ACHE 2017: Organizational culture matters for reducing nurse turnover

If you're a healthcare leader looking for ways to keep experienced nurses from leaving your organization, you should examine your company's culture. Your own personality, however, won’t make much of a difference.

Paulchris Okpala, DHSc, graduate coordinator of California State University, San Bernardino’s master of science health administration program, presented this study at the American College of Healthcare Executives (ACHE) Congress in Chicago.

Nurse retention is a well-known problem, affecting both staff morale and an organization’s finances. He said the cost of an annual 10 percent nurse turnover rate within a health system or hospital can quickly rise into the millions of dollars. The solution for most systems has been to improve working conditions and offer better financial incentives to retain staff, but he said those efforts don’t placate frustrated employees for long.

“The excitement that you see with an increase in salary wears down after four or six weeks, and the desire of the nurse to still resign or quit [doesn’t go away]," he said. “So we need to find something that will be permanent.”

Using a quantitative data analysis from 70 existing studies, Okpala sought to establish what kind of leadership personalities and culture exist in healthcare and show how those qualities set by system leaders (not nursing leaders) filter down to affect nurse retention.  

He identified two types of leadership personalities—pro-social and pro-self leadership—but found that neither approach significantly influenced levels of nurse retention. In other words, being seen as a “nice” boss wasn’t enough to make nurses stay.

However, the culture a leader sets within the organization does matter, according to Okpala’s study, accounting for up to 18.3 percent of nurse retention levels. He identified three different types of leadership culture:

  • Leadership-as-dominance, influencing others through assertive power and knowledge.
  • Leadership-as-coordination, where the healthcare leader helps coordinate group decision-making, which may involve nurses.
  • Leadership by example, where leaders illustrate best practices by performing them themselves, a sort of “follow the leader” approach.”

The latter two options have a positive influence on nurse retention, particularly leadership-as-coordination. Okpala said when nurses know they have a say in the decision-making process, they may be more likely to stick around in an organization.

“This implies that healthcare administrators should not just follow the old, traditional outreach of providing excessive bonuses, excessive incentives, excessive salary increases,” he said.

Notably, the study found most organizations could already be identified as taking a leadership-as-coordination approach—so then why, if many are already doing the right thing to retain nurses, are they still leaving? The answer appeared to be external factors, such as low unemployment in healthcare meaning more open jobs for nurses, and therefore internal changes, like leadership culture, can only do so much to stop nurses from leaving.