The Costs and Benefits of Nurse Turnover: A Business Case for Nurse Retention

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This is not a nursing turnover.

When nurses leave a facility, this research says:

  • “costs of nurse turnover have reported results ranging from about $22,000 to over $64,000 (U.S.) per nurse turnover”
  • “Turnover costs, in general, have been estimated to range between 0.75 to 2.0 times the salary of the departing individual”

The cost to facilities also includes:

  • Advertising and recruitment
  • Vacancy costs (e.g., paying for agency nurses, overtime, closed beds, hospital diversions, etc.)
  • Hiring
  • Orientation and training
  • Decreased productivity
  • Termination
  • Potential patient errors, compromised quality of care
  • Poor work environment and culture, dissatisfaction, distrust
  • Loss of organizational knowledge
  • Additional turnover

The real questions are:

Is there really a nursing shortage?

Do facilities assess and measure nurse retention?

Do they conduct exit interviews to find out why nurses leave?

Do employers attempt to address issues that affect low morale?

What is the average amount of experience for the nurses at that facility?

Are employers even asking these questions?

Here is the original research article:

http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NurseRetention.aspx

   

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Finding A Workplace That Does Not Suck Series Concept #1: Team building

I was sitting at the nurse station on my unit when my boss walked by after interviewing a potential addition to our quirky team. All of us introduced ourselves and sent good wishes toward their

Source: Work Families: Where Nursing Shines

Finding A Workplace That Does Not Suck Series Concept #1: Team building

This article resonated with me. Actually, it got me thinking.  I would agree that work families are emotionally possible, but they have to be cultivated….and can be shaped by the people that are on the team. People can be outgoing, shy, intellectual, snarky, sarcastic, etc.  Everyone brings something to the workplace table.  As long as there is good communication, the team will grow.  The subsequent trust and commitment will make the workplace enjoyable and meaningful.  That can make a great shift fun, and a difficult shift bearable.

However, the team needs to bond organically. It can’t be forced.  Perhaps stating the obvious, but years in a variety of jobs over the years tells me that it isn’t obvious to some….namely, employers.  Unfortunately, businesses and corporations want all of the benefits of the teamwork – but are not aware of/understand/nor care about creating the environment to support a team. No, it’s not boring meetings. No, it’s not getting low-budget bling (lanyards, water bottles, etc.) with corporate logos on them.  More often than not, bosses paraphrase the empty parental solution to siblings that aren’t getting along:

“I want you all to get along. I don’t care how you do it.”

That ranks up there with “don’t make me come back there” and “I will turn this car around and we will go STRAIGHT home!” These statements remind me of my  childhood memories of sitting in a large, light blue Ford station wagon barreling down a distant highway during the 1970s.  We learn, at an early age, the difference between a real and empty threat.  The surface truce with siblings could be masked in front of the parents, but the resentment over such trivial things as this-is-my-side-of-the-car-and-thats-your-side arguments did not fade as easily.  The same can be true of co-workers. One moment, they can be civil and stand-offish to outwardly hostile.  This is what is known as “drama.” It exists, to some extent, in all workplaces.  At high levels, the drama can be as stifling as someone seriously ripping a fart in the med room.  This spontaneous analogy being obvious.  You don’t want to be there, but you have to be.

The synergistic power of having a great team of people is incredible.  As a nurse (extending to any medical field, I suppose), it is even more important.  We face very intense moments that require us to focus, assess, and act on our training, skill sets, and emotional resources to keep our patients safe and healthy.  Research identifies the negative emotions as impeding our ability to provide safe care. When our managers and coworkers function as resources and support; we can maximize our care.  However, when the work environment leaves you feeling alone and overwhelmed; you don’t have enough emotional resources left to be the best nurse/worker you can be.

The bottom line: Regardless of the source of your motivation to work, if you don’t want to be there; it is likely time to move on and work somewhere else.

For Hospitals, High Quality Care And Success Depend On The Happiness Of Nursing Staff

Nurses are the lifeblood of a hospital; now there’s just a study to prove it.

Source: For Hospitals, High Quality Care And Success Depend On The Happiness Of Nursing Staff

Author note: I would love to see the data that supports this statement in the article:

“Magnet hospitals are also known as exemplary health care systems, recognized by the American Nurses Credentialing Center as a great place for nurses to work.”

I will have to do some research. Please feel free to add sources in the comments.

Top 10 Things That I Love About Nursing

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10) Patient Education –  I have always wanted to be a teacher.  As it turns out, nursing includes quite a bit of that.  The good news is that the audience is only patients and/or their families, instead of 35 bored, distracted teenagers.

