When considering the current rates of personnel turnover in the medical field, nurse retention has become a priority for employers, stakeholders, and all those involved in the industry.
Although it is highly necessary to keep nurses, experienced or otherwise, within the workforce, nurse retention strategies are not straightforward and require in-depth knowledge about the widespread issues and concerns related to working in medical settings in the current environment.
If you want to know what nurses expect from a worthwhile workplace, how to improve satisfaction, and even attract as well as promote long-lasting and beneficial employment relationships in nursing settings, you can explore our guide. You will learn what nurse retention is and why it is important, as well as discover reliable nurse retention strategies that should make up the foundation of any workplace culture and employee policy in the industry.
What Is Nurse Retention?
Nurse retention refers to the rate at which practicing nursing personnel stay employed in a healthcare organization over a specific period of time.
Nurse retention is inversely linked to nursing turnover or the rate at which nurses choose to leave their respective organizations within a given timeframe for any reason.
Current Nursing Turnover and Nurse Retention Rates
Despite the year-to-year decrease, the nursing turnover rate remains high in 2024. Approximately 20.7%, or more than 1 in 5, nurses leave their workplace within one year. Nurse retention rates are even poorer for new nurses, where turnover rates have reached 34% in recent years.
When surveyed, 39% of nurses stated that they intended to change their role within six months. The intention to leave was highest among direct care nurses (41%). Additionally, nurses, on average, are 14% less likely to encourage friends and relatives to become nurses, which indicates that the current poor nurse retention rates and higher turnover may increase future turnover rates and the resulting shortages.
Why Is Nurse Retention Important?
A high nursing staff retention rate is crucial not only for a specific organization or workplace but also for the continuity and effectiveness of the industry as a whole.
On the other hand, low nursing retention can indicate poor workplace practices. Additionally, it can hinder the proliferation of knowledge in the organization, reduce the extent of aid provided to communities, and contribute to the concerning levels of nursing shortages in the US.
What Are the Causes of Low Nurse Retention?
Low nurse retention rates are the composite effect of several factors affecting the industry, both at micro and macro levels. These are the byproducts of past sanitary crises and the strains on the industry or enduring issues concerning the field.
In the context of the global health crisis, nursing retention plummeted, with approximately 30% of nurses reporting that they were likely to leave the profession due to the pandemic. This cause can be singled out as the cause for an overall 7% upsurge in intention to leave. Although a growing intention to leave the profession or retire altogether is concerning enough, it is worth remembering that the figure does not account for nurses unable to continue their professional activity due to health degradation or complications.
Satisfaction with the nursing career also faced a vertiginous drop, from the decade average of 80 to 85% to 71% in 2023. This trend comes together with decreasing mental health and well-being among nurses as well as concerning rates of industry-wide nursing burnout.
Low nurse retention creates spurious cycles that feed back into themselves, with poor staffing straining the resources and time of remaining personnel. 9 in 10 nurses believe nursing shortages have worsened in the last 5 years. More so, since turnover rates are worst among new nurses, there is a resulting deficit in industry leadership, as established nurse leaders take the brunt of workforce stressors, with no new experienced personnel coming in to support them.
Learn more about why nurses are leaving the profession and how to reduce nurse turnover.
How to Improve Nurse Retention: Strategies to Increase Satisfaction and Reduce Turnover
We will cover the most critical and effective nurse retention strategies employers, regulators, and stakeholders should adopt, implement, and promote for the industry’s continuity.
Although each of the following approaches has a positive impact on increasing nursing retention and improving the state of the workforce overall, a worthwhile strategy needs to be both comprehensive and able to target the particularities of each medical setting and work environment.
1. Manage and Eliminate Overtime
Although overtime is often seen as a functional, even if temporary, solution for the strain on care provision produced by shortages, their long-term effects mostly impact nurses’ stress levels and worsen overall well-being. One study also links overtime work with a higher occurrence rate of patient safety accidents, with workweeks exceeding 50 hours showing the worst outcomes.
Managing overtime hours with nurses’ quality of life in mind is a first step towards reducing the resulting increase in turnover due to overworking. This process entails investigating the patterns that lead to dips in care availability and quality and setting regulatory protocols for working excessive hours. Ideally, overtime, as a practice, should not only be mitigated but eliminated altogether to promote healthy work practices.
2. Support Continuing Education and Training
As a continuation of bolstering excellence in the field and rewarding those nurses who show real determination to advance their careers and the industry at large, employers and stakeholders should provide access to continuing education and training opportunities as a method of upholding interest and passion among nurses.
Options, such as subsidized or free educational and training programs, are work benefits that improve the nursing retention rate and reduce turnover, especially among those who want to temporarily leave the profession to advance their education.
