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Three Selection Strategies to Reduce Nursing Turnover

December 17, 2015

The Institute of Medicine recently concluded that nurses will play a central role in realizing the vision of the Affordable Care Act. A nursing shortage may make it hard to realize that vision. Nursing turnover – losing the nurses you’ve worked so hard to recruit – compounds the problem. You can only throw so many healthcare staffing and nurse recruiting resources at the problem. That's why it is important to develop a nursing talent strategy.162578816

How much does nursing turnover cost? The cost of turnover is 1.5 times the base salary for exempt employees. The average hospital is estimated to lose about $300,000 per year for each percentage increase in annual nurse turnover.[1] Consider a hospital with 2,000 employees of whom 35% (700) are nurses. Average annual base salary is $67,000 and annual turnover is 20%. Assuming turnover cost of 1.5x average annual base salary, reducing turnover by a mere 5% would result in $3,517,500 annual savings.

Improving turnover is a complex endeavor that may require multiple strategies:

  1. Increase the candidate pool through education and outreach programs
  2. Clarify work expectations during recruiting and on-boarding
  3. Allow nursing to have input on critical issues
  4. Support career development
  5. Optimize scheduling and schedule flexibility
  6. Place and train better managers
  7. Build teamwork and don’t tolerate lateral violence
  8. Ease the administrative burden on front line nurses
  9. Reward superior performance and address under-performance

The best place to start is by hiring the right people in the first place and the most successful organizations do a better job selecting nurses by understanding the nurse hiring trends developing a nursing-specific selection program. Here is a three-pronged approach to get started:

  1. Define important behavioral competencies. Traditional selection strategies do an adequate job evaluating knowledge, training, and technical skills. Where they fail is in the areas of motivational fit (work schedule, pace of work, amount of autonomy or teamwork, and time spent with patients), and behavioral competencies. These include emotional intelligence, collaboration, patient focus and adaptability.

  2. Become better at interviewing candidates. Traditional, unstructured interviews have no predictive validity. You may as well flip a coin. Just having an interview guide is not enough. There is an art and science to interviewing and managers need to understand the importance of this task and hone their interviewing skills.

  3. Proven behavioral assessments. Nearly 75% of successful companies in other industries increase their odds of selecting the right candidate, and reducing turnover, with pre-employment behavioral assessments. Healthcare is catching on. Nothing is more effective at evaluating motivational fit factors and behavioral competencies than a well-designed, nursing-specific assessment designed for selection. Beware of off-the-shelf, generic personality assessments. They are rarely designed for selection, or place enough emphasis on healthcare-specific competencies. The right tool, however, allows the hiring manager to focus their interviewing time on the right candidates.

For more information, download our free Whitepaper:

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Related Topics

[1] What works: healing the healthcare staffing shortage, PriceWaterhouseCoopers, LLP, (2007).


Bryan Warren Bryan Warren was the former Director of Healthcare Solutions at PSI. He was responsible for developing and promoting tools and services designed specifically for the unique challenges faced by healthcare organizations.