High labor costs continue to stress health system leaders.
In 2023, for example, the average turnover cost for one staff RN grew to $56,300, up from $52,350 in 2022. The financial stakes are high — with each 1% percent change in RN turnover estimated to cost or save the average hospital $262,500 per year. In response, healthcare leaders are looking at new ways to attract and retain the next generation of nurses.
Becker’s Healthcare and Works recently conducted a brief survey of chief nursing officers to learn more about the qualities, skills and certifications that are top of mind in their searches for future employees; the current challenges and successes that organizations are experiencing with nurse recruiting; and investments that hospitals and health systems are making to advance nurse recruitment and retention efforts.
More than three-quarters of the 115 survey respondents work at hospitals or health systems, and close to two-thirds (63.4%) work at organizations with more than 250 beds.
Please select the most accurate description of your organization.
Flexibility is an important retention tool and strategic differentiator
Interestingly, 42% of the CNOs surveyed indicated that “reducing nurse workload” was one of the top-three most difficult things to offer or change as part of their organization’s nurse retention strategy.
Although it may be difficult for hospitals and health systems to reduce nurse workloads, many recognize the value of flexibility to employees and are leveraging it in their nurse retention strategies.
More than half (60.9%) of CNOs who participated in the survey indicated that flexible work schedules and arrangements are very important to their nurse retention strategies. For 48% of respondents, “flexible work arrangements” ranked as one of the top-three most necessary changes or updates to attract and retain the younger generation of nurses.
Flexible work arrangements take a variety of forms. While the most popular option among survey participants is self-scheduling, only 31.3% of respondents said their organizations offer that to employees. Interest is strong, however; among the 68.7% of organizations that don’t offer self-scheduling, 88.7% of CNOs said they were considering technology that would allow nurses to pick their own shifts.
“Clinicians are no longer tolerating pre-pandemic working conditions, and the next generation of nurses expects flexibility. We’re starting to see hospitals optimize their current workforce by leveraging digital tools to track talent data. At Mercy, we partnered with Trusted’s Works platform to create Mercy Works On Demand.”
Betty Jo Rocchio, DNP, CRNA, CENP, Senior Vice President & Chief Nurse Executive, Mercy
Other popular types of flexible work arrangements cited by the survey participants include the ability to pick up extra shifts according to preferences, part- time work with hour requirements and the ability to work across different care settings.
What types of flexible work arrangements does your organization offer?
Self-scheduling
31.3%
Ability to pickup extra shifts, according to preferences
29.6%
Part-time work with hour requirements
28.7%
Ability to work across different care settings
28.7%
Choosing which weekends to work
26.1%
Schedules to accommodate new mothers
25.2%
Hybrid shift lengths
24.3%
Hybrid roles
23.5%
Gig work without hour requirements
23.5%
Virtual nursing
22.6%
9 a.m. to 5 p.m. schedules
22.6%
Four-day work weeks
21.7%
12-hour shifts starting at anytime
21.7%
Figure 2: Types of flexible work arrangements offered by survey respondents’ organizations
High demand for nurses with compassion, empathy, and strong communication skills
When asked to identify the most important characteristics or skills they look for in potential nursing recruits, CNO survey respondents rated compassion and empathy highest, followed by strong communication skills. CNOs prioritized these qualities above characteristics like attention to detail and clinical competence.
While many nurses may be innately compassionate and empathetic people, it’s important to keep in mind that without sufficient bandwidth on the job, it’s difficult to display these traits to patients and peers.
What are the most important characteristics or skills you look for in potential nursing recruits?
0%
10%
20%
30%
40%
50%
60%
70%
80%
Compassion and Empathy
27%
18%
25%
Strong Communication Skills
23%
26%
17%
Critical Thinking and Problem-Solving Abilities
18%
20%
17%
Attention to Detail and Clinical Competence
12%
24%
18%
Adaptability and Flexibility
19%
11%
23%
1
2
3
Figure 3: Survey respondents’ most important characteristics or skills in potential nursing recruits
Embracing technology is essential to recruit the next generation of nurses
When asked what aspect of their organization’s nurse retention strategy was most difficult to offer or change, CNOs ranked “embracing new technologies meant to alleviate burdens” as the least difficult.
When it comes to leveraging technology as a differentiator, more than one-third of CNOs (39.1%) indicated that digital recruitment platforms are an effective recruitment strategy to attract the next generation of nurses.
Nearly half (48%) of the CNO survey respondents ranked “embracing technology” as one of the top- three most necessary changes or updates to attract and retain the younger generation of nurses.
“Leveraging technology for staffing and scheduling decisions in healthcare settings offers numerous advantages, primarily enhancing efficiency and introducing flexibility to scheduling systems. Automated algorithms can swiftly analyze vast amounts of data to generate optimized schedules that meet staffing requirements and individual preferences.”
