4 Ways Nurse Leaders Can Effectively Retain Staff

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By Carol Davis

One of the most common practices among nurse leaders to improve retention is employee rounding—so much so that the time-consuming practice has been “hard-wired” into leadership routines.

Problem is, rounding as most nurse leaders conduct it, is generally useless, according to research by, in part, the American Organization of Nursing Leadership (AONL).

That was one of the findings in the study, Connection is Retention: Lessons from Leaders with Unusually High Nurse Retention, conducted in March 2023 by AONL and Crucial Learning. The research studied 1,559 nurse managers and 562 clinical staff at hundreds of U.S. hospitals to discern the drivers behind high levels of nurse turnover.

“The first surprise was that employee rounding—a practice intended to connect clinical staff to their managers with regularity and purpose—had no effect on whether nurses were likely to quit their jobs within the next three years,” the report states. “In fact, employee rounding seemed so irrelevant that employees often didn’t seem to know it had happened.”

Indeed, while 81% of managers in the study reported that they round regularly, only 36% of clinicians say their managers round regularly.

“As we dug into this curious and concerning inconsistency, we concluded that the most likely explanation for the gap is that rounding is being done in a way that is meaningless to the real concerns of frontline nurses,” says Joseph Grenny, lead researcher and Crucial Learning co-founder.

Instead, the study found that nurse managers with surprisingly high retention of their staff were “preternaturally effective” at creating connection with their nurses by offering three things:

  • Care: I feel a sense of belonging and believe my manager cares about me as a person.
  • Growth: My manager takes an active interest in my personal and professional growth.
  • Help: My manager steps in to help when I need it.

Nurses who reported that their nurse managers offered care, growth, and help were more than 80% likely to intend to continue with their work indefinitely, the research indicates.

“One common argument for employee rounding is that frequent structured contact should help nurses know leadership cares about them, is there to help, and invests in their growth. But once again the study found no relationship between consistent reported rounding and perceptions of care, growth, and help,” the report notes.

How to connect

As researchers reviewed nurse experiences that led to both connection and disconnection, four manager best practices emerged, according to the report.

1. Connection is about feeling not frequency. Connection is not made from a certain frequency of interaction. Rather, what created connection was some meaningful moment—an interaction that showed presence, planning, personalization, or follow-up—in a way that made it stand out.

2. Always Be Collecting Dots (ABCD). The report referenced hospitality guru Danny Meyer, who creates connection with his hundreds of thousands of daily guests by advising his employees to always be collecting dots.

“Every time you interact with anyone, they generate dots of information about what’s going on in their life,” he says. “Your job is to collect these and connect them in how you respond to customers to create a special experience for them.”

Great nurse managers do the same, the study says, by taking note of conversations with their nurses about family, interests, or work challenges.

“These dots are leadership gold, if the manager records them, reflects on them, and uses them to inform ways they can show care, facilitate growth opportunities, and offer help,” the researchers write.

3. Connection = Sacrifice. People perceive you value them when you show you’re willing to sacrifice things valuable to you, such as time, money, or other priorities. It doesn’t require a vast amount of sacrifice; just enough to show you value care, growth, and help.

4. Don’t make promises you can’t keep. Keep the promises you make. “Even the smallest broken promises damage perceptions of care, growth, and help far faster than equivalent promises kept,” the authors write. “Better managers are crystal clear about commitments made and impeccable about keeping them. When, on rare occasions they break them, they quickly acknowledge the transgression and find ways to make amends—without waiting to be confronted.”

These recommendations should help overloaded nurse managers create teams of engaged and satisfied nurses, says Robyn Begley, DNP, RN, NEA-BC, FAAN, one of the report’s authors and CEO of AONL.

“We recognize these recommendations might sound daunting to already overwhelmed nurse managers. They should not,” Begley says. “The first two don’t require time; they simply require thought.”

“In fact, the first—connection is about feeling not frequency—suggests that time spent today in ritualistic employee rounding might be recovered and repurposed. Our study suggests that replacing any recovered time with the second two activities will yield dramatically different results in engagement and retention,” she says. “These are things managers are doing consistently and successfully in units just like yours and if replicated, will make a difference in your team.”

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.