In my travels across the country, nurse leaders raise one concern again and again: nurse turnover. Hospitals and health systems are struggling to retain nurses—especially nurses early in their career.

This is a big red flag given the impact turnover has on productivity, staff morale, and maintaining quality and safe standards of care, not to mention the costs: every nurse that turns over costs the organization approximately 1.5 times his or her annual salary.

Here are three retention questions I’m hearing a lot on the road, along with my responses.

1. Why is our organization losing so many young nurses?

If you’ve read anything in the popular press about the 21st century workplace, it’s hard to miss the buzz about millennials—namely, that they’re fundamentally “different” from their older peers. Nursing leaders reading these headlines, struggling to keep young nurses, are asking: Are millennial nurses’ expectations about work so different from other generations’?

There are some fundamental differences between young nurses and their older peers:

• Millennials are early in their careers, so they have fewer past work experiences to compare to their current job. One bad patient event or conflict with a teammate can have an outsized impact on how they feel about your organization.
• They think in pretty short-term increments, because they haven’t been in the workforce very long. Waiting six months for a new growth opportunity is, from their perspective, far too long.
• They have more opportunities than ever to work outside acute care hospitals and health systems. They can choose to work in retail care, health IT start-ups, consulting firms and all sorts of other different-in-kind care delivery sites outside the four walls of acute care (many of which we have built ourselves).

You're losing young nurses not because they are “a generation of idle trophy kids” (Jennifer Graham, Boston Globe), but because they are responding rationally to their environment: if they’re not feeling great about their job, they can easily pursue other options—often outside your organization.

2. Staff engagement has never been better. Why does our organization continue to struggle with nurse turnover?

Traditionally, the number one thing hospital leaders can do to retain nurses is to improve engagement. Many of you have seen your engagement rates improve in recent years—including among young nurses.

This begs the question: Why are engaged, young nurses still leaving our organization? It’s because they are engaged—but not loyal. Let me explain.

In theory, engaged staff stay in their jobs, and disengaged staff leave. But that’s not always the case. Consider an older nurse putting in her last year or two before retirement—she’s not leaving your organization to start fresh, but she might not be going the extra mile anymore to help the organization succeed. She’s loyal, but not engaged.

The inverse can also be true: an employee can be engaged but not loyal. Our National Engagement Database, which includes more than a million responses, shows that millennial nurses fall into this category. They’re engaged, but they haven’t made any plans to stick around for the long haul.

Once these nurses have been with your organization for four years or more, the gap between engagement and loyalty gap closes—in other words, it appears engagement does the job of retaining these staff once they’ve been with you long enough to feel connected to your organization.

3. Will investing in a nurse residency program solve our turnover problem?

It will help—but it won’t solve the problem. Nurse residency programs significantly improve retention in year one, but not as much in years two and three (Ulrich B et al., 2010). To retain nurses past the first year, leaders have to bridge the ‘gap’ between the end of the residency program and years four or five, when nurses have established themselves at the organization.

Part of the problem is that most programs end at (or before) the end of a nurse’s first year with the organization. But the end of year one can be a time when young nurses are still vulnerable to turnover.They’ve just accumulated the clinical experience they need to be recruited by your competitors, but they haven’t worked with you long enough to feel connected to the organization.

To strengthen ties between millennial nurses and your organization, you need to extend the most valuable elements of your onboarding and residency programs—such as mentorship and exposure to new experiences—beyond the end of these programs. Young nurses are more likely to stay if you support them emotionally and invest in their careers during their early tenure.

Want help creating a millennial retention strategy at your organization?

Across the last six months, our research team focused on the challenge of retaining early-career millennial nurses. We’ve collected a set of best practices (with proven results) from organizations across the country that equips leaders to win millennial nurses’ loyalty, while giving managers the tools to detect and address flight risk.

Already a member? Email our Nursing Executive Center faculty to learn more about how we can work directly with your staff to develop an organization-specific set of solutions that reflect your top priorities.

Not a member? Email a member of our team to learn more about how our experts can help your organization create a millennial specific retention strategy.