Brian Weirich, DHA, MHA, RN, CENP, Chief Nurse Innovation Officer, Bon Secours Mercy Health
In your organization’s nurse retention strategy, which of the following have been the most difficult to offer or change?
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Reducing nurse workload
17%
11%
14%
Reducing nurse stress and burnout
17%
5%
17%
Recognizing nurse contributions
5%
20%
13%
Offering work-life balance/flexible options
11%
11%
15%
Fostering a healthy workplace culture
14%
8%
14%
Offering career advancement opportunities
12%
13%
10%
Offering competitive compensation and benefits
9%
17%
3%
Addressing staffing shortages
6%
11%
9%
Embracing new technologies meant to alleviate burdens
10%
3%
6%
1
2
3
Figure 4: Most difficult aspects to offer/change in nurse retention strategies, per survey respondents
What changes or updates do you believe are necessary within the nursing profession to attract and retain younger generations?
0%
10%
20%
30%
40%
50%
60%
Embracing Technology
23%
10%
15%
Flexible Work Arrangements
14%
23%
11%
Focus on Diversity and Inclusion
11%
17%
19%
Enhanced Benefits Packages
16%
11%
18%
Professional Development and Career Advancement
16%
12%
14%
Emphasis on Work Environment and Culture
12%
16%
10%
Holistic Well-Being Initiatives
9%
11%
13%
1
2
3
Figure 5: Changes or updates survey respondents believe are necessary to attract and retain younger nurses
Ready to get introduced to works?
As hospitals and health systems compete to attract nursing talent, technology and flexible work arrangements are key pathways to success. Works offers an industry-pioneering workforce management platform that helps healthcare organizations bolster nurse retention through a centralized staffing model, while driving clinical cost savings.
Works drives clinical cost savings and bolsters nurse retention through flexibility and workforce optimization. With Works, clinicians move across units and hospitals and you fill more shifts with your own labor resources.
2021 Frontline Nurse Mental Health & Well-being Survey
2021 Frontline Nurse Mental Health & Well-being Survey
2021 Frontline Nurse Mental Health & Well-being Survey
For the third year in a row, the Trusted Health team has set out to gauge the mental health & well-being of our nursing workforce. Explore our insights.
Trusted Health
2021 Frontline Nurse Mental Health & Well-being Survey
2021 Frontline Nurse Mental Health & Well-being Survey
By Trusted Health
Overview
The COVID-19 pandemic has pushed the topic of burnout and mental health amongst clinicians into the national conversation as stories of healthcare workers reaching their breaking points have saturated the media. In 2020, as part of our overall mission to better support nurses -- the backbone of our healthcare system -- Trusted Health set out to understand the impacts of COVID-19 through a study of frontline nurses. This year, we’ve revisited and expanded the survey to look at the specific impact of the pandemic on nurses’ physical and mental health and how their experiences over the last year have impacted their career plans.
What we found is a profession in crisis. Not only are nurses reporting significant declines in their mental health; high levels of depression, stress and PTSD; moral injuries, and bouts of compassion fatigue, but nearly half of the respondents in our survey reported feeling less committed to the profession than they were before the pandemic. This finding was particularly pronounced amongst nurses under 40, who were 22 percent more likely than average to report that their commitment to nursing had decreased. At a time when the US Bureau of Labor Statistics projects that demand for nurses is growing faster than any other occupation and that we need 1.1 million additional nurses in order to avoid a further shortage, we simply cannot afford to lose the nurses we already have -- and particularly those in the early stages of their careers.
Our hope is that this report serves as a warning and rallying cry for healthcare leaders, and a step towards coming together to find meaningful solutions to address these issues. Over the last year, nurses have made unimaginable sacrifices, working in conditions they never thought possible when they joined this profession. It’s time for our industry to step up and take care of them the same way they have taken care of us.
Methodology & Demographics
The data in this study is gathered from survey responses from more than 1,000 nurses, 80 percent of whom reported that they were providing direct care to COVID-19 patients in their current role. The survey was conducted online in March of 2021. Eighty-nine percent of respondents were female, 9 percent were male and 2 percent were either gender non-confirming or preferred not to say.
What is your age?
What is your specialty?
Key Findings
For the second year in a row, nurses reported steep declines in their mental health as a result of the COVID-19 pandemic. On a scale of 1-10, nurses rated their current mental health and well-being an average of 5.7, compared to an average of 7.9 prior to the COVID-19 crisis, representing a decline of 28 percent.
Please rate the state of your mental health and well-being (10 is the most positive; 1 is the most negative
Nurses continue to feel that their health and well-being aren’t being prioritized or supported. On a scale of 1-10, nurses rated their current facility an average of 4.6 in terms of the support it has provided related to their mental health and well-being, a slight decline from 2020’s rating of 4.8. More than one in five nurses rated their current facility a 1.
