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How to reduce nurse turnover in first-year nurses

This is the third blog in a six-part series on the state of the healthcare workforce.  

Blog #1: 4 immediate interventions every leader should consider; Blog #2: Tackling workplace violence and compassion fatigue in healthcare; Blog #4: 3 steps to avert physician and nurse suicide

Today’s COVID reality has massively accelerated the national caregiver crisis. And nowhere is this crisis more evident—or dire—than among the nursing workforce.

Before the pandemic, burnout was driving significant levels of nurse turnover, with many not just seeking greener pastures at other hospitals or healthcare organizations, but leaving the medical field entirely. Today, nurse turnover has reached worrying levels. According to the 2021 NSI National Health Care Retention & RN Staffing Report, RN turnover stands at 18.7% nationally, with a third of hospitals reporting an RN vacancy rate over 10%.

First-year nurse turnover continues to outpace all other tenure categories: RNs with less than one year of service make up as much as 83.3% of a hospital’s total turnover (and nurses leaving their organizations within the first year accounts for nearly a quarter of all RN separations nationally). If you expand this view to include RNs with less than two years of service, that number jumps to 91.6%.  

Recent nurse engagement data analyzed by Press Ganey points to a low sense of belonging as a primary driver of first-year turnover for all RNs. Considering this insight, it’s important to note that the identity formation and socialization that occurs in new employee onboarding happens in a very high-stress environment. Studies have shown that a welcoming and friendly experience during the first days on a new unit or team sets the tone for the rest of the year. Increased anxiety and thoughts of abandoning the nursing profession altogether have been associated with a lack of acceptance by peers in the clinical setting. Employees who feel like they belong demonstrate higher performance overall, adapt more willingly, and are generally more resilient than others.

Now that we understand how belonging factors into how to reduce nurse turnover in the first year, leaders can proactively intervene to ensure each member of their team feels like they belong.

5 proven strategies for how to reduce nurse turnover

1. Create a shared vision for your unit or your team. Having a vision that the team can rally around helps new members understand the direction in which the unit is moving and provides a connection point to its values. Once that vision is established, make it visible across all employees. Embed your mission within day-to-day operations and continually reinforce it—from the initial job posting to onboarding and throughout the employment lifecycle—so each RN embodies your values and is grounded in a clear purpose from day one. 

2. Know where you stand as a team or organization in terms of creating belonging. When employees report a sense of belonging, it means they feel that they, as individuals, and the work they do matter. They feel engaged with the organization, its mission, vision, and values, and they feel connected to and accepted by their peers and managers. But this can be hard to measure and track. Ensuring your organization participates in some type of culture survey and ongoing listening is critically important to understanding your team’s needs in real time and as they change. Regularly surveying your workforce helps you keep your finger on the pulse of employees’ engagement levels and their sense of belonging. In fact, a strong predictor of turnover risk is participation in engagement or employee experience surveys: Work units with low survey participation are at greater risk of turnover. Then, it’s equally important that the leadership team communicates just how RN survey responses are used to effect positive change—so they know their feedback is used and their voices are truly heard. 

3. Focus on diversity, equity, and inclusion (DEI). Creating a sense of belonging goes hand in hand with inclusion. Are you, as a leader, creating an environment where people can bring their whole selves to work, honoring their differences alongside their similarities to develop a high-performing team? Do you actively try to make people feel they belong? Do you hire nurses with diverse backgrounds, encourage open dialogue, and create a sense of psychological safety, where each employee feels empowered to speak up when they observe biases, microaggressions, incivility, or unfairness? To aid you on your journey toward a more inclusive workplace, we created the Press Ganey Equity Partnership, making new survey questions, data analytics, and resources available to advance DEI efforts industry-wide. Learn more about our Equity Partnership—and join us—here.

4. Talk openly about belonging, and make the discussion part of your team’s daily communication plan. We frequently acknowledge the most common drivers of turnover, like work schedules, personal reasons, internal conflict, and other new professional opportunities, but rarely do we talk about employees’ sense of belonging—or lack thereof. But the data shows that when you consider the following elements collectively, employee engagement and nurses’ overall sense of belonging improve. 

  • Leadership supports the nursing staff both professionally and personally. 
  • RNs know how their survey feedback is used to drive positive change.  
  • Tools and resources are made available so nurses can provide the best-possible patient care. 
  • Nurses feel respected and recognized for their work. 
  • Nurses are satisfied with their on-the-job stress levels, staffing at the organization, and work–life balance.

5. Ensure you have a solid onboarding and orientation program to support new nurses and role transitions within your organization. Filling just one open RN position takes 89 days, according to the RN recruitment difficult index—which means you need to hang on to each recruit! Mentorship, new-graduate transition programs, and individualized orientation programs all help improve an employee’s sense of belonging from day one. A strong nursing shared governance or shared decision-making model is also key to making employees feel like they have a voice—and that their voice matters to leadership. Encouraging input from all RN caregivers is integral to cultivating a sense of belonging. Flattening hierarchies facilitates organization-wide transparency and opens the lines of communication, from bedside to boardroom. Including executives and leaders in daily huddles and rounding helps them see what’s happening on the ground. And bringing front-line nurses into leadership meetings ensures they’re directly involved in the decision-making conversations that impact their day-to-day work. 

Creating a sense of belonging is a key strategy for nurse leaders to reduce RN turnover during their critical first year at your organization—and in the years that follow. Learn more about how to reduce nurse turnover by reaching out to a Press Ganey nursing expert here.


About the author

As Chief Nursing Officer, Jeff leads Press Ganey’s focus on improving patient and caregiver experience and developing nursing leadership at healthcare organizations nationwide. He also plays an integral role in the company’s workforce initiatives, including Press Ganey’s Workforce Well-Being Collaborative, which focuses on supporting caregivers as they deal with the ongoing challenges of the pandemic. Prior to joining Press Ganey, Jeff served in various chief nursing officer roles at both community-based organizations and major academic medical centers throughout the US. In addition, he was the inaugural Vice President of the Magnet Recognition and Pathway to Excellence programs at the American Nurses Credentialing Center.

Profile Photo of Dr. Jeff Doucette, DNP, RN, NEA-BC, FACHE, FAAN