Nurse Retention Strategy Guide: Lessons from a Former CNO

Despite efforts to combat them in recent years, the triggers for burnout and turnover in nursing are getting worse. If you work in nurse leadership, you’ve no doubt seen it yourself. 

Nurses staying late to chart. Missing breaks. Juggling too many patients, some of whom become agitated and—in some cases—violent. Getting that defeated, overwhelmed look in their eyes that you know means you’re at risk of losing another valued colleague.

It’s time to ensure both the technology nurses rely on and the environments they work in are designed to support them—not wear them down.

Why is nurse burnout getting worse? 

A 2022 CDC study found that burnout in US healthcare workers, including nurses, was getting significantly worse._¹ Nearly half reported feeling burned out frequently, and 44% said they were somewhat or very likely to look for a new job. And even if burnout has stabilized a bit over the past few years, it’s still elevated versus pre-COVID levels.

Some of the biggest contributors to the current burnout crisis among nurses include:

Admin overwhelm

The admin work of nursing is out of control, explains Kelly Conklin, a former Chief Nursing Officer and PerfectServe’s Chief Customer Officer & Chief Clinical Officer.

“The time spent in front of a computer is overwhelming, and documentation is now so highly scrutinized that it contributes directly to burnout. 

Many nurses have to stay after their shifts to catch up, which leads to late charting—and then they’re reprimanded. But they’re only behind because they were focused on caring for the seven patients they were assigned.”  

This kind of “pajama time” is most often discussed in the context of physician burnout, but nurses feel it in their own way, too.

Tech bloat 

Hospitals and clinics have introduced more tools over the years to try and simplify operations. Unfortunately, in many cases, new communication platforms have “just added another layer of complexity,” explains Kelly. One time-motion study found that nurses spent more than a third (34%) of their time just managing communication.² 

Even if a new platform does help them communicate more easily, many of these tools don’t integrate with patient medical records, meaning they can’t fit into the nurses’ workflow. “It’s just another distraction,” says Conklin.

Increased patient acuity

“What has happened over the past few years is that care has shifted, and patients are remaining in their homes as long as they possibly can, receiving virtual care, receiving virtual visits from their providers, receiving in-home care,” commented Conklin.

As a result, by the time a patient ends up in the hospital, they’re often much sicker than they would have been 10 years ago. In other words, even if a nurse’s patient load hasn’t necessarily increased, today’s patients typically require more time, care, and attention.

This means nurses have less time for everything else. That includes basics like charting, taking a break, sending updates or follow-ups to patients and their caregivers, or checking in with their team. Over time, that constant pressure builds up. Even if the number of patients stays the same, the workload doesn’t just feel heavier—it is heavier.

Poor scheduling practices 

Even though nurses have to complete more admin tasks and deal with sicker patients, scheduling hasn’t caught up. 

How nursing leadership can tackle retention issues effectively

For nursing leaders, the situation is challenging—not impossible. There are multiple approaches to tackling systemic burnout among nursing staff.

Here are a few straightforward steps that can mitigate burnout and turnover:

Help nurses feel safer at work

Too many nurses don’t feel safe at work. According to the American Nurses Association, one in four nurses are assaulted at work—an estimated 13% of all missed work days can be attributed to workplace violence.⁵

Despite this high risk, only 20% to 60% of all workplace violence incidents are reported.⁵ Technology can help to address this problem by giving nurses the tools they need to ask for help and report dangerous situations as soon as they develop. As one example, some organizations have implemented Code Violet and show-of-support workflows in their clinical communication systems that allow nurses to quickly and quietly send an alert when a situation is escalating, or when a patient has become dangerous or violent.

Since these alerts are built into the platform, nurses can discreetly send a message requesting help without fear that the patient will realize what’s happening and become even more belligerent or dangerous, which could increase the nurse’s safety risk before help arrives.

By building these alerts directly into the clinical communication system, healthcare organizations can encourage nurses to report dangerous situations and ensure a rapid response by campus security or other personnel.

Reduce communications overhead and cut down on stress 

As Kelly puts it: “Efficiency is everything right now. Everyone’s being asked to do more, but there are no extra hours in the day. Making communication easier is one way to help close that gap.”

Nurses are the central hub of patient care, juggling calls, messages, overhead pages, and endless alerts. But the current setup is overwhelming, inefficient, and contributes to alarm fatigue. Most alerts don’t even require action,⁶ yet they still interrupt care and pull nurses away from the bedside on a regular basis.

Poor communication with providers makes these challenges even worse. Nurses routinely struggle to communicate quickly and efficiently with providers due to out-of-date provider schedules, slow response times, rudimentary technology, and the many other routine events that limit provider availability throughout the day. 

But even though it may be hard to cut down on all the communication overhead that nurses have to deal with, the right technology can still help. With a more comprehensive approach to clinical communication, you can: 

• Centralize alerts, alarms, messages, and pages into a single inbox, so nurses only need to check one communication channel.
• Put that communication channel on mobile devices, so nurses can check their alerts at the bedside instead of racing back and forth from the nursing station.
• Set up different tones for urgent and non-urgent alerts, to mitigate alarm fatigue and make sure all urgent messages are dealt with quickly.
• Implement unified care team communication that allows for instant two-way communication between nurses and providers.

