The subject of nurse retention and turnover came up during a recent conversation I was having with the HR director of a regional hospital system here in Florida. We were discussing the Florida Center for Nursing report that identified the median turnover rate for RNs was 20% in 2007. The HR director responded that prior to the recession they were running in the low to mid twenties, but it had dropped to just below twenty percent in the past two years. As he said this, a look of trepidation came upon his face, as if he was waiting for the other shoe to drop.
The director added, "I hate to think what's about to happen once hospitals begin hiring again. The nursing shortage didn't go away simply because the economy faded."
Curious, I asked him to confirm if the American Hospital Association estimate that it costs an average of $64,000 to replace a single RN was realistic at his institution.
"Easily, and that doesn't account for the increased stress an open position places on the remainder of the staff."
A little short math reveals that a hospital with 200 nurses experiencing a 20% annual turnover rate is very likely expending $2.5 million a year in hard dollar costs associated with this phenomenon. Extrapolated across the nation, this endemic turnover challenge may, in fact, be costing American hospitals more than $10 billion annually. This doesn't take into account the additional costs associated with patient length of stay, the risk for adverse events, cost at discharge, and patient-perceived quality of care, all of which are negatively effected by nursing staff shortages and exacerbated by nursing staff turnover.
A quick search of the peer-reviewed, published research on the subject reveals many of the underlying causes of endemic turnover in hospital nursing are rooted in the "soft skills" of nursing, leadership, and organizational culture. Digging a bit deeper into the literature identifies some innovative, evidence-based suggestions and approaches to lowering costs and improving patient care as it relates to this front-line challenge. More than two dozen studies document the positive role emotional intelligence and the cultivation of emotional resiliency can deliver in nursing and clinical leadership. Fortunately, these are learned skills and competencies that can be developed over one's lifetime. The research clearly reveals that emotional intelligence in nursing:
-Has a positive impact on nursing team cohesiveness and patient/client outcomes.
-Minimizes the negative stress consequences of nursing.
-Reduces nurse burnout.
-Contributes to performance, career longevity, and job retention.
-Builds successful nursing leadership.
-Leads to more positive attitudes, greater adaptability, improved relationships, and increased orientation towards positive values.
-Enables the expression of empathy through healthy, professional boundaries.
-Nurses capable of a self-reflective process become aware of their own emotions. When nurses recognize their own feelings they are more likely to manage them and communicate in appropriate ways.
The nursing profession exemplifies positive intention, a spirit of service, and compassionate behavior. The daily interaction of nurses with their patients has a distinct impact on patient satisfaction, especially the emotional needs of patients and their families. Yet constantly evolving technologies, severe economic constraints, and the chronic nursing shortage combine to challenge the ability of nurses to focus on patient care. The very people that are in the position to have the most positive impact on critical patient perceptions also bear the brunt of many of today's challenges.
The fact is, healthcare is entering a phase of unprecedented change, experiencing pressures from many sides simultaneously. Like so many industries today, healthcare must adapt to a rapidly shifting economics, demographics, and expectations. Investments in technology will undoubtably help contain costs and improve efficiencies, but technology can only go so far. Of all industries and endeavors, healthcare is simply the most human. Investing in the human aspects of care, in developing emotional intelligence, adaptability, engagement, and techniques in self-care should be a key consideration as administrators seek innovative ways to successfully lead their institutions through this period of uncertainty and change.