Here are 10 ways to retain nursing staff

Are you aware of the latest statistics on the nursing shortage? A recent report from the General Accounting Office (GAO) found that the national unemployment rate for nurses is at its lowest level in over a decade. (For information on ordering the report, see "Sources and resources" at the end of this article.)

"The ED shortage is significant and will continue to see declining ranks, like many other specialty care areas," reports Diana Contino, RN, MBA, CEN, CCRN, president of Emergency Management Systems, a Monarch Beach, CA-based consulting firm that specializes in staffing issues. The report also cites regional nurse shortages in several areas of the country and reports that hospitals are having growing difficulty recruiting nurses. "This is very dependent upon geographic location, proximity to nursing schools, pay, and work environment," says Contino. (See box, below.)

Nursing shortage report

Here are key findings of the U.S. General Accounting Office report on the nursing shortage, Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors: A serious shortage of nurses is expected in the future as demographic pressures influence demand and supply. Nationwide, the average change from 1996-2000 for nurses per 1,000 was -2%. Alaska had a 19.5% decrease in employed registered nurses per 1,000 population from 1996-2000 for the biggest decline among all 50 states and Washington, DC. Arizona had the second biggest decline in nurses, with a 12.9% decrease.

The bottom line is that EDs are finding ways to increase benefits and salaries for nurses to attract them, says Contino. "Nurses are in a position to be much more selective who they work for, including the registries," she adds. The real challenge is retaining ED nurses, argues Contino. "There will always be a certain amount of turnover if the work environments are not improved," she says.

Here are effective ways to reduce vacancy rates:

1. Make your ED competitive. As long as there is a shortage, nurses are in a position to negotiate education reimbursement, salaries, vacation, and schedules, so you’ll need to be competitive in what you offer, says Contino. "The economics of supply and demand impact nurses’ ability to command higher salaries," she explains.

2. Give nurses opportunities to display their skills and knowledge. Approach nurses in other departments to give lectures for ED staff, suggests Janet K. Johnson, RN, BSHA, CEN, SANE, coordinator of clinical forensic services and former ED nurse manager at Central Peninsula General Hospital in Soldotna, AK. This can help you find potential candidates for ED nurses, she adds. 

This strategy worked well for Johnson, who leads a series of "Multidiscipline Patient Care Conferences," featuring a nurse or physician identifying an interesting patient who came through the ED, with presentations by all the departments who cared for the individual throughout his or her stay. After a lecture on burn patients, a new nurse in the intensive care unit approached Johnson to discuss the topic. "We talked, and I found out she had great experience as a nurse in a burn center," she recalls. "She offered to lecture about burn care and dressings for us, and now she is working in the ED," she says.

3. Benchmark your staffing. Contino advises comparing your staffing plans with other EDs in your area to see if your staffing is adequate. "Having adequate staffing often decreases turnover," she says.

4. Decrease nursing workloads. Delegate tasks to laboratory staff, patient transporters, and radiology technicians whenever you can, says Contino. "Look at the LVN/LPN scopes of practice for your state," she suggests. "Can they do more than they are currently doing?"

5. Determine the cost of turnover. After documenting the cost of turnover of nursing staff in your ED, "then lobby to spend that money on adequate staffing and customer service programs," advises Contino.

6. Make education a priority. Raise endowment funds for nurse managers and staff education, says Contino. She points to the following goals:

  • Teach staff nurses to be effective supervisors of LVN/LPNs and technicians.
  • Send managers to mediation classes so they’ll be more effective in resolving conflict.
  • Require manager positions to be filled with persons having master’s degrees.

"If you hire under those requirements, then help the employee reach the level within a certain timeframe," she says. Pay a nurse to design a web page that educates the community about emergency services, and have the nurse work with the hospitals’ public relations staff. Provide tuition reimbursement for computer learning and advanced education.

7. Have nurse give patients follow-up calls. Ask nurses to collect data about what patients want, Contino advises. "Then let the nurses collecting the data implement programs to make the ED more customer service-focused," she says.

8. Pay nurses to give talks at local schools. The best source of future ED nurses may be your current nursing staff, says Contino. "Nurses are excellent marketers if they feel passionate about where they work," she explains.

9. Hire local nursing students. Put nursing students to work as technicians in your ED, with the agreement that they will be hired upon graduation if they meet certain requirements, says Contino.

10. Set up a "walk a mile in my shoes" program. Contino suggests setting up a program to have nonclinicians spend a day with clinical staff, and vice-versa. "It will greatly enhance teamwork and help employees to identify solutions," she says. 

Sources and resources

For more information about the nursing shortage, contact:

  • Diana Contino, RN, MBA, CEN, CCRN, Emergency Management Systems, 24040 Camino Del Avion, Suite 123, Monarch Beach, CA 92629. Telephone: (949) 493-0039. Fax: (949) 493-7568. E-mail:
  • Janet K. Johnson, RN, BSHA, CEN, SANE, Central Peninsula General Hospital, 250 Hospital Place, Soldotna, AK 99669. Telephone: (907) 262-8126. Fax: (907) 262-0717. E-mail:

A survey by the Florida Hospital Association has reported the highest nurse vacancy rate since 1989, with more than 90% of the hospitals responding reported a shortage of nurses in adult critical care, medical-surgical, emergency, and telemetry areas. The November 2001 report, Florida’s Nursing Shortage: It is Here and It is Getting Worse: FHA Study on Nurse Health Staffing Issues in Florida can be downloaded free of charge at: An August 2001 report, Finding and Keeping Nurses: What is Working? FHA Study on Recruitment and Retention, identifies solutions for the nursing shortage. (Click on "Data/Publications," then "Nursing & Human Resources," then the report titles.) The National Heart, Lung, and Blood Institute’s Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma (NIH Publication 97-4051) is $7 for single copies. An abbreviated version of the guidelines, Practical Guide for the Diagnosis and Management of Asthma (NIH Publication 97-4053), is $5 for single copies, with no shipping and handling charge for orders less than $6. To order, contact:

  • National Heart, Lung, and Blood Institute Information Center, P.O. Box 30105, Bethesda, MD 20824. Telephone: (301) 251-1222. Web site:

A complete copy of the report, Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors, can be downloaded at Click on "GAO Reports," "Find GAO Reports," and under "Options" and "Find Reports by Report Number," enter "GAO-01-944." Single printed copies of the report are available at no charge by contacting U.S. General Accounting Office, P.O. Box 37050, Washington, DC 20013. Telephone: (202) 512-6000. Fax: (202) 512-6061. Web ordering form: