How Cultural Initiatives Can Be Key to Retaining Nurses

May 15, 2023
University of Michigan-Health West senior nursing leaders Steve Polega, R.N., and Kate Veenstra, D.N.P., look at the complex issues around nurse retention--and what must be done going forward in hospital-based organizations

For all the well-documented stress nurses face on the job, some tragedies cannot be numbed. Recently, a young person passed away in our intensive care unit. Her family stood by her bedside and did not leave as she was wheeled out of the room to have her organs harvested for donation.

The “Honor Walk” is a nationally recognized ritual for the families of deceased organ donors, who are often young. Their families have described the accompanying walk from the death bed to the operating room as lonely and difficult. To support the family of the deceased, a team of nurses traditionally lines the hallway to make the moment less solitary, and hopefully a little easier. Before this particular Honor Walk, our ICU manager advised the nurses what they were about to feel. It would not be easy.

Honor Walks hold a reciprocal benefit to the hospital staff as an organic bonding moment. It is natural to relate to patients as someone we know ― a daughter, an uncle, a friend ― and difficult to process their loss when these associations are fond. Processing each loss together imbues a sense of family among overextended co-workers.

The dire statistics around nurse burnout and retention are familiar. By September 2021, 66 percent of nurses had considered leaving the profession, according to the American Association of Critical Care Nurses. One year later, half were still considering leaving, according to ConnectRN. Yet another post-pandemic survey revealed the desire to quit extends to nurses young and old.

Strategies for managing the nationwide nursing shortage are many. Actionable success stories are relatively few. At our hospital, no nursing team leaders have left since the beginning of the pandemic. This cannot be owed to a single practice or program, but to a process of trial and error that ultimately birthed a series of small measures that helped re-humanize the job. Each initiative shares a common goal of helping staff heal and feel safe. Not all have stuck around. Some, like the Honor Walk, have worked better than others.

Start with CISM (critical incident stress management), a heuristic for responding to extreme circumstances in a healthcare setting like a violent patient, the sudden death of a fetus or NICU patient, or any unexpected tragedy. Prior to the pandemic, CISM was emerging as a standard of care. Critical incidents involving mental health and traumatic stress have demanded extra attention ever since. These incidents are emotionally taxing on a nursing team, but where can they take their emotions?

Our CISM protocol included bringing the staff together for a post-incident debrief: a time for nurses to gather and discuss the shared experience and how they felt. A team of trained facilitators, led by our chaplain department, leads each session. Allowing nurses to talk through their stress has helped prevent burnout. The chaplains, case managers and social workers who comprise our facilitators are familiar to the nursing staff. Whenever clinicians can lean on one another, it enhances the team dynamic.

Once, we devoted an entire day to a “Heal to Healers” session led by psychologists promoting wellness, resilience, and healing. The protocol was developed by university psychologists to combat symptoms of post-traumatic stress disorder. Staff sat around tables with others from similar departments, and were given space to be vulnerable about their shared experiences. Nobody wanted to leave the conference. Another session has been planned for our forthcoming Nurses Week in May.

We also re-instituted a mental health wellness program, which provides space for people to talk 1-on-1 with licensed clinical social workers on our staff. The program was short-lived, but it was particularly helpful during the height of the COVID-19 pandemic.

Each initiative helped us to define our new normal, and take us out of the 24-7 “survival mode” that began with the pandemic. The unexpected result was a shared sense of ownership in the staff culture. That might sound quaint compared to the very real economic challenges facing the healthcare industry. Hospitals are being asked to slash millions of dollars from their budgets, to do more with less while supply-chain issues further erode their bottom line. Approximately half of all hospitals reported negative profit margins in 2022.

Against this backdrop, retaining nurses is the rare imperative that benefits both a hospital’s bottom line, its staff, and its patients. Cultural initiatives cannot solve the nursing crisis, but it can enrich the work environment for a profession in peril.

Steve Polega, RN, MHA, has served University of Michigan Health-West since 2012 as its Executive Vice President and Chief Nursing Officer. Previously, he was UMH-W’s Director, Emergency and Urgent Care Services. Steve obtained his Masters in Health Administration from Ohio University. He is also a veteran of the U.S. Navy and has more than 23 years of experience managing and improving the delivery of healthcare in acute care, ambulatory, and inpatient settings.

Kate J. Veenstra, DNP, RN, CNL, CMSRN, ACM, NEA-BC is University of Michigan Health-West’s Associate Chief Nursing Officer and Vice President of Nursing. She previously served as the hospital’s Director of Case Management, Social Work and Spiritual Care, as well as a clinical nurse leader, clinical coordinator, nursing administration shift supervisor and registered nurse. She received her Doctor of Nursing Practice from the University of Michigan-Flint and is a longtime mentor to new nurses and nursing leaders.

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