Caring for the caregivers: How to keep RNs in the workforce

Simply put, no hospital can function without its nurses. As primary bedside caregivers, essential informaticists, and visionary leaders, nurses are the connective tissue that keeps the organization running.

But in too many places, that connective tissue is breaking down.  Just like physicians, nurses are experiencing burnout at an unprecedented rate, resulting in rapid turnover and widespread shortages that threaten the safety of patients and the financial sustainability of health systems.

A 2022 report from the Health Resources and Services Administration (HRSA) projects a shortage of 78,610 full-time registered nurses (RNs) in 2025 and a shortfall of 141,580 full-time licensed practical nurses (LPN) in 2035, although the authors note that these estimates are based on pre-COVID graduation and attrition rates, which have gotten dramatically worse in the post-pandemic environment.

Combatting these shortages will require the health system to take a much closer look at what’s going wrong – and make a much bigger investment in truly impactful strategies to hopefully reverse the trend before it’s too late.

Why nurses are fleeing the profession

Some of the factors contributing to the mass exodus of existing nurses from the workforce, and the lack of new people to replace them, are fairly well known at this point.

A recent publication from the Center for Health Workforce Studies at the University of Albany found, for example, that the tougher units, including the ED, med/surg floors, and ICUs, are more likely to experience high turnover due to the demanding nature of the job.  Night shifts remain unpopular, and rural settings with fewer advancement opportunities are having more trouble than urban ones in keeping enough staff on board.

But the report also calls out some generational differences that have the potential to become even bigger problems if left untreated.  RNs who received their training in the pandemic era were forced rely on simulations much more than previous cohorts, and with less hands-on patient care experience, they feel much less prepared for the realities they’re facing on the job.

They also have less help from older generations to support them.  With experienced nurses seeking employment elsewhere, there are fewer mentorship and preceptorship opportunities to act as a conduit for knowledge transfer.  This may contribute to the younger workforce feeling “less mission-driven” and “more concerned about work-life balance” – although whether those are good or bad things rather depends on the generational identity of the reader.

Regardless, the study did note that younger nurses are more likely than older ones to report burnout, and that about 15% of hospital patient care RNs between the ages of 20 and 39 reported plans to leave their current position within the next 12 months – just under the national average of 18.4%, according to a separate report from NSI Nursing Solutions, a nursing staffing agency.

NSI found similar patterns of newer nurses leaving their jobs in droves, with an average of 28% of nurses with less than 2 years tenure saying goodbye to their employers in 2023.

With the average hospital spending approximately $380,600 a year for each percentage point change in RN turnover and about 16% of RN positions remaining unfilled, what is a hospital C-suite to do?

Strategies for keeping RNs engaged in the workforce

 It’s clear by now that pizza parties and the occasional shoutout aren’t sufficient to sustainably boost morale in the workplace. Instead, leaders must fundamentally reengineer the way they provide support, opportunities, and compensation for the nursing profession.

They can start by getting to grips with the roots of burnout: persistent moral injury, lack of autonomy and opportunity, unending physical and mental stress, and a feeling of being undervalued, both at the bedside and at the bank.

Creating a scaffolding of support with improved mental health resources and mentorship relationships can go a long way toward preventing career-ending burnout, finds new research from NYU to be published in an upcoming edition of the Online Journal of Issues in Nursing.

The authors found that nurses who experienced symptoms of depression, which may be comingled with symptoms of job-related burnout, were much more likely to consider a different career path, including half of those with mild symptoms and 73% of those reporting moderate or severe depression.

With 60% of nurses in the survey reporting some level of depression, organizational leaders cannot afford to ignore the role of mental health in workforce retention.

Providing holistic, tangible support for nurses in the form of making mental health resources available, listening to (and taking action on) job-related concerns, and providing opportunities for peer-to-peer relationships could change the game for nurses feeling under pressure.

The NYU authors found that strongest factor for predicting whether nurses intended to stay in their jobs was having support systems at work. Nurses who felt supported by their colleagues were almost twice as likely to want to stay, while nurses who felt a strong sense of organizational support were 2.4 times more likely to say they planned to keep their positions.

There are a number of strategies at the disposal of health systems who wish to take a stronger approach to nursing workforce retention.

For example, the Center for Health Workforce Studies notes that many New York hospitals are embracing enhanced educational opportunities for new and aspiring nurses, including summer externships for students, and nursing residency programs for recent graduates to give them more of the hands-on mentorship experience they might have missed during training.

Hospitals are also leaning into the aforementioned mental health and self-care resources, from wellness teams with trained behavioral health professionals to tranquility rooms to give nurses a break from the constant sensory overstimulation of the hospital environment.

However, while “self-care” has become a very popular buzzword in HR departments, the American Nurses Association (ANA) points out that while wellness perks like massage gift cards and soothing eye masks might be nice-to-haves, they can only supplement – not replace – serious investments in mental healthcare and workplace improvements.

The ANA’s suggestions for these larger changes include the elimination of mandatory overtime, which is associated with decreased quality of patient care, competitive salaries that are more in line with the wages offered to traveling nurses, and more opportunities for professional autonomy and advancement.

A concerted effort to reduce workplace violence against nurses is also a top agenda item and a key component of developing a culture that values nurses, listens to their concerns, and takes proactive steps to solve the unique problems faced by this segment of the workforce.

Overall, improving nurse retention depends on actively assisting nurses with growing their professional confidence while avoiding burnout.

While it often takes a long time to shift an organizational culture, implementing targeted strategies – developed and deployed with the direct input of nursing staff members themselves, of course – can start to close the gaps in the nursing field and ensure that current and future members of the workforce feel supported, empowered, and fully able to provide high-quality patient care.

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.