Improve care team collaboration and patient outcomes with better routing 

Here’s a real-life situation one nurse experienced that many others can likely relate to: 

A patient’s condition was slowly worsening, but the nurse couldn’t reach the on-call physician. Messages went unanswered, and there was no way to know if they were even being seen. 

Eventually, the situation became urgent, and the nurse followed hospital procedure by calling a code—only to be reprimanded in front of her colleagues when the physician finally showed up. In essence, she was punished for doing her job correctly.

Nurses shouldn’t have to guess who’s on call or whether their messages are being read. With a purpose-built healthcare communication tool, they can:

Better routing and visibility improve care team collaboration, resulting in fewer delays and less emotional fallout for nurses who are just trying to do the right thing for their patients.

Introduce better staffing and scheduling to increase nurse autonomy

Staffing and scheduling issues are some of the biggest contributors to nurse and provider burnout: According to a 2024 KLAS Research report, 65% of nurses cited staffing shortages as contributing to burnout in their current role.⁷

Feeling a lack of control over your schedule is also strongly correlated with burnout. But many hospital scheduling systems are so inflexible that individual needs and preferences are seldom taken into account. In some cases, nurses are assigned more patients than they can reasonably care for, and are sometimes overscheduled to the point where even short breaks are unmanageable.

For instance, a 2024 study by the Washington Center for Nursing found that just 58% of staff nurses could participate in developing their own work schedules.⁸ 

While it’s tempting to think the solution is more tech, the reality is that many health systems need to prioritize better staffing and scheduling protocols to alleviate nurse burnout and better support them in their roles.

Addressing staffing shortages, providing nurses with up-to-date scheduling information, and improving communication with providers can alleviate some of the burdens placed on nurses while giving them greater autonomy and control over their day-to-day work.

Don’t just address burnout—actively promote nurse wellbeing 

Yes, many nurses are burned out and have been for years. But just acknowledging that isn’t enough. 

Because the real burnout trigger isn’t just stress. It’s stress that feels unnecessary and unfair. The experience of being overworked and overscheduled. The burden of inefficient clinical communication. The juggling of multiple systems and tools just to accomplish simple tasks.

It’s time to move the conversation from “burnout is a problem” to “how do we actively support well-being?”

From nurse retention strategies that improve safety and collaboration across clinical care teams, communication tools that reduce the constant noise, or mobile-friendly systems that simplify their day-to-day, the goal is the same: help clinicians focus more on patient care. 

And it works.

For example, when Orange Coast Medical Center embarked on a project to improve clinical communication software, they reported that physician callback times dropped from 45 minutes to just 14 minutes. Nurses reported that communication was much easier.

As Critical Care Nurse Tim Hortter put it: “[This project] has changed contacting physicians from a 10-step process to a one-step process.” Even pain control scores improved by 4.4%, likely as a result of faster care.

As a healthcare leader, you know you can’t afford to keep losing the staff you have.

By addressing some of the biggest and most consistent challenges nurses face every day—and helping them feel valued and safe at work—your organization can alleviate the stress contributing to burnout, improve nurse retention, and empower your nursing staff to provide even better patient care.

Sources

1. Vital Signs: Health Worker–Perceived Working Conditions and Symptoms of Poor Mental Health — Quality of Worklife Survey, United States, 2018–2022. Centers for Disease Control and Prevention: https://www.cdc.gov/mmwr/volumes/72/wr/mm7244e1.htm
2. Nurses’ Time Allocation and Multitasking of Nursing Activities: A Time Motion Study. National Library of Medicine: http://pubmed.ncbi.nlm.nih.gov/30815156/
3. Development of a Nursing Assignment Tool Using Workload Acuity Scores. National Library of Medicine: https://pmc.ncbi.nlm.nih.gov/articles/PMC8402942/
4. Nursing Shortage Fact Sheet. American Association of Colleges of Nursing: https://www.aacnnursing.org/news-data/fact-sheets/nursing-shortage
5. Workplace Violence. American Nurses Association: https://www.nursingworld.org/practice-policy/work-environment/end-nurse-abuse/
6. Alarm fatigue: a patient safety concern. National Library of Medicine: https://pubmed.ncbi.nlm.nih.gov/24153215/
7. Understanding & Addressing Trends in Physician & Nurse Burnout 2024. KLAS Research: https://klasresearch.com/archcollaborative/report/understanding-and-addressing-trends-in-physician-and-nurse-burnout-2024/561
8. Prioritizing Nursing Well Being to Strengthen the Workforce 2024 Washington Nursing Burnout Survey and Next Steps. Washington Center for Nursing: https://www.wcnursing.org/wp-content/uploads/documents/reports/2024-July_WCN-Burnout-and-Retention-Report_FINAL.pdf