Adam Chambers headshot
Adam Chambers

Registered nurses are the backbone of long-term care.

Make that the beating heart, if regulators’ call for 24/7 RN coverage in some settings comes into force. Nurses will become indispensable for those facilities’ survival should the political tide continue in this direction.

But recruitment and retention are challenges across all of senior living and care.

Retaining existing and new RNs is vital given long-term care providers’ recruitment woes: 95% of nursing homes experience difficult hiring, according to the American Health Care Association/National Center for Assisted Living. And overall, assisted living communities are short 40,000 workers compared with pre-pandemic employment numbers, NCAL said earlier this year.

In August, my company, Nurse Recruitment Experts, ran our first Nurse Retention Survey. We asked 2,000 RNs one question: what’s making you stay in your current job?

The results challenge perceptions that pay and benefits are pre-eminent and provide a more nuanced view of which aspects of culture are important to nurses. I’ve shared the highlights below. You can view the whole report and analysis by visiting our website.

The survey found that 80% of respondees mentioned one of five reasons for staying:

  1. Co-worker relationships (34%): Interpersonal connections in the workplace.
  2. Factors relating to familiarity (21%): Loyalty, seniority, uncertainty about the consequences of leaving, and the ability to find a better environment.
  3. Pay (16%): Compensation (excluding retention bonuses).
  4. Benefits (9%): Healthcare coverage, retirement plans and other perks.
  5. Other (20%): A fragmented range, headed by safe staffing, flexibility and convenience.

Why relationships with co-workers are crucial

Eighty percent of participants who mentioned co-workers included no other factors, whereas pay was listed as the sole reason by only 10% who mentioned it.

In senior living and care, nurses work closely with their colleagues in high-pressure, emotionally charged environments. Strong bonds with co-workers provide emotional support, camaraderie and a sense of belonging, all of which are vital for coping with the challenges of the job.

One respondent summed it up: “No bullying…co-workers that help each other…friends at work…a boss that respects you…working in an area or specialty you enjoy…feeling appreciated by patients and families.”

How to foster interpersonal relationships

The good news: This approach is not costly. The bad: It can have the opposite effect if implemented incorrectly. Encouragement of togetherness should be worked through nurse ambassadors and staff on the ground, rather than as a corporate mandate. (Zero respondents mentioned free boxes of pizza.)

Here are a few suggested strategies:

1. Keep it fun: 32% of nurses mentioned that co-workers commented on enjoying their company. Consider how you can foster a positive, enjoyable working environment among staff members.

2. Mentorship programs: Pair experienced nurses with newcomers, promoting knowledge sharing and relationship-building.

3. Discover why: Talk to your staff to uncover what they like about their team and what can be improved. Although you’re not responsible for people being friends, you can uncover how to create an environment that encourages bonds.

The importance of ‘familiarity’

The survey’s “familiarity” category challenges the commonly held, two-dimensional view of participation in company culture as subscription and interaction with an agreed set of values.

Rather, it suggests that instead of just staying for a positive culture, nurses don’t leave because they’re unsure about finding a better one.

One nurse said, “Partly loyalty, partly knowing that the grass isn’t greener anywhere. There is no perfect place to work. I am pretty committed to my patients that come in all the time.”

Administrators must consider that leaving is a big upheaval for their staff members. Implement policies to make them feel at home and make it easy to form relationships with both staff and residents or patients.

Secondary role of pay and benefits

Although pay and benefits were mentioned by a portion of respondents, they played a secondary role in nurse retention, as evidenced by the lower percentages. Further, retention bonuses, a commonly suggested solution, were mentioned by less than 2% of survey respondents.

This finding suggests that although competitive compensation and benefits packages are necessary, they may not be sufficient on their own to retain nurses. Instead, long-term care facilities should prioritize building a workplace culture that values relationships, loyalty and a sense of belonging.

To summarize

The survey data make it clear that success in retaining nurses goes beyond competitive pay and benefits. Co-worker relationships and factors related to familiarity play a significant role in nurse retention. Healthcare organizations should look to creating an environment in which friendships, community and a sense of belonging can flourish.

Nurses join facilities as strangers. They stay for their friends.

Adam Chambers is the president of Nurse Recruitment Experts (NRX). Since 2019, NRX has sourced and hired 10,000s of RNs, LPNs and CNAs for health systems across the United States and Canada. NRX focuses on amplifying clients’ employer brands and reaching a wider field of passive candidates.

Adam has sat on the Social Media Committee of the National Association of Healthcare Recruiters, the Healthcare Council of the American Staffing Association and currently is a member of ASA’s Direct Hire Council. His informational series, “Nurse Recruitment Secrets,” regularly reaches 11,500 healthcare human resources professionals monthly via its blog, newsletter, podcast and webinar content.

The opinions expressed in each McKnight’s Senior Living marketplace column are those of the author and are not necessarily those of McKnight’s Senior Living.

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