A monthly column featuring insights and ideas on the most challenging communication issues facing health care professionals

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Is today’s “generation gap” sabotaging your retention efforts?

As summer turns to fall, our thoughts often turn to back-to-school.  Even if you don’t have children returning to class this year, that feeling of excitement mixed with apprehension is one we can all relate to.

Every new school year brought some degree of stress, but it was likely those major turning points in our academic careers – the freshman year in high school and the transition to college – that were most nerve-racking.  Fear of the unknown, doing or saying the wrong thing, or simply failing produced the stress.  Then that stress was either diminished or exacerbated by the treatment we received from the upper classman.

Isn’t it funny how those trying experiences as a freshman seem like just yesterday, especially if our memories are painful ones.

“Freshmen” enter our hospitals every day.  We call them new employees.  Regardless of the support they receive from managers, how they are accepted and treated by their colleagues – especially the “upperclassman” – usually determines how they feel about working in our hospital.  And whether or not they stay.

Quite unlike our experience in school, our freshman employees have choices.  With the labor shortage in nursing and other clinical ancillary professions, staff members often can have multiple job offers from our competitors if they want them.  Making sure they don’t want them is critical to reducing turnover and maintaining a productive, satisfied workforce that stays with an institution for a career, not just until the next best offer comes along.

In many hospitals, young employees admit that a culture of professional “hazing” encourages them to look elsewhere for a more supportive work environment.  Institutions with a large core group of experienced professional staff who have exceptionally high expectations – and limited patience for anything less than perfection – are often the most difficult cultures for new graduates to break into.

What factors contribute to a culture that intimidates rather than embraces new staff members?  And how can we change those factors to promote high performance and encourage retention?

The way staff communicate with one another is a good place to start.
Are instructions to junior staff members clear and complete?  Are they encouraged to ask questions for clarification?  Is communication among colleagues respectful?  And do senior staff members understand how important these principles can be to providing quality care and retaining the next generation of clinical professionals?

As a manager, you can make a difference in way your staff communicate by the behaviors you encourage and reward.  Following are suggestions that help create a communication culture that supports and encourages young professionals.

• C:  Compose – Remind staff members that clarity and completeness are especially important for new staff members.  Many practices and procedures are second-nature because they have been in place for so long.  But new staff members don’t know that.  Given these circumstances, focused communication is even more important for new colleagues.
  
  
• A:  Acknowledge – Remember that new staff members want to make a good impression.  Their desire to please may make them especially reluctant to ask questions that they think could make them “look stupid.”  Protect everyone by giving them an opening to ask questions using “I” instead of “you” phrases:  “Let me be sure I explained everything clearly.  Why don’t we review together our priorities for this patient today?”  “What details did I miss or not explain clearly?”  “What questions do you have that I can help with?”
  
  
• R:  Respond – Paying particular attention to the verbal, non-verbal and other visual cues new staff members send can help us respond most effectively to their questions and issues.  Active listening is particularly important to ensure we really understand the circumstances and issues that are most troublesome to new staff.
  
  
• E: Evaluate – The “evaluate” step may be the most important component of the C.A.R.E. model when communicating with new colleagues who are unfamiliar with our organization’s policies and culture.  How are they doing – both personally and professionally?  Are they “getting it” in regard to departmental procedures and practices?  And are they fitting in with their new colleagues and establishing beneficial relationships with others?

Discussing these issues in general staff meetings is fine, but also find a few minutes to talk with small groups of both senior and new staff separately about the challenges they are facing.  Not talking about the issue certainly does not make it go away.  So address it in a proactive, non-threatening, constructive way.

The intervention strategies you identify will likely involve discussions with both the new employee as well as with senior colleagues.  If you have not identified a “mentor” for the new staff member, that may be helpful.  If you have already paired the junior staff member with a mentor, watch to be sure they are “clicking” and that the relationship is beneficial for both parties.

Estimates by professional associations put the cost of recruiting a new nurse as high as $50,000.  Given the competitive labor market in health care, organizations can no longer afford to make significant investments in hiring new staff, and then simply hope they stay.  Spending a relatively small amount of time and focused effort on improving communication between experienced and junior staff can reap substantial benefits in retention and in the overall working environment in your department.

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