Mitigating Nurse Turnover:

A Multifaceted Approach

Tracey Moffatt, MHA, BSN, RN

Ochsner Health System

System Chief Nursing Officer

& Vice President of Quality

Ochsner Health SystemOur Mission is to Serve, Heal, Lead, Educate, and Innovate

Clinic Visits

In 20171,940,000+

Patients Served in 2017733,000

700+ 1,200+

90Medical

Specialties &

Subspecialtie

s

Active

Clinical

Trials

Employed

Physicians

10,600More Than

Regional Referrals

80+Health

Centers

273

27

Residents in

Programs

11

19

Hospitals (Owned &

Managed)

OHN or OHS

Affiliated Hospitals

Our VisionOur Vision

140,000Telemed Consults n 2017

18,000+

Employees

Ochsner Health SystemOur Mission is to Serve, Heal, Lead, Educate, and Innovate

Disturbing Projections….

The Headlines Are

Everywhere We Turn

The Statistics Support The Hype

• More than 25% of hospitals report an RN vacancy rate exceeding 10% (NSI 2018)

• Best practice vacancy rate is 11-15%

• (Advisory Board)

6

Source: NSI Nursing Solutions, 2018

The Statistics Support The Hype

• Last year bedside RN turnover rose by 2%

• Job opportunities abound in the more comfortable clinic, ambulatory and virtual spaces

7

Source: NSI Nursing Solutions, 2018

Turnover is Costing Health Systems Millions

• Estimated cost of turnover per nurse $22,000-$64,000 (Jones & Gates, 2007)

• Each percent change in RN turnover costs/saves the average hospital $379,500. (streamline verify.com/nurse turnover rate, 2017)

• “The cost of nurse turnover can have a huge impact on a hospital’s profit margin. According to the, the average cost of turnover a nurse ranges from $37,700 to $58,400. ( National Healthcare Retention & RN Staffing Report, 2016)

8

Lost Productivity

Lost Productivity

Onboarding Expense

Onboarding Expense

TrainingTrainingCompromised

QualityCompromised

QualityPatient LoyaltyPatient Loyalty

Employee Morale

Employee Morale

LostCapacity

LostCapacity

But…We Are Slow To Respond

Strategically

• While an overwhelming majority (83.8%) of organizations view retention as a “key strategic imperative” it is not evident in operational practice/planning. Almost all hospitals have retention initiatives, however, only 38.9% have translated these into a formal retention strategy.

• Approximately, sixty percent (58.6%) of hospitals have strategies in place to protect new hires, but only 21.6% have a strategy on retaining older workers. With Baby Boomers ready to retire, expect hospitals to focus more energies on retaining this knowledge base.

http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/NationalHealthcareRNRetentionReport2018.pdf

9

Why Are We Facing A Shortage?

• Increased life expectancy

• Growth in chronic diseases and disorders

• Nurses remain vital to care delivery

• Complexity of care delivery

• “Graying of America”

• Nursing school capacity restraints

• Retiring RN Workforce

• Opportunities ABOUND for nurses

10

What’s Driving Nursing Turnover?

11

TurnoverTravel

BurnoutP

atien

t Ratio

s

Scheduling

Pro

fessio

nal G

row

th

Manager

Work Environment

Job Opportunities

# 2 Relocation

Work/Life Balance

Incivility

#3Retirement

#1 Personal

Reasons

Health System Leaders Must Play To Win

A Comprehensive & Targeted Approach

“There really isn’t any single program by itself that will significantly improve experienced

nurse retention. You need several things. You need a system wide effort. You need

leadership. Then you can provide a program that will flourish.”

(Robert Wood Johnson Foundation [RWJF], 2010)

12

Building A Multi-faceted Approach

Future Pipeline

Retention Tools

Career Development

Recruit Effectively

How do we hire right?

Programs designed for every level

This is a supply issue –

not just a demand issue

Tool kits that are targeted -not general

Short-Range/Targeted Tools Long Range Strategic Tools

Staff Effectively For Today Support Growth For Future

Building A Multi-faceted Approach

RecruitEffectively

How do we hire right?

Short-Range/Targeted Tools

Staff Effectively For Today

Recruit & Retain New Hires

• Standardize Behavioral Interviewing

• Personal Onboarding – “welcome wagon”

• Formal New Hire Mentorship Program

• ANCC Accredited Nurse Residency Program

• Competitive Salary

• Hiring Bonuses: Sign-on & Referral

Staff To Targets• Intermittent External Agency – Be Selective

o Travel Nurses (contract)

o Per Diem

• Internal Agency

o Attractive In-house Float Pool

o Per Diem

• International Nurses

Building A Multi-faceted Approach

RetentionTools

Tool kits that are targeted - not general

Short-Range/Targeted Tools

Staff Effectively For Today

Targeting Tenured Staff• Red Zone Retention Triggers

• High Performance Retention Program

• Improved Staff Ratios/ Flexible Scheduling

• Resignation Recovery Protocol

• Self-scheduling & Variable Shifts

• Evaluate and staff up support services

• Lean on Technology – Make the job easier

• Drive a Culture of Safety

• The Daily Connection

• Remain competitive on Comp & Benefits

• Explore alternative models of care delivery

• ANA Care for the Caregiver Program

• Unit Manager/Director Compensation

Building A Multi-faceted Approach

Career Development

Programs designed for every level

Long Range Strategic Tools

Support Growth for Future

Career for Life: Investing at Every Stage• Clinical Ladder

• Tuition Reimbursement

• Specialty Certification Financial Assistance

• Reimbursement for NCLEX Exam Review Courses

• Ochsner Leadership Institute Courses

– Charge Nurse Academy

– Emerging Nurse Leader

– Mentor Academy

– Nurse Preceptor Academy

• Phased retirement options

• Child Care

Building A Multi-faceted Approach

Future Pipeline

This is a supply issue

– not just a demand

issue

Long Range Strategic Tools

Support Growth For Future

Planning for the Future• Partner with area colleges of nursing

– Invest in faculty wages to improve capacity

– Allow our own nurses to work for OHS while serving as faculty

• Chamberlain School of Nursing

– 3 yr. BSN program

– Clinical rotation site at Ochsner

“Growing Our Own”

