The Retention of Health Care Workers in the Commonwealth
With the cost to replace an employee now estimated at between 150 and 200 percent of that employee’s salary, staff retention is a critical concern in the health care industry in Pennsylvania.
A potential shortage of health care workers has intensified the focus on retention as one of several steps necessary to maintain health care quality in the commonwealth.
The PCHC report, “The Retention of Health Care Workers in the Commonwealth,” concluded that improving retention requires addressing the overall workplace culture, with attention to issues such as work design, workforce development, safety and workplace relationships at all levels within the organization. Providing career opportunities and positive and productive workplace environments are additional key elements identified as essential to retaining health care workers and keeping them working in the industry in Pennsylvania.
The PCHC report is driving new initiatives in health care that can improve Pennsylvania’s workforce and serve as models for other industries:
- Training programs have been established to teach frontline managers skills to be effective “chief retention officers.”
- Close to 2,000 health care managers and leaders from 36 counties have completed supervisory and leadership development programs — “Improving Healthcare Through Supervisory Development” and “Improving Healthcare By Building a Retention Culture.”
- A two-day pilot program for frontline health care workers from the mid-state region, “Developing a Culturally Inclusive Workplace,” addressed the challenges of creating diverse, multi-generational work teams. This program is being rolled out this summer and fall across Pennsylvania.
- Best practices for retention and other health care workforce challenges were shared during a conference, “Redefining Excellence: Pennsylvania’s Best Healthcare Practices,” held in March 2008 and attended by more than 200 nursing and health care leaders.
The Journal of Nursing Administration calculated the cost of replacing nursing staff at nearly double the salary of a newly hired frontline nurse. And far more is at stake. Incumbent employees understand the company’s culture and work processes; they have a wealth of intellectual property that can’t be found in the new employee handbook. In addition, they have relationships with patients and other stakeholders who have confidence in their skills. Incumbent employees also are generally more productive than new employees or employees who are planning to leave the health care organization.
The retention report was prepared by the PCHC’s Retention of Health Care Workers Working Group, a public/private partnership that included representatives of hospitals, long-term care organizations, inpatient and outpatient providers, professional associations, labor and state agencies that came together to study the issue of retention.
Using national and state-level research, the group developed a set of recommendations to achieve a vision and set core principles. The recommendations are organized into six overall themes:
- Organizational culture — Address workplace factors that influence organizational culture such as communication, respect and intimidation, approaches to safety, workforce diversity, staffing patterns and decision-making processes.
- Transition from education to work and advancement — Address worker needs at two periods of transition that have critical implications for retention: the entrance of new graduates into the workforce and advancement opportunities for incumbent workers. New graduates experience a 35 to 60 percent turnover rate in their first year of hire, due in part to the stresses of feeling under-prepared for assignments and lack of support. 1 One cause of attrition of experienced health care workers can be addressed with clear opportunities for advancement within the health care organization. Well-publicized career ladders or lattices also have the potential to serve as a recruitment tool.
- Staff development — Ongoing education helps workers keep abreast of rapid changes in health care and achieve skills that enable them to provide high-quality care. Education also offers workers the chance to deepen their knowledge of particular topics or specialties.
- Leadership development — Leaders and managers play critical roles in retaining staff and in establishing a positive workplace culture. Investment in cultivating and developing strong leaders and managers at all levels has a high return for an organization, with positive effects for organizational culture, employee satisfaction and retention.
- Regulations and professional codes of conduct — Frontline workers can be greatly impacted by the body of regulations, requirements, programs, and processes affecting health care. Compliance with these policies can add to the workload of already busy health care employees. Professional associations could assist with addressing retention challenges such as employee-to-employee relationships. In particular, abusive behavior from other health care practitioners emerged as an important issue requiring attention.
- Retention data — Making information about retention research and best practices available to health care organizations throughout the commonwealth is critical. Organizations can learn much from the efforts of their peers as well as from research studies.
The work group is continuing to track positive outcomes from the report and support program models that address the six recommendations.
1 Hospital & Healthsystem Association of Pennsylvania. May 2004. "Internship and Residency Programs."
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