Sad: One in Five Nurses Quits Within a Year


    Amid nurse shortage, hospitals focus on retention

    I've heard a similar theme before — the problem isn't that we need to graduate more nurses, we need to just quit losing so many from the field.

    Newly minted nurse Katie O'Bryan was determined to stay at her first job at least a year, even if she did leave the hospital every day wanting to quit.

    Why this waste, this waste of talent? Why this frustration?

    Many novice nurses like O'Bryan are thrown into hospitals with little direct supervision, quickly forced to juggle multiple patients and make critical decisions for the first time in their careers. About 1 in 5 newly licensed nurses quits within a year, according to one national study.

    This really sounds like a management issue, does it not? Thankfully, some hospitals are working on better training programs. The typical “bad” process is described here:

    While Milian was paired with a more experienced nurse at the New Jersey hospital, they didn't see patients together; they split the workload. Her first week on the job, Milian was charged with caring for several patients with complicated issues — those on ventilators and with chest tubes — and she felt thoroughly unprepared.

    “It just didn't feel right, it felt very unsafe,” Milian said.

    So instead of getting help and coaching from the experienced nurse, the experienced nurse used the trainee to lighten her workload. Waste, poor process training, lack of coaching, lack of support… of course that would be frustrating. It's one thing to graduate from school with the clinical skills, but knowing how to operate effectively in a hospital setting is a different story.

    At work the other day, we spent a little time with a nursing student who was visiting the hospital and seeing our Lean work (in addition to the normal day-to-day of “real world” nursing). The reality of waste was eye-opening to her. When we talked about how we were starting to fix things with Lean methods, she said, “This makes sense… so why aren't more hospitals doing this?”

    Our efforts to standardize processes helps reduce some of the chaos. The standardized work documents can now be used to orient and properly bring new nurses on board so they don't get so frustrated.

    As the old Training Within Industry program would have said, “If the Student Hasn't Learned, The Instructor Hasn't Taught.” I guess you could also say (generally), “If the nurses are quitting in droves, then the leaders haven't managed”???

    Today is the last day of this current project I'm on. I'm really proud of the nurses and other staff who have been brave enough to go out on a limb to try to make things better. That doesn't always make you the most popular kid in class. They've done some really great work and have a lot of improvement ahead — but thankfully, with Lean skills and methods in their toolkit, the staff members and their leaders (armed with some Lean management methods) are going to be on a good path, I think.

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    Mark Graban
    Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


    1. Hi Mark,

      This is a great example of why managers should consider Job Instruction as part of their stability strategy.

      Turnover is an awful problem to deal with and as this example illustrates, poor training methods, lack of trainer standards and job expectations along with clear trainee development milestones are at the root cause of the problem.

      Now, the trainer will be blamed for this problem when we really should look deeper into the systems that management has designed.


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