What's driving nurse satisfaction?

According to a recent survey from the American College of Healthcare Executives, hospitals CEOs cited staff shortages and burnout as their top problem, with 90% saying that nursing shortages are a particularly acute issue.

In 2021, the total number of RNs in the United States dropped by more than 100,000 workers, the largest decline observed in over 40 years. This decline was largely driven by younger RNs under the age of 35. If nurses continue to leave the workforce, research suggests that the U.S. healthcare system could see a shortfall of up to 450,000 nurses by 2025, or 20% fewer than what the nursing workforce requires for patient care.

To understand how nurses feel about their workplaces, the authors identified 200 of the largest healthcare employers in the United States, including hospitals and health systems, home healthcare providers, senior living facility operators, and staffing agencies. For each employer, the authors calculated how nurses rated the organization and senior leadership on Glassdoor.

Among the employers, nurses' Glassdoor ratings ranged from 2.6 to 4.9 on a five-point scale. Nurses' ratings on how well senior leadership performed before and after the pandemic also ranged from 2.1 to 4.9 on the same five-point scale.

The authors also analyzed 150,000 reviews left by nurses on job employment sites like Indeed and Glassdoor to understand their potential job satisfaction. The reviews were collected from the beginning of the pandemic through June 2023.

For each review, the authors analyzed whether it mentioned one of 200 topics and assessed whether the nurse spoke about the topic positively or negatively. The topics were based on different elements of employees' experiences, such as culture, compensation and benefits, work schedules, and organizational support, and grouped together into 24 broader themes.

These themes were then used to predict nurses' overall ratings of their employers. Overall, compensation was the top predictor of job satisfaction among nurses who reviewed their current employer, followed by workload.

However, there were slight differences among nurses who reviewed a former employer. Among these individuals, the top predictor of their job satisfaction was toxic culture, followed by organizational support.

The authors noted that some factors had little to no impact on how nurses felt about their workplace and would be unlikely to improve their experiences.

"Perks are nice, but they will not compensate for a punishing workload or wages that fail to keep pace with inflation," the authors write. "Highlighting the corporate mission to promote patient health won't help much either. Nurses already know that their job serves a higher purpose; that's why most of them became nurses in the first place."

How organizations can improve nurse satisfaction

To help healthcare organizations improve nurses' work experiences and better retain workers, the authors offer four tips:

1. Don't rely on ratings alone to assess employee satisfaction

Many healthcare organizations use annual employee surveys with dozens of items rated on a five-point scale to gauge employee satisfaction, but the authors argue that these types of restrict what employees can discuss and do not leave room for why they chose a particular rating.

"Open-ended, free-text feedback provides a rich source of nuanced and actionable insights," the authors write. "When nurses can decide which topics to write about, they use their freedom to discuss what matters most to them."

Free-text feedback can also provide information on how pain points may vary for specific groups or for specific locations and allow organizations to provide more tailored interventions as needed.

2. Listen to former employees about where improvements can be made

Typically, organizations limit their surveys to current employees, but "ignoring feedback from former employees is a big mistake," the authors write.

By interviewing or surveying former employees, organizations can identify why they left and figure out the most effective course of action to retain their current workers. Organizations may also uncover blind spots that they previously overlooked.

3. Leverage your strengths to attract and retain workers

Some areas where nurses said staffing agencies performed better than hospital and health systems include efficient processes, resolving issues effectively, speed in replying to inquiries, transparency, and trust.

However, the authors note that hospitals and health systems have their own advantages, including learning and development opportunities, benefits, and colleagues. "Health care systems should invest in their comparative advantages and emphasize them when communicating their value proposition to potential and current employees," they wrote.

4. Consistently act on feedback to build trust

"Organizations need to put in place structures to consistently act on employee feedback," the authors write. When employees don't believe their managers will act on feedback, they're less likely to bring up issues or offer potential solutions. Workers are also more likely to quit if they believe management will not or cannot make changes based on their suggestions.

Overall, "[m]any organizations, including some of the largest employers of nurses, have significant room for improvement," the authors write. Leaders should be "aware of the magnitude of the gap between their organization's performance and what is possible when it comes to providing a healthy workplace for nurses." (Sull/Sull, MIT Sloan Management Review, 10/18)

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