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Nurse Retention: Where Are We Now & Strategies for Moving Forward

If you work in healthcare now you probably cannot remember a time when nurse retention was not an issue. Nurse retention statistics identifying the problem can be found as early as the mid-1930s; reports re-emerged in the 1960s and persist today. So, where are we now and what are the strategies that might improve nurse retention statistics, drive nurse recruitment, and lead to long-term solutions?

By the Numbers

While historically nursing shortages have been driven by a variety of factors, the current shortage actually resembles earlier ones in that it is partially driven by an increase in demand. An aging population and their increasing healthcare needs has led to an increase in demand that has well exceeded the nursing workforce. In addition, the historically female profession has had retention issues now that women have a greater variety of career options. Nurse-led efforts to improve opportunities, pay, and working conditions have led to improvements in retention and work-life balance; yet, demand for nurses continues to exceed supply resulting in an increased focus on retention.

The Bureau of Labor Statistics Occupational Handbook provides some insight into the current situation and makes some estimates about what the future of the profession might look like. Their most recent report estimates that in 2018 there were approximately three million nursing jobs in the US. They also projected a growth rate of 12% in the expected number of jobs between 2018 and 2028. This projection means that nursing is growing at a much faster rate than the national average. The Bureau also predicts an additional 203,700 nurses will be needed each year through the year 2028 in order to fully staff newly-created nursing positions and those created by a very high number of retiring nurses. Some reports estimate that as many as 1 million nurses will retire by 2030 creating an even larger gap between supply and demand. To see the full report, click here: https://www.bls.gov/ooh/healthcare/registered-nurses.htm

We Need More Nurses Than Ever

If the Bureau’s prediction that an additional 203,700 nurses will be needed for each of the next 7 years is accurate, where will those nurses come from? Nursing school enrollment was slightly up in 2018 (3.7%), but according to a recent study conducted by the American Association of Colleges of Nursing, more than 75,000 qualified applicants were turned away from nursing programs. Nursing programs are also impacted by nurse retention issues and have cited insufficient faculty, a lack of clinical sites, classroom space and preceptors as contributing factors to their limitations.

Nationwide nursing turnover is at about 15.9%, however; there are some nursing specialties that exceed that number. Nurses in behavioral health, step-down units, emergency departments, critical care and med-surg units all exceed the national average making these

areas particularly vulnerable to shortages. It is encouraging to note that nurse practitioners and allied health professionals have turnover rates that are somewhat lower than that of hospital nurses.

Strategies to Close the Gap on Nurse Retention

So what nurse retention strategies might work to help improve retention and alleviate shortages? Universities and healthcare providers are getting creative in their attempts to manage these issues.

  • Stay connected to what matters to nurses to improve retention.
    • Culture matters – So, create a culture where nurses can provide the kind of care that they want to deliver. Nurses want to work in an environment that supports goals of safety and quality.
    • Self-governance matters -- It is an essential piece of obtaining Magnet status and a real model of self-governance can make a substantial contribution to the kind of culture that can make positive contributions to retention.
    • o Professional development matters -- Ensure that development programs help nurses take steps toward fulfilling their professional goals.
  • Creative, New Strategic Partnerships – The University of Minnesota and the Minnesota VA Healthcare System formed a partnership which will enable the university to expand enrollment in their BSN program while also expanding the number of clinical slots in the healthcare system. The program is a win for aspiring nurses, patients and the two healthcare organizations.
  • Remove Financial Barriers to Entry to Nursing School – the University of Wisconsin’s, Nurses for Wisconsin initiative provides fellowships and loan forgiveness for future nurse faculty provided that they agree to teach after graduation.
  • Be Proactive in Eliminating Nurse Burnout – The University of Iowa’s nurse residency program provides a structured learning environment where nurses learn strategies to help them cope with death and dying along with self-care strategies that are taught alongside their clinical skills.

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