Five best practices that have the greatest impact on minimizing nurse first-year turnover—and can be applied to all industries.
Organizations looking to drive improvement in their first-year employee retention must start by understanding the current drivers of turnover. PwC Saratoga interviewed hospital systems that reported low nurse first-year turnover rates in a comparison of more than 40 systems that participate in PwC Saratoga’s Human Capital Effectiveness Benchmarking Report. Nurse first-year turnover is defined as the percentage of nurses who voluntarily or involuntarily left the organization during their first year of service. The interviews focused on systems that reported turnover in the lowest quartile in an effort to identify practices that have proved effective in retaining this critical population. While nurse first-year turnover of all systems ranged from 14 percent to 60 percent, the median first year turnover rate for nurses of the best practice systems was 17.1 percent, and the average headcount was 15,700 employees.
While the hospital systems described a variety of programs and practices during the interviews, five practices were repeatedly mentioned as having the greatest impact on minimizing nurse first-year turnover—and many of these practices apply to all industries, not just nursing.
1. Competency-based interview processes/selection testing that includes an emphasis on cultural fit. Best practice hospital systems reported using competency-based interviews/selection testing based on a standard set of questions to identify whether candidates have the desired qualities and skills. One system, which uses assessments that vary by job classification, has developed a "grading" system in which it can hire "B" or "C" level candidates for certain roles but is required to hire only "A" candidates for others. These systems have found a correlation between those who meet the requirements of the upfront selection process and lower turnover.
In addition, systems increasingly are concerned with whether candidates fit into the organization along cultural and ethical lines. Common methods of assessing fit include using behavioral questions and involving other nurses in the interview process, often in a team interview setting. The interview process at one system also includes job shadowing as a method for the candidate to gain firsthand perspective into the work environment and culture. This also helps the hiring team assess whether the candidate is an appropriate fit.
2. Relationships with nursing schools and a robust nurse resident program. All hospital systems with nurse resident programs consider their programs highly effective. The nurses hired from these programs are generally strong performers because the systems are able to assess their clinical performance prior to hiring them permanently. These nurses are also less likely to leave the organization given that they are very familiar with the culture. One hospital system fills the majority of its nursing positions from its nurse resident program, which pays for participants’ tuition. The program begins after the first quarter of school and offers flexible hours. Program participants attend orientation with other employees and are partnered with preceptors.
Another system offers outreach to nursing graduates in the form of networking and career workshops (even during periods when hiring freezes went into effect because of the economy). These events provide a forum for nurse graduates to network and stay connected to the industry and the region as they search for employment opportunities. In addition, the system is able to stay ahead of its competitors by strengthening its pipeline of potential candidates and developing its employer brand.
3. Extensive orientation followed by touch points that provide opportunity for employee feedback. New nurses are encouraged to maintain contact with and provide feedback to human resources staff through orientation programs that last up to a full year. Orientation may be customized by department/unit, and touch points typically occur after 30/45 and 90 days, six months, and a year.
One hospital system offers a week of central orientation followed by additional orientation with the same group of employees at 45 days and 90 days. At 45 days, nurses are asked to complete a questionnaire on their level of satisfaction and to identify concerns (i.e., regarding their supervisor or interest in transferring to a different unit). Another system conducts “re-interviews” at three and 10 months to ensure that individuals are satisfied with their current positions and that they see a fit with the culture/environment of their units.
Some touch points take the form of events where recent hires can reconnect and “celebrate” their time with the organization. One system hosts reunions for recent hires at four months and a year and also offers off-site retreats by nursing unit. Another system provides the opportunity for recent hires to have lunch with the site president after one month and one year.
4. New hire support programs. Beyond orientation and preceptor relationships, hospital systems are ensuring that new nurses have access to individuals who can provide confidential support and guidance. In many systems, this is in the form of a “buddy” who is not a supervisor.
In an effort to decrease turnover, one system offers a nurse retention contact to all nurses. The nurse retention contact, who is a member of the HR department, offers a “safe haven” where employees can air concerns and provides guidance, sometimes in the form of role-playing, to help employees tackle issues they face.
5. Measurements to drive accountability. Hospital systems indicated they use metrics to drive retention and programs that support retention. One system tracks data on turnover, employee engagement, and patient satisfaction on a unit level and will initiate interventions for units that do not meet their turnover metrics. Another system measures key performance indicators (KPIs) addressing retention and operations (i.e., patient satisfaction). Senior management selects these KPIs each year, and the ability of employees to achieve the goals is tied to a bonus-sharing program.
PwC Saratoga is a leader in workforce research. Its metric-based services include access to PwC Saratoga’s U.S. and global benchmark databases and assistance in developing HR dashboards. Employee survey services include employee engagement, exit, onboarding, and HR department assessment surveys. For more information, visit www.pwc.com/saratoga.