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The Department of Veterans Affairs runs the nation’s largest health care system, but that doesn’t make it immune to the severe nursing shortage the U.S. is facing today. Not only are there not enough nurses, but medical facilities across the nation are seeing a higher turnover rate for these critical staffers. In 2018, the rate was 17.2 percent, according to one study.

It may be years before we find a permanent answer to this problem, but in the meantime, the VA Medical Center in Tomah, Wisconsin, has taken a series of steps that has cut our turnover rate by more than half. Here’s how we did it.

We started seeing nurse recruiting challenges about five years ago, and decided we needed to be proactive about ways to retain the nurses we had. After researching the issue, we created what we call the Nursing Stay Interview process.

Under this system, nurses are interviewed by their nurse managers after being on the job for 30 days, and then again after 90 days.

Some of the questions they are asked include:

  • What, if anything, would you change about your job?
  • What things would you like to learn more about or what experiences would you like to acquire?
  • What things demoralize you and make you long for the weekend?

The questions led to free-flowing conversations that helped staff discuss concerns and ideas with top leaders, and helped those leaders fix problems that kept these nurses at their jobs, serving Veterans.

After the first year of the Nursing Stay Interview process, turnover dropped by 52 percent in Tomah, Wisconsin.

Before we took this process on board, nurse managers recommended nurses stay in their units for a year before transferring to another unit – the idea was to prevent disruptive changes in staff.

But after our interviews began, managers could see examples of nurses who were hired into a unit that wasn’t the best fit, and more quickly move them to other units that align with their individual strengths and career goals. Instead of keeping nurses in units where they didn’t feel fulfilled and increasing the chance that they leave, the system helps us put them in units where they want to work.

We’ve since honed the process to ask specific questions of our nurses after 30 days, 90 days, and annually in order to make sure we’re identifying problems that could prompt them to become frustrated with their jobs.

Part of the process involves educating our nurse managers on how to conduct these interviews, and making sure they make the rounds to interview all of their new hires.

The process has been so successful that we’ve broadened it further to include LPNs and CNAs, and have included staff who provide mental health services such as social workers, psychologists, peer support specialists, and others.

Many might guess that nurses would tell the VA that they aren’t making enough money. But not a single nurse had that complaint. Instead, many said they were uncomfortable with coming to work and not knowing if they were going to spend their shift on their regular unit or if they were going to be floated to another unit for coverage.

After hearing that feedback, we created “pods” — a mental health pod, an acute pod, and two long-term care pods. We knew it may have been unrealistic to completely prevent floating, but we committed ourselves to reducing it as much as possible.

Nurses also told us that what we were doing for new employee orientation and nursing core orientation was not setting them up for success. As a result, nursing leadership met with the education department to adjust the curriculum to be more discipline specific so that RNs could get the orientation in education before starting.

As we evolve, we always let the staff know that changes are being made “because of the information we received from the stay interviews,” so they understand that their voices are being heard.

Marissa Dobratz is an RN who started her position in April and has already taken part in two stay interviews. She says she likes the process because “it offers an opportunity for a person to be part of the change. And, if you feel like you’re part of the change, you’re more likely to stay.” She had previously worked for an employer that did not offer such interviews and says that facility has a large turnover problem.

What we built in Wisconsin has worked so well that we shared it with other parts of the VA, including medical centers in Oklahoma and Texas.

It always makes sense to listen to your employees. But especially at a time when nurses are in such short supply, we’ve found that taking time to ask questions, listening to the feedback we get, and then acting on that information is going a long way toward retaining these valuable staff members.

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Natalie Hackbarth, MSN, RN

Natalie Hackbarth, MSN, RN, is the Acting Associate Chief of Staff–Mental Health and Associate Chief Nurse–Mental Health at the Tomah VA Medical Center in Tomah, Wis.

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