Hospitals are struggling to hold on to all nurses, but especially the new ones. Eighteen percent of new nurses will change jobs, or even professions, within the first year after graduation. An additional one-third leave their organizations within 2 years. Nursing turnover can be extremely costly for health systems. Besides just the hard cost of recruiting and onboarding, it is hard to build a nurse leader pipeline when there is fluctuating talent being brought up within the system.

1^st year nurses may be talking to their nursing school peers, and hearing about better opportunities at other hospitals. Or 1^st year nurses may have no ties to a city/region which makes them more likely to interview other places. But even worse, your organization itself may be contributing to young nurses are leaving the organization. It could be creating a reputation among young nurses to avoid your hospital and go elsewhere.

How can your health system leadership, or your more seasoned nurses, actually contribute to 1^st year nurse turnover?

• Not valuing 1^st year nurses, or at least are not showing it. Older nurses may make comments about Millennial workers or work ethics/work styles.
• 1^st year nurses could feel they are stuck picking up the slack for other nurses, or doing work other nurses do not want to do.
• 1^st year nurses may be given little role clarity. They may feel like goals are ambiguous, and that more experienced nurses are not helping to prepare them.
• 1^st year nurses may see little opportunity for growth or leadership development.

How can your organization turn this phenomenon around?

Offer better role clarity, which can also help alleviate stress

First year nurses have just had 14-16 years of schooling or more, where curriculums are clear from the first day. Then they begin working and realize work and life are messy and there is role ambiguity. This can lead to a low sense of control over job performance, and ultimately stress. What can nurse leaders do to stop this? For starters, make sure role expectations and performance is communicated well and across multiple channels. Have periodic check-ins with your new nurses. Let them know how their performance is contributing, and offer support.

Offer better communication; a 1^st year nurse needs management to communicate about critical issues

Most surveys and studies show that Millennial workers want more communication and feedback, or at least more than other generations have. While older generations value a big paycheck or advancement opportunities, Millennial workers are more likely to aim for career or organization purpose. Show your 1^st year nurses how their contributions help the larger health system at a macro level, and how they contribute to your team at a micro level. Management and supervisors should be available, or at least visible to nurses who are finding their way early in careers. Solicit input from young nurses on critical work issues. Incent your team to share 360-feedback to improve how critical issues are handled. This could show 1^st year nurses that you value communication, and show they are a part of critical issues and decisions.

Offer rewards or recognitions for accomplishments

Nurses who feel valued, appreciated, and respected—and who enjoy professional communication and working relationships—will stay at an organization and remain engaged in their profession. This is especially true for nurses newly out of school.  Offer recognition for accomplishments to show young nurses they are valued. Recognizing and rewarding nurses does not have to be complicated or time-consuming. It could be on-the-spot recognition, maximizing staff meetings, fun activities, feedback surveys, or general retention activities.

It’s not uncommon to forget to show associates that they are highly valued. Sometimes a shout out will do; other times an offer of lunch with the boss or an invite to attend an off-site training will help demonstrate that you are indeed happy to have this young nurse on your team.

Offer support from more experienced nurses

Young nurses are not looking for authoritarian leadership, they want coaching to help them learn and grow as professionals. Retaining nurses requires adjusting to adapt to this generation, so make sure the right older nurse is coaching. The right coach/mentor can help a young nurse to see how their contributions are valued. It can also help encourage continuous learning, can help young nurses to build networks/join professional organizations, and can even help teach young nurses about emotional intelligence. For example, Franciscan St. Francis Hospital in Indianapolis implemented a preceptor and mentor program to help new graduate nurses during their first year of employment. This decreased the organization’s 1^st year turnover rate from 31% to 10% in 2 years. There is nothing in a textbook that can replace real-life experience of a seasoned nurse who has navigated a full career. If your health system doesn’t already have a young nurse mentor program, maybe it is time to start.  

Offer opportunities for growth for high-performing young nurses

1^st year nurses want to see that their health system is willing to invest in them and prepare them for future leadership roles. Actively supporting career development through online and in-person training courses can help maximize skills, growth potential and professional opportunities. For a young nurse, the first opportunity for team leadership is generally the Charge Nurse role. Leading and delegating to peers, especially to older peers, is stressful. As a manager or director, you may see that offering these roles to young nurses without leadership development and preparation may lead to stress for young nurses. So offer Charge Nurse leadership development.

