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Introduction

The healthcare industry is grappling with a pervasive issue that undermines its ability to deliver consistent, quality care: high staff turnover. As of October 2023, U.S. healthcare employment across the continuum remained 481,900 jobs below projected levels based on pre-pandemic trends (ECRI). Hospitals face a relentless cycle of recruiting, training, and then losing physicians, registered nurses (RNs), and certified nursing assistants (CNAs) to burnout, better opportunities, or sheer exhaustion. This turnover not only strains existing staff, who are often left understaffed and overworked but also complicates the already daunting task of recruiting new talent in a fiercely competitive market.

A country-wide shortage of healthcare professionals and an increased need for medical services following the pandemic has led to hospitals focusing on keeping front-line medical staff but have trouble doing so. In the past 5 years, the average hospital turned over 105% of its workforce.¹ This lack of personnel poses a risk to patient care and contributes to quicker burnout rates among clinical workers.

Let’s look at the core issues behind these high turnover rates and potential strategies for improvement.

The Core Issues

Underpayment

Despite their critical role in healthcare, many nurses and CNAs do not receive compensation that reflects their value and the complexity of their work. This issue is exacerbated in regions with a high cost of living, where the disparity between earnings and living expenses is stark.

Understaffing

Understaffing is a pervasive problem, creating a vicious cycle where the workload on existing staff increases, leading to burnout and even higher turnover rates. This situation is not only detrimental to the staff’s well-being but also impacts the quality of patient care and the potential for increased medical errors. Refer to Fig. 1.1.

Overwork

The combination of being understaffed and the increasing demands on healthcare services means that nurses and CNAs often face long hours, mandatory overtime, and high-stress environments, all of which contribute to job dissatisfaction. This extended exposure to stress has had both a physical and emotional toll on providers wellbeing.

During 2022, nearly half of US healthcare workers reported feeling burnout with 57% experiencing anxiety symptoms and 34% experiencing depression symptoms. (ECRI)

Lack of Appreciation

A lack of recognition and appreciation from both management and society can leave healthcare workers feeling undervalued, further diminishing job satisfaction and loyalty.

Workplace Violence

A 2023 survey found that 40% of US healthcare workers experienced an incident of workplace violence in the last two years (ECRI). This exposure to physical harm and harassment has created a stressful and unsettling work environment.

Training Challenges

Recent graduates are experiencing difficulties transitioning from education to practice due to lack of clinical preceptors, guidance, and mentorship from senior staff. This has to lead to newer nurses experiencing loss of confidence and burnout.

Competition for Talent

The demand for skilled nurses and CNAs exceeds supply, leading to fierce competition among hospitals and healthcare facilities. This competitive landscape makes it even more challenging to recruit and retain talent.

Fig 1.1 – Hospital Turnover Rate 2023 NSI National Health Care Retention & RN Staffing Report

Strategies for Improvement

To help combat the turnover and recruiting challenges they’re facing, the 2023 Benefits Survey of Hospitals² found that hospitals relied on offering premium benefits to reward and hopefully keep employees:

• 95% of hospitals offered tuition reimbursement programs.
• Flexible work options were provided by 93% percent.
• Personal leave and financial wellness/planning benefits were offered by 80%.
• 45% paid parental leave beyond state and city mandates.
• 44% offered student loan repayment plans.
• Adoption subsidies were provided by 43% percent and back-up childcare was offered by 34%.

Beyond these measures, hospitals must adopt comprehensive strategies focused on improving working conditions, enhancing compensation, and fostering a supportive and appreciative workplace culture.

Competitive Compensation Packages

Hospitals should ensure their compensation packages are competitive, reflecting the skills, qualifications, and contributions of their nursing staff. This includes not just base salary but also benefits like health insurance, retirement plans, and opportunities for bonuses and overtime pay.

Staffing Ratios

Implementing optimal nurse-to-patient ratios can help reduce the workload on individual nurses, improve the quality of patient care, and decrease burnout and turnover. Legislative action may be required in some regions to make this a standard practice.

Flexible Scheduling

Offering flexible scheduling options can help staff manage their work-life balance better, reducing burnout and making the profession more appealing to potential recruits.

Career Development and Education

Providing opportunities for mentorship and professional development/ continuous education can help retain staff by showing an investment in their careers. This might include tuition reimbursement for advanced degrees or certifications and clear paths for career advancement.

Mental Health Support

According to survey data³, the need for mental health is atop the list of what needs to be done in response to the increasing costs, labor shortages, and shifting workforce expectations. Offering robust mental health support, including counseling services and stress management programs, acknowledges the emotional and psychological challenges of healthcare work and provides much-needed support.

Culture of Safety

Develop a culture in which staff feel comfortable raising their hand and reporting safety events or unsafe working conditions. This will not only assist with early mitigation or issues, but allow staff to feel heard and acknowledged.

Data-Driven Recruitment and Retention Strategies

Hospitals should use data to understand the causes of turnover within their facilities, and tailor their recruitment and retention strategies accordingly. This might involve surveys to gather feedback from current and departing staff, analyzing exit interviews⁴ for common themes, and tracking the effectiveness of implemented changes over time.

Conclusion

The challenges of staff turnover in hospitals are complex and multifaceted, rooted in systemic issues of underpayment, understaffing, workplace violence, overwork, and a lack of appreciation. Addressing these issues requires a comprehensive approach that not only improves the immediate working conditions and compensation for nurses and CNAs but also fosters a culture of support, recognition, and advancement opportunities.

By implementing these strategies, hospitals can create a more stable, satisfied workforce, which is essential for delivering high-quality patient care in an increasingly demanding healthcare environment.