A few days ago I was reading an article written in April of this year on the “7 Nurse Retention Strategies You Can Use Now”. The paragraph that stood out the most to me was this one:
“It’s estimated that over 260,000 nurses leave the profession annually and are not being replaced as quickly as they leave. In turn, new academic nurses do not have the same experience level as more mature nurses. For skilled nursing, the median turnover rate is 43.9. Each percentage change costs about $379,000 on average, which means an average loss for a hospital of about $5 to $8 million annually, not to mention the erosion in quality of care.”
I was struck by the phrase “more mature nurses”. I know a few of them and they’re total rock stars who need an abundance of support right about now.
The photo above is mom’s graduation photo from the Nursing school she attended (and graduated from) in the early 1950s. That’s her on the far right. As you can see, she was a young nurse with confidence. One of the traditions upon graduation was to sign each other’s sash. As mom was a “diploma grad” and traveled across Massachusetts from hospital to hospital, many of the comments on her sash were about the different hospitals where she had worked and some of the humorous stories of their adventures at each place. They all were supportive, encouraging, and nurturing — wishing her all the best in the career she had ahead of her.
In all honesty, though, I’m glad my mom is not here to see how her field of Nursing and our healthcare system has been affected by the Covid19 pandemic (she died in 2018). I’m also glad she’s not here to be present for the suggested retention strategies that the hospital where she worked and where we both volunteered, has probably implemented to retain their team today.
Notice I wrote “hospital” — no plural — no “s”?
During her career, once she had her license, she only worked at one place; our local hospital. She was “in it” — totally loved her nursing career and was able to maintain her (what is now called) “work-life balance”. Even as she worked in acute care (in the ED, ICU, and what was then called Recovery), she had quality time to spend with us (our family) while also taking classes related to the hobbies she enjoyed — photography and gourmet cooking.
If mom worked in acute care now, I’m sure I’d never see her as she was the type of person who would have picked up additional shifts. And I know caring for just a few of the over 700,000 #Covid19 patients who have died would have taken an emotional toll on her as well. As smart, and compassionate as she was, it would have been very difficult to see her leave for work each day knowing the effect her career (and the lack of support, staffing, and equipment) would have on her life. — And I am haunted by this — knowing she would have navigated moral stress, critical thinking, and decision making like the trooper she was, it would have all taken a toll on her; my mom — “the mature nurse”.
The nursing retention strategies listed in the article were:
1. Engage from the first touch in recruiting and hiring
2. Establish a hiring standard
3. Put science in your selection
4. Adopt a structured competency nurse residency program
5. Actively support career development
6. Support clinical decision making at the point of care
7. Foster a culture of learning and competency
When I see lists like the one here of the “7 suggested Nursing retention strategies”, I often wonder what mom would have thought of it. I don’t know that she would have understood the science behind recruiting and hiring as just being a “part of the team” was most important to her; I know for sure she would have supported the importance of career development.
After she had retired she told me that she wished she had held onto her Nursing license so that she would be available to give flu shots in the community where she and my dad lived. Instead, she developed a “recovery closet” that held wheelchairs and walkers for the residents in their community who needed support and assistance after surgery or joint replacements. I remember driving her to drop off equipment and watching her as she instructed each resident on how to use the equipment based on their injury.
When she got back in the car, you could see that same confidence that is in the photo above. She loved being a nurse.
In her 80’s she made the decision to return to our home state and live in an assisted living community. As we were packing up to move she said to me “I hope they have nursing students there so I can teach them something they may need help with.”
In 2018 she developed pneumonia that she never recovered from. I remember one night when I was staying with her, she was wheezing and struggling to breathe. I got up and sat with her and patted her back as she pointed to the different places she wanted me to pat to help her feel better. “Do you want to go to the hospital?” I asked her. “No” she said, and explained to me what she had heard throughout her career — that “pneumonia is a friend of the aged that takes you at night when you are sleeping.” A few weeks later, that’s exactly what happened.
Did I tell ya I’m glad she’s not around to see the challenges her healthcare colleagues are experiencing as a result of the #covid19 pandemic?
Several months ago, I was interviewing for a position at a local hospital and was discussing some of the challenges faced in hospitals today with the senior administrator I was interviewing with. He asked, “have you ever heard the expression ‘Nurses eat their own’?” When I told him I had, he asked me what I thought “was meant by that”.
“Ohhhh…not a nurse.” I told him, thinking “nope, not gonna sign up for that class” (and even attempt to answer his question). Needless to say, the interview seemed to progress downhill from there and I never heard back about the job. Months later, that question still haunts me. When I have thought about it, I think buried deep underneath the question are unresolved concerns and issues about the challenges with retaining experienced healthcare teams.
And then I go back to thinking about my mom and the 1 hospital where she worked. She resigned from the hospital when she was asked to return to working weekends. She declined and resigned from her full-time position choosing instead to work per diem when she wanted to.
When she resigned from Nursing altogether, she still went back to the hospital and volunteered on the fund-raising committee. I remember how happy she was one day when she came home and told me that her committee had negotiated to have a nice Harley Davidson motorcycle donated to the hospital and how much money they would be able to raise from the raffle tickets they had planned to sell.
Healthcare was her mission and will always be part of the legacy of our family.
And maybe that’s where we need to start when having a discussion about retention; not just with Nurses but with our entire healthcare team. Maybe it needs to start with an authentic conversation about the mission we are on and if our mission is in line with the mission of the hospital where we would like to work. Maybe instead of the scientific data-driven recruiting and retention strategies, we need to just ask “what brings you to our hospital and how can we support you in your career, and how would you like to contribute to our mission and vision towards caring for the patients and families we serve?
And then just listen.
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