What hospitals must do to retain nurses and nurse managers
Health systems continue to see shortages of nurses. Claire Zangerle, CEO of the American Organization for Nursing Leadership, offers insights on keeping nurses.
Many nurses have left bedside roles in recent years, and more could be joining them.
About 40% of registered nurses say they plan to leave the workforce or retire within five years, according to a report released last month by the National Council of State Boards of Nursing.
Claire Zangerle, CEO of the American Organizations for Nursing Leadership, says she’s been worried about the departure of nurses for some time. She tells Chief Healthcare Executive® that the shortage of nurses is a particularly disturbing problem in hospitals.
“Most of this is in the acute care settings,” she says. “It’s not that it's not a problem in other areas like ambulatory or post-acute care, but it's really troublesome for the acute care areas, because where are the sickest patients? They're in the hospitals within those four walls. And not being able to care for those patients at their most vulnerable times because we don't have the staff to do it is troublesome.”
Many nurses are leaving due to high work demands because of staffing shortages, and the high rates of violence and hostility nurses are encountering in hospitals, Zangerle and other nurse leaders say.
But Zangerle says she and her organization are very motivated to tackle the problems in nursing.
In a recent interview with Chief Healthcare Executive®, Zangerle talks about the steps hospitals need to take to retain younger nurses. She also talks about the steps needed to help nursing managers, and why nurse managers can play a key role in helping retain nurses if they get the support they need.
(See part of our conversation in this video. The story continues below.)
Meeting expectations of nurses
Hospitals that are struggling with retaining nurses need to examine their compensation. If hospitals are not competing with peers when it comes to pay, nurses are willing to go elsewhere, Zangerle says.
“Make sure that you are market competitive with your compensation,” she says. “That is table stakes. If you're not market competitive, then you don't even get to play the game. So you have to stay market competitive.”
Beyond compensation, hospitals and nurse leaders need to be nurturing young nurses early in their careers. Newer nurses need more “check-ins” from their managers to make sure they aren’t getting overwhelmed and can help them grow.
Health systems need to be “intentional around onboarding,” she says.
“Those first couple of years as a new graduate nurse when you're coming from school to a job are very critical, because that could define your future,” Zangerle says. “And how a health system manages that onboarding, and continual feeding and watering in those first couple of years, is foundational to your future.”
Some newer nurses were educated during the COVID-19 pandemic, and may have had less socialization in nursing schools. Some may also not have had as much experience in their clinical rotations than others who came before them.
Younger nurses possess a strong work ethic, but they also want to have some semblance of work-life balance, and that’s something hospitals must realize, she says.
While Zangerle says it never would have occurred to her to say she couldn’t take on an extra shift when she was younger, today’s young nurses are more willing to draw boundaries. And she stresses that’s not a bad thing.
“Our expectations of our new nurses have to be aligned with their expectations of how they want to live,” Zangerle says. “And we're seeing that in every industry.”
“Everybody wants to have a life. And it's not that people don't have a work ethic. They just want more balance … they're playing the long game, and they want to make sure that they have the stamina to play that long game, and they don't want to burn out quickly. And we're seeing a lot of burnout because they're being pushed to the point where they don't want to work that much because we have the shortage,” she says.
- Read more: Nurses in hospitals: Burnout by the bedside
Helping nurse managers
Nurse managers can help hospitals keep talented nurses, Zangerle stresses.
Managers need to be checking in with younger nurses, and more experienced nurses, she adds.
It’s not enough to meet with nurses when it’s time for an evaluation. And as Zangerle says, it’s difficult for managers to do a proper evaluation without spending some one-on-one time with their nurses.
“Checking in and doing sort of a pulse check on a regular basis with your team is super important,” she says. “Because everybody's an individual, and they all have individual needs.
“You can't assume that everything is okay because you haven't heard something. You have to be a nurse leader. You have to be the initiator of the conversation, because these are your people. This is your team,” she says.
Hospitals and health systems need to put managers in position to succeed and to be able to check in on their staff. If nurse managers are overseeing too many people, it’s virtually impossible to regularly check in with them.
If nurse managers are supervising 90 or more direct reports, turnover rates among newer nurses reach up to 40%, according to a recent report from The American Organization for Nursing Leadership and Laudio. Conversely, managers with fewer than 45 staff members saw turnover of 27%.
“Sometimes these nurse managers have upwards of 100 direct reports,” Zangerle says. “Nobody can keep up with that.”
And she says having enough managers to check in on staff is crucial for the well-being of nurses, especially at a time when health systems are struggling to keep them.
“That check-in is so important because it could mean the difference of somebody staying and somebody leaving. Because they feel appreciated if they get this check-in, they feel like they have somebody to talk to, that somebody has their back, that somebody is interested in their own professional development. And it's very important to have those check-ins,” Zangerle says.
Plus, nurse managers faced with managing up to 100 employees are going to be more prone to burnout and more at risk of leaving their job.
Zangerle says her organization is focused on how to retain nurse managers, and encouraging nurses to take on those important roles. She says nurses should look at being a manager as an attractive position.
“What we don't want is having those potential leaders who are looking at their current leaders saying, ‘I don't want that job,’” Zangerle says.
Plus, overwhelmed managers struggling with burnout can also pass that stress down onto their teams.
“Those feelings and the behaviors all trickle down to the whole staff, and then you have a toxic environment, which I think is something definitely that would have an impact on patient care and safety,” she says.