East Alabama Medical Center (EAMC) is a 340-bed hospital in a rural area. Because it is an area where there is a smaller talent pool than larger metro areas, EAMC really prioritizes growing its talent from within. Rosemary Cummings is the Director of Medical Surgical Services at EAMC, and recently implemented NCharge to prepare young nurses for leadership roles. She commented “We take a lot of pride in how we do things from a quality and cost perspective. It <NCharge> helps our frontline nurse supervisors to see we’re investing in them. Development at this organization is an important piece of who we are. I think that’s why people stay.”

NCharge: “Nurses Learning to Lead” is an evidence-based curriculum that gives first level supervisory nurses the insights, interpersonal skills, and business knowledge they need to more effectively manage, inspire, and lead. Courses are delivered either classroom-based or virtually. NCharge is for nurses who desire to build management and leadership skills and/or want to learn about the business-related aspects of nursing. Health systems use NCharge to build a nurse leader pipeline, ensure a smooth transition from peer to leader, and to increase nurse engagement and retention.

Feel free to read our related articles!

“Preparing Millennial Charge Nurses to be Successful Leaders”

“Encouraging Your Nurses’ Career Path?”

“What Your Nurses Didn’t Learn in Nursing School”

Sources

“Millennial Workers Want More than a Paycheck. So What Exactly do They Want?” Monster Inc, Roberta Matuson

“Nurse Retention Toolkit: Everyday Ways to Recognize and Reward Nurses,” HC Marketplace, Lydia Ostermeier MSN, RN, CHCR and Bonnie Clair, BSN, RN

“Strategies to reduce nursing turnover,” Nursing Made Incredibly Easy, Lisa Lockhart MHA, MSN, RN, NE-BC, April 2020

“7 Things That Cause Nurse Turnover (and 8 Things That Stop It)” ita group

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For nurses, especially those who are new to peer leadership positions, “soft skills” are important in career development. Being the best clinical and bedside nurse may mean little if other nurses are not buying into a new leader’s vision. “Soft skill” development is vital for new Charge RNs, and these skills can quickly help set a new nurse leader apart from others. But these skills are hard to quantify and are not widely taught. Most nurses get into the profession to help patients, not to lead teams. HCA designed its Charge Nurse Leadership Program to address this critical skills gap:

“The vision was to build a program based on the voice of nurses. The program would incorporate what the front line needed and wanted from a leadership perspective, with attention to meeting their needs and providing support for their careers.”

Nurse Leader, Volume 17, Issue 4, p.331-334, “Investing in the Front Line: Preparing the Best Nursing Leaders for the Next Generation”

So how can we encourage our nurses to develop these skills? And what are the top skills or techniques that should be learned?

Ways to Encourage Your Nurses

Change the entire “soft skill” dialogue

The first way to encourage nurses to have a positive attitude towards soft skill development is to discourage the narrative that these skills are actually “soft.” These qualities can sometimes be interpreted as less valuable by team members, but try to keep that from happening. Tell the team that in today’s super complex healthcare environment, and especially during the pandemic, that skills like communication, critical thinking, and teamwork are the skills that will yield big results when it comes to achieving organizational and team goals. Bristol Hospital builds on its Magnet success by teaching charge nurses these key skills:

“Critical thinking, decision making, effective communication, and conflict resolution all help to advance our nurses’ practice,” stated Kerry Yeager, Clinical Informatics Specialist at Bristol. “The participants were most engaged in the communication and conflict style assessments. I believe it gave them a greater understanding of how effective communication and conflict resolution skills impact patient care. As the charge nurse, these skills are essential.”

Teach nurses to write down goals, and find motivation to obtain them

Any newly learned skill or technique needs motivation behind it, and soft skill learning and development is no different. Teach nurses to write down reasoning for learning new techniques. For example, if your nurse wants to learn how to delegate work more efficiently, have her write down past situations where that skill would have helped the team, how it can help her lead in the future, and how she can practice that skill in the future.

Encourage working individually on each desired “soft skill,” – intentionality about practicing them

Like any skill learned, practicing helps us to improve. Encourage nurses to think small at first, gradually increasing intentionality until a desired outcome becomes easier. For example, if there is a charge nurse on your team who generally is quiet and stays in the background in a group meeting, ask her to share a few more opinions at the next meeting. This may help with learning and may lead to her more actively contributing, and this skill may become more natural for her later.

