How To Decrease Nursing Turnover on Your Unit!

Nursing turnover costs a hospital roughly $26,000 per new nurse that voluntarily leaves the facility. If several leave within the first year, then the cost drastically increases. With a focus on stewarding healthcare dollars better (as third party reimbursements decrease), nursing turnover is a real cost, even if it is not directly viewed.

There are steps a nurse leader can and must take to decrease nursing turnover.

1. Effective and efficient new hire on boarding, starting with HR and the nurse leader. After a nurse candidate is chosen, HR should set up lunch with the candidate and the hiring leader of the unit. This way, the new hire feels as though they are wanted, and part of the team. Bringing a small gift during lunch is a great touch.

2. Set very clear expectations for preceptors and unit staff on how to treat the new nurse during training. Make sure you, as the nurse leader, set clear expectations ahead of time to your staff on civility and acceptance. This needs to be ingrained repeatedly that a culture of civility and just culture is expected at all times.

3. Hold preceptors and unit staff accountable for bullying and uncivil behavior, such as backbiting, rudeness, belittling, etc. A great saying is "What you permit, you promote". If you allow this behavior to continue, you promote this bad behavior further. When issues are reported by the new nurse, deal with it quickly by obtaining both sides of the story. If indeed this behavior is found accurate, some sort of progressive discipline in a must, and must be documented well.

4. When negative feedback is reported by the preceptor or other staff, keep emotions out of the conversation and obtain the new nurses story. By doing this, the new nurse has the opportunity to explain themselves regarding the feedback. If further work needs to be done regarding some lacking skills, then a coaching plan is a must. Most of the time, this works, however, after all options are exhausted, there are times where an involuntary termination is needed for non fit.

5. Check on the new nurse often, and ask questions to stimulate learning and critical thinking. During nurse leader rounding, ask how the new nurse is doing. Every week have meetings with the preceptor and the new nurse. This will keep everyone on the same page and allow for tweaks of orientation.

6. For existing nurses, engage and build them up. This can not be overstated enough. Seek nurses that wish to become preceptors or front-line leaders and offer skill training, coaching and mentorship to obtain these skills.

7. Be transparent and accountable to the staff. As a leader, we sometimes make mistakes, own them and develop a plan to improve. As leaders, we must role model behavior we wish to see in our staff.

Nursing turnover can be avoided to a certain extent. Following just some of the bullet points above will go a long way to lowering this often unseen and forgotten real cost.