As Simple as 1-2-3: Recruit, Respect, Retain
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Evidence-based Practice Abstract Purpose: Poor nurse retention incurs an enormous and often unrecognized cost to an organization which can be measured in more than dollars. Barriers to staff retention include personal life changes, colleague callouts, and unpredictability of staff on leave, toxic behaviors, and the overall challenging environment of urban Emergency Departments. The purpose of this quality assurance project was to recruit the talent, respect them once they arrived, and retain the best and the brightest. Design: Quality assurance project. Setting: The project was conducted in a Level I Trauma Center which is supported by a 59 bed Adult Emergency Department that is the busiest in the state and serves as the safety net healthcare provider for the service area. A total 250 professional and ancillary staff coordinates care for nearly 80,000 patients per year. Participants: Adult Emergency Department Leadership team, Human Resources, Emergency Department staff nurses. Methods: Alarmed at the high turnover of RNs (21.5%) the new leadership team determined to identify the causes, put strategies into place to ameliorate them, and create a culture that prevented a resurgence of RN turnover in the future. ED leadership conducted focus groups with shared governance representatives; potential drivers of RN turnover were identified and action plans put into place. Four key leadership principles were adopted and action plans attached to each. These four leadership principles included: 1) “The all hands on deck” approach to daily staffing in which a member of leadership is assigned as an on-the-floor resource 24 hours a day/7 days a week. 2) “The all staff has a voice” approach in which shared governance meetings are scheduled near the shift change and leadership covered patient care. Shared governance initiatives impacted retention and include reduced on call requirements and relief from holiday staffing. 3) “The all staff is family” approach: Daily rounding by leadership promoted individualized support for staff both personally and professionally. Daily reports include “kudos” for outstanding care which is followed up with real time feedback from leadership. 4) “The care for self” approach: ED leadership encourages work-life balance via self-scheduling; a respite room has been located within the department for staff to use during their shift. Results/Outcomes: The results of leadership team’s laser focus on turnover have been phenomenal. RN turnover has steadily decreased each year; while the national benchmark for Emergency Departments in hospitals of similar size is 15%, our latest results indicate an RN turnover rate of 5.8%. Implications: Losing an experienced, highly skilled staff member can negatively affect a team’s efficacy, the ED cultural dynamics, and subsequently, patient safety and satisfaction with care. Using staff input to develop targeted leadership principles has proven to positively impact staff retention.