How to Improve Nurse Retention by Building a Business Case to Address Bullying and Incivility

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Nurse retention is top of mind for every nurse executive due to the ever-growing turnover rate. More and more, healthcare organizations are feeling the sting of turnover in numerous ways.

The first sting is obvious – costs.

According to the 2016 National Healthcare Retention & RN Staffing Report, the average cost of turnover for a nurse ranges from $37,700 to $58,400. Hospitals can lose $5.2 million to $8.1 million annually when nurses leave.

The second sting relates to patient outcomes.

A 2002 study by Linda Aiken, PhD, RN, at Penn, first caught people’s attention.

It found that for every additional patient a nurse cared for, patients were at a 7% greater risk of dying within 30 days of admission, and there was also a greater risk of failure to rescue. A 2011 University of California, Los Angeles, study also reported that nurse staffing below target levels was linked to increased patient mortality.

The third, and less recognized sting is the indirect burden to the organization:

  • Burden on human resources or recruitment personnel to find replacements for terminated or resigned nurses.
  • Cost for advertisement, recruitment, hiring process (interview, medical tests), orientation and training. Vacancies lead to additional cost in terms of overtime pay or for hiring contingency staff, i.e. non-in-house (agency) nurses, to fill the gap.
  • Specific organizational processes may be forgotten and not passed on by employees who have left the organization to newer employees.
  • Turnover may also demoralize remaining staff, affecting their productivity, attendance and overall satisfaction at work. Those who are forced to fill in the hours may feel overworked, burned out, and disengaged.

Therefore, healthcare organizations have a financial and ethical obligation to reduce turnover and improve retention of highly qualified, compassionate nurses. Yet, many are focusing their efforts on recruitment and not really trying to solve the problem.


The turnover rate for RNs continues to rise. Turnover statistics for bedside RNs in 2016 was 14.6%, according to a survey by NSI Nursing Solutions. And, the healthcare market has never been more supply driven.  A restless workforce can go anywhere it pleases at any time.  How high can turnover go?

Nursing Solutions, Inc. showed that 81% of nurses who leave an organization cite peer and nurse manager relations as a cause for leaving. And the problem is even greater with newly graduated nurses.

A study in the current issue of Policy, Politics & Nursing Practice reveals that an estimated 17.5 % of newly licensed RN’s leave their first nursing job within the first year, and one in three (33.5%) leave within two years. Of the new nurses who quit their first job within the first 6 months, 60% state they are quitting because of the bad behavior of their coworkers – culture is more important than a paycheck.

We can’t afford to ignore the negative impact disruptive behaviors have on the financial health of our organizations, the physical and emotional health of our employees, and ultimately the health of the patients we serve.

Recruitment isn’t an issue. Retention is. Once you get them in, if you don’t create a professional, supportive, and nurturing work environment, they will leave.

[Tweet “Once you get them in, if you don’t create a professional, supportive, and #nurturing work environment, they will leave.”]


At The Healthy Workforce Institute, we’ve surveyed over 1800 nurse leaders regarding addressing bullying and incivility among their employees. The number one (1) reason why leaders aren’t addressing disruptive behaviors is because they don’t know how.

Despite what some employees think, leaders HATE counseling or disciplining their employees. A recent study by Nursing Management reported that the number one stressor for managers is when they have to discipline their employees. Disciplining employees for either performance issues or behavior can be so stressful for managers that many choose to just ignore it.


The solution is equipping front line leaders with the skills they need to cultivate a healthy workforce by eliminating disruptive behaviors.  

[Tweet “The solution is equipping front line leaders with the skills they need to cultivate a #healthyworkforce by eliminating #disruptivebehaviors.”]

By investing in education, training, and support for your front line leaders to help them develop the skills required to set behavioral expectations and hold their employees accountable, you will be saving millions of dollars and improving the quality of care that your patients deserve.

To use silence as a strategy doesn’t make logical or economic sense!

At the Healthy Workforce Institute, we offer a cadre of services to do just that. From online blended learning programs, workshops, coaching calls and resources, to onsite assessments and consulting – we have options for every budget.

If you’d like to discuss how to address the #1 reason why nurses are leaving your organization and how to stop the bleeding, contact the team at the Healthy Workforce Institute.

Be kind. Take care. Stay connected.

Helping you create a healthy happy workforce,

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3 thoughts on “How to Improve Nurse Retention by Building a Business Case to Address Bullying and Incivility”

  1. Best nursing college in indore

    I have gone through all the reasons why nurses were leaving the hospital and I think that only solution to this problem is that the hospital should provide them better services and give respect to them they serve as a most important task in the health sector without them a patient cannot be recovered properly irrespective of how capable doctor is.

    1. Thank you for commenting! What it takes to retain nurses is complex but feeling respected is definitely part of the solution!!

      1. Yes!! You’re absolutely right. Creating a supportive environment where nurses thrive and want to stay is complex at best. However, respect is top of the list!

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