Reducing High Turnover Rates Among Registered Nurses

In 2016 Nursing Solutions estimated registered nurse (RN) turnover in the United States at 14.6%, down from previous year’s number of 17.2% (2). Nonetheless, we are experiencing an upward trend in turnover. According to Hunt, based on current projection, by 2020 the United States would experience a shortage of nearly a million nurses (6). The current financial fallout according to the 2017 National Healthcare Retention & RN Report is that the average cost of a turnover for an RN range from $37,700 to $58,400; each percent increase in turnover rate, cost the hospital an additional $410,500 (8). In none financial terms, RN turnover results in decreased quality of care, loss of patients, and high replacement cost –an average of 82 days (Hunt 3). The high turnover among registered nurses can be mitigated by improving the work environment, creating mentor programs, and instituting residency programs.

Improving work environment is an effective way of reducing high turnover rates among registered nurses. According to Shimp, “the nursing practice environment directly impacts nurse retention, turnover, and staff perception of staffing and resource adequacy” (258). Work environment might not be an overt issue in retention effort, nonetheless, it is an important one. Christmas describes it this way, “more subtle influence is the tone of any workplace, often referred to as work environment” (316). From this sort of assessment, several institutions that employ the services of nurses have undertaken retention campaign by seeking to improve the work environment. When this is the strategy for reducing turnover rates, the key aspect of such effort should be on staffing levels and resource availability, measured as the patient to nurse ratio (Lieneweber 48).

Current efforts on improving staffing levels include legislation at the federal level and some regulations at the state level. “At the federal level, legislation was created in 2008 to amend or introduce new staffing guidelines for the healthcare industry;” at the state level, California instituted a patient-nurse ratio law in 2004, seven other states have followed with similar laws and regulations (Shimp 240). The outcome of California’s law that went into effect in 2004 was an increase in RN license application of over 60%, and “by 2008, vacancies for registered nurses at California hospitals plummeted by 69 percent,” and in 2010 a study concluded that the legislation had achieved its goal of increasing retention and recruitment of nurses (Department of Professional Employees 4). Setting and monitoring patient-nurse ratio should be a legislative and regulatory priority. “one study of 601 RNs found that 43% of nurses would actually prefer increased staffing levels over increased wages scheduling” (Hunt 5). Therefore,

High turnover rates among registered nurses can also be cut back by Instituting residency programs. Both new RNs and nursing leaders conclude that new RNs are unprepared for the demands of the profession, “in the face of such a serious problem, a residency program post-graduation offers a solution” (Trepanier 207). By this acknowledgment, institutions like hospitals are beginning to engage in residency programs to increase retention. In 2002 Utah University Hospital implemented a residency program for new nurses, and by 2005 turnover among its registered nurses had dropped to 1.56% from a high of 24% (Peyton et al 388). Notwithstanding, implementing a residency program is not a cakewalk. Coming up with an effective program that serves its retention purpose could be a little tricky, but still worth a good outcome. How did Utah get it right? by engaging in a very specific curriculum that “discussed University Health Care –specific protocols, procedure development processes and sources of evidence,” in addition, peer support forums helped new nurses grapple with the enormous demand of nursing (Peyton et al 391).

According to Trepanier, nurse residency programs are also good economics, a cost-benefit analysis shows the “total cost benefit of the nursing residency program to be between $8.1M and $41.7M combining the impact of turnover and contract labor usage for a total of 15 hospitals that introduced” a residency program (212). In other words, “if [a] residency program prevents at least one new graduate nurse from leaving the organization, the program becomes cost-effective” (Bratt 422).

Another means of reducing the high rate of turnover among registered nurses is by creating mentor programs. “Nurse mentoring is a progression that builds skills, increases job satisfaction, and encourages retention,” to underscore this position, a study of the outcome of mentoring found that 35% of unmentored nurses quitted, compared to only 5% of mentored nurses (Fox 311). Such type of enormous change is accomplished by creating effective mentor programs like The Partners in Nursing Program (PIN) which has been at the forefront of this fight. The program was structured in such a way that new graduates were teamed up with experienced RN then the mentors got paired up with “experienced faculty nurse members,” thus establishing a support network (Cottingham 251). Participants indicated a staggering 100% intend to stay in the profession, the economic side is likewise good, the program had a 17% return on investment based on the difference in cost of the program to that of filling up a turned over position (Cottingham 254).

The mentor program at St. Francis Hospital and Health Centers (SSFHS) is another example of a success story. The program relied on three core foundations. First, selecting mentors that were compatible with proteges both in education and personality; second both parties were trained together; lastly, the program maintained a feedback loop that allowed for constant readjustment of the of the curriculum (Fox 313-314). The outcome of this program was a 100% retention rate of all mentored nurses (Fox 315). The lesson from successful mentor programs is that institutions that pursue this strategy help keep their nurses and save on a lot of recruiting expenses. For the greatest test of a mentor program is that it changes the negative perception of new nurses described as “feeling unsupported and overwhelmed when transitioning to their new role” in the absence of such a program “an estimated 35% to 60% of new graduate nurses will leave their position in the first year” (Shroyer 2016).

The problem of turnover among RNs does seem complicated and its consequences severe, but the solutions proposed are viable and effective. Implementing these solutions can reduce turnover to an inconsequential level.