Health Systems Can’t Afford to Neglect New Nurses
Vizient President and Chief Executive Officer
Before my time as Vizient's CEO, I started my career in the financial world. While my education prepared me for a traditional path in finance, I was promoted into a corporate strategy role after a few years. With few mentors around to show me the ropes, I realized what I learned in school was much different than what was expected of me in this new role. In fact, I noticed much of what was required for success in the 'real world' went beyond the classroom entirely.
As healthcare's workforce challenges persist, first-year nurses find themselves in a similar predicament when they graduate from nursing school. They have years of formal training but limited on-the-job experience. However, instead of making decisions about what direction to take a company, they're expected to immediately begin making life-or-death decisions. And many aren't receiving the support they need to be able to make those decisions confidently.
Workforce shortages create a vicious cycle of burnout and turnover
We know there's been a shortage of nurses for years, requiring nurses to attend to more patients and take on a larger workload — stressful conditions that cause burnout, which is a key driver of turnover and attrition. The COVID-19 pandemic further exacerbated these challenges, forcing patient to nurse ratios even higher and preventing nurses from taking time off or even taking a break during their shift.
As a result, nurses under age 35 are leaving the profession at four times the rate of nurses over age 50 and candidates are passing their board exam at lower rates. Considering some estimates show a gap of as many as 450,000 nurses by 2025, it's imperative for providers to retain the nurses they have while building a more robust pipeline for new nurses.
Reducing turnover costs can help providers in challenging financial environment
Vizient's latest Workforce Intelligence Report shows nursing overtime hours remain considerably higher than before the pandemic. We see this contributing to increased burnout and ultimately higher turnover. Our data shows the turnover rate for all licensed nursing staff has stabilized between 7-8%, which is 47% higher than it was before the pandemic. The turnover rate for bedside RNs is about 23% nationally, signaling an even larger impact to those providing direct patient care.
These elevated turnover rates are not sustainable, particularly as health systems' financial margins continue to struggle. Each percent change in turnover costs the average hospital $380,600 annually, which means providers have an opportunity to rein in costs by focusing on retaining early career nurses — who are the most likely to leave.
A comprehensive approach to supporting first-year nurses
When NYC Health + Hospitals realized many nurses were leaving in their first year of practice, they determined through exit interviews that it boiled down to two primary reasons: a lack of clinical support and a lack of emotional support. As a result, they partnered with Vizient to implement a large-scale nurse residency program (NRP) developed by Vizient and the American Association of Colleges of Nursing (AACN).
Initially, only about 30 of the 1,000 nurses hired each year participated in the health system's nurse residency program. Working with Vizient, NYC Health + Hospitals doubled down on their investment in first-year nurses by involving more nurse leaders and managers in the program. This improved structure and organization expanded the number of participating nurses by more than 600%.
As COVID-19 taxed health systems everywhere, NYC Health + Hospitals experienced dramatic improvements in turnover rates — directly attributable to its commitment to the NRP. They now retain 90% of newly hired nurses which drives continuity in patient care.
Helping new nurses build confidence while transitioning into clinical roles
Nurses who go through the NRP report increased confidence and better clinical decision-making skills, as well as enhanced professional development and team communication. Crucially, from 2021 to 2022, more than 87% of participating nurses stayed in their positions after one year, compared to only 67% nationally.
Implementing a program that takes nurses away from the bedside may seem counterproductive while facing the workforce challenges I noted above. However, by planning for these challenges ahead of time, providers can offer this vital resource to first-year nurses while maintaining appropriate staffing levels.
Support and training are vital to new graduates — no matter the occupation
Most of us would not be successful if we were thrown into the toughest part of our jobs on day one. I know I'm where I am today in large part because of the mentors and sponsors who helped me learn the skills I needed beyond the classroom to successfully navigate work in the 'real world.'
In the same way, resources like nurse residency programs provide the kind of guidance new nurses need not only to provide better patient care, but also to maintain their own wellbeing. Our healthcare system literally and figuratively cannot afford to ignore these challenges. And in an environment when the shifts are long and the environment is stressful, caring for our caregivers is an investment with returns far beyond the balance sheet.