The Baby Boom and the Bottom Line: Project Highlights Strategies for Retaining Experienced Nurses

Look at any study of the nationwide nursing shortage and right alongside the discussion of an aging nurse workforce is a discussion of the aging patient population. Baby Boomers from all walks of life are beginning to need increased and more specialized health care just as Boomers in the nursing profession (nearly half the current nurse workforce) are beginning to retire. The average age of a registered nurse (RN) in America is rising every year, and nurses generally retire younger than people in other professions because the work is physically grueling and burnout rates are high. With 55 being the age at which RN’s generally begin reducing their hours and heading towards retirement, the numbers add up to an imminent exodus of experienced nurses from the workforce – and lower quality of care and unwelcome medical outcomes for all health care consumers.

Keeping these veteran nurses in the workplace – and bringing back those who have already left – can go a long way towards mitigating the looming nursing shortage and improving quality of care. Experienced nurses also hold tremendously valuable knowledge and it is critical to find strategies that help them transfer this knowledge to younger nurses entering the profession.

The Robert Wood Johnson Foundation (RWJF) has taken up this issue as part of its ongoing work on nursing and health care. In 2006, the Foundation commissioned a white paper called Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace, and followed it up with grants for, and rigorous evaluation of, individual hospitals and other organizations’ programs designed to retain this vital workforce.

The original white paper identified three general types of value that experienced nurses bring to health care. Experienced nurses:

1. Improve health outcomes for patients.
2. Are sources of institutional and organizational knowledge.
3. Are extremely expensive to replace.

As it turns out, the first two values are difficult to demonstrate. RWJF researchers also discovered that health care organizations have yet to seriously consider measuring the value of experienced employees the way other industries have. Of course, common sense tells us that more experience makes one better at his or her job as well as a good resource for newcomers in the workplace, and Wisdom at Work provides pages of qualitative data that support these arguments. That third value, however, regarding the cost of replacement, is well documented with quantitative evidence and makes a powerful case for retaining older nurses all by itself.

In most industries, the cost of employee turnover, including hiring costs, training costs and productivity losses, is conservatively estimated at 25 percent of the employee’s salary; but for nurses, the cost is roughly two times the salary – even higher for more specialized nurses. In its own case studies, RWJF found it could run as high as $64,000 to lose and replace an experienced nurse. In one recent analysis, the combined annual cost of nurse turnover in U.S. hospitals came to $12.3 billion dollars. Whatever extra salary and benefits these senior employees might accrue is still less than the cost of losing them.

According to RWJF’s follow up report, Evaluation of the Robert Wood Johnson Wisdom at Work: Retaining Experienced Nurses Research Initiative, several strategies for keeping a wiser workforce on board have been demonstrated to work both inside and outside the health care industry. RWJF’s researchers also discovered what does not work – at least in isolation – to keep experienced nurses on staff. For example, although older nurses frequently cite the challenge of physical work as a reason for retiring, this study concluded that ergonomic improvements, by themselves, do not necessarily result in higher retention rates. An illustration is the Virtual Intensive Care Unit (VICU) at Froedtert Memorial Lutheran Hospital in Milwaukee. Although it was designed to relieve older ICU nurses of some physical work while still taking full advantage of their wisdom, this program was not found to directly increase retention.

RWJF looked at 13 different retention projects that fell into three kinds of efforts:

1. Those testing evidence-based ergonomic workplace redesign approaches.
2. Those testing the impact of new clinical information technologies.
3. Those testing the impact of human resource-related strategies, including staffing models, leadership development and other initiatives designed to transform organizational culture.

While the Foundation concluded that there is no “silver bullet,” no single kind of initiative that is consistently successful in improving retention rates of older nurses, they were able to identify organizations that were successful in retaining older nurses as result of individualized programs based on their unique workplace and staff input.

For instance, one such program at Lynchburg General Hospital and Virginia Baptist Hospital, both in Lynchburg, Va. instituted a “closed staffing” policy that kept nurses on their home units rather than moving them to units where they had less expertise. The program was designed following focus groups with nurses who expressed discomfort with new assignments for which they felt inexperienced. As a result of the new policy, not only did retention improve, but they have also achieved, among other things, a heightened sense of teamwork and greater staff participation in problem solving.

In another case, at Pitt County Memorial Hospital in Greenville, N.C., veteran staff nurses expressed a desire for continuing education, and the hospital developed “Fanning the Flame,” a program that takes experienced nurses on three-day retreats focused on education and professional development. Pitt County Memorial is seeing not only reduced staff turnover (97 percent of “Fanning the Flame” participants remain with the hospital), but increased job satisfaction and collegiality.

Each case study describes the potential and realized monetary benefits of instituting these retention policies, which run as a high a $1.1 million saved annually in reduced staff turnover. For the same good reasons that experienced employees are paid more, they are also worth more – in ways that cannot always be measured.

All facts and figures are from Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace, 2006 and Evaluation of The Robert Wood Johnson Wisdom at Work: Retaining Experienced Nurses Research Initiative, 2009. Both are available here.