How to Attract (and Keep) the Best Employees

Employee turnover is a critical issue for hospitals, and it’s not just a human resources problem.

Statistics reveal the startling realities of healthcare employee retention, including an average hospital turnover rate of 17.2 percent nationally. From recruiting to training, temporary staffing and termination costs, replacing a single registered nurse (RN) can cost up to $88,000, with total RN turnover costing large acute care facilities up to $6.4 million annually, according to the 2015 National Healthcare Retention and RN Staffing Report.

Beyond direct costs, high employee turnover hurts team morale. Studies suggest it may also lower the quality of care.

ManagementMatters_Cox“One of the things that really made the staff trust us is knowing that managers will come out and help when there’s a need.”

— Sherry Cox, RN, BSN

So how can managers build—and retain—rock star teams? According to leaders in the emergency department (ED) at Tennessee’s TriStar Hendersonville Medical Center, where turnover is just 5.6 percent, it comes down to three core elements: smart hiring, prioritizing cooperation and being proactive about employee satisfaction.

Step 1:

Hire the Right People 

“We’ve been very strategic in how we approach building a team,” says Sherry Cox, RN, BSN. Now HCA’s director of Key Acquisition and Development for Emergency and Surgical Services, Cox has spent the last 18 years as a director in various roles at TriStar Hendersonville.

In making hiring decisions, Cox looks for integrity, intellectual curiosity and a commitment to serving the community. And, a positive attitude is paramount.

ManagementMatters_Scott“I can teach anybody skills, but what I care about is your attitude. Can you get along with people? Do you have a passion for doing the right thing?”

— Melony Scott, RN, BSN, CEN

“We want that person who comes to work every day to do so with an attitude that today is going to be a great day,” she says.

Melony Scott, RN, BSN, CEN, who worked closely with Cox before recently taking over as director of Emergency Services, also focuses on a person’s outlook.

“I can teach anybody skills, but what I care about is your attitude,” Scott says. “Can you get along with people? Do you have a passion for doing the right thing? To me, a stellar employee is one who understands the concept of having your coworker’s back.”


Scott relies on behavioral questions during interviews, asking nurse candidates how they would handle angry patients or disagreements with physicians. Peer interviews are also involved, with each interviewer writing separate evaluations before talking with coworkers.

She also seeks input from those who have previously worked with a candidate. While this doesn’t make or break her decision (and she does give prospective hires a chance to address any negative feedback), it provides valuable insight into how a person interacts in a team setting.

Scott says you have to be willing to pass on candidates who aren’t good fits, even if their resumes are impressive.

“Just because you’re smart doesn’t mean you know how to use that to help people,” she says. “You can look really good on paper and have the worst attitude in the world.”

Step 2:

Set Clear Expectations

According to Darlene Cleveland, RN, BSN, who’s worked at TriStar Hendersonville for three years, management sets a clear expectation that staff members always help each other.

ManagementMatters_Cleveland“Even on busy days, we still pitch in and help one another. If someone gets three new patients at once, we all help that person catch up and ensure that his or her patients get immediate care. We don’t leave anybody on an island.” 

— Darlene Cleveland, RN, BSN

“Even on busy days, we still pitch in and help one another,” Cleveland says. “If someone gets three new patients at once, we all help that person catch up and ensure that his or her patients get immediate care. We don’t leave anybody on an island.”

Rather than assign blocks of adjacent rooms to nurses, assignments are staggered so nurses have to walk by each other’s rooms, with the expectation that they’ll fill in for one another when needed.

HealthTrust Workforce Solutions℠

StaRN Program Addresses Nursing Shortages, Provides Specialty Training

One of the healthcare industry’s largest staffing challenges is a nursing shortage caused by the disproportionately aging labor pool. Compounding the problem is that newly graduated nurses are having trouble getting their first job because they lack the experience hospitals require.

“Nurses in general are in short supply, especially competent specialty nurses,” says Tony Pentangelo, executive vice president of managed services for HealthTrust Workforce Solutions℠. “And many new graduates can’t get jobs because they aren’t qualified to start taking patient loads on day one.”

