While hospitals throughout the U.S. are struggling with both attracting qualified nurses and keeping them in place and happy once employed, Northwell Health is seeing nursing turnover statistics far below the national average.
The key to this success, Maureen White, RN, executive vice president and chief nurse executive of New Hyde Park, N.Y.-based Northwell Health, told Becker's, is to focus on both recruitment and retention — at the same time — with the intention of creating a nursing pipeline that never runs dry.
Ms. White, who is also the director of Northwell's Institute for Nursing, said the healthcare system reported a 13 percent nursing turnover rate in 2022, compared with the same year's national average turnover rate of 27 percent, as per NSI. It's not that the New York metro area has more qualified nurses, she said, because the regional turnover rate in 2022 was 25.4 percent.
The low turnover rate can be attributed to Northwell Health's commitment to creative and focused recruitment programs ("We are not just looking for anyone") and to giving front-line nurses "a seat at the table" to empower them to take part in creating environments where they want to stay and flourish.
Moreover, Ms. White said, best practices recruitment and retainment initiatives aren't enough; Northwell Health actively cultivates a nursing pipeline which, in non-pandemic years, has kept the registered nursing turnover rate to about 8 percent annually.
Ms. White said Northwell has seen many trends in the nursing profession over the last decade and two, in particular, spurred a renewed focus on the way the organization recruits its nurses and how it keeps them learning, growing and moving up the ladder at Northwell.
Here, Ms. White shares the "whys" and "how" of Northwell Health's multi pronged initiative to grow its own nursing workforce and keep it flourishing regardless of difficult tests including a pandemic.
Question: You have said the programs Northwell has put in place to recruit and retain registered nurses have been informed by the realities of current workforce trends. What do you mean?
Maureen White: Baby boomers are retiring from the healthcare sector and millennials have come into the workforce with very different ideas about their careers. This is a very transitional group of people who will change jobs, even careers, many times in their lives. We have to accept it. It is what it is.
At Northwell, we decided to figure out how to work within that to create recruitment programs that attract the people who both really want to enter the nursing field and who belong at Northwell Health.
Q: What drives the nursing recruitment efforts at Northwell Health?
MW: We make sure we have access to the best of the up-and-coming nursing students. We don't work only with a few nursing schools — we have over 70 affiliation agreements with schools of nursing so their students can be introduced to not only the professional practice of nursing but also to Northwell and our culture.
We want them to get a sense of who we are and what we're about. At the same time, we get a sense of who they are. We are not just looking for anyone.
Q: Can you describe some of Northwell's creative nursing recruitment programs?
MW: We have several programs in place that allow us to find the nurses who will fit in at Northwell. For example, about 10 years ago we started our "Golden Ticket" event. We send out invitations to nursing schools around the country looking for students who are interested in working in the Northeast. We send a set number of golden tickets to each school and bring those students to Northwell to learn about us.
From this group of rising seniors, we recruit for our nurse externship program. This is an eight-week summer program where we give these students the opportunity to spend time in different hospitals throughout our system and offer them experiences that they may not normally get in their clinical rotations or in school. We allow them to really focus on caring for patients in a more concentrated way.
I've had several professors from the schools of nursing call me up after their students have gone through the nurse externship program and saying to me, "I gave you a student. You gave me back a nurse."
That's a powerful statement. More than anything else, this program gives students the chance to really decide if they want to be a nurse. Because nursing is not for everyone.
Q: How do you find nursing students who will fit into Northwell's culture?
MW: Last year, we had over 100 junior nursing students going into their senior year of nursing school participate in our externship program. During that time, we get to see if the person has what it takes. When we identify someone, saying this is somebody we really should have on our team, at the end of their externship we give them a job offer and they can start their senior year with a job lined up after graduation.
Q: When the nursing shortage is so dire, how can a hospital be this selective?
MW: My philosophy is this: Think about a sink with no stopper and the faucet turned up full force. All your water will go right down the drain. We focus on bringing on the right people, the people we believe will fit in and be the kind of nurses who want to take part in creating a culture where people want to remain and grow. When we do that, we can feel confident that they aren't coming in and flowing out. They belong here.
In 2022, we hired over 2,100 registered nurses. We had an applicant pool of over 100,000 applicants, but we hired 2,100. As important as it is to attract talent, it is equally as important to retain those individuals.
Q: As you know, Northwell's low nursing turnover is admirable. What are you doing to retain nurses that other healthcare systems might be able to emulate?
MW: I always believe the best ideas are not coming from the C-suite. They are coming from the front line. The C-suite can discuss goals for outcomes. But it's the front-line staff who are going to get us there.
In 2007, we established Collaborative Care Councils of front-line registered nurses. Today, we have over 500 collaborative care councils throughout our system — in our hospitals, our ambulatory care areas and in procedural areas. We ask managers to support the council meetings, but not to lead the discussions.
These groups routinely meet to work on any or all of one of these four areas: patient experience, quality and safety initiatives, resource management, and creating a healthy work environment. These councils give the front-line nurses a seat at the table. They're making the suggestions. They're carrying out different initiatives. This is their opportunity to tell us how we can do things differently.
And, they know that when we see great practices put in place or improvements that have been made, we spread those programs throughout that hospital and throughout our system.
Q: How does this empower seasoned and new nurses as individuals?
MW: We work actively to create and maintain what we call "empowering environments" for all our team members, and most particularly for our registered nurses. These are environments where people feel trust, where they feel safe to speak up when things are not right and safe knowing their physical and emotional health will be cared for.
When we ask them to share their ideas for what we can do to make improvements within the environments they work in, we really want to hear individual ideas. We ask them for their wild ideas, and many of them are great ideas. Then we work out how to implement these ideas into the environments, so nurses know that their opinion matters. They are treated like the professionals they are —– as important members of our team. And they feel valued.
Q: Is there anything you are doing to retain the new nurses coming in?
MW: We are very focused on appropriate onboarding of new nurses. During the pandemic, a lot of schools of nursing weren't able to give bedside clinical experiences to nurses; many of their experiences came from simulation labs at the school.
So these new nurses come in afraid — they haven't had many real patient assignments. We started our "Nurse Residency Program" in which we meet every month with all new graduates from nursing schools. We talk them through some of their angst that they may be feeling coming into the workforce and ask how we can support them better. We also have fellowship programs in many of our specialty areas like critical care, perioperative services, cardiac catheterization areas, procedural areas, behavioral health, pediatrics, just to name a few.
We have extended orientations for these individuals to really help them through that onboarding. It's very important that they feel comfortable caring for our patients.
Q: Beyond efforts to attract and retain nurses, how does Northwell handle difficulties including nurses who are frustrated and burnt out?
MW: We acknowledge that staffing is an ongoing concern and an area that we will continue to focus on. We are always looking at our teams to make sure there is enough staff.
I don't have closets filled with nurses ready to go at a moment's notice, but about 10 years ago, we developed an internal staffing agency which we call Flex Staff. This is an agency in which nurses can go to if they want to take on extra shifts outside of their building. They can come on to this agency and they can get paid additional money for signing up to do work at other facilities throughout our health system. We also have a travel group of nurses in-house to help with leaves of absences and some of the day-to-day staffing challenges that we have.