How to Support Nurses and Raise Nurse Retention Rates

It’s not uncommon as a nurse to have thoughts about leaving the nursing profession. Many nurses face short staffing, long hours, and a lack of support from the administration. From February 2020 to September 2021, 18% of healthcare workers quit their jobs. Additionally, 12% have been laid off and 19% thought about leaving their job.

There are many ways nurse executives and fellow nurses can raise nurse retention rates during the nursing shortage. We interviewed three experienced nurses about the challenges in hospital systems, how to support nursing staff, and ways to prevent low retention rates.

Changes to the healthcare system are necessary to help support nursing staff and improve retention rates. By continuing to use the same strategies hospital systems have used in the past, you can expect the same results.

While there are many reasons for the nursing shortage, more nurses nearing retirement and the stress placed on the system by the pandemic has made the situation worse.

Heather Sweeney is a senior talent sourcing partner with a focus on nursing. She practiced as a registered nurse (RN) for more than eight years before moving into recruiting. She has the advantage of seeing the system from many viewpoints and describes the need for changes.

“Instead of thinking about how to keep plugging holes and simply hiring RNs to fill an open slot,” she says, “organizations need to think long-term strategy to keep the ship afloat, retain existing RNs, and have a viable pipeline of RNs waiting in the wings.”

There are several changes that need to be made to support nurses who are considering career changes. Many of these strategies focus on lowering stress and improving retention rates.

Nurses have a history of being strong advocates for their patients and community. To effect change in the hospital environment, it is necessary to use those same skills and passion to advocate for the nursing profession.

The healthcare system is complex and fragmented. Management is often in the hands of professionals dealing with other issues that may lead to ill-informed decisions and poor outcomes for the nursing staff.

One way to advocate for change is to propose and promote the employment of a nurse ally in the healthcare system. These individuals are often nurses whose job is to advocate for change and improve working conditions.

In some cases, allies are used to address the inequality and healthcare disparities that exist for population groups. However, nurses also experience disparity in workplace environments, such as representation in nursing and healthcare, leading to stress and burnout.

Adina Maynard is an experienced, certified oncology nurse who also offers guidance for cancer patients through her website Nurse Adina. She expresses a need for more changes to occur in healthcare to retain more nurses. In the past, many hospital systems have been more reactionary than proactive, initiating strategies to reduce threats to patient care.

Maynard encourages nurses to participate in #TheLastPizzaParty movement for nursing advocacy. The group’s mission is to ensure a safe workplace, promote safe patient care through legislation, and educate providers on protective strategies.

Nurses can leave bedside nursing without leaving the profession. Nursing is a versatile profession that offers nurses many options to use their skills while staying in healthcare.

When organizations support those moves through education and nursing mentorship, they retain a greater percentage of their staff. Sweeney offers several suggestions for what needs to happen to increase access for nurses to learn new skills:

Prioritizing mental health and emotional wellness in the healthcare system supports nurses and patient outcomes. During a time of crisis, such as the pandemic or consistent staffing shortages, the adverse mental health impact on nurses increases the risk of low staff retention and high nurse burnout rates. These can raise staffing shortages even further, creating a vicious cycle.

Public health emergencies can cause stress experienced during shortages worse. Organizations must develop interventions that support their nurses’ mental health and well-being.

“The units that I support that have the best retention rates are units where the nurses report feeling supported, heard, valued, and feel like they are part of a family,” Sweeney says.

Sweeney advises that organizations move beyond keeping a wellness website or providing a phone number for nurses to call to talk with someone.

“It just isn’t effective,” she says. “Organizations need to implement hands-on training and deliver it to their nurses at orientation and then throughout their career as needed.”

Maintaining a safe nurse-to-patient ratio is one of the biggest challenges nurses face today. To improve patient outcomes, nurses need more time with patients. According to a study by Johns Hopkins Medicine, nearly 250,000 people die each year due to medical errors, making medical errors the third leading cause of death in the U.S.

Nationally mandated staffing ratios will not make an immediate difference in the nurse shortage but will improve patient care. To adequately staff units with minimal impact on patient beds, hospitals would be required to use creative strategies.

