Angela Purgiel
Abstract
New graduate, millennial nurse turnover is affecting hospital units at a rate of 30 percent in the
first year and upwards of 41-60 percent by the second year. It is important for leaders to focus on
this issue in order to inhibit costly turnover within their unit. By understanding the basic needs of
the new graduate, millennial nurse, like concepts related to teamwork, and leadership structure a
nurse leader can help meet the staff member’s needs and decrease the likelihood of that staff
member leaving the unit. It is also important to implement strong leadership characteristics like
structure and commitment while using Lewin’s change theory in order to ensure cohesive
Turnover in the nursing profession is certainly not a new concept but with the recent
introduction of the millennial workforce and the surpassing of baby boomers, retaining
millennials in the workforce has become extremely important. According to Kathy Bonser,
Vice President of Nursing and CNO at SSM Health DePaul, millennials are seeking a certain
formula within their work environment including “frequent feedback, celebration of milestones,
and the need for performance feedback” (Bonser, 2016, para. 3). Retention is also important as it
creates positive compassion within the workforce. When the group as a whole is satisfied with
their work environment they provide high quality and compassionate care (Sorensen Marshall,
2011). Providers need to feel satisfaction within their work environment; they need to feel
important to the profession as a whole. The purpose of the paper is to advocate for the solutions
in decreasing millennial turnover, provide rationale for addressing this issue all while using
A millennial nurse is defined as a person born after the year 1980, many of these nurses
are entering the field currently as new graduate nurses (Randall, 2013). Turnover is an extremely
important issue facing the profession because “high job turnover for new graduate nurses is
associated with detrimental patient outcomes, costly for employing organizations and
problematic for the profession” (Randall, 2013, p. 152). It is estimated that 41-60% of all new
graduate RNs plan to leave their current roll within two years. One of the common identified
dissatisfiers for newly hired, new graduate nurses is the difference between their perception of
the profession and what the role actually entailed once they were contributing members of the
KEY ISSUE: MILLENNIAL TURNOVER IN THE NURSING 4
work force (Randall, 2013). This concept is important for nursing schools as there may be a
In a study published in the International Journal of Nursing Studies it was found that
almost 30% of new nurses will leave their profession within in the first year (Kovnen et al.,
2016). The estimated cost to the organization is roughly $62,000 to $67,000 per nurse (Kovnen
et al., 2016). Not only does this cost the organization money but it also creates shortages within
the unit leaving the potential for units to have to work understaffed until more nurses can be
trained. This then becomes a patient safety issue as the demands of the nurse increase.
Both of these articles had very similar solutions to this problem. Both stated that leaders
within the nursing units play an important role in reducing turnover within units. According to
Randall, it is important for nurse leaders to work towards solutions in reducing millennial turn
over as it leads to higher associated costs to the unit. It is the leader’s responsibility to manage
cost (Randall, 2013). According to the other study nurse leaders need to address turnover and
work with new grad staff nurses to build career plans. Although unit staffing is a high priority for
these managers it is more beneficial to work with the employee and ensure job satisfaction by
Not only is millennial turn over a costly problem it is also is a patient safety issue, these
two reasons alone are why it is vitally important for a nurse leader to work towards solutions in
reducing the units turnover. In order to create effective change in a unit a strong unit leader
should be developed. There are several important concepts related to what a strong leader
embodies and these concepts are directly related to fostering an environment a new grad,
millennial would want to work in. Keeping in mind there are certain factors uncontrollable from
KEY ISSUE: MILLENNIAL TURNOVER IN THE NURSING 5
the leader standpoint, for instance a staff member leaving the unit due to a change in living
situation or leaving to pursue an advanced degree, which to some extent is not within the leader’s
control.
article written by Bruce Avolio and William Gardner, leaders should “lead by example” and
leaders should “demonstrate transparent decision making, confidence, optimism, hope and
resilience, and consistency between their words and deeds” (Avolio & Gardner, 2005, p. 326).
These concepts echo characteristics staff members look for in their unit leaders. According to
Randall, millennials expect “challenging work, opportunities for advancement, a social work
responsibilities” (Randall, 2013, p. 153). Not only does a leader need to embody the important
characteristics of an effective leader but they also need to address the needs of the millennial
nurse. Another important concept related to effective management of a millennial nurse is the
“organizational structure and managerial support” (Randall, 2013, p. 153). According to Randall
many millennial nurses grew up playing team sports and respond well to structure and support.
Also closely related to these concepts is the integration of teamwork. Many millennials grew up
working in teams in order to complete task and will gravitate to a work environment that
supports teamwork.
Not only does the unit leadership need to embody these concepts but it needs to be
considered at all levels of the organization leadership. These concepts need to extend from a
chief nursing officer to the director level on down to nurse managers and supervisors. It is
important to encompass these concepts within other nursing department’s including nursing
education and unit clinical nurse specialists. Incorporating these concepts at a broader level
KEY ISSUE: MILLENNIAL TURNOVER IN THE NURSING 6
shows the organizations commitment to the staff member’s success by offering a stable
environment.
When implementing a change at a unit level there are three main aspects to consider in
making the change a permanent staple in the nursing culture. Using Lewin’s change model of
unfreezing, moving, refreezing as it relates to decreasing millennial turnover can ensure this
change will become a permanent part of the unit culture. Unfreezing is the act of identifying a
change is needed using evaluation tools to diagnosis the problem. Moving is the actual act of
initiating the change by implementing change behaviors and shifting the culture of the unit.
Finally, refreezing, is making the change a permanent staple on the unit and restoring
equilibrium into the culture (Mitchell, 2013). There are certain characteristics leaders must
exhibit in order to influence the culture of the unit during change. These characteristics are
commitment to the change and clarity. Leadership commitment to the change needs to be all
various levels of the leadership team. Not only does the leader need to show commitment to the
change but the staff needs to understand their role related to clarity of the change.
Making a change in a unit’s culture can be challenging but it is likely one of the most
important roles a leader can have. With the increasing demand of unit staffing, decreasing
millennial turnover is a change unit’s will likely face. It is important for unit leaders to
understand the basic needs of millennial nurses along with understanding what qualities a
successful leader encompasses. In order to prevent this turnover from occurring a change will
need to be implemented. Using Lewin’s change theory can help leaders successful implement
change behaviors into their unit’s culture and ultimately decrease unit turnover within millennial
nurses.
KEY ISSUE: MILLENNIAL TURNOVER IN THE NURSING 7
References
Avolio, B., & Gardner, W. (2005). Authentic leadership development: Getting to the root of
www.sciencedirect.com
Bonser, K. (2016). Millennial Nurse Retention: Bridging the Generation Gap - On-Demand.
the-generation-gap
Kovnen, C., Djukic, M., Fatehi, F., Fletcher, J., Jun, J., Brewer, C., & Chacko, T. (2016,
August). Estimating and preventing hospital internal turnover of newly licensed nurses: A
panel survey. International Journal of Nursing Studies, 60, 251-262. Retrieved from
http://www.journalofnursingstudies.com/article/S0020-7489(16)30041-4/abstract
Mitchell, G. (2013). Selecting the best theory to implement planned change. Retrieved from
http://home.nwciowa.edu/publicdownload/Nursing%20Department%5CNUR310%5CSel
ecting%20the%20Best%20Theory%20to%20Implement%20Planned%20Change.pdf
http://dx.doi.org/10.1097/NAQ.0b013e3182869d9f