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New Study Identifies Strategies to Retain Experienced Nurses (DS)

Innovative Staffing, Educational Opportunities, Wellness Benefits
Improve Retention of Nurses, Other Workers at Health Care Agencies

Health care organizations can use a variety of strategies, many of which are simple and affordable, to keep veteran nurses at patient bedsides, according to a new study sponsored by the Robert Wood Johnson Foundation (RWJF) and coordinated by The Lewin Group.
“Wisdom at Work: Retaining Experienced Nurses” finds that a number of health care organizations lowered turnover rates among experienced nurses by making a concerted effort to improve nurse morale and productivity. Innovative approaches to staffing, employee health and wellness programs, and training and development opportunities for veteran nurses are all effective in keeping them on the job.

“Wisdom at Work” finds that ergonomic initiatives, such as teams and equipment to help nurses lift patients and other heavy items, do not contribute to an overall drop in turnover among experienced nurses, but improve morale and cut expenses associated with work-related injuries.

The new study is a follow-up to the groundbreaking white paper, Wisdom at Work: The Importance of the Older and Experienced Nurses in the Workplace, commissioned by the Foundation in 2006. Veteran nurses provide quick and accurate assessments of patient health and well-being, maintain institutional memory, mentor less experienced staff, and more. Retaining experienced nurses is critical as the population ages, creating greater demand for hospital care. Nurses will be needed to provide much of that care, but today’s nursing workforce is aging and many nurses are approaching retirement.

“We know that there is no quick fix to the crisis in health care,” said Susan B. Hassmiller, Ph.D., R.N., F.A.A.N., RWJF Senior Advisor for Nursing. “But the initiatives explored in our ‘Wisdom at Work’ initiative are pieces of a larger puzzle that will help health care organizations keep experienced nurses from walking out the door—and taking their expertise with them—just when we need them most.” By 2010, nearly half of the nation’s registered nurses will be over 50, and many will be considering retirement.

The average cost to replace a full-time registered nurse at the 13 hospitals in the study totaled $36,567, a sum reflecting expenses associated with termination payouts, filling temporary vacancies, additional overtime costs, and hiring and training new staff. The loss of veteran nurses is especially costly.

“Wisdom at Work” also finds that health care and non-health care companies that have successfully retained experienced workers cite the following reasons for their success: sustained commitments by corporate leadership; corporate cultures that value aging; and compensation packages that cater to older workers, offering benefits such as phased retirement options and flexible work arrangements. It includes seven in-depth case studies examining strategies used by health care and non-health care institutions that have received recognition for their success in retaining experienced workers, as well as the findings from 13 separate research projects conducted from January 2007 to December 2008 to explore the impact of interventions aimed at retaining experienced nurses in hospitals.

It offers health organizations real life examples of simple, affordable and easily replicable strategies to keep nurses on the job and improve the quality of care. Successful initiatives include:

  • An innovative staffing model at Centra Health in Lynchburg, Va., where managers implemented a “closed” system to respond to dissatisfaction among nurses who were being assigned to multiple medical units. Nurses now have the option of staying in the same unit, and turnover rates fell roughly two percent since the practice began.
  • Continuing education opportunities at Pitt County Memorial Hospital in North Carolina, where experienced nurses were offered the opportunity to spend three days off-site re-envisioning their practice at the hospital.
  • Flexible work arrangements at Carondelet Health Network in Tucson, Ariz., which has a “snow bird” program that allows registered nurses to work for three, six or nine months at a time—a particularly attractive option among experienced nurses who are in Tucson for only certain parts of the year.
  • An “eldercare” program at Scripps Health in San Diego that helps employees provide in-home care to aging, sick or disabled family members.
  • An ergonomic initiative at Hillcrest Memorial Hospital in Greenville, S.C., where managers spent a modest sum on patient lift equipment; trained nurses in safe patient handling; and hired a “Nurse Ergonomist” to oversee patient care.
  • The creation of a “Leadership Cabinet” at Scripps Health, where nurse leaders advise administrators on important decisions and act as a conduit for employee concerns.


The 13 “Wisdom at Work” research projects were conducted in

  • Los Angeles, California: Impact of Reducing Physical Practice Burdens on Retention of Experienced Nurses at Cedars-Sinai Medical Center
  • Ft .Collins, Colorado: Impact of the Base Staffing Model on Retention of Experienced Nurses at Poudre Valley Health System
  • Tampa, Florida: Impact of a Lift Team on the Recruitment and Retention of Experienced Nurses at Florida Health Science Center
  • Atlanta, Georgia: The “Smooth Moves” Initiative to Retain Experienced Nurses at the Bedside at Saint Joseph’s Hospital
  • Aurora, Illinois: Impact of the ACT Nurse Program on Experienced Nurse Retention at Rush-Copley Medical Center
  • Naperville, Illinois: Impact of the Wellness at Work Lifestyle Change Initiative on Retention of Experienced Nurses at Edward Hospital and Health Services
  • Cooperstown, New York: Impact of the Admission Nurse Initiative on Recruiting and Retaining Wisdom at Mary Imogene Bassett Hospital
  • Rochester, New York: The Minimum Lift Program Initiative to Reduce Lost Staff Time Due to Patient-Related Injuries at Strong Memorial Hospital at The University of Rochester Medical Center
  • Greenville, North Carolina: Fanning the Flame: A Retention Initiative for Experienced Nurses at University Health System of Eastern Carolina
  • Greenville, South Carolina: Addressing Retention of Experienced Nurses While Promoting Safe Patient Handling at Greenville Hospital System
  • Nashville, Tennessee: A Comprehensive Evaluation of the “Smooth Moves” Safe Handling Program at Vanderbilt University Medical Center
  • Lynchburg, Virginia: Implementing a Closed Staffing Model as a Nursing Retention Strategy at Centra Health at Lynchburg General Hospital
  • Milwaukee, Wisconsin: The Virtual Intensive Care Unit as an Alternative Environment for Critical Care Practice and Experienced RN Retention at Froedtert Hospital

The seven case studies examined: Bon Secours Richmond Health System; Scripps Health; Carondelet Health Network; Monongalia County General Hospital; Mitre Corporation; L.L. Bean; and First Horizon National Corporation.

The Lewin Group served as the National Coordinating Center for this initiative and provided coordination, technical support and data collection and analysis for the “Wisdom at Work” evaluation. The Lewin Group also developed the seven in-depth case studies of high performing organizations. To view both, visit

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, we work with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years we’ve brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and health care of those we serve. When it comes to helping Americans lead healthier lives and get the care they need, we expect to make a difference in your lifetime.