Successful strategies to improve RN retention and patient outcomes in a large medical centre in Hawaii

Aims and objectives. The purpose of this paper is to describe an assessment of a major retention initiative implemented at The Queen’s Medical Center in Honolulu, Hawaii, in response to the nursing workforce shortage in the state. Background. After tracking the situation for several years, nursing leadership at the medical centre critically analysed their registered nurse retention data. The retention rate among new nurses in their first year of employment was only 55·97%. Design. A training programme was initiated to improve registered nurse retention and patient care outcomes with external funding from the US Health Resources and Services Administration. Method. New nurses were supported via additional training and clinical coaches beyond the basic orientation period. Leadership skills of nurse managers were expanded to strengthen their role in retention of new nurses. Four inpatient nursing units became Magnet Pilot Units to demonstrate progress towards achievement of Magnet standards and improvement of patient outcomes. Results. From 2005–2009, first‐year‐registered nurse retention improved from 55·97–68·20%; registered nurse vacancy rate decreased from 11·26–2·19%; patient satisfaction increased from 84·6–87·8%; registered nurse satisfaction‐autonomy improved from 43·55–49·29; registered nurse satisfaction‐decision‐making went from 41·13–47·97%; and nosocomial decubitus ulcer rate decreased from 15·3–6·7% in the intensive care units. Conclusions. Dedicated resources and targeted activities can make a difference in outcomes for both nurses and patients. Keys to success included engaging staff, having high expectations coupled with high support, providing data to unit‐level staff to measure improvements emphasising renewed accountability and maintaining the focus on quality patient care. Relevance to clinical practice. When the goal is to provide the highest level of quality patient care, professional development of staff and managers is important to meet performance expectations and achieve target clinical goals. Improving registered nurse retention and vacancy rates while also improving patient outcomes had significant human resource and financial benefits for the organisation and contributed to achieving Magnet Recognition.