Encourage your team to take care of themselves

Let your nurses know that taking care of themselves requires thought, time, and practice. It might mean finding a nutritionist, therapist, mentor, or trainer. Identifying nursing “needs” and devising a plan to fulfill them requires a mix of soft skills, including time management, confidence, and adaptability. Investing in oneself is crucial.

Which ‘Soft Skills’ Should You Encourage Your Team to Improve?

Encourage practicing conflict resolution techniques

Better conflict resolution helps the entire team. In healthcare facilities, navigating conflicting personalities between coworkers, patients, and their families is hard, but a good nurse leader can resolve issues and minimize stressors. Healthcare delivery is stressful enough, even without personality differences. So with your team, practice resolving issues. There are many frameworks which can be used.
See this article to learn more, “Nurse Conflict Resolution Strategies.”

Communication

For any nurse, and especially for nurses new to leadership, it is crucial to be able to listen, understand, and give instruction. When communicating with patients or colleagues, getting a point across without being condescending or uncompromising is a skill that should be practiced. Voicing suggestions and opinions with peers or those in a position of authority requires practice.
According to Wellstar’s JONA case study on “The Effectiveness of Charge Nurse Training”:

“Among the leadership skills that were identified as being important to the role, communication was the most consistently reported area in which charge nurses needed to demonstrate effectiveness.”

Positivity and professionalism

When Nurse Managers and Directors are looking for young nurse talent for future leadership roles, they value those who lead by example, and are looking to improve. Encourage your team to practice positivity and professionalism by showing initiative and by thriving under direction. Let nurses know that serving as a good example and demonstrating a strong work ethic, flexibility, and positive attitude will help pave the way to future leadership positions.

The truth is, skills usually labeled as “soft” will impact the “hard” issues like organizational financial goals, patient outcomes, and patient experience which healthcare systems are eager to impact.

NCharge®: “Nurses Learning to Lead”

Are you interested in preparing your nurses to lead, especially those new to frontline leadership roles? NCharge® is an evidence-based curriculum that gives first level supervisory nurses the insights, interpersonal skills, and business knowledge they need to more effectively manage, inspire, and lead. Our customers use NCharge to build nurse leader pipelines, increase nurse engagement and retention, and impact financial awareness and results. Critical leadership skills like communication, delegation, and conflict resolution require ample practice time. That’s one key reason that up to 70% of time in NCharge courses is spent in group discussions and interactive activities. Courses like “Supervisory Skills for Positive Outcomes” teach a collaborative approach to managing conflict, and Critical Thinking Skills for Charge Nurses teaches using a process to make informed decisions. Learn More!

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“The Importance of Soft Skills In Nursing,” Eastern Illinois University RNBSN literature, May 10, 2019

“Soft Skills That Deliver Hard Results,” Health Leaders Media, Jennifer Thew RN, November 26, 2019

“The Importance of Soft Skills in Nursing, Hondros College of Nursing, Beth Smith

“Fostering soft skills among new nurses,” Wolters Kluwer, January 28, 2019

“Top ten soft skills for nurses,” Lippincott Nursing Center, Valeria Dziados MSN, CRNP, ANP-C, AGACNP-C, March 9, 2019

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Health providers experience many stressors and complex situations as they administer patient care. Its estimated that 25%-50% of hospital nurses suffer from some type of burnout even during “normal times,” resulting in stress or work anxiety. But during Spring of 2020, it is probable that these numbers have been higher. Nurse resilience as a concept has been attracting more attention and research in the past couple of years but has never been more important than it is in Spring of 2020. Sustaining nurse resilience requires action and engagement from organizations from the top down.

Nurse resiliency is the ability to prepare for, recover from and adapt to stress, challenges or adversity in the workplace. It is a way to combat and cope with burnout, stress, and feelings of nursing inadequacy by practicing self-care, self-awareness, connectedness, and management of work stressors. While our nation has been dealing with a viral crisis, nurse burnout is also a crisis to our public health community.

How can I Promote Nurse Resiliency from the Top-Down?

One of the best ways to help nurses as they provide care is to promote resilience, and help RNs feel prepared enough to tackle challenges the job throws at them. But how?

