Healthcare has long been a highly regulated industry with a diverse and specialized workforce — one that’s hard to hire and even harder to retain at the best of times. Even though healthcare has been projected to add 4 million jobs — more than any other industry — between 2012 and 2022, turnover is high and hospitals perennially face a shortfall of registered nurses (RN).
Competition is fierce for these highly skilled workers, and job satisfaction is vital to preventing nurses from resigning or worse, leaving the profession completely. When this occurs, it exacerbates the top three challenges that these workers face (taken from a CareerBuilder survey of 315 nurses):
- Lack of advancement opportunities (49% of respondents)
- Too few staff (49% of respondents)
- Work overload (48% of respondents)
According to a survey by NSI Nursing Solutions, the average cost of turnover for a bedside RN ranges from $44,380 to $63,400. The cost of resignations is compounded by the fact that median tenure for RNs is only 1.57 years, which leads to these costs being incurred at a high frequency.
With the demand generated by the Affordable Care Act, baby boomers starting to retire, and more people battling chronic conditions, patient care is needed more than ever. But as the data above shows, there aren’t enough nurses to spread out the workload and provide each patient with the attention they require. So there is a direct correlation between patient satisfaction and nurse job satisfaction. Hospitals need to invest in programs that will give RN’s a reason to stay, but it can be difficult to determine which programs are right. Giving a salary increase isn’t going to work in the long-term if the RN would rather have better training or advancement opportunities.
Workforce intelligence can provide HR with the insights needed to find out what nurse retention issues exist at their organization and develop solutions tailored to the needs of their staff. In turn, better retention is likely to lead to better care and higher patient satisfaction. Here are the steps to achieving this:
Identify your Retention Problem
Determine what ails your organization’s nurse retention by assessing what damage has already been done. These metrics help you accomplish this task:
Surprisingly (perhaps), it is not uncommon in a single organization for turnover to be calculated a number of different ways — meaning there is a lack of ability for meaningful comparison across the organization. Start by ensuring you calculate your nurse resignation rate the same for all hospitals and groups.
As you dig into the data revealed by this metric, be sure to also take note of who exactly is resigning: Is it your top performers? Senior RNs? When many of the nurses who leave are your best and brightest, they take all their skills, knowledge and connections with them, putting your organization at a disadvantage.
Impact on patient readmission rates
Stay on top of how workforce dynamics, such as resignations, are impacting your patient readmission rates. With less skilled or tenured nurses available to provide patient care, it becomes harder to avoid hospital-acquired conditions that require readmission. Recently, over 700 hospitals had their Medicare reimbursement reduced due to high readmission rates. With a detailed picture of how nurse exits affect patient satisfaction — and your financial position — you are more able to take action to reduce any negative impacts.
Look for the symptoms
Once you know your hospital’s diagnosis, use workforce analytics to dig deep into what’s causing your nurses to leave.
Building on the resignation rate, perform an analysis to determine what factors increase and decrease resignations. The example below shows the results of an analysis performed by an advanced clustering algorithm. With this approach, you can effectively target and fine tune your retention strategies based on data (and not intuition or anecdote).
Find out how resignations are affected by things such as compensation ratio, promotion wait time, pay increases, tenure, performance, and training opportunities. This insight supports better decisions around changes to pay, benefits, and nurse development in order to manage costs, while retaining the right people.
Determine who can be saved
Implementing a one-size-fits all retention program is the antithesis of strategic HR: not all turnover is bad, particularly when it is occurring among low performers in non-critical positions. Once you have determined which general groups are experiencing high rates of turnover, you need to ask: What is the population that has a high impact on patient outcomes and is at highest risk of leaving? Let the data from these metrics inform your decisions.
By comparing how resignation rates vary across locations, functions, tenure, age and diversity groups, performance level, and more, you gain insight into how different nurse populations are responding to their work experience. This insight is valuable in strategically investing in programs that will deliver the biggest results.
Risk of Exit
This type of predictive analytics reveals which of your nurses are at risk of leaving the organization before they hand in their resignation letter. For example, the Visier solution is up to 10x more accurate at predicting who will resign over the next 3 months than guesswork or intuition — and this is invaluable because it is easier to stop a RN from leaving than it is to bring them back. You may not be able to stop everyone, but if you retain even a handful of key nurses for more than a year, the savings, as well as improvement in patient satisfaction and outcomes, can be significant.
Prescribe a Remedy (or two)
Now that you know where you need to focus your efforts, you can start crafting a program based on an understanding of both what drives away and retains key people.
To get a picture of what motivates a group of people to stay, ask questions such as: Is it career advancement opportunities? Learning and development? Flexible work policies? If you don’t already know, have a conversation with your HR business partners and their leaders. Use these metrics to drive these discussions.
If you’ve determined that lack of career advancement opportunities is driving resignations, then you need to look at how promotions are being handled within your hospital. First, find the clinical group that develops the most promotable people, then speak to managers from this group to see what they’re doing differently and incorporate their feedback into your solution.
It’s important to note that classic promotion metrics simply look at how many people in a group have received a promotion, but don’t indicate whether or not they were promoted within the group or came to the group from somewhere else. If you want an accurate picture of which manager is good at growing talent — or not — look instead at promotions actioned, which calculates the percentage of people being promoted from the organization that they worked for at the start of the time period being reviewed.
Training Impact on Performance and Promotions
A demanding workload can leave little time for an RN (or other critical talent) to spend on learning, which holds them back from advancing their careers. If you need to justify a learning budget increase or time allocated to learning, this metric can reveal the correlation between a higher investment in training and high performance and promotions.
New Hire Performance
Insights into new hires tell you whether new nurses are getting up to speed effectively. This can tell you if you need to improve your onboarding program or look into their manager’s effectiveness — it could be a sign that the manager needs help creating a better onboarding experience for new hires.
According to a 2013 survey, 55% of the RN workforce is age 50 or older. While this is a group that will certainly be leaving at some point, workforce planning will help you determine how many positions they will be leaving vacant. This insight demonstrates how important L&D will be and enables you to put a program in place that ensures junior nurses will have the skills necessary to take over the roles of retiring RN’s.
Monitor for Improvements
Once you’ve launched your targeted nurse retention program, your need for timely and accurate workforce intelligence continues. It is as important to use the steps above to monitor the program and make improvements, or watch for any upcoming issues. Program participation levels are not a measure of success. It is important to follow KPIs (such as reduced resignation rates, improved engagement scores or lower patient readmission rates) that actually reveal whether the programs are acting as levers to improve organizational performance.
Keep in mind that analytics is as much about organizational success as it is about data: if you spend all of your time gathering the information, you will have less time to spend making decisions based on a solid understanding of what drives service quality and ensures positive patient outcomes. The cure for nurse turnover requires the right investment in people, process and technology to make the above steps accurate and actionable.