Make 2019 the Year You Embrace the Agile Nursing Workforce

New Approaches for Addressing a Timeless Challenge

It’s no secret that the nursing workforce has undergone transformational changes over the course of this decade. Whether you believe this is due to generational shifts in the profession, the progression of accountable care and population health models, or the pervasiveness of technologies to support the delivery of care – or maybe all of the above – the current employment environment promotes vertical and horizontal agility for today’s nurses.

Agility, simply defined, represents the power to move quickly and easily. This transformation toward a more agile nursing workforce is often personified through commonly-held observations of the millennial generation. In all fairness, this age group sometimes gets a bad rap – it just so happens that their ability to adapt to industry changes in care delivery, labor supply and demand, and disruptive technology is probably more well-tuned than most. And that’s what happens when agility and change meets structure, rigor, and tradition.

The speed of the healthcare industry to create effective responses for current workforce demands might be characterized as slow at best. Case in point: The continued rise in nursing turnover, which was recently reported at nearly 17% (more than two percentage points higher than 2016 [NSI Nursing Solutions, Inc., 2018]). This may be in part due to confusion about the problem at-hand to solve for. On one hand, the US Department of Labor’s Bureau of Labor Statistics (2018) predicts a 15% growth in nursing jobs through 2026, while another agency projects the actual supply of nurses is expected to exceed demand by 2030 (US Department of Health and Human Services, 2017). In other words, the perceived “nursing shortage” will likely continue to be felt in specific regions (i.e., California and parts of the Southeast) and areas of healthcare services delivery.

Which then begs the question... are you experiencing a true nursing shortage or is yours a problem of attrition? After all, now that millennials comprise more than a third of the nursing workforce, and 17.5% of new nurses leave hospital-based jobs within the first year, maybe the cause of your hypovolemia is simply hemorrhage. And with that kind of problem you might need to get creative to stop the bleeding, especially if what you’ve been doing hasn’t slowed it down.

I’ve always been intrigued by what motivators bring out the best in people and learning ways to create the conditions necessary for that to happen. Over the last few years I’ve spent time both speaking with nursing leaders around the country and researching workforce engagement strategies. While my own leadership experiences haven’t been exclusive to nursing, what I’ve come to believe is that current workforce trends place a premium on an organization’s speed, creativity, and the effectiveness of feedback loops. With this in mind, here are four themes that nursing leaders should act upon in 2019 to prepare for the roaring twenties:

It’s time to double-down on burnout. There’s just too much data out there now to hide from this. A survey by Kronos Incorporated (2017) found that 90% of nurses are considering leaving their hospital for another job because of poor work/ life balance. According to a different survey, the average hospital is expected to lose $4.4 to $7M on nursing turnover, making the return-on-investment for dedicating resources towards burnout clear. Providing lateral mobility for new experiences, structured mentor/ preceptor relationships, and creating meaningful recognition programs that highlight individuals’ contributions and reconnect them to the “why” behind their work will be key in addressing this.

Information can accelerate everything. And using quarterly or annual surveys to drive your engagement and retention strategies is so old school. While I’m always in the front row to embrace benchmarking, traditional survey practices capture “lag” data. By the time you get your results, it’s all in the rearview mirror. Leveraging technologies designed for real-time feedback loops, short and frequent surveys, and “vote to promote” capabilities to surface workplace improvement ideas will put you in the driver’s seat of engagement. Check out what companies like TINYpulse and Laudio are doing in this space for more ideas.

Target high-risk groups with pinpoint accuracy. Armed with better information, customize your workforce interventions with surgical precision. We’d all agree that “one size fits all” doesn’t work – so it’s time to figure out who your at-risk staff are, where and when they work, and why they are a turnover risk. To illustrate this approach, let’s cobble together a risk profile drawn from a few different studies:

• Emergency department nurses continue to be the most mobile nursing specialty. Over the past five years, this group has turned over 102.4% (NSI Nursing Solutions, Inc., 2018).
• 43% of newly licensed nurses who work in hospitals leave their jobs within three years, 33.5% resign after two years and 17.5% work for only one year (PressGaney, 2018).
• 46% of the millennial nurse respondents to the PressGaney survey on nursing workforce resilience (2018) work night shift. This same study also found the lowest levels of engagement with this generation.

While simply an example, data points such as these could create a unique profile for your organization and tailor your interventions and approach to reduce disengagement, burnout, and ultimately turnover.

Get ready to position yourself to be on the receiving end of migratory patterns. A national initiative is underway that is designed to create greater flexibility and workforce mobility through multistate licensure compact. According to a 2018 survey by AMN healthcare, a majority of registered nurses heavily support national licensing, regardless of generational differences. Of the three generations analyzed nearly eight in ten millennials reported wanting to see national licensing. Given that this generation (and most nurses, really) generally seek to improve their nursing practice through education, professional development opportunities, and safe, supportive work environments, those organizations that create desirable cultures and conditions can become a magnet for that migration.

Each of these strategies may be increasingly important for regions with predicted supply-side shortages in the coming decade. In his text Exponential Organizations (2014), Salim Ismail characterized the current dominant generation in the workforce as “... naturally independent, digitally native, and resistant to top-down control.” Creating conditions that reward individuals’ contributions towards a greater purpose, are communicatively agile, and embrace “big tent” innovation through crowdsourced feedback loops are matched strategies to help retain and attract nursing talent into the future.