Nursing is one of the fastest-growing occupations—by 2022, it’s estimated there will be a need for 3.44 million nurses in the United States. Unfortunately, while the demand for nurses is increasing, the RN population is shrinking. Healthcare organizations must address the nursing shortage by examining the data and addressing issues that lead to job dissatisfaction for nurses. An important step in solving this issue is for organizations to discover how to engage nurses and then work diligently to create innovative solutions that will improve job satisfaction.
At a time when many experienced nurses are starting to retire, it’s imperative that organizations focus on not only retaining tenured nurses but also retaining recent RN graduates. One of the biggest struggles that new RNs experience is starting work on an active, busy floor immediately after they graduate. In many cases, these new nurses feel unprepared for the reality of what it’s like to work on the floor.
“Some skills, like starting IVs and foleys, were difficult when I first started working on the floor,” says Kaitlyn who graduated with her RN-BSN in 2013. “Fortunately, my coworkers were there to observe and assist until I felt comfortable on my own. Being a new grad was hard, but my facility really helped make it a smooth transition.”
To allow for a smoother transition between school and the hospital clinical experience, many practitioners see the value of creating an RN residency program. One hospital in Tennessee created such program in which recent graduates work in different units of the hospital together and receive experience on different floors. At the end of the program, the new graduates compete for spots in their desired units. This program helps create friendships and a support system for the new RNs, as well as promotes some healthy competition and camaraderie. The investment in the program was significant, but the hospital management believes it was well worth the outcomes they have seen so far.
Hospital leaders aren’t the only people who see the value of these programs. New nurses find RN residency programs extremely helpful as they make the transition from being in school to working on the floor.
“At first, I had a hard time, and the unit was very short staffed,” says recent RN graduate, Kaitlyn. “Thankfully the hospital had a new graduates program, so I had six weeks with a preceptor. My preceptor made herself available and I was able to ask her questions.”
By offering innovative programs, such as RN residencies, opportunities for career development, and an engaging work environment, healthcare organizations are able to increase job satisfaction among their entire nurse population. Kaitlyn explains how these types of benefits make a difference.
“I really appreciate when the hospital offers perks for employees, like awarding raises for certifications and covering the cost to help nurses get other certifications. My hospital also has a concierge service for employees. It helps make life a bit easier, with things like changing the oil in your car.“
When RN engagement levels improve, nursing managers and directors see increased retention rates, higher levels of service, and ultimately better patient care.
High Employment Demand for Nurses
According to the American Nurses Association, by 2022, there will be a need for 3.44 million nurses. That’s a 20.2 percent increase in RNs, with the need for an additional 1.13 million nurses by 2022. Within the U.S., there are ten states (Texas, California, Florida, New York, Pennsylvania, Ohio, North Carolina, Illinois, Michigan, and Massachusetts) which are projected to account for half of the nurse job growth. The increase in demand for nurses means it’s even more critical that medical institutions across the nation make a concerted effort to engage their existing nurse population and retain recent RN graduates.
Increasing Healthcare Needs Promote Job Growth
By 2030, according to the U.S. Census Bureau, more than 20 percent of U.S. residents are projected to be age 65 and over, compared to just 9.8 percent of the population in 1970. The increasing healthcare needs of this aging “Baby Boomer” population are contributing to the growth rate for nursing jobs. Skilled nurses are needed to provide preventative healthcare services and to treat chronic conditions, such as diabetes and obesity, that are on the rise in the Baby Boomer population, as well as in younger generations.
Nurse Hiring Trends Indicate High Vacancy Rate
While management in every industry wants to avoid turnover, job vacancy issues in the healthcare industry are more than an inconvenience—they can be a life and death matter. The nursing shortage has been increasing over the last decade and in the last few years. In 2014, the RN turnover rate was 17.2 percent, with a job vacancy rate of 6.7 percent. Depending on the specialty it took recruiters between 53 to 110 days to fill empty RN positions—an average increase of more than 14 days when compared to 2014. These high nurse turnover and vacancy rates affect access to healthcare and impact the level of care patients receive. Several studies suggest a correlation between appropriate levels of RN staffing and safe patient care, including fewer deaths, lower rates of infection, and shorter hospital stays.
