Hospitals, Providers

Why So Many Nurses Are Fleeing Healthcare — And How Hospitals Can Address The Problem

Nurse managers being too busy to train and support their team members is one of the biggest reasons nurses are exiting the healthcare industry, according to a new report.

Nearly one-fifth of nurses are projected to leave the healthcare workforce by 2027. The American Organization for Nursing Leadership published a report revealing one of the biggest reasons nurses are exiting the industry: their managers are too busy to train and support them.

AONL released the report last week in partnership with Laudio, a startup that provides software to automate administrative tasks for frontline nurse managers. The report was based on Laudio’s dataset, which comprises more than 50 acute care hospitals and hundreds of ambulatory and clinic facilities across the country. The dataset includes 8,106 nurse managers and 105,862 employees, with most of these employees working in an inpatient setting.

Nurse managers play a vital role in nurse retention, patient outcomes and hospital innovation, pointed out Robyn Begley, CEO of AONL and chief nursing officer at the American Hospital Association. These managers are also responsible for administrative responsibilities crucial to the functioning of hospitals and health systems — such as scheduling, compliance, recruiting and coaching, she noted.

“Organizational excellence is only achieved through unit level excellence,” Begley stated. 

She added that nurse managers provide “invaluable support” and mentorship to direct care nurses. The report found that nurse turnover levels are significantly lower when nurse managers have consistent, meaningful interactions with the members of their team.

“The most impactful interactions involve timely and personalized recognition of the real work frontline team members do daily, ideally when directly connected to a unit’s outcomes,” Begley explained. “Recognizing accomplishments and celebrating team members’ personal milestones help team members feel valued and engaged.”

For the average hospital nursing team, one meaningful interaction per team member per month can reduce nurse turnover by 7%, the report showed.

The report also noted that elevated spans of control limit a manager’s ability to engage in those important interactions. The term “span of control” refers to the number of direct reports assigned to a nurse manager.

“High spans of control leave managers stretched thin, making it difficult to frequently engage, support and mentor every member of their team,” Begley remarked.

The median span of control for inpatient nurse managers in the report’s data set is 46 direct reports, and the 75th percentile is 78 direct reports. The report noted that these values differ depending on the specialty. Emergency departments have the highest median spans of control at 83 direct reports, and inpatient therapies and transplant departments have the lowest median lowest at approximately 15-25 direct reports.

Nurse turnover is usually reduced when assistant nurse managers are added to teams with a high span of control, the report said. However, having too many nurse managers can be ineffective and even associated with higher turnover — the report noted this could possibly be a result of a lack of role clarity. 

For larger nursing teams, hospitals should hire assistant nurse managers to offset manager workload — and there must be a clear understanding of the definition and scope of the assistant manager roles to maximize their impact, Begley said.

Hospitals should also try to reduce nurse managers’ span of control when possible. The report pointed out that it might sometimes be a good idea to turn one large department into two smaller ones.

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