compared to the aforementioned national average of 22.5%. At a time when administrators are furiously searching for ways to trim operating costs, all of this comes as one big financial and hiring headache.
Do You Need a Magnet to Attract Nursing Talent?
In Installment 1 of this two-part blog series, I wrote “It’s true of any worker in any industry: An employee who is engaged, fulfilled, and convinced their efforts are making a difference is happier and more productive in the workplace. More specifically, happier nurses and caregivers create more fruitful care environments which leads to shorter hospital stays, satisfied patients, better patient outcomes, and higher levels of reimbursement. The obvious solution is to hire more and more of these types of professionals … but how do we make that happen?”
In the early 1980s, the term “Magnet®” was developed by the American Academy of Nursing to describe hospitals that could “attract and retain” high-performing nurses. A decade later, the American Nurses Credentialing Center created the Magnet® Recognition Program which provides a roadmap to higher levels of nursing excellence, with contented and engaged staff at its core.
Repeatedly, studies have shown optimum job satisfaction results in lower rates of RN attrition, improved patient outcomes, and higher hospital revenues and profits. Job satisfaction among the nursing corps is further enhanced by the fact that Magnet® hospitals’ RN salaries are 4.8% higher than RN salaries at non-Magnet® hospitals.
The Magnet® Model is based on five key pillars:
Transformational Leadership
Structural Empowerment
Exemplary Professional Practice
New Knowledge, Innovations & Improvements
Empirical Outcomes
A nationwide study conducted in September 2023 indicated only 612 [or roughly 10%] of U.S. hospitals had earned Magnet® designation which is granted for four years and may be renewed if the facility reapplies and continues to demonstrate performance according to specific quality benchmarks and reporting. Basically, a hospital recognized as a Magnet® facility is considered the gold standard of healthcare, particularly as it relates to nurses.
Or is it …?
I did some research and located a 2018 National Institutes of Health [NIH] National Library of Medicine study entitled Impact of Magnet® Hospital Designation on Nursing Culture that concluded:
“A key finding was that Magnet® designation appears to enhance organizational culture for nurses and the framework used to introduce Magnet® helps to empower nurses to direct organizational culture in their facility. Conclusion and Implications for Nursing and Health Policy: Magnet® appears to have a positive impact on organizational culture, particularly for nurses.”
Key phrases among the conclusions jumped out at me: “appears to enhance organizational culture for nurses” and later “appears to have a positive impact.” The researchers then stated more specific and complete data was necessary to get a truly accurate snapshot.
Hmmm …
So I decided to do some additional digging and found a more recent version of an NIH National Library of Medicine study from July 2020 entitled How Magnet® Hospital Status Impacts Nurses, Patients, and Organizations. It found “Magnet® hospitals have better nursing work environments and are associated with better outcomes for nurses, patients, and organizations than non-Magnet® hospitals.”
More specifically, this more thorough study found that Magnet® hospitals enjoyed lower rates of nursing shortages, job burnout, job dissatisfaction, and turnover compared to non-Magnet® hospitals. Even more specifically, it noted Magnet® hospitals had lower rates of patient mortality, falls, hospital-acquired infections, and pressure ulcers.
The nursing culture in Magnet® hospitals proved to be safer and was associated with a higher level of care versus non-Magnet® hospitals. This translates to enhanced cost efficiencies for all involved, and this evidence “should inform future decision-making with regard to pursuing Magnet® designation,” according to the findings.
Now, this sounds more convincing. But wait …
A Trend Is Apparent
Still not completely satisfied, I dug a little more and found an even more recent NIH National Library of Medicine study [August 2022] entitled The Business Case for Magnet® Designation.
It concluded: “Magnet® designation and the preceding journey are more important than ever as the Sources of Evidence [SOE] reflect the role of the nurse in quality, safety, and the patient care experience … in addition, Magnet® recognition is a signal to the nurses in the organization, and the nurses considering joining the organization, that there is a commitment to nursing. Creating a business case to secure the resources required to embark on the Magnet® journey will be an essential tool for the Chief Nursing Officer [CNO]. Each CNO should create a framework of the goals that they hope to achieve through both the Magnet® journey and the Magnet® designation over time.”
As more and more data was gathered and analyzed, it became apparent that, in terms of nursing culture, it is not only the final achievement of Magnet® designation that’s most important, it’s the transformational and ongoing journey towards becoming an ever-higher-achieving member of an extraordinary team of nurses who deliver care at the highest level. Doing so pays dividends for patients, caregivers and organizations because Magnet® designation results in:
Higher nurse job satisfaction
Higher likelihood among nurses to communicate about errors and participate in error-related problem-solving, thereby contributing to improved patient safety
Higher adoption of National Quality Forum Safe Practices
Lower patient fall rates
Lower risk-adjusted rates of 7-day mortality, nosocomial issues [hospital acquired infections], and severe intraventricular hemorrhage of very low–birth-weight infants
Lower nurse-reported adverse events
Lower rate of nurse occupational injuries
Higher patient satisfaction
Lower rate of catheter-associated urinary tract infections
Lower patient mortality
Lower failure to rescue
Lower odds of hospital-acquired pressure injury
Considering all of the above, two things are now abundantly clear: First, finding and retaining great nurses is a chronic challenge. Second, the evidence is there for exploring and/or pursuing Magnet® designation.
If you’re a hospital administrator or a CNO who tosses and turns at night wondering what you can do to field a fully staffed, world-class team of high-standards, high- achieving, happy nurses, I think you know what will top your “To-Do List” tomorrow morning.
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ABOUT JEFF LITTLE
Jeff is a Partner at Excelerant Consulting and a widely recognized thought-leader in hospital supply chain, purchased services, hospital operations, facilities and construction, and medical capital equipment. He brings a deep insight and understanding of today’s healthcare environment and is well-connected throughout the industry, having worked in clinical settings within world-class hospitals, and multiple Integrated Delivery Networks [IDN] and Group Purchasing Organizations [GPO]. He is highly skilled at educating clients on subtleties and nuances of today’s complex healthcare ecosystem and excels at the development of commercial strategies.
Jeff is an active member of the Association for Health Care Resource & Materials Management [AHRMM], American College of Healthcare Executives [ACHE], Federation of American Hospitals [FAH], the IDN Summit, and serves on the board of the ACE Summit.
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ABOUT EXCELERANT CONSULTING
Excelerant Consulting is the go-to organization for med-tech companies that need to position products and services successfully for value analysis committees, contract acquisition, and sales modeling and execution to commercialize the launch of medical devices or services with Group Purchasing Organizations [GPO], Integrated Delivery Networks [IDN], or Regional Purchasing Coalitions [RPC]. Clients rely on Excelerant to enhance their product positioning, navigate corporate contracting opportunities, and provide sales support to accelerate growth and profits.
For more info, contact Excelerant Consulting at info@excelerantconsulting.com.