mitigating nurse turnover: a multifaceted approach 11/tracey...mitigating nurse turnover: a...
Post on 04-Jun-2020
8 Views
Preview:
TRANSCRIPT
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.
21
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/
top related