Methods of supporting continuing education include tuition reimbursement or “Grow your own” programs sponsored by employers. You can discover more financial aid options for nurses and how they uphold and improve education in the field.
If you want to bolster nursing excellence and help in the provision of quality education to underserved and underrepresented populations, you can support the Nightingale Foundation, an organization aiming to guarantee the resources needed by students to attend and complete their academic programs through scholarships and other types of material support.
Learn more about what we do and discover ways to support our cause.
3. Create Opportunities for Professional Advancement
Stagnation in one’s career can reduce the appeal and increase the likelihood of turnover, while the real opportunity for advancement guarantees nurse retention and can bring about a new generation of leaders in the industry.
Workplace settings should have clear and pursuable paths for career advancement and reward members who show determination and perform exceptionally well in their respective settings.
4. Create a Mentorship Program
Nurse mentorship programs are tried and tested ways of staff retention and turnover reduction. According to one study, workplaces that provided mentors to nurses were able to retain their staff at a 25% higher rate than those that did not provide mentorship.
On the employer side, nurse retention through mentorship reduces the costs of hiring and training new personnel, thus allowing for a better overall allocation of resources. The nurses retained are also better prepared and can provide high-quality care in their given environment.
5. Present Opportunities for Autonomy
One central way of increasing job satisfaction and reducing the intention to leave the workplace is by allowing nurses to make decisions and take charge in their practice. A secondary effect is the generation of a new generation of nurse leaders.
However, nurses regularly report on the issue of excessive time spent on administrative tasks, which may indicate that increased autonomy comes with a caveat. While the ability to perform tasks independently in the workplace is essential for increasing nurse retention, it also needs to account for the efficiency and time spent on administrative tasks.
6. Offer Fair and Satisfactory Salaries
Nurse salaries are one of the central methods of increasing job satisfaction and attracting new nurses both to specific work environments and into the workforce as a whole. Increasing pay and promoting fairness in remuneration are both desired by nurses and recommended for employers who wish to retain their team members.
Salaries should also reflect the experience, skills, and responsibilities of each nurse while also accounting for the expenses related to the profession, such as transportation and the cost of living. However, as one study shows, while better and fairer salaries are a must, their effect on the well-being of employees is outshone by the prospect of fewer working hours and more free time.
7. Provide and Support Wellness Programs
However, salaries are not the only perks that attract new staff and bolster nurse retention. Employers should also explore the viability of and invest in various benefits and programs that improve the wellness of nurses. These can include therapy sessions and workshops, both at the workplace and in private, as well as memberships for personal improvement and the development of self-care skills and abilities.
As a rule of thumb, programs and benefits are to be seen as supplementary to the salary and should not aim to replace gaps resulting from poor pay.
8. Build a Culture of Respect, Empowerment, and Flexibility
The culture in the workplace has a considerable impact on the outlook of nurses and other personnel. In its best iterations, it bolsters inclusivity, improves accommodation and friendliness, and reduces stressors related to workplace conflict or discrimination.
Building an inclusive, empowering, and welcoming environment is a goal in itself. However, it can also broaden the pool of aspiring nurses and bolster recruitment from previously underrepresented groups and communities. Policies that accommodate specific needs and scenarios also increase the profession’s appeal and should be implemented from the earliest moments possible.
Read more about the importance of diversity in nursing and why inclusivity is key for a better working environment.
9. Give Reasonable Breaks
Reducing work intensity and allowing for reasonable staff break time improves the perceived quality of life and the appeal of working in an environment.
More than the confirmed increase in job satisfaction, mental health, and well-being, breaks also improve productivity and allow employees to be more engaged with their work, according to one survey. Taking breaks also has a proven positive effect on decision-making, thanks to improvements in focus. Constant work and stimulation, on the other hand, results in tuning out, which, in medical contexts, can result in patient safety accidents.
10. Deal with Bullying and Other Conflicts
Reducing bullying and interpersonal conflicts is a central extension of developing positive behaviors and an inclusive culture within the workplace. This approach increases cohesion and reduces risks of accidents or ill-communicated information.
Most importantly for nurse retention, it increases satisfaction with the job and allows members of previously underrepresented to join the workforce without the prospect of disproportionate stress or harassment.
11. Promote Workplace Safety
The prospect of adverse medical effects is a leading cause of turnover in many sectors, especially in the medical industry, where the daily activities of a nurse involve interacting with patients and materials in potentially risky scenarios. More than ensuring that sanitary crises do not spiral out of control, maintaining a safe environment ensures that nurses can work without interruptions due to medical leave.
Considering the effects of the pandemic on staff perspectives and turnover, it can be safely said that a hazardous workplace reduces satisfaction and puts nurse retention objectives at risk.
