Editor's note: This popular story from the Daily Briefing's archives was republished on June 11, 2019.

By Rachel Schulze, Senior Staff Writer

Despite their best efforts, health systems are losing early-tenure millennial nurses almost as fast as they can train them, Marisa Deline, a practice manager with Advisory Board's Nursing Executive Center (NEC), told the Daily Briefing.

Given that millennials make up about a third of the nursing workforce, what can health systems do to reverse the trend? Read on to find out.

The trouble with turnover

Overall bedside RN turnover rose steadily from 2009 to 2015, landing at just under 12 percent in 2016. The rate of early turnover is particularly concerning: one-quarter of nurses who left their facility in 2016 had less than a year of tenure. Many of those departing nurses are younger than 35, an age group that comprises nearly one-third of the nursing workforce.

This rising turnover is concerning for health system leaders because every nurse that turns over costs employer about $90,000 to replace, according to Advisory Board research. Turnover also creates more work for the institution's staff: HR has to identify and screen new candidates, managers have to train new hires, and frontline staff have to absorb more work.

How millennials are different—and how they aren't

According to Deline, high turnover among millennials has "led many health system leaders to conclude that there is something fundamentally different about the youngest part of their workforce." However, "the surprising truth is that millennial staff aren't so different." When NEC researchers reviewed hundreds of thousands of responses in Advisory Board's National Employee Engagement database, they found that the top 10 engagement drivers for millennial nurses were "nearly identical" to those for all nurses, Deline said.

Their research did uncover one key way that millennial nurses are different from their older peers. Engagement usually mirrors loyalty: engaged employees of all ages are more likely to stay at their organization, while disengaged employees are more likely to leave. However, unlike other age cohorts, millennials are more engaged than they are loyal during their first three years at an organization. As a result, Deline said, "engagement is necessary but not sufficient to retain young nurses in their early tenure."

You need millennial retention tactics

This gap between engagement and loyalty is occurring at a time when nurses have more job opportunities than ever, Deline pointed out. If young nurse aren't satisfied with their job in one hospital, they can easily find work in another. They can also work in a clinic, for an EHR vendor, or an ambulatory surgical center. What nursing leaders need to adopt are tactics that will fast-track loyalty in their millennial workforce.

These tactics, Deline said, should be based on three realities of the millennial mindset: they have fewer past work experiences for perspective; they think more in short-term increments; and they have more opportunities than ever.

Your approach should include:

• Taking additional steps to foster a safe environment for new nurses, such as by conducting a float nurse civility survey, establishing a unit-based mentor program; and explicitly incentivizing staff to keep first-year turnover low; and
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• Promoting lateral mobility and long-term career opportunities so nurses don't feel stuck in their positions and know you are invested in their development, such as by establishing formal mechanisms to manage staff requests for unit transfers and hosting career pathing events with director- and executive-level leaders.

Millennial nurses are a third of our workforce—here’s how to retain them

In 2016, millennials surpassed Baby Boomers as the largest living generation in the United States. As more millennials have entered the nursing workforce, health care leaders have confronted a growing challenge: young nurses are turning over at higher rates than their older peers, especially early in their careers.

Use the strategies and best practices in this study to build a millennial-specific retention strategy for your organization.