While some hospitals may hire new graduates, they then take on the cost of training and orientation, which can last for weeks at sizable expense.

What often happens, Pentangelo explains, is that hospitals use sign-on and shift bonuses to lure qualified nurses away from competitors, creating vacancies at those facilities. This “stealing from competitors” cycle will never solve the dilemma, he says.

“The demand for nurses is going up and up,” Pentangelo says, “but nothing has been increasing the pool of qualified nurses.”

In response, HealthTrust Workforce Solutions℠ added the Specialty Training Apprenticeship for Registered Nurses (StaRN) program. The innovative program offers training for new graduates who lack work experience. The 13-week program offers a combination of classroom, preceptor and simulation training. Instructors can test and track the new nurses’ progress as they develop applicable skills while working on computerized cadavers. Participants are also given the opportunity to make clinical rounds in the hiring facilities.

Since StaRN nurses are on the Parallon payroll during the program, hospitals don’t incur the expense of orientation and training. Rather, the hiring facility only pays Parallon a placement fee for new nurses. Parallon executives estimate the program can lead to $100,000 or more in savings per nurse per year when using a StaRN graduate.

“Hospitals get nurses who are specialty trained and more competent than new grads, and orientation time is reduced because they come to the facilities with orientation completed,” Pentangelo says. “The time to proficiency in the unit is significantly less.”

“Parallon’s StaRN program addresses a critical industry issue by increasing both the quantity and the quality of skilled nursing resources most in demand by hospitals,” says Brendan Courtney, president and CEO of Parallon. “By bridging the gap between classroom theory and clinical care in ICU, PICU and OR, Parallon can deliver nurses with the practical knowledge and work experience needed to make an immediate positive impact on patient care.”•

In addition to designing the workplace around cooperation, Scott says you have to be clear that bad behavior isn’t tolerated.

“We don’t allow cliques, we don’t allow people to mistreat one another and we don’t allow people to talk harshly about one another,” Scott says.

Whenever Scott sees a rift developing, she immediately calls a meeting, emphasizing that managers be fair and listen to all sides. Her strong stance comes from personal experience in a broken department, pointing out that even one or two people can destroy an otherwise great team.

“If you allow cliques or disruptive behavior to start, it becomes corrosive,” Scott says. “It will eat away at everything positive you have built.”

Step 3:

Commit to Staff Satisfaction 

Managers are often under pressure to minimize payroll costs, but Cox notes that maintaining appropriate staffing is critical to supporting your team.

“We’re very attentive to our staffing needs,” says Cox, adding, “It’s important that the crew knows they have enough staff to do the job.”

She says department leaders also need to be willing to leave their offices and help when things get busy or chaotic, and she empowers staff to call management any time day or night if there’s a situation where they truly need help.

“I think that’s one of the things that really made the staff trust us, knowing that we would come out and help when there’s a need,” Cox says.

Cleveland agrees that having leaders who jump in has a big impact on team morale.

“Some days, we’ve got so many patients we may not have time for lunch. When leaders notice that and give us a break, that makes our attitudes totally different,” Cleveland says. “Keeping us fed is keeping us happy.”

In addition, Cleveland says management makes a genuine effort to accommodate scheduling needs, and that employees are always willing to pick up shifts for one another.

“The flexibility is there for us, and that makes a huge difference,” Cleveland says.

Staff members also point to leadership’s focus on giving authentic praise, an area where Scott says some organizations struggle. Managers should take every opportunity to pass along positive feedback.

Ultimately, Cox and Scott believe management’s role is to help team members grow. That means connecting a person’s interests to professional development opportunities, as well as helping people overcome fears and obstacles.

Being more intentional about hiring, creating a team culture and boosting employee satisfaction all take serious effort. But for Scott, the benefits go beyond simple statistics.

“It’s amazing how connected and committed our team has become,” she says. “They know we’re a family, and we take care of each other.”

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