First, encourage nurses to foster resilience by taking emotional breaks. During times of personal distancing, you could encourage nurses to take an online class that is stimulating but not work focused. Encourage them to exercise, journal, listen to music, enjoy general hobbies, video chat with loved ones, and enjoy personal spiritual practices. Another way to encourage nurses to take a mental break is to encourage them to spend time outdoors when the weather permits, and hopefully even enjoy the sun.

Another way to help nurses deal with stress or burnout is to offer early interventions by training Nurse Managers to listen and encourage. At Children’s Hospital & Medical Center in Omaha for example, managers are trained to listen and provide safe spaces for nurses to talk through work stressors. Omaha Children’s early intervention program began with a need to address secondary trauma, then saw there was also a need to reduce workplace stress.

Encourage nurses to practice self-awareness. One of the most important steps in being able to stop energy drains is to expand self-awareness and identify unnecessary energy expenditures. There are several quick coherence techniques which you could encourage your teams to do. One is to focus all attention in the area of the heart. Imagine one can see their breath and breathe slow and deep. Another self-awareness technique is to make a deliberate and sincere attempt to experience a regenerative feeling such as appreciation for someone or something. One suggestion is to ask nurses to re-experience feelings of caring, a special place, a proud accomplishment, or special past memory. Heart focused breathing, or activation of a positive or renewing feeling are easy ways to de-stress, even while at work.

When huddling with your work teams, remember to tell nurses to recognize what they can and cannot control. Remind them to focus on the optimistic ways they help people rather than all the possible negative outcomes which could occur. Tell your nurses that when they are doubtful, scared, or feeling inadequate, to remember that every other nurse feels the exact same way. There has been much we’ve been unable to control in 2020. Ask nurses to give themselves mental empathy, and when self-doubt creeps in, give themselves compassionate words.

To encourage nurses to pursue emotional support and connectedness to peers, have your work teams find a buddy who they can reach out to when workload is intense. Maybe instead of a buddy, connect nurses to a nurse mentor, counselor, or other Employee Assistance Programs which your health system has for support. Or bring nurses together and let them feel the social support they have in their hospital; for example, a debriefing session can help nurses bond and learn from each other, while sharing stories and experiences. Consider bringing in someone to lead a session who is trained to structure reflection, learning, and healing.

You may have the best Nurse Managers or Charge RNs in the country, in leading, administering, and organizing care. But that doesn’t mean these leaders are trained to build resilient teams. So, encourage these leaders to engage staff, rollout, and coordinate these nurse interventions to provide a sense of camaraderie, teamwork, and trust. And if you show that building nurse resiliency is important to you, your mid-line managers will probably follow your lead.

Keeping nurses safe and supported during the ups and downs of the COVID-19 pandemic is a major priority. Even as the country is giving support for these vital members of our workforce, stressful situations generally make people feel isolated, not supported. Prioritize helping nurses with resiliency building techniques to help their physical, mental, emotional, and spiritual domains. The consequences of not doing so are too high. The country desperately needs to prioritize nurse satisfaction, productivity, health outcomes, and stress. Not doing so will cause the next public health crisis; a stressed and burnt out nurse workforce.

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Sources

“How to Measure Resilience With These 8 Resilience Scales,” Positive Psychology, Courtney E. Ackerman, MSc, April 5, 2020
“7 Habits of Highly Resilient Nurses,” Reflections of Nursing Leadership, Diane Sieg
“Developing resilience: the roles of nurses, healthcare teams and organizations,” Nursing Standard, Caroline Barratt
“Nurse Resilience: A Concept Analysis,” Wiley Online Library, Alannah L. Cooper, Janie A. Brown M.Ed, PhD, Clare S. Rees BA (Hons), MPsych, PhD, Gavin D. Leslie BAppSc, Post Grad Dip (Clinical Nursing), PhD
“Building Emotional Resilience in Nursing,” Catherine Kelsey from Queens Nursing and blog
“Building personal resilience,” American Nurse, Teresa M. Stephens, PhD, MSN, RN, CNE, August 13, 2019
“A Call to Leadership: Navigating Uncharted Waters,” American Association of Colleges of Nursing, a Webinar by Randolph F.R. Rasch, PhD, RN, FNP, FAANP, March 20 2020
“Nurses well-being: Supporting staff and encouraging resilience,” Becker’s Healthcare, Jackie Drees, May 30 2019
“Help Hospital Employees Find Resilience and Reduce Burnout,” Children’s Hospital Association, Kelly Church, October 24 2019