According to a recent survey conducted by Becker’s Hospital Review, when asked what factors influence job retention, nurses responded:
- Flexibility and work-life balance: 39 percent
- Compensation/benefits: 31 percent
- Colleagues: 17 percent
- Career advancement/growth: 7 percent
- Management: 5 percent
Frontier Signal surveyed experienced nurses and asked them “Why do some nurses stay and others leave?” The range of answers echo the findings from the Becker survey:
- Some nurses stay in positions if hours/ location work for them.
- Some don't adapt well to change or take the position that the grass isn't always greener on a new unit.
- Others leave if they have specific career goals and their goals aren't being met on their current unit or could be better met elsewhere.
We then asked, “What do you think causes high turnover in your profession?” The response below, provided by a 30+ year professional nurse manager employed by a large healthcare system in the country, sums up the situation as follows:
- In interviews and at the time of hiring, human resources or nurse managers often give a new hire a very rosy picture of position about what is required for the execution of the job.
- Often a unit or team has been chronically short-staffed and then is expected / not asked but expected to mentor a new staff member. A new hire isn't always welcomed to the new unit with open arms.
- Additionally, staff turnover can be so great that a newer staff member often becomes a "senior" person on the team and is given assignments way beyond their capabilities simply because there is no one more senior to perform tasks.
- It is often not the patient care that is daunting but learning the computer system for the EMR (electronic medical record software) and how to overcome obstacles to work through the working realities of a large health care system that causes a nurse to leave.
Our interview concluded with the questions “What do you believe works well in the hiring process for nurses? What do you believe does not work well or can be improved?” Another experienced nurse manager offered this candid advice:
- Bring the potential new hire to the unit that they will be working on. Require minimally they visit the floor for half a shift. Go over specific situations that occur in the unit's patient population and role play.
- Use virtual labs before someone is hired to see how they interact with others and potential patients.
- Look to hire staff with a BSN. 2-year graduates do not have the clinical foundation or clinical experience to do the job.
- Consider developing "Fellowships" for all entry-level positions. Instead of hiring staff and having them report to their new unit on the first day of work, have a month-long probationary fellowship with classroom instruction in the EMR, organizational awareness, and spend time in the virtual role-playing lab. In this period, nurse educators would be able to better evaluate performance and if it was clear the potential job candidate did not have the skillset or ability to develop the skills needed for the position they would not pass probation.
This frank assessment touches upon several aspects of the recruiting, hiring and on-boarding process that can improve retention. Here are suggestions that the nurses we interviewed told us can improve hiring and retention:
- Provide a realistic job preview. For example, detail what the administrative task entail and the tools and non-clinical skills to fulfill those duties and list managerial or supervisory expectations.
- Assess for ancillary technical skills like proficiency in electronic medical record software
- Assess for culture at the team or unit level. Hospitals have different subcultures. Working and being happy working in an ER unit is very different than working in an oncology unit.
- Assess for managerial or leadership potential. Due to high turnover and shortages, nurses are often thrown into management positions based on seniority alone. Skills related to managing people and other supervisory demands and leadership should be assessed.
- Provide job shadowing or probationary opportunities to assess clinical skills.
- Use virtual technology to assess soft skills like communication, teamwork, attitude, adaptability, flexibility as it relates to interactions with patients, co-workers and supervisors, and resilience towards change.
- Be transparent in career pathing opportunities.
Frontier Signal’s product helps pinpoint a set of five signals specific to an organization’s job roles. Once a benchmark is established for a role, internal/incumbent candidates can take a brief assessment to see how much “fit” they have for a role. If there have been other benchmarks done for other roles in the company, Frontier Signal’s technology will identify skill-adjacent roles for the incumbent or internal candidate, which can help assure success in the new role.