This article is a summary of a digital workshop given by Rose O. Sherman and Catalyst Learning Company on 9/1/2021. Ms. Sherman’s presentation was titled “Become the Boss No One Wants to Leave: Nurse Recruitment in Turbulent Times.” Catalyst Learning sponsored the event in recognition of the heroic role that nurses played in the U.S. in 2020 and 2021.
Across the U.S., nurse leadership is struggling with unprecedented staffing shortages and high turnover. COVID-19 has been a ‘Quake Experience,’ a massive life change with aftershocks that will likely last for years. Nurses have experienced an impact both personally and professionally, leading to stress, burnout, exhaustion, hopelessness, and some disengagement. Nurses and other health staff may be reconsidering their professional lives, asking questions like “am I really supposed to go back to work like nothing happened?” “What is my economic worth, and am I respected?” “Is acute care the right setting for me? Have I found the right work-life balance?”
In the midst of this nursing workforce landscape, nurses are leaving the hospitals and systems they work for. While burnout, stress, inadequate staffing and better pay may get more attention and headlines, a major reason that nurses leave organizations is lack of good leadership. A lack of leadership doesn’t just mean the nursing VP. All levels of leadership, including the Charge Nurse, play a key role in retention. Nurses look for stability, trust, compassion and hope from their leaders. Younger nurses especially have different work demands than their more experienced peers, with needs evolving from paycheck to purpose, from wanting a boss to wanting a coach, and they look more for frequent feedback than annual reviews.
So given this new reality, how can I be the boss that no one wants to leave?
Focus on a Healthy Work Environment, plus Focus on Unit and Team Culture
Unit culture is an invisible architecture that new staff sense quickly. To have a healthy work environment, Nurse Managers and Charge Nurses set the tone. Make sure these frontline leaders encourage nurses to ask questions, make nurses feel appreciated, and listen to staff concerns. Nurse leaders who inspire staff generally have a strong bias toward taking action to correct situations, are vulnerable and compassionate toward staff, and manage conflict and diversity of ideas well.
Teach frontline nurse leaders to have zero tolerance for disrespect and abuse. A Charge Nurse who sees and ignores incivility or bullying has just normalized the behavior. Staff then either become part of the hostile workplace or leave entirely.
What is something nurse leaders can do quickly to help with culture issues? Consider bringing back an old ritual, or even start a new one. During COVID madness, many teams lost the rituals that connected nurses to the team and created a psychological safety net for the unit.
One last thought to help with work environment is to create a culture of recognition. Give symbolic gestures to show that leaders appreciate nurses. Begin shifts with “thank you for being here,” nominate your staff for awards, write thank you notes, and attend events where staff are being recognized. If your managers and Charge RNs see you doing this, they will likely follow your lead.
Do what you can do to encourage group cohesion and stronger work teams, remember that a toxic culture will destroy the best plans. Focus on work culture will help make leaders that staff do not want to leave.
Develop Charge Nurses to be Unit Cohesion Leaders
Organizational loyalty is cemented through relationships with supervisors, managers, Charge Nurses and team members. Many nurses don’t leave a health system, they leave their first-level supervisor. Develop your Charge RNs to be unit leaders, by teaching critical thinking, delegation, effective communication, conflict management, leading through change, and other qualities for successful leadership. Charge Nurses are the first-level supervisors who play a role in retention, onboarding, coaching, plus of course patient experience and safety.
Be Flexible to Meet the Needs of Your Staff – Be a Coach for Younger Nurses
Older nurses are retiring fast, and even Gen X makes up barely a quarter of the nursing workforce. Gen Y and Gen Z make up 60% of the nursing workforce now. As a leader, don’t wait for these Millennials to grow up and become Baby Boom or Gen X nurses. It is not going to happen. Be flexible in your leadership style to meet needs of younger staff. Be as accommodating as possible with work schedules for example. Also be flexible in your leadership style by trying to think more like a coach than a boss. Younger nurses think more about purpose than prior generations, so show young staff how their role contributes to the mission of the organization.
Lifetime employment is not the goal of most nurse staff today. Staff are more likely to see their jobs as “tours of duty” on a professional career ladder. To show support for Millennial and Gen Z nurses, support nurses’ career goals and do not give any perception that you may hold associates back from moving to the next level. Ask your nurse staff questions to aid their career development with questions like: “what goals do you have,” “what types of professional roles have you considered,” “what obstacles are you encountering,” and “what new skills do you want to achieve.” Consider using a Career Development GROW® Model Coaching Template with nurses to show you value their career trajectory.
Communication is Key, Especially During Turbulent Times
In complicated times, transparent communication and visibility is key. When leaders don’t communicate, staff will fill in gaps with misinformation. Nurse leaders should practice effective communication during practice and policy changes, consider diverse communication styles among different staff, and choose the right words and tone for communication. If leaders do not communicate effectively it can lead to gossip, mistrust, perceptions of staff favoritism, and staff can become defensive.
The correct communication tone and style can be difficult even during ‘normal’ times, but it is even more critical when staffing is short. When there are staffing issues, make sure leaders are transparent about the challenges the team is facing. Make sure leaders are transparent about recruiting tactics that have been tried, ask for staffing ideas from the team, and acknowledge that nurse leaders do not have all the answers. It may be a difficult message, but staff will appreciate honesty, and may even be able to help.
STAY Interviews and Strategic Off-Boarding
STAY Interviews are a way to help with avoidable turnover. Aim to do at least 2 each year per nurse, the first one within 90 days of hiring. After this interview, note the actions that you will take and the actions the nurse/staff member will take. After this interview, use a stoplight method to assess risk of turnover, with green being likely to stay 1+ years, yellow to likely stay 6-12 months, and red a high risk for immediate loss. Ask questions like “what do you look forward to each day,” “what are you learning or do you want to learn,” or “how can I make your job better or want to stay?” Even if you are likely to lose an employee in their current role, you may find other internal roles that may be better professional fits. STAY interviews can help with internal mobility which reduces recruitment costs, and keeps high-potential staff in the organization.
If and when nurses do leave, stay upbeat and positive. Thank them for their contributions, and remember that other staff will watch how you manage resignations. When valued staff resign, think about how to create loyal alumni who will recommend your organization, and leave the door open for boomerang employees.
Catalyst Learning produces the curriculum NCharge™: “Nurses Learning to Lead” for Charge Nurses, which is available for on-site or virtual instruction.