How satisfied are you with the level of support your facility has provided related to you mental health and well-being? (10 is extremely satisfied; 1 is not at all satisfied)
Nurses also report feeling unsupported at a systemic level. When asked how they think that the healthcare industry prioritizes and supports nurses’ mental health and well-being, 95 percent said they felt that it was either not a priority or that it was a priority, but that there were inadequate measures in place to support it. This finding is consistent with last year’s report, but is notable given the level of discourse and reporting in the mainstream media about the issue of clinicians’ mental health in the wake of several high-profile incidents.
Nurses have experienced a variety of negative outcomes on their physical and mental health as a result of the pandemic. In this year’s study, we wanted to dig into the specific impact that the pandemic has had on nurses’ well-being. Nearly two-thirds of respondents reported feelings of depression, declines in their physical health and compassion fatigue towards their patients. While nearly 1 in 5 nurses tested positive for COVID-19 over the last year, it’s clear that the knock-on negative effects on mental health were significantly more widespread than actual COVID-19 infections amongst the nursing workforce.
Nursing can take a toll on you under the best of circumstances. After a year-long global public health crisis, I feel completely drained -- mentally, physically and spiritually. - Jeri, Pediatric Nurse
How well do you think the healthcare industry prioritizes and supports nurses' mental health and well-being?
Since the COVID-19 pandemic began, which of the following statements apply to you? Please check all that apply.
Nurses are ambivalent about being called heroes. Healthcare workers of all kinds have been referred to as heroes throughout the pandemic, but less than 1 in 4 respondents in our study felt that this label was fitting. Forty-nine percent felt that the label was an oversimplification and asked them to sacrifice their health and well-being for others.
I know this whole sentiment of ‘health care heroes’ is well-intentioned, but it's damaging. It sets us up for feelings of guilt and sets the tone that we can or should sacrifice ourselves for others. - Tayler, ICU Nurse
Over the course of the COVID-19 pandemic, nurses and other healthcare workers have frequently been referred to as "heroes." Please select the answer below that best describeds your response.
Nearly half of nurses are less committed to the profession than they were before the pandemic, and many are considering leaving the workforce. This finding was particularly pronounced amongst nurses under 40. Nurses between the ages of 20 and 29 and 30 to 39 were 24 percent and 15 percent more likely to report that their commitment to nursing had decreased, respectively. Looking across specialties, nurses who work in acute care, emergency, critical care and pediatrics were the most likely to report that their commitment had decreased.
We asked a follow-up question to the respondents who said they were less committed to the profession, and found that nearly 1 in 4 are actively looking for a job outside of nursing or planning to retire. The most common write-in responses under “other” were from nurses who were looking for a job away from the bedside or in a less acute care setting.
How has the COVID-19 pandemic affected your commitment to nursing?
What are your future career plans?
Recommendations
The fact that more than half of nurses under the age of 40 feel less committed to the profession than they did a year ago is alarming, particularly at a time when Baby Boomer nurses are retiring in record numbers. In the coming months and years, retention of the nursing workforce has to be the industry’s number one priority. Here are three ways to achieve that goal.
Focus on culture over messaging. While the campaigns referring to nurses and other healthcare workers are well-intentioned, the respondents in our survey have made it clear that this label is harmful. Moreover, when held up next to the finding that the overwhelming majority of nurses feel that their mental health isn’t supported by their facility or the industry at large, it can feel hollow. Hospitals who focus on gestures like yoga classes or pizza parties over substantive workplace changes risk making nurses feel that they are simply being placated, rather than truly supported. Culture changes should be informed by listening that starts at the top of the organization and might include strategies meant to address bullying and incivility, education and coping mechanisms for compassion fatigue and moral injury, and comprehensive support for nurses who are experiencing acute mental health issues.
Rethink nurse staffing. The industry’s thinking about nurse staffing ossified years ago, and hasn’t evolved in response to more widespread generational changes in attitudes about work. Millennial and Gen Z nurses want more flexibility around their careers, and the ability to try different things. New technology is being built that will allow hospitals to push out extra shifts to full-time nurses and local per diem nurses so that they can easily take on additional work when they want it and get the experience that comes from floating to other units. The industry also needs to stop treating contingent labor like second-class citizens, and focus on creating a work environment that leverages travel nurses’ unique experience and expertise, and keeps them coming back. Fifty-seven percent of the nurses in our study said that the number of roles available to them had increased over the last year, which means that hospitals can’t afford to treat any of their staff -- full-time or contingent -- as disposable.
Create new opportunities for nurses. The write-in responses from nurses who reported feeling less committed to the profession indicated that many are simply looking for a new role within the field. This should be a clear signal to hospitals that they need to identify opportunities in less acute settings or away from the bedside for those who want it. Technological advances like telehealth, remote patient monitoring and eICUs can help us better leverage the skills of each nurse while still delivering a high standard of care. Career planning also needs to be a priority and focus less on simply moving nurses up the career ladder, and more towards tailored programs that map to each individual’s career goals and preferences.
