Retaining nurses is an important part of running an office. Studies have suggested that the average cost of replacing an RN can run anywhere from $22,000 to over $64,000. When looked at in the context of an annual turnover rate between 8.4% and 13.9%, the cost to a practice can be significant. Keeping your current nursing staff happy and employed should be a priority for the practice.
One of the big drivers of nurse retention is job satisfaction or, more importantly, dissatisfaction. Studies have shown that low job satisfaction is the most frequently cited reason why nurses leave their current jobs.
To assess what makes for a good work environment, we talked to four nurses about their job expectations. Th ose we interviewed were employed in large and small practices across North America. One of the more important areas to these nurses was the trust and respect of their physician employers.
In Nurses We Trust
“Having the physician trust my reporting and suggestions for care is important to me,” says Andrea Mossoney, RN, a staff nurse at Community Physician Network Diabetes and Endocrinology Care in Indianapolis, Indiana. “Th ere should be a link with the doctor so they listen to you as far as what is going on with the patient. That really does have a substantial impact on job satisfaction.”
Trust, in turn, leads to another important piece of the retention puzzle: autonomy. As healthcare changes, and even outpatient settings are seeing more acute patients, this may become harder to accomplish for both the physician and the nurse.
“Healthcare in general has changed from more autonomy to less,” notes Cathy Metzinger, RN, CDE, a diabetes/endocrine educator in a pediatric endocrine practice and immediate past-president of the Pediatric Endocrine Nursing Society (PENS). “As a nurse I can say that the doctors understand the pressures that are being put upon us as more and sicker patients come in through the door.”
Underlying this is the need for good communications between both parties. The interactions should be such that RN and MD alike are able to freely talk about concerns and be heard by the other. While there is no requirement that the doctor agrees with everything the nurse suggests, there should be an effort to explain why input wasn’t followed.
“Communication has to go both ways,” says Michelle Gurel, RN, BSN, a nurse at Massachusetts General Hospital’s Neuroendocrine Clinical Center in Boston. “Th e concept of good communication has to have a component of support from the higher echelons of the practice. In the very few times where I felt the communication was less than perfect, I have been able to get support from my administrator and director.”
However, it shouldn’t be just confined to talking about professional topics. Showing an interest in the person in addition to the nurse was also integral to a good work environment.
“The interpersonal interactions are an additional sign of respect,” says Nicole Kirouac, RN, BN, a pediatric endocrine nurse clinician at Winnipeg Children’s Hospital in Winnipeg, Manitoba. “Sometimes it can be as simple as saying, ‘Hi, how are you?’ The two-minute conversation that shows they care and that I am not just another person at another desk.”
For many, learning opportunities is another consideration in making a good work environment. In many ways this ability for personal and professional growth feeds back to the communication and trust aspects.
“It should be recognized that we are all continuing to learn and need the opportunity and ability to improve our knowledge base,” notes Kirouac, who is also the current president of PENS. “This doesn’t always have to be trips to conferences; it can be something as simple as making sure I see an important journal article.”
Encouragement to take on responsibilities outside of the practice can also be seen as a retention tool. For example, Kirouac’s employers allow her to be active in both the Canadian Pediatric Endocrine Nurses group and the Pediatric Endocrine Nursing Society.
Basically this boils down to having respect for nurses and their professional contributions to the practice. A nurse’s perception of respect has been shown to be predictive of satisfaction and his or her intent to leave the organization within the next 12 months.
“You want to feel that you are valued in your job,” Metzinger says. “Every colleague I have spoken to says that when they feel respected, they are much more likely to feel comfortable in their position. Being valued can go a long way toward balancing out the increasing pressures from more and more work to do.”
— Ullman, RN, MHA, is an Indiana-based freelance writer
with nearly 30 years of experience. He wrote about
mentoring in the September issue.