The healthcare industry has been a rapidly growing sector for job growth. With that, there is a definite shortage. We know that there aren’t enough students enrolling in nursing to meet the aging population’s demand while the job itself is highly demanding—both physically and mentally—and there are a large number of nurses over fifty years old. What other factors do you see playing a role in this shortage?
I want to take a step back and look at the bigger picture. We are in a debate about the chicken and the egg. Let me explain what I mean.
Currently, most healthcare organizations are hiring any frontline staff who apply with the proper credentials. These healthcare organizations tell us they can’t be selective with this shortage. As a result, proper vetting of candidates isn’t taking place.
This is a big problem.
This causes a revolving door.
All of the theories and ideas on how to properly motivate people should create satisfaction with their job. That satisfaction usually results in long-term employment.
But all of that means nothing if you don’t hire the right person.
Hiring a bad fit results in high turnover costs, and many organizations don’t understand what it truly costs to replace people.
For facts on the current nursing shortage, visit the American Association of Colleges of Nursing (AACN) – here.
How to attract and retain good nurses
Let’s first talk about what’s being done now. Signing bonuses. If you have an employee coming to you solely for a signing bonus, I would ask you, “What needs are you satisfying?” And this is getting into how people are motivated. If you go back to even early motivation theories, money and titles are extrinsic motivators. It provides some sort of social or material gain. This is the root of the problem with retaining people.
We attract them with a signing bonus, and we attract them with decent pay. And then what? Usually, the answer is “very little.”
We are using low-level extrinsic motivators to attract people, and once they arrive, they need higher-level intrinsic needs. Those needs include a sense of belonging, esteem, and purpose.
Motivational Maintenance – Employers are doing just enough to keep people going. If you want people to stay, you have to offer more. Organizations that have an extraordinarily low turnover are going a step further for the candidate or employee and providing more intrinsic value. They are providing a sense of autonomy and ownership over their job. I understand autonomy can be tricky in healthcare. You can’t let everyone be completely autonomous, but you can provide a sense of ownership. That ownership of their job results in a sense of purpose and pride.
Motivational maintenance won’t work. Employees can get that anywhere. So, what I am suggesting is that employers start thinking about the intrinsic factors that are going to make them stay: autonomy, purpose, opportunity, growth, and a greater sense of the why behind what they are doing.
In general, healthcare organizations have great missions and values. But do nurses and CNA’s understand their role in the overall purpose of the organization? I’m not sure they do.
The bottom line is that if the industry or healthcare continues with this shortage and their current hiring and retention mentality, I doubt anything will result in better retention. There has to be a shift in thinking that the upfront cost and time is worth it to find the right fit.
Part of this discussion is changing the mental model of how organizations go about hiring people. Right now, it is a dysfunctional thought process and mental model of how they hire people. If they would just take a little bit of time and spend a little bit of money up front, they won’t go through this again in six months.
Types of commitment to organizations
There are three types of ways people are committed to organizations:
1. Continuance Commitment – the cost of leaving is too great. The cost can range from a fear of losing what they have (a parking spot, seniority, etc.) or just a lacking desire to want to change. As an employer, the continuance commitment is the least desirable. This is when your team is doing the bare minimum.
2. Normative Commitment – a sense of obligation to the employer. If we look back at previous generations, this normative commitment was very common. People in the workplace now feel very little of this normative commitment.
3. Affective Commitment – the employees’ connection with their coworkers, the company, the vision, and the values. It’s the connection to the culture of the organization. Employees with this affective commitment tend to work in organizations that are people-centric, have positive work environments, and strong leaders. It’s those strong leaders that create and cultivate a positive work culture that breeds this affective commitment. This commitment will prevent your best nurse from leaving when the healthcare center down the street offers them $2 more. They won’t want to leave because they feel they have it good where they are. When this happens, you know the nurse’s intrinsic values/motivators are met.
Read John’s post on how to create a positive culture, here.
John Fuehrer, Associate Professor, Baldwin Wallace University
I’ve been teaching at Baldwin Wallace for eighteen years. I teach in the area of organizational behavior, or behavioral theory management. We look at the behavior of people in organizations and the psychology of doing business. Everything I do is nonquantitative. We don’t use formulas to figure out how to lead people or keep people at an organization. We study different theories and test to see what works.
From a professional perspective, I took over a business in 1994 that focuses on helping organizations find the right people. We do that through a number of different tools, ranging from online assessments to the application of the organizational behavior theories I mentioned before. The online assessments help us understand more about a person’s behaviors and personality. The last step is assessing the fit of a particular person for a particular organization or employer.