Nursing Shortage Impacting Quality Of Patient Care
The nursing shortage becomes an even more serious issue when considering how it impacts patient care. Evidence suggests that some in-hospital or discharge deaths could be prevented with improved nurse-to-patient ratios. In a study of 232,342 surgical discharges from several hospitals in Pennsylvania, 4,535 patients (2 percent) died within 30 days of hospitalization. Based on a group of that size, investigators estimate that the difference between patient–nurse ratios (4:1 to 8:1) may account for 1,000 deaths. Researchers believe that increased care—which comes with better nurse-to-patient ratios—is a critical factor in decreasing these illness or mortality rates.
Nurses Retiring With Long Tenure
The majority of today’s nurses are rapidly approaching retirement. In the last 15 years, the percentage of nurses over the age of 50 years old has steadily increased from 33 percent of nurses in the year 2000 to 44.7 percent of nurses in 2008, and more than 55 percent of working nurses over the age of 50 in 2013. By 2022, it’s estimated that 551,000 nurses will retire. The rate of RN retirement combined with other factors, such as difficulty retaining recent nurse graduates and a reduced capacity in nurse training programs, makes it increasingly difficult to meet the demand for RNs.
New Nurses Leaving
Research indicates that nurses frequently change jobs—13 percent of newly licensed RNs changed jobs after one year, and 37 percent reported that they felt ready to change jobs in the first year. Nurse graduates report feeling pressure not to ask questions, and describe situations in which nurses with more experience often aren’t willing to mentor or offer help. Training and orientation are the second biggest issues cited by nurses as to why they left a position within the first three months. These factors, along with undesirable shift hours, high levels of job-related stress and insufficient staffing, all lead to lower job satisfaction causing many new nurses to change jobs.
Increased Demand for Nurses With Bachelor’s Degrees
Adding to the shortage of nurses is the recommendation and requirement for more nurses with baccalaureate degrees. Research has shown that positive patient outcomes, including lower mortality rates and fewer errors with medications, are linked to nurses prepared at the baccalaureate and graduate degree levels. In 2000, only 40.8 percent of nurses held a bachelor’s degree. Ten years later, in 2010, that number had increased by just 9.2 percent with only 50 percent of RNs holding bachelor’s degrees. Seeing a need for more nurses with a higher level of skill and training, in 2010 the Institute of Medicine made the recommendation to increase the number of nurses with bachelor’s degrees to 80 percent—an increase of 30 percent—by 2020.
Nursing School Capacity Issues
In 2012, nearly 80,000 qualified applicants were turned away from nursing baccalaureate and graduate programs. Obtaining baccalaureate or graduate level degrees is becoming more and more difficult due to the limited number of faculty available to provide instruction. In 2010, only 10.6 percent of nurses held graduate level degrees. With a reduction in the full-time nursing faculty available to teach in nursing programs, and an aging faculty population—72 percent of nursing faculty were age 50 and over in 2013—there aren’t enough programs for nurses to receive their preferred education.
Costs Of Nursing Turnover
The longer a nursing position is vacant, the more costly it becomes in terms of overtime, and staff burnout. The average cost of turnover for a bedside RN is between $36,900-57,300. The average financial loss from RN turnover per hospital is $4.9-7.6M. Many nurses indicate that they become frustrated, disengaged, and even consider leaving the organization if they don’t receive professional development or opportunities for promotion. Healthcare organizations can reduce turnover costs by investing in programs to entice nurses to stay. It’s ultimately more cost-effective to improve engagement and job satisfaction by offering development opportunities and promoting talent from within than it is to pay the price of losing skilled, trained nurses.
Nurses Concerned With On-the-Job Injuries
Government figures show that from 2011-2013, nursing ranked fifth of all occupations in the number of work-related musculoskeletal injuries. Results from surveys conducted by the American Nurses Association indicate that 42 percent of nurses feel that lifting or repositioning patients put their own safety at a “significant level of risk”. When asked about the top two health and safety concerns, nurses indicate that the acute or chronic effects of stress and overwork (77 percent), and risk of disabling musculoskeletal injury (62 percent) are among their top three safety concerns. These fears are justified when considering that estimates indicate that in total, RNs in the U.S. miss more than 11,000 days of work each year due to injury. These on-the-job risks take a toll not only on job satisfaction but also negatively impact staffing levels and labor budgets due to sick leave and absenteeism.