MHA 543 Week 3 Recruitment and Retention Strategies Example

Keep the Nurses You Hire: A Recruitment and Retention Strategy Built on a Year-Long Residency, Safer Workloads and a Better Work Environment

[Student Name]

University of Phoenix

MHA/543: Tackling the Talent War in the Health Sector

Week 3 Assignment

[Instructor Name]

[Date]

The health system, its programs, costs and targets are composites written for a model paper; research findings come from the sources cited.

The composite two-hospital Omaha system spent $22 million a year on travel nurses and lost 27% of its new graduate nurses in their first year. At a board retreat, the vice president of talent framed the choice plainly: the system could keep paying to rent and replace nurses, or invest in keeping the nurses it already hired. This paper presents the recruitment and retention strategy she recommended.

Recruitment Is Not the Main Problem

The system recruits well. Partnerships with three local nursing schools bring about 180 new graduates a year, clinical placements introduce students to the units and starting pay is competitive. The problem is that too many leave before they become experienced nurses. Spending more on recruitment would fill a bucket that keeps leaking.

Matching Strategies to Causes

The earlier diagnosis identified five causes of turnover: weak first-year support, difficult schedules, stretched managers, pay compression and dependence on agency staff. The strategy targets the first three directly and addresses the others through savings and later budget decisions.

Strategy One: A Year-Long Residency

The system's eight-week orientation will be replaced by a twelve-month residency for all new graduate nurses. Residents will have a trained preceptor for the first twelve weeks, monthly cohort seminars on clinical judgment, communication and self-care, a designated mentor for the year and scheduled check-ins with their manager at three, six and nine months.

Evidence for Residencies

Research supports this approach. A decade of data from a national residency program for newly licensed bachelor's-prepared nurses showed that retention of new graduates increased considerably in participating hospitals, and that residents' perceived ability to organize and prioritize work, communicate and provide clinical leadership improved significantly over the year-long program (Goode et al., 2013). A residency treats the first year as training, not as a test new nurses must survive alone.

Strategy Two: Safer Workloads

The system's medical-surgical units often assigned six or more patients per nurse on day shift, especially when vacancies went unfilled. The strategy sets a target of no more than five patients per nurse on medical-surgical day shifts, with a charge nurse without a patient assignment on every unit.

Evidence on Workload

Workload shapes how nurses and patients experience a hospital. A study of hospital nurses and patients in two states found that nurses were burned out and working in understaffed conditions, and that each additional patient per nurse increased the odds of nurses giving unfavorable reports on safety and quality and of patients giving unfavorable ratings, with odds ratios from 1.15 to 1.52 for medical-surgical nurses (Lasater et al., 2021).

Strategy Three: A Better Work Environment

The third strategy strengthens the nursing work environment through shared governance councils on every unit, nurse input into scheduling and equipment decisions, visible nurse leaders and investment in professional development. The system will pursue Magnet recognition, a national designation for nursing excellence, as a structure for this work.

Evidence on Work Environments

A study comparing hospitals that became Magnet-recognized with hospitals that did not found that the emerging Magnet hospitals showed markedly greater improvements in their work environments, and that their 30-day surgical mortality and failure-to-rescue rates improved more, by 2.4 and 6.1 fewer deaths per 1,000 patients respectively, with similar gains in nurse-reported quality and nurse outcomes (Kutney-Lee et al., 2015).

Scheduling Changes

Supporting all three strategies, new graduates will no longer be assigned floating in their first six months, and units will offer a mix of 8-hour and 12-hour shifts so nurses can choose after their residency.

Manager Capacity

The strategy splits the four largest units' management roles, reducing spans of control from more than 100 staff to about 60, so managers have time for coaching and stay conversations.

Recruitment Improvements

Recruitment will focus on fit and honest previews: candidates will shadow a nurse for a shift before accepting an offer, and recruiters will describe the residency and schedules accurately. Realistic previews reduce early departures by those who discover the job is not what they expected.

Why Not Bonuses

Sign-on and retention bonuses were considered and largely rejected. Competitors can match them, they deepen pay compression and exit interviews showed pay was not the leading cause of departure. A modest retention payment at the end of the residency year was kept to reward completion.

Costs

The residency will cost about $2.1 million a year, mostly preceptor and coordinator time. Workload targets require about 45 additional nurse positions, roughly $4.5 million a year once filled. Additional managers cost about $600,000. Work environment and Magnet preparation cost about $400,000 a year. The total is about $7.6 million a year.

Expected Savings

If first-year turnover falls from 27% to 15% and overall turnover from 19% to 14%, the system would need far fewer travel nurses. The finance team estimated that reducing travel positions from 140 to 60 would save about $12 million a year, and lower turnover would save several million more in recruiting and orientation costs.

Building the Preceptor Corps

A residency depends on preceptors. The system identified 120 experienced nurses willing to precept, trained them in adult learning and feedback and reduced their patient assignments during a new nurse's first weeks. Preceptors receive a stipend and recognition in their performance reviews. Without this investment, the residency would add to experienced nurses' burden and risk driving them out.

Involving Nurses in the Design

Front-line nurses helped design every element. A council of new graduates and experienced nurses reviewed the residency curriculum, the workload targets and the scheduling options. Their suggestions included a quiet room on each unit for breaks and a peer support group for residents after difficult patient events, both adopted.

Phasing the Plan

The strategy begins with the next cohort of new graduates in the medical-surgical units with the highest turnover, then expands to all units within eighteen months. Workload targets phase in as new positions are filled, starting with the two units with the highest patient loads.

Risks

Savings depend on retention improving, which takes time. Filling 45 new positions will be hard at first, and travel spending may rise before it falls. The board agreed to fund the strategy for three years before judging it, with a formal review at eighteen months.

Targets and Measures

Targets for year two: first-year turnover at or below 15%, overall registered nurse turnover at or below 14%, vacancy below 7% and travel positions below 60. Measures are reported quarterly, alongside engagement scores and patients per nurse.

Conclusion

The system did not need more recruits; it needed to keep the nurses it hired. A year-long residency, safer workloads and a better work environment address the causes of early turnover and rest on research linking each to retention or outcomes. The strategy costs less than the travel nurses it aims to replace, if retention improves as the evidence suggests it can.

References

Goode, C. J., Lynn, M. R., McElroy, D., Bednash, G. D., & Murray, B. (2013). Lessons learned from 10 years of research on a post-baccalaureate nurse residency program. The Journal of Nursing Administration, 43(2), 73-79. https://doi.org/10.1097/NNA.0b013e31827f205c

Kutney-Lee, A., Stimpfel, A. W., Sloane, D. M., Cimiotti, J. P., Quinn, L. W., & Aiken, L. H. (2015). Changes in patient and nurse outcomes associated with Magnet hospital recognition. Medical Care, 53(6), 550-557. https://doi.org/10.1097/MLR.0000000000000355

Lasater, K. B., Aiken, L. H., Sloane, D. M., French, R., Martin, B., Reneau, K., Alexander, M., & McHugh, M. D. (2021). Chronic hospital nurse understaffing meets COVID-19: An observational study. BMJ Quality & Safety, 30(8), 639-647. https://doi.org/10.1136/bmjqs-2020-011512