9) Patient Advocacy – There is something very empowering about being the voice of a patient, especially one that is not able to speak up for themselves.

8) Teamwork – There is something very synergistic about working with others, especially if there is a good sense of teamwork.  Coworkers go beyond being other people at work.  They become friends (or work family, at times) and everyone looks out for each other.  The support and encouragement from them can give you more energy to get through a rough shift, as well as make an smoother shift seem even better.  It is also empowering to be able to share insight and discuss how to manage new issues as they arise.  Unfortunately, not all employers provide and/or maintain this kind of environment. Sometimes, you have to work to find them.

7) Scrubs – Having spent decades in the corporate world, I can speak from experience that dress clothes and neckties suck.  Scrubs rock.

6) Improved Time Management Skills – The constant practice of assessing the situation, available resources, and knowing how long it takes to complete a task carries over into my personal life.  Juggling family demands, as well as academic and social demands seems easier, if that makes any sense.

5) Confidence – I am far from being an experienced or expert nurse, but I have faced down some fairly emergent situations that do provide some perspective on what it means to be in a crisis.

4) Doing Something Meaningful – Some people look to make a difference in the world. It is not a requirement, but when applicable, can add an extra layer of satisfaction.

3) Respect – Nurses rank as the most respected and most trusted profession.  I chose nursing because of the overwhelming desire to take care of others.  However, it is nice that I am in a profession that is respected.  It can be troubling, and sometimes annoying when new acquaintances (and even strangers) solicit me for my medical opinion.  A cashier at a gas station, one morning, started rambling on about changing medications. I did not know her.  I just wanted to finish my drive home to get some sleep.  I told her to ask her primary care physician.

2) Evidence-based practice – Anything a nurse does is based on evidence-based practice. In other words, nurses study an issue…..do research….test the findings….then use that data to shape our practice.  Not only does science rock, nurses use it to support their work.

1)Plenty of opportunities to learn – There are so many aspects and layers to nursing that the learning process is always on-going.  Our profession requires continuing education credits, but there is always formal training at work (on-line/in-person classes) as well as informal training (getting a patient with an illness/injury that you’ve never seen before).  For those of us who pursue more education, there are always classes toward a bachelors, masters, or even doctorate.

Did I Mention That I Love Being A Nurse?

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It was a rough week at work.  Patient assignments can vary, but sometimes the acuity level of the patients can elude the numbers generated on paper.  At the end of a few 12 hour shifts in a row, I felt like my body and brain were steamrollered. Luckily, I work with a great team. Nursing seriously rocks.

Setting Unrealistic (Medical) Expectations

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Laser Spine Institute Commercial

Being in the medical field, I take care of wide range of patients….including those with joint and spinal problems.  Pain not only can make doing everyday tasks difficult; it can also be difficult to manage.  Sometimes, pain management is finding the right combination of the type of pain medicine, physical therapy, and even other non-invasive procedures.  Surgery can be an option, but it shouldn’t be the first choice.  Doctors are required to present patients with information about what the surgical procedure is, what the possible benefits are, what the risks are, and what to expect afterwards.  There is ALWAYS a risk with surgery.  It can happen for any number of reasons, including allergic reactions or extrapyramidal responses to medicine, comorbidities with the patient, or any complication during the procedure.  Every person is different; therefore, their response to the medicines, treatment, and surgery can be different, as well. Here is where I begin to have a problem with commercials with the Laser Spine Institute.  It presents all of the benefit with none of the risk. Setting expectations really high….unrealistically high, in my opinion.

I found one website that gives patient reviews about the organization. Granted, I am not completely sure of the credibility of the website….or those who present any information about it.  I am not gullible enough to believe that any presence of data on the Internet means it is true. I also found a Bloomberg Business article about lawsuits against Laser Spine Institute, so I would think there may be more credibility with this information. I will leave it up to the reader to check its veracity of its statements.

Speaking of veracity of its statements, I am reminded of a similar “rosy picture” painted by commercials produced by the Cancer Treatment Centers of America.  I have read articles that say that their success rates are heavily influenced by not taking on patient cases that may have more serious, more aggressive forms of cancer (that may not be as likely to survive).  Quoting a Doctor interviewed for an article from Reuters News Service that Iinked to:

Accepting only selected patients and calculating survival outcomes from only some of them “is a huge bias and gives an enormous advantage to CTCA,” said biostatistician Donald Berry of MD Anderson Cancer Center in Houston.

This is more than just a nurse pointing out nonsensical responses to medical crises on Grey’s Anatomy (Don’t get me started!). This is irresponsibility among those whose motives are financially-oriented that patient-driven.