The national average exit rate for nurse managers is 8.8%, according to a recent report. At hospitals in California, Ohio and Louisiana, leaders shared with Becker's how they have achieved turnover rates as low as 3%.
The American Organization for Nursing Leadership and Laudio, a healthcare intelligence platform company, found the highest exit rates in the first few years of a nurse management role. In the first four years, between 10% and 12% of nurse managers step down and return to front-line work. In the first three, up to 12% leave the organization.
To shrink this turnover rate, chief nursing officers are leveraging various strategies to support these leaders through new onboarding programs and equitable scopes of control.
Ways to 'connect the dots'
Nurse management is a difficult role; these leaders oversee budgets, manage care quality and staff interactions, recruit and train nurses, coordinate schedules, manage direct reports, provide care to patients, and raise front-line issues to directors.
This role will never be easy, according to Tiffany Murdock, DNP, RN, senior vice president and chief nursing officer at Ochsner. But that doesn't mean CNOs cannot make the job easier.
At the New Orleans-based system, the overall turnover rate — including voluntary and involuntary departures — is 6.67% for nurse managers and 4.9% for nursing directors. Annual voluntary turnover is 5.7% for managers and 2.4% for directors.
One factor for these lower-than-average rates lies in the Ochsner Leadership Institute, which places employees on pathways to prepare them for formal and informal leadership opportunities. Another contributor is a nurse leader retreat Ochsner launched last year that helped "connect the dots" and tap into nurse managers' values, Dr. Murdock said.
Keck Hospital of USC, which has an annual nurse manager turnover rate of 3%, has "mastered" the skill of engaging these leaders and ensuring job satisfaction, according to Chief Nursing Officer Ceonne Houston-Raasikh, DNP, RN.
The Los Angeles-based hospital hosts quarterly listening sessions for its 13 nurse managers to share their challenges and frustrations. Additionally, anonymous pulse surveys examine engagement levels.
One issue that Keck Hospital of USC recently addressed was the timeline for performance evaluations. They were originally due Dec. 31, but after managers expressed the "crunch time" coupled with scheduled end-of-year time off, leaders postponed the deadline to Jan. 31.
A younger workforce
When Dr. Houston-Raasikh joined Keck, several nurse managers were fairly new to their roles. They were also relatively new to healthcare, as many had fewer than three years of experience.
Deana Sievert, DNP, RN, chief nursing officer of Columbus-based UH/Ross Heart Hospital, The Ohio State Health System, noted the same trend. In the beginning of Dr. Sievert's 32-year career, nurse managers had 10 or more years of experience. Now, nurses with two to three years are filling these roles.
This presents pros and cons. Younger nurse managers can be more innovative and tech savvy, but they can also miss the big picture and knowledge of sweeping industry trends, Dr. Sievert said.
"While there are a lot of positives of having our Gen Z population move into our leadership roles, there are a couple things that I think we have to do as healthcare leaders to put in place to help them," she said.
For example, physical and psychological safety, work-life balance and skill development are — and have historically been — the most important priorities for nurse managers. To better support younger nurse managers, though, UH/Ross Heart Hospital had to revamp its onboarding program and amplify conflict management training.
Nurses a few years into their career have less lived experience with conflict than those with 10-plus years into leadership, and thus need more support when navigating tense situations, Dr. Sievert said.
"That nurse manager role, by far, is the most important role in nursing leadership," Dr. Sievert said. "I don't know any chief nursing officer or any other senior nursing leader that doesn't believe that that role is critical. They are the bridge between our front-line staff and our patients and our senior leaders and so, we really have to give them the opportunity to learn and to practice these skills, like deescalation training."
Redefined scopes
Several systems are also right-sizing nurse managers' scope of control.
Advocate Health recently undertook an initiative to homogenize nurse manager's span of control, as did Keck Medicine. Earlier this year, the organization ensured each leader would solely focus on one unit and equitably distributed assistant nurse managers.
Think of it like the U.S. legislative branch, which promises two senators per state — equality — and issues representatives based on a state's population — equity. At Keck, a telemetry unit with 14 beds has one nurse manager and shares its assistant nurse manager with another small unit. In contrast, a critical care unit with 100 full time employees, on the other hand, has one nurse manager, two assistant nurse managers and an extracorporeal membrane oxygenation program manager.
At Ochsner, after realizing some leaders had more full time employees than others, the organization worked to standardize by evaluating the ideal head count under the control of nurse managers and nursing supervisors. In January, the 46-hospital system will launch its new leadership structure.
Dr. Murdock expects the new model will level set and clarify the role.
"I think it gives them a sense of value; they want to know what their expectation is. We're never going to make this an easy job," she said. "What we need to do is engage them on how they feel most valued. If we do that, if we stop trying to make the job easier, then we'll get closer to the answer to the problem, which is that they want to feel valued and they want to feel connected to their purpose."