In the Spring of 2023, Nursing Catalyst researchers wanted to better define successful retention in 2023 and, perhaps more importantly, understand if traditional retention strategies, including Magnet principles, are still impactful today.
To answer these questions, the research team conducted 22 in-depth interviews and collected data from top-performing med-surg nurse managers. Nursing Catalyst health system members each nominated one Med-Surg nurse manager leading system-wide retention, and one Med-Surg nurse manager leading retention at a 500+ bed facility.
The Nursing Catalyst team then shared the results of their interviews with Chief Nurse Executives from 21 top health systems for deeper understanding.
Based on their collective feedback, here are six insights for nurse leaders to guide retention strategy in 2023.
6 Insights to Guide Nurse Leader Retention Strategy in 2023
Insight 1: High Retention Rates are Possible Now with the Right Strategy
A major driver of rising health system costs is nursing turnover. Forty-to-fifty percent of the spike in health system operating costs can be attributed to labor, with labor costs expected to comprise an estimated 68% of operating budgets in 2023.
In 2022, the national turnover rate of RNs was 23.1%.
High-performing units with low turnover experience rates ranged from 1-19%, averaging 8%.
While national turnover remains high, top-performing med-surg units are not only able to maintain pre-pandemic rates—they exceed pre-pandemic success by a wide margin.
Permanently inflated turnover rates are not a foregone conclusion. Health systems can achieve pre-pandemic retention and should set aggressive turnover goals as part of a smart retention strategy.
Insight 2: Safe Staffing Levels Are a Prerequisite to Improve Retention
Nurse leaders take note: Although top-performing med-surg units were highly variable across factors like bed size, span of control, and RN experience level, they had one commonality—these units maintain safe and consistent staffing levels.
Most units with high retention have nurse-to-patient ratios of 1:4 or 1:5, occasionally rising to 1:6 to 1:7 in times of crisis with alternate models of care readily available to deploy simultaneously. Health systems can’t outmanage unsafe or consistently stretched staffing. The bottom line is this: Traditional retention strategies are not effective unless the unit is adequately resourced.
Insight 3: Market-Level Compensation is Necessary But Insufficient As a Singular Tactic
While offering market-level compensation is crucial, raising compensation as a standalone tactic isn’t sufficient to drive retention gains.
Participating nurse managers in top-performing units, like many nurse leaders, report that their staff want higher compensation. However, they remain onboard because of cited intangible benefits, such as a strong support network and an engaging professional environment.
Insight 4: What Nurses Want Isn’t Changing—Their Patience for Waiting Is
According to top-performing managers, today’s nurses want the same things they did before the pandemic. Thus, their retention strategy is largely in line with proven Magnet Principles and other evidence-based approaches.
What has changed, however, is how long nurses are willing to wait for health systems to meet their expectations.
Health systems cannot guarantee a nurse’s calling to result in organizational loyalty. If a nurse’s current role doesn’t meet their expectations in terms of the work environment or their personal needs, they will leave. “The Great Reprioritization” and Increased workforce mobility are two market forces largely responsible for this changing tide in loyalty.
Insight 5: Personalization and Responsiveness are a Key Part of the Equation
A strong retention strategy includes personalization and responsiveness to the individual nurse.
With personalization, top-performing managers know the specific needs and goals of their employees and they tailor classic retention strategies accordingly.
Nurse Managers also disproportionately prioritize personalization in high-impact areas, such as:
New nurse onboarding, growth, and development
Connection to purpose
Re-centering employee humanity in the work environment
Recognizing milestones
Resourcing and advocating
Enforcing self-care
“I tried offering more PTO, but what we learned is that they just wanted the autonomy for self-scheduling. I just give them the self-scheduling rules and allow them the opportunity to plan as they want.”
While this won’t prevent staff truly set on compensation gains from leaving the organization, it’s sufficient to retain most of the unit—when combined with tailored support in the areas most important to them.
Insight 6: Nurse Managers Must Be Set Up for Success for the Unit to Succeed
The nurse manager is the most important role in the health system to drive frontline retention. While managers have always been hugely influential, they are the leaders best positioned to deliver on personalization and responsiveness, given their proximity to the frontline.
As nurse leaders are aware, frontline managers are most impacted by turnover and vacancies. Moreover, the growing scope of their role prevents them from spending sufficient time with their staff to make personalizing a reality. For example, a 2021 study on nurse manager workload found that each nurse manager was responsible for completing 24.3 hours of work in a typical eight-hour day.
The best way for health systems to improve frontline retention is to re-scope their manager roles to free up time to connect with staff—an essential function of the successful nurse manager.
How Nursing Catalyst Can Help
The Health Management Academy’s Nursing Catalyst program accelerates innovation by supporting Nurse Leaders as they pilot tests of change in their units, and by providing executive-level research and idea-sharing to develop disruptive solutions to nursing enterprise challenges.
Our members are experiencing success in implementation – isn’t it time for a different solution in your health system?
To find out more about Nursing Catalyst, contact Anne Herleth, Vice President.