While previous generations of nurses tended to stay at the bedside for years, making a career in the acute care setting, today’s nurses tend not to do that. Organizations across the country consistently point out how difficult it is to retain bedside RN talent for the long term, especially millennial nurses. Multiple factors have contributed to this decline in bedside RN tenure.
Over the past few decades, the bedside RN role has become more difficult due to an increasingly complex care environment. Sicker patients now spend less time in the hospital, requiring RNs to deliver the same or more advanced care in a shorter time frame. This demanding practice environment—coupled with insufficient staffing levels intensified by the pandemic—has exacerbated nurse burnout. As a result, some RNs have exited the nursing profession entirely amid the stress of pandemic-era patient care and staffing shortages. At the same time, some experienced RNs have opted for early retirement.
Additionally, with myriad opportunities now available to nurses in the health care and broader labor market, many nurses view the acute care bedside role as a stepping-stone, not a destination. RNs are leaving acute care to get advanced practice degrees (e.g., becoming NPs), to work in ambulatory care settings with more flexibility and thus a better work-life balance, and to pursue roles in a different part of health care (e.g., at a payer organization). This is especially prevalent in new graduate RNs who are leaving the bedside after an average of just two years. 1 Since the start of the pandemic, RNs of all experience levels have left their organizations to pursue lucrative travel contracts that offer better pay and extended time off between assignments.
Ultimately, there are many reasons why nurses choose to leave the bedside role. To compete in the workforce market, leaders must develop a workforce strategy that doesn’t rely on waning nurse loyalty.
Mindset shift 1: Fully leverage the RNs you have, while you have them
Organizations must accept the reality of employees’ increased mobility. A lack of experienced RNs and high bedside RN turnover is the new normal. Executives need to tap their existing RNs and position them to lead, delegate, and care for patients most efficiently.
Revamp clinical ladders to reflect accomplishments, not tenure
In recognition of the loyalty challenges organizations face, leaders need to take a critical look at existing career development programs for RNs and tailor them to meet the reality of decreased bedside longevity.
Organizations can start by redesigning their RN clinical ladder to reflect annual awards and recognition based on performance, rather than gradual or cumulative awards based on tenure. Ensure clinical ladders and professional development opportunities respond to the reality of shorter bedside RN tenure instead of trying to fight it.
Support top-of-license practice to maximize the value of each nursing hour
To fully leverage the contribution of bedside RNs, leaders must include mechanisms to support top-of-license practice. Time spent on care activities that another member of the care team could safely execute prevents RNs from spending their time on responsibilities where they are most needed. In addition, unnecessary time spent on below-license work discourages RNs from working in the acute care setting.
For best practices on elevating the impact of the frontline nurse and to view the eight core attributes of top-of-license practice, see Achieving Top-of-License Nursing Practice.
Use virtual care to scale the impact of RNs
One way to support inexperienced RNs and retain experienced RNs, while simultaneously reducing cost and improving quality, is to provide virtual nursing opportunities. Organizations deploying this technology find that novice nurses benefit from the remote oversight and the clinical expertise of the experienced nurse in virtual roles. Virtual nursing roles allow leaders to retain RNs in a way that meets the organization's needs. In addition, these positions make organizations more competitive with virtual RN roles offered by out-of-industry employers.
Virtual RN roles can be used to scale experience in different care models, including the two models detailed below.
- Virtual expert nurse care model: In the virtual expert nurse staffing model, one virtual expert RN leads a care team that oversees
10 to 12 patients. 3 The rest of the care team varies but may consist of another RN, a CNA, and a patient care technician. Roles on the care team should be created based on patient acuity, organization preferences, and what staff are available in the local market. By implementing the virtual expert nurse staffing model, hospitals can see a 24% reduction in contract RN labor use and a 35% reduction in RN turnover. 4 This model of care also helped CHI Health—a 14-hospital health system headquartered in Omaha, Nebraska—realize labor savings of $4.7 million. For guidance on implementing the virtual expert RN care model, read our case study on How CHI Health Implemented a Virtual Expert Nurse Staffing Model.
- Virtual sitter model: In this model, experienced RNs are used as "virtual sitters." RNs remotely monitor the status of multiple patients, freeing up capacity for other frontline nursing staff and helping to avoid the use of more expensive labor to provide this level of care. For instance, one health system reduced patient fall rates by more than 25% and produced cost savings of $286,230 by using a 6:1 virtual sitter model. To learn more about this model, see how Mission Health significantly reduced patient falls and cut costs with virtual sitters.