– Financial Assistance for MSN and DNP programs

• Key Leadership Placement on State Boards of Nursing

• 13th Annual EBP/Research Day

Measure Strategy Success

BAPTISTBATONROUGE

CHABERT KENNER NORTHSHORE OMC ST ANNE WESTBANK

Overall YTD 12.2% 16.9% 0.0% 18.4% 7.5% 23.4% 30.5% 23.4%

Total EEs 343 178 66 196 159 1,027 59 205

YTD Terms 7 5 0 6 2 40 3 8

0

200

400

600

800

1,000

1,200

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Annual Bedside TurnoverFeb YTD

Measure Strategy Success

55

62

63 67 70

72

7985 90

97

187

-

20

40

60

80

100

120

140

160

180

200

2/1

2

2/1

9

2/2

6

3/5

3/1

2

3/1

9

3/2

6

4/2

4/9

4/1

6

4/2

3

4/3

0

5/7

5/1

4

5/2

1

5/2

8

6/4

6/1

1

6/1

8

6/2

5

7/2

7/9

7/1

6

7/2

3

7/3

0

8/6

8/1

3

8/2

0

8/2

7

9/3

9/1

0

9/1

7

9/2

4

10/1

Active + Offered Bedside LPNs Target

Measure Strategy Success

Nurse Mentor Program

• New graduate nurses targeted as mentees

• 5 hour mentor training

• 182 bedside nurses trained

• 125 mentoring relationships

• November 2017 expanded to capture all new nurse hires in Med-Surg areas

5.6

6.4

5.8

5 5.5 6 6.5

2017

2016

2015

First Year Flight

Food for Thought…..

• Short-term strategies such as increasing hospital nurse’s pay may be inadvertently exacerbating the shortage, given that the majority of U.S. nursing education occurs through publicly funded colleges and universities that can’t offer competitive salaries to nursing faculty.

• Shortage is being experienced worldwide.

• U.S. efforts to obtain foreign nurses to help mitigate the shortage may be viewed as poaching by other countries.

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ReferencesBaernholdt, M., & Mark, B. A. (2009). The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. Journal of Nursing

Management, 17(8), 994–1001. http://doi.org/10.1111/j.1365-2834.2009.01027.x

Becker's Hospital Review. (2016). Infographic: What's the cost of nurse turnover? Retrieved from

https://www.beckershospitalreview.com/human-capital-and-risk/infographic-what-s-the-cost-of-nurse-turnover.html

Drenkard, K. (2010). Going for thee gold: The value of attaining Magnet recognition. American Nurse Today, 5(3). Retrieved from https://www.americannursetoday.com/going-for-the-gold-the-value-of-attaining-magnet-recognition/

Ermak, L. (2014). Beating the burnout: Nurses struggle with physical, mental, and emotional exhaustion work. Holland Sentinel. Retrieved from https://www.nationalnursesunited.org/news/beating-burnout-nurses-struggle-physical-mental-and-emotional-exhaustion-work

Eubanks, B. (2015). The Hidden Cost of Nursing Turnover. Retrieved from https://peopleelement.com/the-hidden-cost-of-nursing-turnover/

Fink, J. (n.d.). 5 Signs of Burnout. Retrieved from http://nursinglink.monster.com/benefits/articles/2481-5-signs-of-burnout

Goodman, A. (2016). Nurse Turnover Rate - Infographic. Retrieved from https://www.streamlineverify.com/nurse-turnover-rate/

Jones, C. B. (2008). Revisiting Nurse Turnover Costs. JONA: The Journal of Nursing Administration, 38(1), 11-18. doi:10.1097/01.nna.0000295636.03216.6f

References

Kerfoot, K. (2015). Four Measures that Are Key to Retaining Nurses. Retrieved from

https://www.hhnmag.com/articles/3253-four-measures-that-are-key-to-retaining-nurses

Nursing Solutions Inc. (2016). 2016 National Healthcare RN Retention Report. Retrieved from

http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/NationalHealthcareRNRetentionReport2016.pdf

Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Health Affairs, 31(11), 2501-2509. doi:10.1377/hlthaff.2011.1377

Stokowski, L. A. (2014). Nurse Turnover: The Revolving Door in Nursing. Retrieved from https://www.medscape.com/viewarticle/836577

Trossman, S. (2013). Better Prepared Workforce, Better Retention. American Nurse, 45(4). Retrieved from

https://www.questia.com/magazine/1P3-3077835571/better-prepared-workforce-better-retention

Wisniewski, L. (2011, December). Nurses: Is it Stress, Burnout, or Compassion Fatigue? Retrieved from

http://nursetalksite.com/nurses-is-it-stress-burnout-or-compassion-fatigue/