12. Keep up with Technology Standards
Technological advancements in the field of medicine come with various benefits and improvements in day-to-day activities. These can include increased safety in the workplace, better patient outcomes, and a more streamlined activity.
More importantly, the adoption of new medical technology, such as informatics systems, virtual communication solutions, or mobile applications, was shown to reduce the workload for nurses. Additionally, increasing access to essential technology in rural and underdeveloped areas has a positive impact on retention and recruitment, where nursing shortages are most accentuated.
13. Foster Effective Communication
Communication within nursing environments is not only helpful in improving efficiency and patient outcomes but can also avert and mitigate frustration and dissatisfaction among the staff.
Crucially, effective communication can address the causes of burnout ahead of time and reduce the overall effects it has on turnover. Promoting a proactive approach to communicating personal and collective gripes represents an important step. Still, it needs to be accompanied by quantifiable surveys and assessment tools that allow managers and employers to evaluate the state of employees on the go.
14. Acknowledge Performance
Another central part of maintaining an open and communicative workplace is acknowledging and promoting performance in healthy ways. However, instead of developing an overly competitive and potentially stressful environment, managers and employers should positively reinforce good practices and help foster leadership among staff.
Recognition and timely acknowledgment lay the foundation of an attractive work setting for nurses. However, it is essential for them to also see their efforts reflected in benefits and career opportunities.
15. Ask Nurses for Feedback
However, communication ought to go two ways, and requesting constant feedback from nursing staff can ensure that managers and employers do not lose touch with the rest of the team. Although requesting feedback already stands as proof of proactivity and care for the well-being of nurses, it also needs to be actionable and materialize into improvements in work practices.
16. Use Exit Interviews to Improve
Similarly to requesting feedback from currently employed nurses, exit interviews from past members of the team can help elucidate the main causes of turnover in a specific organization or workplace.
Information gathered from exit interviews is valuable in developing new nurse retention strategies and approaches. In other words, no attempt to reduce the current turnover in an organization can ignore the insights provided by past employees.
Implement Nursing Retention Strategies During Recruitment
There are some nurse retention strategies and actions that should be implemented from the earliest moments of recruitment in order to ensure that each new team member feels welcome, appreciated, and able to flourish.
Communicate Expectations During the Hiring Process
The hiring process is a two-way evaluation process, during which a prospective employee should consider whether a work setting fits their expectations and aptitudes. Transparency during the recruitment process can make the difference between early turnover and a longstanding professional relationship.
Maintain Adequate Staffing Levels
One efficient way to ensure a positive early experience and to prove that you care about the well-being and continuity of each nurse in an organization is to maintain appropriate staffing levels.
Reduced staffing can be a sign of an adverse working environment, thus deterring newly recruited nurses from pursuing a role within it. Additionally, it also signals higher prospective demands placed on members, as well as fewer leadership figures that may orientate and mentor new arrivals.
Develop an Attractive Work Culture that Supports New Nurses
The culture developed within an organization can be an attractor for new nurses as long as it demonstrates its inclusivity, friendliness, and reliability. Support provided to new nurses and other members should also represent a central principle within any workplace that wishes to retain its staff.
Emphasize the Opportunities Offered by the Workplace
Most importantly, applicants should perceive their prospective role not only as the start of their life as nurses but also as the principal opportunity for advancing their careers in the direction they desire.
Make mentoring programs, advancement opportunities, and options for continuing education central parts of the presentation of the role. Additionally, demonstrate, using past examples from the organization, that you prize the development of skills and the overall career advancement of your employees.
Invest in the Future Generation of Nurses
The best way to demonstrate your care for the industry and its members is to show your material support for future nurses and for the improvement of their conditions. Such support should start as early as during their education and should continue throughout their career.
If you wish to aid in promoting excellence in the field and provide tangible, material support for the new generation of aspiring nurses, you can choose to support the Nightingale Foundation, an organization whose mission is to provide resources to current and future nursing students in order to remove the financial barriers for equitable access to quality education.
The scholarships we provide aim to support outstanding candidates from underrepresented and underserved communities and aid in the effort to reduce current national shortages, improve rural health, and promote inclusivity and diversity in the field.
Since we know that support should come as early as possible, we also organize the Community Education Outreach program that offers guidance, support, and resources to prospective students from as early a moment as post-high school graduation. Thus, we bolster aspiring learners’ longstanding commitment to the industry and the mission of nursing by being by the side of nurses every step of the way.
You can find out more about what we do and the scholarships we provide, as well as ways to support our efforts. If you wish to contribute to upholding the next generation of nurses, you should consider donating to the cause.