Best Practices for Minimizing Nurse Turnover

February 8, 2011 ( – A report from PwC Saratoga, a division of PricewaterhouseCoopers, says hospital systems looking to drive improvement in their first-year nurse retention must start by understanding the current drivers of turnover.

PwC Saratoga interviewed hospital systems that reported low nurse first year turnover rates in a comparison of more than 40 systems that participate in PwC Saratoga’s Human Capital Effectiveness Benchmarking Report and five practices were repeatedly mentioned as having the greatest impact on minimizing nurse first-year turnover. All of the best practice systems were able to drive change through first understanding the root causes of turnover (e.g. supervisor issues, work team, etc.), according to a press release.    

In addition, these organizations measure the success of the programs they institute, and are committed to understanding how to continuously improve the selection, hiring, and onboarding processes. 


The press release said the five best practices are: 

  1. Competency-based interviews/selection testing based on a standard set of questions to identify whether candidates have the desired qualities and skills.  One system, which uses assessments that vary by job classification, has developed a “grading” system in which it can hire “B” or “C” level candidates for certain roles but is required to hire only “A” candidates for others.  These systems have found a correlation between those who meet the requirements of the upfront selection process and lower turnover. In addition, systems are increasingly concerned with whether candidates fit into the organization along cultural and ethical lines.  Common methods of assessing fit include using behavioral questions and involving other nurses in the interview process, often in a team interview setting.  The interview process at one system also includes job shadowing as a method for the candidate to gain firsthand perspective into the work environment and culture.  This also helps the hiring team assess whether the candidate is an appropriate fit. 
  2. Relationships with nursing schools and a robust nurse resident program. All hospital systems with nurse resident programs consider their programs highly effective.  The nurses hired from these programs are generally strong performers because the systems are able to assess their clinical performance prior to hiring them permanently.  These nurses are also less likely to leave the organization given that they are very familiar with the culture.  One hospital system fills the majority of its nursing positions from its nurse resident program, which pays for participants’ tuition.  The program begins after the first quarter of school and offers flexible hours.  Program participants attend orientation with other employees and are partnered with preceptors. Another system offers outreach to nursing graduates in the form of networking and career workshops (even during periods when hiring freezes went into effect because of the economy). These events provide a forum for nurse graduates to network and stay connected to the industry and the region as they search for employment opportunities.  In addition, the system is able to stay ahead of its competitors by strengthening its pipeline of potential candidates and developing its employer brand. 
  3. Extensive orientation and employee feedback. New nurses are encouraged to maintain contact with and provide feedback to human resources staff through orientation programs that last up to a full year. Orientation may be customized by department/unit, and touch points typically occur after 30/45 and 90 days, six months, and a year. One hospital system offers a week of central orientation followed by additional orientation with the same group of employees at 45 days and 90 days.  At 45 days, nurses are asked to complete a questionnaire on their level of satisfaction and to identify concerns (i.e. regarding their supervisor or interest in transferring to a different unit).  Another system conducts “re-interviews” at three and ten months to ensure that individuals are satisfied with their current positions and that they see a fit with the culture/environment of their units. 

4. New hire support programs. Beyond orientation and preceptor relationships, hospital systems are ensuring that new nurses have access to individuals who can provide confidential support and guidance. In many systems, this is in the form of a "buddy" who is not a supervisor. 

5. Measurements to drive accountability. Hospital systems indicated they use metrics to drive retention and programs that support retention. One system tracks data on turnover, employee engagement, and patient satisfaction on a unit level and will initiate interventions for units that do not meet their turnover metrics.  Another system measures key performance indicators (KPIs) addressing retention and operations (i.e. patient satisfaction).  Senior management selects these KPIs each year, and the ability of employees to achieve the goals is tied to a bonus-sharing program.   


PwC noted that first year nurse turnover is an area that concerns many hospitals.  Besides the associated out-of-pocket costs, the constant churn has many other negative impacts that can create a poor environment for delivering quality patient care.  Many of the systems with which we spoke indicated that the ability to manage retention of this critical population occurs before the individuals even begin their first day of work and does not end after 30 days of service.  

More information is at