Teamwork and Team Leaders Make the Difference In Retaining, Supporting Nurses

By Karlene Kerfoot, PhD, RN, FAAN, Chief Nursing Officer, symplr
Twitter: @symplr

Reports throughout the pandemic have brought the plight of nurses into every living room, engendering concern for the individuals who compose the nation’s most honest and ethical profession.

After all, nurses’ very presence in hospitals and healthcare systems brings confidence and comfort. And if staff assignments are inequitable or aren’t based on patient need, everyone—patients, nurses, physicians, and the hospital itself—is disadvantaged.

Now is the time to use the spotlight on the nursing workforce to make positive, lasting change.

Let’s start with how your healthcare organization can spark retention initiatives and be counted among the health systems where nurses and nurse managers choose to stay.

The environment for nurses, nurse leaders

Public support through organizations such as The DAISY Foundation and expressions of gratitude help our nurses greatly, but healthcare administrators must lead the charge in their organizations to create more sustainable work environments for nurses and nurse leaders, and to keep morale among teams high.

Nurses’ resilience depends on a combination of adequate staffing, fair compensation, and feeling heard, and there are downstream effects of failing to adequately staff, pay, and support your nurse workforce—ideally to the needs of the patients and to the specific skills of the nurses.

In fact, when nurses don’t perform necessary care, it’s called “missed nursing care” and it can lead to serious negative outcomes for patients ranging from increased falls to medication errors and pressure ulcers. On the other hand, evidence suggests that units with optimal staffing have fewer instances of missed care and incidents.

Nursing shortages and staff retention are major concerns for nursing leaders. An August 2021 survey of 1,781 nurse leaders by symplr partner American Organization for Nursing Leadership (AONL) revealed nurse leaders’ top challenges:

• 47% of nurse executives identified staff retention and layoffs as a top challenge
• 61% said surge staffing, training, and reallocation was a major issue
• 75% cited emotional health and well-being of staff as one of the most critical problems

Nurses compose the largest provider group that spends the most time in patient-facing roles. As a result, creating a safe work environment for nurses—and thus, patients—must be a priority for all healthcare organizations. But often, achieving that goal is easier said than done. To retain nurses, nurse leaders, with the support of administrators, can take action to increase their nurses’ job satisfaction.

Making nurses want to stay is important, of course, for nurses’ job satisfaction and for the aforementioned positive effects on patient outcomes. But there’s more at stake in retaining nurses. Turnover negatively affects care quality and the healthcare organization’s financial well-being under value-based payment models.

Nurse job satisfaction, staffing assignments tied to healthcare outcomes

Research supports the anecdotal relationship between satisfied nurses and patient care quality. The more support nurses have from their employers, the better their performance and the higher the quality of care they deliver.

One American Nurses Association (ANA) study found that a 25% increase in nurse job enjoyment over a two-year period was associated with an overall quality of care increase of 5%-20%. Not surprisingly, longer shifts are linked to dissatisfaction—for nurses and patients. According to one study, as the proportion of hospital nurses working shifts of more than 13 hours increased, patients’ dissatisfaction with care increased. Nurses working shifts of 10 hours or longer were more than twice as likely than nurses working shorter shifts to experience job dissatisfaction and burnout, and to intend to leave the job.

Studies have also shown an association between nurse staffing assignments and patient safety, documenting greater risk of patient safety events, morbidity, and even mortality as the number of patients per nurse increases.

Nursing turnover is expensive

According to the 2021 NSI National Health Care Retention and RN Staffing Report, the average cost of turnover for a bedside RN is $40,038 and ranges from $28,400 to $51,700, causing a hospital to lose $3.6 million to $6.5 million per year. Each single percentage change in RN turnover costs (or saves) the average hospital $270,800 per year.

In 2021, the average RN vacancy rate was almost 10%, with more than a third of hospitals reporting an RN vacancy rate greater than 10%. The RN Recruitment Difficulty Index was 89 days, indicating that it takes three months to recruit an experienced RN.

Why do nurses stay?

Why do nurses commit to the continuous dedication and ongoing education and training it takes to work in today’s tumultuous healthcare environment? Work satisfaction ultimately depends on many personal factors, but there’s a common human thread among these professionals who are driven to care for others.

Connecting and making a difference

Despite challenging work environments, nurses value their relationships with patients. About a third of registered nurse (RN) and licensed practical nurse (LPN) respondents to a Medscape Nurse Career Satisfaction poll reported that helping people and making a difference were the most rewarding aspects of their work. Advanced practice nurses—a group that includes nurse practitioners (NPs), clinical nurse specialists (CNSs), and certified registered nurse anesthetists (CRNAs)—were most likely to cite relationships with patients as the most rewarding aspect of their jobs.

Meaningful work and belonging to a care team

According to a 2021 survey, RNs consider several highly influential factors when deciding whether to stay in their current role, including safety, flexibility (e.g., work schedule control, work-life balance, control over time off) and a positive work environment.

Surveyed nurses who were more likely to stay cited:

• Having a trusted/caring team
• Feeling valued by the organization
• Realizing the value in doing meaningful work
• Feeling a sense of belonging
• Feeling engaged by their work

In terms of well-being support, surveyed RNs highly value having more breaks and receiving sufficient recognition. Early and mid-tenured nurses surveyed placed particular importance on safety, compensation, their ability to care for their own family, feeling valued by their organization, and access to professional development opportunities.

Nurse leaders increase nurse job satisfaction and retention

Nurse leaders can increase job satisfaction and retention by creating a positive, supportive work environment where nurses feel safe, valued, and a part of a caring team.

