Strategies for Hospital Executives to Retain Emergency Department Staff

Authored by:

Mark Feinberg, Managing Partner, Chief Executive Officer

JoAnn Lazarus, MSN, RN, CEN, FAEN, Managing Partner, Emergency Department Services Peregrine Health Services, LLC

Recruiting and retaining quality staff remains a huge challenge for many healthcare facilities. Emergency department staffing is a pressing concern for hospital executives, given its impact on patient care quality, operational efficiency, and overall hospital success. According to the 2023 NSI National Health Care Retention & Staffing Report, published by NSI Nursing Solutions, Inc. the RN vacancy rate remains critical and is 15.7% nationally. While 1.3% lower than last year, over seventy-five percent of hospitals surveyed reported a vacancy rate of more than ten percent. The RN Recruitment Difficulty Index jumped an extra eight days to an average of 95 days. It takes over three months to recruit an experienced RN and the average cost of turnover for a staff RN is $52,350.

This article explores the challenges associated with employee retention in the emergency department (ED) and provides suggestions for hospital executives to implement effective strategies. By focusing on leadership development, work-life balance, recognition, professional growth, and a positive organizational culture specific to the emergency department, hospitals can create an environment conducive to long-term staff commitment and engagement.

Employee retention in the ED is a critical issue with far-reaching implications for patient care quality, healthcare system sustainability, and the well-being of staff. High turnover rates among ED workers can lead to disruptions in care continuity, increased recruitment and training costs, and a negative impact on patient outcomes.

“Employee retention in the ED is a critical issue with far-reaching implications for patient care quality, healthcare system sustainability, and the well-being of staff.”

Staff retention challenges in the ED are unique and stem from factors such exposure to unsustainable working conditions, ineffective leadership, workplace violence, high patient-to-nurse ratios, and nurses feeling undervalued. The high-stress work environment often leads to decreased engagement and morale, mental and physical exhaustion, and increased probability of medical errors. These challenges require targeted strategies to address specific issues faced by emergency department staff.

One strategy is providing leadership development for the ED leaders. Effective leadership in the ED is crucial for creating a supportive work environment. Hospital executives should prioritize leadership development programs tailored to the ED, focusing on skills such as crisis management, teamwork, and rapid decision-making. Supportive leaders who can guide their teams through high-pressure situations are essential for retaining ED staff.

Finding ways to assist staff in creating work-life balance is another important strategy. Achieving work-life balance in the ED is particularly challenging due to the 24/7 nature of the work. Hospital executives can implement scheduling practices that consider the unique needs of emergency staff, such as shift rotations that allow for sufficient rest between shifts or working with nurses who have unique needs like young mothers or the more mature nurses. Implementing fatigue management protocols and ensuring adequate staffing levels are essential for preventing burnout.

Recognizing the efforts of ED staff is a crucial strategy for maintaining morale. Hospital executives should establish formal recognition programs specific to the ED, acknowledging outstanding performance during high-stress situations and responding to emergencies efficiently. Tangible rewards, such as hazard pay or additional leave, can further motivate staff to remain committed to the department.

A career advancement path is critical to nurse retention. Providing opportunities for professional growth within the ED is key to retaining experienced staff. Hospital executives should invest in advanced training, certifications, and simulations for emergency staff. Offering educational incentives and career pathways can motivate employees to stay in the department.

Fostering a positive culture within the ED is vital for staff retention. Open communication between nurses, managers, and administrators reduces workplace frustration and dissatisfaction. Hospital executives should prioritize open communication, teamwork, and conflict resolution specific to the unique challenges faced by ED staff. Promoting a sense of camaraderie and a shared mission among emergency teams can help retain valuable talent.

Nurses have more career options than ever. Wage increases and bonuses are viable incentives for them to want to stay where they are. Hospital executives must ensure that the compensation and benefits packages for ED staff are competitive within the healthcare industry. Regular benchmarking against similar emergency departments and hospitals can help identify areas where adjustments are needed. Offering comprehensive healthcare coverage, retirement plans, and other incentives can enhance the overall value proposition for emergency department staff.

Hospital executives should actively seek feedback from ED staff to understand their unique concerns and needs. Regular surveys and forums specific to the department can provide insights into areas that require improvement. Involving emergency staff in decision-making processes related to emergency care protocols and workflow changes can enhance their sense of ownership and commitment to the department’s success. Allow nurses to make decisions and take charge within their scope of practice. Implementing peer support and mentoring programs within the ED can help new and experienced staff navigate the unique challenges they face. Pairing new hires with experienced colleagues who can provide guidance, share their experiences, and offer emotional support is crucial for reducing turnover in the ED.

Retaining ED staff is a critical priority for hospital executives seeking to ensure the highest level of patient care and the overall success of their hospitals. By implementing strategies tailored to the ED, such as leadership development, work-life balance, recognition, professional growth, a positive departmental culture, and competitive compensation, hospitals can effectively enhance employee retention rates in this crucial area. These strategies not only contribute to better patient care outcomes but also support the long-term sustainability of emergency care services within the hospital.


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