However, this would also improve patient care while new nurses complete their programs. Nurses can advocate for a national mandatory staffing ratio by taking advantage of professional nursing organizations supporting the effort, such as National Nurses United.

It is vital that nurses are appropriately compensated for the work that they do.

However, while improving the pay scale is one strategy to improve nursing retention, it should be accompanied by other initiatives that address the daily needs of the bedside nurse.

Chris Crady, RN, works for the healthcare startup SmileMD. “I am all for giving nurses what they are worth,” Crady says.

“But,” he continues, “until we resolve the real issues that nurses face, more money will always be just a buffer to buy more of your time until you can’t take it anymore and then no amount of money would be worth it.”

RN benefits are another strategy to improve retention rates of experienced nurses. While money won’t solve the nursing shortage, Crady points out that “most nurses probably feel disrespected when a travel nurse can be brought in, making double or triple the pay for doing the same job as they are.”

Most full-time nurses have a benefits package that includes paid time off for vacation and sick time. However, benefits are lacking in other areas:

Of each of these benefits, fewer licensed practical nurses receive them than RNs or advanced practice nurses, and 9% work full time without any benefits.

Hospitals and healthcare organizations may also consider other benefit options that are not as costly to the organization but raise nursing satisfaction. These may include flexible scheduling, in-house education, and certification reimbursement.

One of the barriers to nursing retention is an unsafe work environment. Spending 10-12 hours daily with other overwhelmed nurses can get challenging. Some nurses cannot handle the stress and act out at work with their colleagues.

Patients and families can also bully and humiliate the nursing staff. There has been an increase in workplace violence against nurses since the pandemic. However, the healthcare environment should be a safe place for nurses and patients.

Bullying can involve verbal attacks, condescending attitudes, and other forms of intimidation or exclusion. According to psychologists, bullying peaks around age 13 and should decrease as we age. However, working in a stressful environment can bring out bullying behavior in the healthcare staff.

The response to bullying starts at the top. If your nurse manager allows a coworker to undermine your authority with a patient or dismisses a physician’s verbal abuse, then it’s likely the behavior will not change.

However, when management and the administration value the nursing staff with their actions and words, they will not tolerate bullying behavior. This contributes to a safer workplace and better retention of seasoned nurses.

Humans have a need to be heard, recognized, and appreciated. Money is not the driving force in employee satisfaction. In fact, employees place a high value on culture, values, senior leadership, and growth opportunities. One study published in 2019 found that employees valued a strong company culture over compensation.

While money puts food on the table, employees stay at their workplace when they feel heard and valued. Nursing management may find that they have a significant impact on the mental wellness of their staff when they take the time to connect and build solid relationships with their nurses.

Nurses may also find a community on social media and nursing blogs where they can share their experiences. For example, nurses may participate in the #AsaNurse social media campaign on Twitter and LinkedIn. This gives nurses a platform to share experiences and educate the general public about what nurses do every day.

Throughout the pandemic, the nursing shortage grew larger. Staff were leaving hospital units over disputes concerning personal protection equipment and mandated health strategies.

Nurses felt they were treated as disposable, not receiving respect or being heard by management or administration. Nurses have been voted the most trusted profession for 19 consecutive years. And yet, they also experienced more workplace violence during COVID-19.

It is management’s responsibility to create a safe culture in the workplace where violence and bullying are not tolerated. Crady believes facilities are trying their best to keep experienced nurses, but respect goes a long way with nurses.

“Respect what we do, respect the hours we put in, respect the stress we are in, and respect our emotional well-being,” Crady says. “It goes a long way.”

Mentors and career coaches give nurses a sense of belonging. They focus their efforts on career fulfillment. Having a mentor or career coach can help shape your career. Some relationships develop naturally, but more often, nurses must take the time and make an effort to find a mentor. Mentors must be trustworthy, available, reliable, and good listeners.

Some hospital systems have internal mentoring programs, while other nurses may need to seek a mentor outside the system.

“Offering RNs a personal mentor, the opportunity to work with another RN who has been in their shoes, and providing RNs a resource that will be there to help them grow and progress in their career is such a huge asset,” Sweeney says.