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5 Surefire Ways to Not Retain Nurses


5 Surefire Ways to Not Retain Nurses

If  for some crazy reason an organization wanted to increase its turnover- here’s 5 of the fastest ways known to lose nurses

5 Surefire Ways to Not Retain Nurses:

1. Ignore the Bleed

Spend money and resources on recruiting but ignore the bleed- nurses streaming out the back door.

The cost of turnover is astronomical. Money is desperately spent on the front end (hiring bonuses, orientation, moving costs) but not so much on the back end (retention).

“I  stayed for about 7 years on a med-surg floor. A great manager and awesome staff helped retain me. My director and I didn’t see eye to eye and lots of awesome staff left as well as increased ratios and increased patient acuity happened towards the end so I left when those things happened”

5 Surefire Ways to Not Retain NursesWithin a unit, leaving  is contagious. When a good team breaks down, members leave.

While the quantifiable costs of turnover are huge, the non-quantifiable costs are even greater. With high turnover, the group is constantly in flux and re-gelling. This results in lack of teamwork, low morale, and a high ratio of non-experienced nurses to experienced nurses. There is a loss of group knowledge and patient care suffers with high potential for rookie mistakes. 

5 Surefire Ways to Not Retain Nurses: 

2. Tell Nurses What They Need

Rather than asking nurses, decide what they need in terms of job satisfaction. It’s assumed all nurses want is a higher salary. Because nurses themselves are not asked. When nurses are asked, their responses are thoughtful and on point. And none of the answers involve pizza, doughnuts, or hiring bonuses.

On a recent thread in Show Me Your Stethoscope (SYS) on Facebook, a member posted: Hello fellow nurses. ……….I have a question. What is the key to the retention of bedside nurses? What are you looking for to keep you in a medical-surgical floor for a few years?

Hundreds of nurses responded. Here’s one response that resonates, reprinted with permission:

“Achievable tasks, reasonable nurse to patient ratios, being treated like a professional and being left alone to do our work effectively. Not being burdened with redundant and senseless documentation/tasks that provide no patient benefit. Being valued as an asset and not being treated as a consumable/expendable product. Not being lied to. Honesty, integrity, and supporting the staff as well as backing their decisions. Recognition of the cultural issue that most people ignore or think violence toward health care workers is O.K.”    Via JM 

Over and over readers  said: “A manager that has your back” Nurses need to know that their manager is advocating upwards for nurses and for patients. No nurse wants a manager who is a “Yes-man” and is unwilling to speak up.

And salary? Of course salary is important.  But salary is not the strongest job satisfier, although it is a dissatisfier when it’s lower than the competition.

[Tweet “Nurses need great leadership, adequate staffing, and appreciation”] 

5 Surefire Ways to Not Retain Nurses:

3. Think Short Term

For immediate short-term gain and to improve monthly budgets, lay off CNAs and PCTs.

Cutting CNAs, PCTs, and unit secretaries will save a small amount of money each month. It will also drive nurses away. CNAs have gone from having 6-8, to 8-11, and up to 15 patients in some areas. We all know this affects patient satisfaction scores.

This is stepping over a dollar to pick up a dime. Nurses lose faith in the decision-makers when they see short-term savings that are costly  in the long run.

5 Ways to Not Retain Nurses:

4. Blame Nurses

Often untenable work situations are framed as poor time management skills on the nurses’s part.

“I want to take a break without feeling guilty and I want to clock “no lunch” if I did not take lunch without fear of reprisal”  (anonymous)

Nurses are told to clock “no lunch’ if they are unable to take a lunch free of duties, but nurses are blamed if they don’t take lunch.

Never mind breaks. Nurses are hard pressed to keep themselves hydrated as they cannot drink water in the nurses station. New nurses especially are unable to manage their time for well up to a year (read Nursing’s Dirty Little Secret) and fail to take breaks altogether.

5 Surefire Ways to Not Retain Nurses:

5. Maintain Unsafe Nurse Patient Ratios

Perhaps more than any other single concern, nurses want to practice nursing safely. Only one state, California, mandates nurse patient ratios.

Recently a nurse on SYS dismayingly shared that in her ICU, a small  unit in an unnamed hospital, administration was planning to change the nurse patient ratios from 1:2 to 1:3. This in a less than 10 bed unit where there are no CNAs and no unit secretaries. The decision was arbitrary, nurses were not at the table, and the only recourse nurses had was to walk.

Creative Incentives

The problem is, only nurses will read this. We all know these things, and we’re all singing to the choir talking to each other. But why do decision makers not consult us?

I do not mean to criticize CFOs and CEOs and COOs as I do not have enough business knowledge and training and experience to do their job. Likewise….only nurses truly understand nursing practice.

Maybe there are sound business reasons for failing to focus on nurse retention. If so, I would appreciate hearing the rationale.

Meanwhile, there are countless ways to incentivize and retain nurses:

  • Provide more educational support for nurses returning to school. Subsidize their education- BSN, MSN, certifications
  • Show genuine appreciation for nursing staff.  Speaking for myself-I stay where I’m valued.

[Tweet “A person who is appreciated will always do more than expected”]

  • Provide more on the job training and skills fairs to give nurses the tools to do their jobs. The return is confident, competent nurses who provide safe care.
  • Lease a car for nurses who have stayed (5,7, 10?) yrs or more or
  • Hire a housekeeper to come to clean 2x a month for nurses who have stayed (5, 7, 10?) yrs. Increase to 1X week after 10 yrs. 
  • Provide on site day care 
  • Make sure nursing opinions matter

 Note that leasing a car or contracting with a housecleaning company is still far cheaper than recruiting and retaining a nurse. The nurse pays no income taxes on the commodities, and the hospital has a stable workforce. Who would leave a job with a car lease?  By contrast, Davita in certain locations is offering a 3K sign on bonus plus 25K after 3 years retention bonus. So…..

What is your experience, and how does your organization work to retain nurses?

Best wishes,

Nurse Beth

The Real Story Behind Nursing Ratios

Reasons for Refusing a Patient Assignment

Nurse-Patient Ratios: A Biased View

Author “Your Last Nursing Class: How to Land Your First Nursing Job..and your next!” 

Come visit me at Ask Nurse Beth  career column at for all kinds of  entertaining and informative career questions and answers, and to submit your own question :) 




About Beth Hawkes (146 Articles)
Nice to meet you! I'm a Nursing Professional Development Specialist in acute care, a writer, speaker and career columnist.

2 Comments on 5 Surefire Ways to Not Retain Nurses

  1. One great way of having nurses stampede out the door is a young, inexperienced administrator requiring nurses to have “clinical privileges” to perform procedures they have years of experience with. I had been drawing radial ABGs for years with no complications when a young supervisor decided to impose clinical privilege directives. It sounded like institutional licensure and I fled (along with many others) to greener pastures.

  2. Or being a hospital and getting the reputation that you are “known ” for turning nurses into the board of nursing , and have the bon members on your staff to make sure they tangle with you , all for speaking up . Yes folks this happens YUMA REGIONAL MEDICAL CENTER liars thieves , putting in fake complaint just to upset you and get you black balled and worse . DO NOT WORK HERE all of the other 5 things are here too, shameful mgt !!!

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