Evidence-Based Practice Guideline: Nurse Retention for Nurse Managers

Nurse retention is a critical issue for health care organizations, as it affects the quality of care, patient safety, staff satisfaction, and organizational costs. According to the American Nurses Association, the turnover rate for registered nurses (RNs) in the U.S. was 17.2% in 2019, and the cost of replacing an RN ranged from $28,400 to $51,700. Therefore, nurse managers need to implement evidence-based strategies to retain their nursing staff and prevent turnover.

The purpose of this guideline is to provide nurse managers with practical recommendations for improving nurse retention based on the best available evidence. The guideline is organized into four sections: assessment, planning, implementation, and evaluation.


The first step in developing a retention strategy is to assess the current situation and identify the factors that influence nurse retention in your organization. Some of the common factors are:

– Work environment: This includes the physical, social, and psychological aspects of the workplace, such as staffing levels, workload, autonomy, teamwork, communication, leadership, recognition, and support.
– Job satisfaction: This refers to the degree of fulfillment and enjoyment that nurses derive from their work, such as their sense of accomplishment, competence, contribution, and alignment with organizational values and goals.
– Career development: This encompasses the opportunities and resources that nurses have for learning new skills, advancing their education, obtaining certification, and progressing in their career path.
– Work-life balance: This reflects the extent to which nurses are able to balance their personal and professional responsibilities and needs, such as family, health, leisure, and spirituality.

To assess these factors, you can use various methods, such as surveys, interviews, focus groups, exit interviews, turnover data analysis, and benchmarking with other organizations. You can also involve your nursing staff in the assessment process to gain their input and feedback.


The second step in developing a retention strategy is to plan the interventions that will address the identified factors and meet the needs and expectations of your nursing staff. Some of the evidence-based interventions are:

– Enhancing work environment: You can improve the work environment by ensuring adequate staffing ratios, reducing workload and overtime, providing sufficient equipment and supplies, promoting shared governance and decision making, fostering collaboration and respect among team members, enhancing communication and feedback channels, providing effective leadership and mentorship, recognizing and rewarding achievements and contributions, and creating a culture of safety and quality.
– Increasing job satisfaction: You can increase job satisfaction by providing meaningful and challenging work assignments, facilitating role clarity and expectations, supporting professional autonomy and accountability, encouraging innovation and creativity, aligning individual and organizational goals and values, and soliciting staff input and feedback on work processes and outcomes.
– Supporting career development: You can support career development by offering educational opportunities and financial assistance for continuing education or advanced degrees,
providing access to certification programs or specialty training,
creating career ladders or pathways for advancement,
providing preceptorship or residency programs for new graduates or transitioning nurses,
and facilitating mentorship or coaching relationships for professional growth.
– Improving work-life balance: You can improve work-life balance by offering flexible scheduling options,
providing paid time off or leave benefits,
offering wellness programs or employee assistance programs,
providing childcare or eldercare services or referrals,
and encouraging staff to pursue personal interests or hobbies.

To plan these interventions, you can use various tools, such as logic models,
action plans,
SMART goals,
and SWOT analysis. You can also involve your nursing staff in the planning process to gain their buy-in
and commitment.


The third step in developing a retention strategy is to implement the planned interventions in a systematic
and timely manner. Some of the best practices for implementation are:

– Securing adequate resources: You need to ensure that you have sufficient human,
and technological resources to support the implementation of your interventions. You can also seek external funding or partnerships if needed.
– Providing training and education: You need to provide training
and education for your nursing staff
and other stakeholders on the rationale,
and expected outcomes of your interventions. You can also provide ongoing coaching
and support during the implementation process.
– Communicating effectively: You need to communicate clearly
and frequently with your nursing staff
and other stakeholders about the progress,
and lessons learned from your interventions. You can also use various communication channels
and methods
to reach different audiences
and elicit feedback.
– Monitoring and adjusting: You need to monitor
and evaluate the implementation process
and outcomes of your interventions using appropriate indicators
and measures. You can also adjust
or modify your interventions based on the feedback
or data collected.


The fourth step in developing a retention strategy is to evaluate the effectiveness
and impact of your interventions on nurse retention
and other outcomes. Some of the methods for evaluation are:

– Measuring outcomes: You need to measure the outcomes of your interventions using valid
and reliable instruments
or tools. Some of the common outcomes are nurse turnover rate,
nurse retention rate,
nurse satisfaction,
nurse engagement,
nurse performance,
patient satisfaction,
patient outcomes,
and organizational costs.
– Comparing results: You need to compare the results of your interventions with the baseline data
or the pre-intervention situation. You can also compare your results with the established standards
or benchmarks
or with other organizations
or units.
– Analyzing data: You need to analyze the data collected from your interventions using appropriate statistical
or qualitative methods. You can also use various software
or programs
to facilitate data analysis.
– Reporting findings: You need to report the findings from your evaluation using clear
and concise language
and visuals. You can also use various formats
or media
to disseminate your findings to different audiences
or stakeholders.


[1] American Nurses Association. (2020). 2019 National Health Care Retention & RN Staffing Report. https://www.nursingworld.org/~4aeeeb/globalassets/practiceandpolicy/work-environment/health–safety/2019-national-health-care-retention-and-rn-staffing-report.pdf

[2] Becker’s Hospital Review. (2017). 6 things to know about nurse turnover. https://www.beckershospitalreview.com/human-capital-and-risk/6-things-to-know-about-nurse-turnover.html

[3] National Library of Medicine. (2018). The effects of nurse staffing on patient outcomes. https://www.ncbi.nlm.nih.gov/books/NBK493175/

[4] NHS Employers. (2020). Improving the retention of registered nurses and midwives. https://www.nhsemployers.org/publications/improving-retention-registered-nurses-and-midwives

[5] NurseJournal.org. (2023). How to support nurses and raise nurse retention rates evidence based practice essay. https://nursejournal.org/articles/how-to-support-nurses-considering-resigning/

[6] NursingWorld.org. (2022). Nurse retention strategies: How to combat nurse turnover. https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-retention-strategies/

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