In any profession, employee retention is an important indicator of job satisfaction, company culture and opportunities for advancement. When retention rates need improvement, leadership should take a holistic look at the work environment, get staff feedback and collectively identify problem areas and solutions.
For healthcare settings in particular, falling nurse retention rates demonstrate the need for a cultural shift. According to the 2021 National Nurse Work Environments study, 67% of survey participants said they plan to leave their current position within the next three years. This finding is bolstered by American Nurses Foundation’s 2022 Workplace Survey, which reports almost half (49%) of direct patient care nurses are currently planning to leave or considering leaving their position within the next six months.
How can healthcare organizations motivate nurses to stay and grow professionally within them? The following nurse retention strategies and resources may help.
Assess the health of your work environment
Fostering a Healthy Work Environment (HWE) is one of the most effective nurse retention strategies your organization can pursue. HWEs enable nurses to provide the highest standards of patient care while feeling fulfilled at work. The American Association of Critical-Care Nurses (AACN) defines a healthy work environment based on six evidence-based standards: skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition and authentic leadership.
Nurses who work in healthier work environments report less burnout, less job dissatisfaction and a lower intent to leave their organizations. AACN offers a free assessment tool to measure the health of your work environment against the six standards. Once you’ve completed the assessment, you can use your team’s ideas along with AACN’s resources to measure progress over time.
Featured resources
- Healthy Work Environments (AACN)
- Healthy Work Environments Assessment Tool (AACN)
- AACN Standards for Establishing and Sustaining Healthy Work Environments
- My Workplace Is Unhealthy, Now What? (AACN Blog)
Staff units appropriately
Appropriate staffing ensures an effective match between the needs of the patient and family, and the knowledge, skills and abilities of the nurse. Still too often, mismatched and inappropriate nurse staffing threatens patient safety and nurse well-being. A number of states have passed or are considering legislation to establish minimum nurse-to-patient ratios. The key to staffing, however, is that nurses must be included in any staffing decisions related to their units.
As you pursue nurse retention strategies, establish professional governance committees that include direct-care nurses. Ensure that these committees are empowered to create and sustain flexible staffing approaches. And for times when staffing standards are not met, identify the high-value care that should be prioritized.
Featured resources
- Staffing Clinical Resources (AACN)
- AACN Standards for Appropriate Staffing in Adult Critical Care
- Nurse Staffing Task Force Imperatives, Recommendations, and Actions (PDF)
- Nurse Staffing Advocacy: Learn what AACN is doing (AACN Leadership Podcast)
- Transforming Nurse Staffing and Care Delivery (AACN Leadership Podcast)
Give nurses a voice
When nurses have a seat at the table alongside organization leaders, they have an opportunity to design processes that align with organizational values and benefit team members and patients. Ask yourself, how clearly does your organization articulate its values? How well do team members incorporate these values when making decisions? How empowered do they feel to make important decisions?
Over 70% of respondents in the 2021 National Nurse Work Environments Study said that respect from their administration and management may influence their decision to stay. Make employees feel valued by systematically listening to their ideas, and go further by putting those ideas into action. Consider creating an idea progress board to show how the organization is implementing suggestions from staff members.
Another powerful way to give nurses a voice is to have them participate in AACN’s Clinical Scene Investigator (CSI) Academy. CSI Academy is a hospital-based, experiential leadership and innovation training program wherein unit-based teams of nurses identify a patient-care or professional challenge. The team develops, implements and evaluates solutions that result in quantifiable improvements. CSI teams have addressed issues such as reducing first-year and overall turnover, improving employee engagement and morale, increasing retention and improving the health of the work environment. CSI participants bring about meaningful, ongoing change in their workplace.
Featured resources
- CSI Academy
- CSI Innovation Projects
- The idea board: A best practice initiative (PDF)
- Encouraging Nurse-Driven Initiatives and Healthy Work Environments (AACN Leadership Podcast)
Provide continuing education
Nurses thrive when given professional growth opportunities. In fact, 59% of surveyed nurses said that professional development may influence their decision to stay.
One turnkey nurse retention strategy is to offer membership in a professional organization such as AACN as a staff benefit. AACN membership includes unlimited continuing education activities, clinical resources, access to scholarships and grants, subscriptions to peer-reviewed journals, networking opportunities and discounts on certifications, conferences and learning materials.
Keeping staff engaged in continuous learning bolsters their clinical confidence and increases loyalty.
Featured resources
- AACN membership for organizations
- AACN organizational discounts on certification
- Organizational discounts to NTI, the largest critical-care conference in the country
Address bullying in all its forms
Among the reasons that nurses leave a position or leave nursing altogether is because they are no longer willing to work in a culture where they lack support. When violence, bullying and incivility are tolerated, nurses feel alone. In the 2021 National Nurse Work Environments study, 72% of RNs reported experiencing at least one negative incident within the past year. These incidents may have occurred between them and a patient, a patient’s family member or with another employee—sometimes a manager. Workplace violence can take many forms, from physical assaults to verbal abuse and even racism.
Your organization should take a zero-tolerance stance on bullying, incivility and verbal abuse in the workplace. Implement enforceable policies and culture-changing programs to prevent and eliminate abusive behaviors, with guidelines on how to report violations, enforce disciplinary actions, counsel victims and track institutional progress. Take a proactive approach by providing de-escalation training, which has been shown to significantly reduce lost workdays, improve retention and reduce complaints. Always take action when an incident occurs: hold offenders accountable, counsel victims and other employees, perform follow-up analyses of incidents and impose corrective measures to prevent recurrence.
Encourage employees to promptly report incidents and ensure that no employee who experiences and reports workplace abuse experiences reprisal. Fostering a culture of safety improves workplace morale and nurse retention.
Featured resources
- Workplace Violence Prevention for Nurses (NIOSH)
- Strategies to Improve Retention by Reducing Bullying (AACN Blog)
- 33 Scripts to Address Disruptive Behavior When You Don’t Know What to Say (Healthy Workforce Institute)
- Understanding and Advocating Against Workplace Violence (AACN Leadership Podcast)
Further reading on nurse retention strategies and Healthy Work Environments
- Additional HWE Resources (AACN)
- HWE Continuing Education Activities (AACN)
