Nurse survey: Satisfaction has stabilized, but trust and loyalty are fragile

What’s trending: Survey reveals four keys to long-term nurse engagement and retention 

A new annual survey of 800 nurses offers mixed news. On the whole, nurse satisfaction has stabilized, and fewer nurses are looking to leave healthcare. These are positive markers to celebrate. But other critical factors that make nurses want to stay at an organization remain fragile. Healthcare leaders need long-term strategies to address them. 

We share four key findings from our third-annual survey and priority actions to foster greater engagement and retention. 

Why it matters 

While many organizations report improved turnover and overall vacancies, inpatient and emergency department nursing remain challenges for most. And the immediate financial cost is high. On average, organizations spend $51,000 to $74,000 to replace a single full-time equivalent (FTE) staff registered nurse. Organizations with 1,000 nursing FTEs and an annual turnover rate of 18%, for instance, are losing $9 to $13 million each year. Turnover also impacts patient access and engagement, care quality and safety, and revenue. 

With that backdrop, the survey by Jarrard Inc., a Chartis Company, uncovered four key themes: 

1. Job satisfaction has plateaued. As has been the case for the past 2 years, two-thirds of nurses are satisfied with their job. More than three-quarters plan on staying in healthcare. Nurses who recently changed jobs cite work schedule, pay, and work-life balance as the top reasons. 
2. Internal engagement is weak. Nurses identified poor communication as a top issue—only behind pay and staffing. Less than half of nurses say that leadership teams engage them in strategic decisions or do a good job engaging them on issues that affect their work.  
3. Trust and loyalty are fragile. Only half of nurses say they are very loyal to their team lead or organization. Loyalty and trust wane for leaders higher up the organizational ladder. Fewer than four in 10 nurses express “a great deal or fair amount of trust” in executives or believe their leaders are making good operational and financial decisions. Same as last year, only one-third have a great deal or fair amount of trust that executives are honest and transparent. 
4. Technology is both a risk and opportunity. Two-thirds of nurses view technology favorably, particularly because certain technology has improved communications and allowed them to do their jobs more efficiently. When it comes to artificial intelligence (AI), nurses are skeptical. But a slight majority are optimistic about its potential. 

What’s next 

The survey findings highlight the fact that strengthening the nurse workforce will require a significant long-term strategy. Leaders will need to engage and communicate more than ever before. Several actions will be crucial: 

1. Target drivers of dissatisfaction. Organizations can move the needle on nurse satisfaction by assessing critical factors specific to each department. Because experiences often vary from team to team, more specific assessments can help leaders target solutions where they will make the most impact.    

Assessments and improvement efforts should start with the basics, like ensuring personal safety, hydration, and bio breaks. To create effective solutions, organizations should bring together leaders from Human Resources, clinical, operations, finance, and communications functions. They should also seek to engage nurses as shared owners of the solutions.   

For instance, if nurses report difficulty achieving work-life balance, an organization might consider developing flexible staffing options or ensuring floor nurses have a full complement of support resources, including virtual nursing.   

One health system had a particularly high turnover rate among junior nurses. After systematically assessing the friction points that mattered most to them, the organization prioritized actionable solutions that improved nurses’ daily work experience. For instance, the health system developed a mentoring program for new nurses on night shift, installed panic alarms for staff safety, and ensured manageable span of control for mid-level nurse managers. This led to a 41% reduction in turnover intention among registered nurses (RNs) and a 34% reduction in burnout.    

2. Empower nurse managers to engage their team members. Managers are the link between leaders and front-line staff. But just 50% of nurses agreed that their manager involved them and their colleagues in decisions that affect their work.    

This trend plays out at individual organizations as well. A recent burnout survey at an academic health system found that while nurses felt connected to their immediate supervisors, they did not feel that executive leaders appreciated them or shared similar values.    

Addressing this issue requires creating stronger engagement. For instance, organizations should ensure effective shared governance models so nurses can exercise agency in their work lives. A unit-based council with staff nurses, for example, can easily identify where inefficiencies and redundancies lie.    

A unit-based council at one organization could identify that vital sign documentation is taking away from the time nurses and techs have to care for patients at the bedside. By implementing machines that automatically upload patient vital sign data into the electronic health record, staff will no longer need to enter the data into a computer and will have more time to meet patient needs. 

Regular one-on-one meetings with nurse managers is another important tactic. Many survey respondents shared that they would greatly improve communications. Health systems have found that these meetings create a mechanism for bidirectional feedback. 

For nurse managers to do this effectively, organizations should give them time to interact with the nurses they supervise and training to improve as communicators. This should include creating opportunities for positive conversations and moments with nurses so not every conversation is about a problem.  

Similarly, health system leaders should have regular, uplifting conversations with managers to show support.    

3. Build trust through regular, honest communications and engagement. One of the survey’s most concerning findings was nurses’ persistent lack of trust in leaders and their decisions. Leaders who regularly spend time with nurses can create trust by acting on concerns, then communicating progress and outcomes of improvement efforts.   

Pairing that direct engagement with honest communications about organizational decisions and goals can also build nurse confidence that leaders are making sound decisions that prioritize the well-being of patients, staff, and the organization.  

For example, one health system launched a workplace violence awareness campaign, which included a town hall. This visibly demonstrated the commitment to change. An academic medical center focused on customizing communications and engagement resources for nurse managers, then built a detailed nurse communications plan based on direct nurse feedback. This contributed to an increase across 100% of the system’s categories measuring nurse engagement.   

When asked what their organization could do to better communicate with them, survey respondents pointed to in-person interaction and transparency. They emphasized how leaders should listen to and work with employees on more effective solutions. 

4. Leverage technology to improve nurses’ daily experiences. The survey found that nurses have mixed experiences. Nearly 60% of nurses said technology had improved the flow of information and helped them do their job more efficiently. On the flip side, 60% said it made healthcare less personal.   

Solicit nurse feedback on technology to identify what has been helpful, what their concerns are, and how to better leverage technology to improve their work experience. For example, the Information Systems team at one health system conducted preventative technology “rounding” in clinical units to solicit feedback and fix or replace equipment.   

Another important action is ensuring full utilization of available technology functionality. For example, flexible schedules is a significant satisfier for nurses, and many healthcare organizations have software that enables mobile self-service, mobile notifications, shift swapping, and transparent recruitment of shifts that are critical to fill. But most organizations aren’t fully utilizing that functionality. Removing barriers to technology enhancements would give leaders and staff control of the schedule and enhanced flexibility. 

Additionally, as organizations roll out AI and new technologies, leaders should understand and communicate the problems they are working to solve. And they should involve front-line users in developing the solutions and creating the processes for implementation and utilization. Fostering buy-in and realizing benefits means approaching implementation not as something leaders do to or for their nursing staff but with them. By working with nurses, leaders and staff can keep the human in healthcare and ensure the personal touch is not lost.   

While the state of the nurse workforce has improved, critical factors remain inadequately addressed. Organizations that cultivate trust and engagement will build long-term satisfaction and stability.

ABOUT CHARTIS

The challenges facing US healthcare are longstanding and all too familiar. We are Chartis, and we believe in better. We work with more than 900 clients annually to develop and activate transformative strategies, operating models, and organizational enterprises that make US healthcare more affordable, accessible, safe, and human. With more than 1,000 professionals, we help providers, payers, technology innovators, retail companies, and investors create and embrace solutions that tangibly and materially reshape healthcare for the better. Our family of brands—Chartis, Jarrard, Greeley, and HealthScape Advisors—is 100% focused on healthcare and each has a longstanding commitment to helping transform healthcare in big and small ways. Learn more.

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