The Urgent Need for Nurse Retention Strategies

In May of 2020, just as the world was beginning to grasp the full, horrifying effects of the COVID-19 crisis, I penned a piece for this blog on what I believed to be a looming mental health crisis in nursing. I shared data from a survey that my company, Trusted Health, had conducted of nurses working on the frontlines of the pandemic, which found that nurses were experiencing steep declines in their mental health and they felt unsupported by their facilities and the industry at large. 

Just over a year later, and in spite of significant media reporting about the issue of clinician mental health, I wish I could say that the situation has improved and that nurses are getting the support they need. Sadly, the follow-up to our original study found not only are nurses continuing to experience severe, adverse mental health effects as a result of the pandemic, but many of them are now considering leaving the profession entirely. In fact, nearly half of the respondents in our survey reported that they feel less committed to nursing. This finding was particularly pronounced amongst nurses under 40, who were 22 percent more likely than average to report that their commitment to nursing had decreased. 

At a time when the US Bureau of Labor Statistics projects that we need 1.1 million additional nurses in order to avoid a further shortage and tens of thousands of Baby Boomer nurses planning to retire in the coming years, we simply cannot afford to lose the nurses we already have -- and particularly those in the early stages of their careers. The situation is dire enough that the US Senate met recently to discuss possible legislative solutions. 

The unfortunate reality is that the healthcare industry has never been particularly good at retaining nurses: even before COVID-19, nurses were reporting record levels of burnout and nearly 20 percent left their first post within two years. But as with so many aspects of the healthcare system, the pandemic has exacerbated long standing issues and made the status quo untenable. In order to prevent a tsunami of departures, hospitals must put strategies in place to support and retain their nursing workforce. Here are three ways they can do so. 

Create new opportunities away from the bedside. Many nurses who are considering leaving the profession are conflicted, and can still be won over. In the short-term, nurse leaders need to meet with members of their staff individually and move nurses who are in periods of mental distress from the most demanding units like the ER or ICU into less acute roles or away from the bedside entirely. Over the long-term, technological advances like telehealth, remote patient monitoring and eICUs can help hospitals better leverage the skills of each individual nurse while still delivering a high standard of care. Career planning -- typically non--existent or an afterthought at most hospitals -- also needs to be a priority and focus less on simply moving nurses up the career ladder, and more towards tailored programs that map to each nurse’s career goals and preferences and do a better job at retention. 

Focus on culture over messaging. While the campaigns referring to nurses and other healthcare workers are well-intentioned, nurses have made it clear that this label is harmful. Moreover, when held up next to the finding from Trusted’s survey that the overwhelming majority of nurses feel that their mental health isn’t supported by their facility or the industry at large, it can feel hollow. Hospitals who focus on gestures like yoga classes or pizza parties over substantive workplace changes risk making nurses feel that they are simply being placated, rather than truly supported. Culture changes should be informed by listening that starts at the top of the organization and might include strategies meant to address bullying and incivility, education and coping mechanisms for compassion fatigue and moral injury, and comprehensive support for nurses who are experiencing acute mental health issues. 

Rethink the nursing workforce. The industry’s thinking about nurse staffing ossified years ago, and hasn’t evolved in response to more widespread generational changes in attitudes about work. Many nurses tried travel nursing for the first time during the pandemic, and aren’t keen to move back into full-time roles even as COVID-19 wanes in the US. The technology that the vast majority of hospitals use to do workforce planning is woefully outdated and needs updating to newly developed systems that can easily push out extra shifts to full-time nurses, local per diem nurses and travel nurses. This approach allows hospitals to avoid paying exorbitantly high fees for contingent labor, while giving Millennial and Gen Z nurses the flexibility they are looking for in their careers. 

While I found the results of our study deeply concerning, as a former ED nurse and a longtime nurse executive, I believe that there is still time to address these issues and to prevent a full-blown crisis. In reading through the write-in responses to our survey questions and speaking with nurses in the Trusted Health community, I firmly believe that most nurses -- even those who are considering other options -- love this profession and want to stay in it. But we must start giving them the support they need to do so.