Ensure adequate staffing

Nursing leaders are responsible for achieving an optimal nurse-to-patient ratio to facilitate the delivery of safe, high-quality, compliant care. For nurse leaders and the administrators who support them, this requires careful attention to demand forecasting, scheduling, and staffing. Nurse leaders strive to make appropriate staffing assignments by matching staff resources to patients based on:

• Patient care needs
• Staff skill mix
• Nurse education and training
• Competencies
• Unit variables

Technology helps drive staff engagement and supports nurses and teams. For example, workforce management software automates and simplifies forecasting, scheduling, and staffing processes. It also helps healthcare organizations make data-driven staffing decisions to contain and manage labor costs, improve productivity, increase staff engagement, and positively affect patient satisfaction and outcomes. By using advanced analytics, healthcare organizations improve accuracy and timeliness of demand forecasting, workforce alignment, and real-time labor management.

Specifically, healthcare workforce staffing and scheduling software:

• Translates policies, staffing data, and evidence into business rules to create schedules
• Promotes nursing staff satisfaction surrounding perceptions of fairness for the actual work schedule, along with the process used to generate the schedule
• Facilitates effective communication and active staff participation, increasing staff autonomy and satisfaction
• Alerts nurse managers of variances and urgent staffing issues
• Provides dashboards and reports that help nurse leaders monitor productivity
• Provides reliable and valid data to decision-makers across units and settings

Protect nurses’ safety and well-being

Sadly, violence against healthcare workers, including nurses, has increased since the pandemic. About 20% of RNs and LPNs surveyed reported experiencing physical abuse, most often from patients. More than half (58%) of RNs reported experiencing verbal abuse, most often from visitors. National Nurses United is calling for the U.S. Senate to pass HR 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act that would require hospitals to adopt plans to prevent violence. Violence prevention plans may include, among other components, better reporting (to increase awareness and corrective actions) and de-escalation training.

Nurse leaders need to protect their staff from physical and verbal abuse. According to National Nurses United, staffing is the most effective workplace violence prevention measure. Increased nurse staffing levels allow nurses to deliver patient care in a timely manner (reducing patient frustration and anger), give them more time to recognize and de-escalate indicators of potential violent behavior, and let them respond faster and more effectively to workplace violence incidents when they begin.

The American Nurses Foundation’s August 2021 health and wellness survey of more than 9,500 nurses found that the negative effects of COVID-19 on nurses’ mental health and well-being have increased significantly over the last year. More than a third (34%) of the survey respondents rated their emotional health as not, or not at all, healthy. Most of the nurses surveyed said they have felt stressed (75%), frustrated (69%), and overwhelmed (62%). Among nurses who said they intend to leave their position in the next six months, almost half (48%) cited work as negatively affecting their health and well-being as a top reason, followed closely by insufficient staffing (41%).

Nurse leaders must support their staff’s emotional and physical well-being, and one of the best ways to do so is by promoting work-life balance.

Nurse managers: Model and encourage work-life balance

As caregivers who tend to put others first, nurses often neglect their own needs for rest, proper nutrition, and physical activity. This can lead to stress, illness, exhaustion, depersonalization, burnout, depression, and even self-harm or suicide. Nurse managers can model appropriate self-care and help their staff improve work-life balance by implementing these strategies:

1. Maintain equitable assignments based on patient need. Balance is nearly impossible when one nurse is caring for too many patients.
2. Encourage teamwork. Working together lightens the workload and provides practical and emotional support.
3. Set boundaries. Nurse leaders need not take on every project. Learn to say no, and pay attention to feelings of discomfort, resentment, or guilt that may indicate when someone is overstepping your boundaries.
4. Take a lunch break and require your staff to take breaks. You and your staff will work more safely and efficiently if you aren’t running on empty.
5. Take vacations and encourage your staff to do the same.

How nurse managers create positive work environments

To increase nurse satisfaction, engagement, and retention, employ the following strategies:

• Allow flexible work schedules when possible. Keep shifts to 10 hours or shorter when possible.
• Improve team dynamics and foster a sense of belonging by using skillful communication and encouraging collaboration.
• Provide support. Be visible and available/accessible to nurse teams. Listen to them. Ask if they want help solving a problem, or whether they just want to vent.
• Show appreciation for your staff every day (not just during Nurses’ Week). To feel valued, nurses must feel heard, seen, valued, and formally and informally recognized for their contributions.
• Praise your staff for hard work, the delivery of exceptional care, and teamwork.
• Ask for their opinions and really listen to their input, implementing positive change based on their feedback whenever possible.
• Encourage everyone in and associated with your organization—clinicians, support staff, patients, families, visitors, vendors, etc.—to express their gratitude to the nurses who have made a difference in their lives through The DAISY Foundation.
• Ask nurses to share successes and positive accomplishments (their own and/or their coworkers’) during circle-ups. Talking about accomplishments reminds nurses of the great meaning in their work.
• Create a safety culture so nurses feel comfortable reporting near misses and personal safety concerns (e.g., verbal or physical abuse). Tell people how the problems will be/have been addressed/corrected.
• Provide ongoing training (e.g., violence de-escalation or conflict resolution) and continuing education opportunities to develop skill sets (such as in behavioral health, a skill set that is often under-developed).

As one young nurse who began her career in the pandemic stated,”[W]e work really well as a team. Regardless if we have new travelers or new nurses, we really help out our neighbors and try to make the care as best we can for our patients.”

Nurses know what they need to stay—and to succeed for their patients. Now, healthcare leaders must support them to the best of their ability.

This article was originally published on the symplr blog and is republished here with permission.