How Endeavor Health has improved nurse retention

In 2023, John Tressa became the first chief nursing executive with Endeavor Health.

The Chicago-based health system operates nine hospitals. The system was formed by the merger of NorthShore University HealthSystem and Edward-Elmhurst Health.

Since taking the inaugural role for the system, Tressa tells Chief Healthcare Executive® that he has worked to help Endeavor keep more nurses and to help them grow in their positions.

Tressa says he’s focused on “advancing the professional practice of nursing.” He also says he sought to empower nurses.

“The voice of the clinical nurse is really paramount in terms of driving their practice, driving their outcomes, and a new concept that I introduced in driving their joy,” he says.

Tressa says when he first talked about the concept of driving joy, he encountered some skepticism, with some saying that it’s not feasible to make someone feel happy in their work.

But he says, “You can provide an environment that enhances their feeling of joy based on what they've defined.”

(See part of our conversation in this video. The story continues below.)

Improving retention

Tressa says the work of improving the environment for nurses is based on certain foundational goals.

The system is working to give nurses the tools on a daily basis “to consistently provide great outcomes and experiences for my patients and those who love them,” Tressa says.

Nurses need to feel supported in the workplace and empowered to use their voice, and they need opportunities to grow. Nurses also need to feel safe in the workplace, he adds.

• Read more: These warning signs are tied to nurses leaving hospitals

Like many health systems, Endeavor experienced challenges with nurse turnover during the COVID-19 pandemic. Some veteran nurses with decades of experience opted to retire, and some younger nurses pursued more lucrative opportunities to work as travel nurses.

But the system has seen success in improving retention over the past two years. Turnover has dropped eight percentage points, and Endeavor’s nurse turnover sits at about 15%, reflecting the national average. Tressa says the system’s turnover is a couple of percentage points lower than peers in the midwest.

Endeavor has developed a strong nurse residency program that is making a difference, Tressa says.

“We have a very solid nurse residency program that is our secret sauce, for lack of a better term, at not only onboarding our new nurses, but engaging them, retaining them, supporting them, and keeping them long term,” he says.

Nursing students have the opportunity to take roles as patient care technicians, even on a part-time basis, “to really get immersed in our system and understand it and know it,” Tressa says.

“It makes it a much easier transition when they've completed their nursing education to say, you know, this place has really wrapped a warm blanket around me, so I want to start and continue my career there,” he says. “So that's one facet of our nurse residencies.”

Nurses going through the residency program have been much more likely to stay with the health system.

“There was a much greater degree of stickiness for nurses that went through the formal nurse residency than those in transition to practice, and the key to this is really around the lock step pieces that are consistent in the nurse residency program and the ongoing mentorship that those nurses gain,” Tressa says. “And that's been really successful, so now we are rolling that out as our primary pathway for new grads to enter our system across each of our acute care hospitals.”

• Read more: Nurses remain the most trusted workers. They can help counter misinformation.

Advancing careers

Endeavor has also worked to help its nurses grow in their careers and gain more capabilities. The majority of Endeavor’s registered nurses only possess a few years of experience, much like other health systems.

“Seventy percent of our RNs across the system have less than three years of experience, and that's really a sign of the times,” Tressa says.

To help nurses grow and gain better career opportunities, Endeavor has developed its Nursing Professional Advancement Program.

Tressa says it was important to develop the new program, because it wasn’t easy for nurses to find ways to move up the clinical ladder.

“I didn't see a consistent pathway for nurses to develop and advance within the system,” he says.

At first, interest in the new professional advancement program was slow to build. But early participants helped spread the word, enthusiasm grew, and now hundreds of nurses have taken part in the program.

Tressa says some may not be interested. But he likens the program to a buffet.

“It’s really up to the individuals to eat,” he says.

• Read more: Hospital nurses need a better workplace, and these leaders have ideas

Being accessible

Endeavor employs 8,000 nurses, and while Tressa can’t speak to every nurse every day, he makes a goal of being accessible.

Tressa has told the nursing staff that he wants to hear from them, and he says any nurse who reaches out to his assistant will hear from him within 24 hours.

“That's worked out really nicely,” he says.

Health systems need to recognize the importance of engaging nurses in improving patient care, he says.

“It's super important that you use the power of clinical nurses and patient care tech support teams, etc., to drive change in your organization,” Tressa says.

While Endeavor has delivered strong patient care, Tressa says the system needed to improve its consistency. Now, he says the system has raised the bar.

“I can honestly say that we have driven evidence-based practice to the highest level in the organization,” Tressa says. “And we are seeing very tangible results in our clinical outcomes and the amount of pride and ownership and feelings of engagement that we've seen from our clinical nurses.”