Med-Surg Unit Reduces RN Turnover

Medical-surgical nurses have a 20.4 percent turnover rate, according to Modern Nurse, which is third highest in the profession behind behavioral health and emergency nursing. 5 Main Tower, a medical-surgical unit at Cleveland Clinic’s Hillcrest Hospital, implemented a multipronged approach to combat high RN turnover, which for first-year new graduate RNs stood at 49.7 percent on the 59-bed unit at the beginning of 2017.

“5 Main had really struggled with staffing,” says Veronica Ukotic, BSN, RN, CMSRN, who joined the unit as nurse manager two years ago after serving as a nursing operations manager (NOM) for 12 years. “If you don’t have enough staff, it’s very challenging. When I came on board, I used my skills as a NOM to figure out how to build up the team, tap into available resources and create relationships.”

Part of a hospital-wide strategic nursing plan

One of the goals of the 2016 Cleveland Clinic Hillcrest nursing strategic plan was to decrease the RN turnover rate throughout the hospital. Chief Nursing Officer Sue Collier, DNP, RN, NEA-BC recruited a small team to assess the root causes in order to improve nurse practice environment. The team interviewed nurses throughout Hillcrest with less than one year of experience, asking what things had gone well since they were hired and what had been a challenge.

Eleven new nurses from 5 Main Tower participated in the interview process. Among their responses, four nurses stated they were unhappy with staffing and acuity, and one indicated she was challenged acclimating to her role as a nurse on the unit. When Ukotic saw the results, she decided to act swiftly to reduce RN turnover on 5 Main Tower.

A three-tiered approach to boost morale

During the first half of 2017, Ukotic used three tactics to decrease turnover: She contracted with PRN nurses, planned morale-boosting events and recognized team accomplishments.

• PRN Contracts – During her time as a NOM, Ukotic developed relationships with PRN staff. She hand-picked five high-performing PRN nurses to contract for three months with 5 Main, which addressed immediate staffing shortages and infused new energy into the unit. “A lot of PRNs need job flexibility for their lifestyle, however they want to have a ‘work’ home,” says Ukotic. “If we make them part of our family, then they will want to come back.” Three of the five PRNs continue to contract with 5 Main.
• Team Events – The unit-based Shared Governance Council on 5 Main formed an Activity Planning Committee to organize events that would motivate staff and create bonds among the team. The events, held every few months, have included a picnic, a paint ball outing, a murder mystery dinner and a 1980s-themed dinner cruise.
• Recognition of Accomplishments – “It’s hard for nurses to come in and give it their all, so we looked at what we could do aside from just saying, ‘Great job!’” says Ukotic. When the unit went several months without a patient fall, Ukotic told everyone they were “on a roll” and handed out Tootsie Rolls® and Fruit Roll-ups™. The next recognition will be a pizza party to celebrate completion of a continuous improvement project board.

Initiative achieves its goals

“Sometimes the smallest things really do go the longest way,” says Ukotic. For instance, she coordinated a “love fest” party for staff who worked on Valentine’s Day, raffling off a gift basket. “Things like that they always remember,” she says.

A combination of PRN contracts, events and celebrations have helped 5 Main Tower decrease its first-year new graduate RN turnover rate from 49.7 percent in January 2017 to 8.1 percent in August 2017, well below the national average for medical-surgical units. “Our efforts have been quite impactful,” says Ukotic. “When staff are treated well and recognized for their work, and when you develop relationships, people tend to stick around.”