Trauma programs are struggling to retain experienced staff. Factors driving trauma staff turnover include higher trauma volumes, increased patient acuity, growing PI and registry backlogs, and trauma provider burnout.
Recently, I asked trauma program managers in the Trauma System News subscriber community to share their best advice for improving staff retention. Their feedback was gathered using an online response tool. Nearly two dozen TPMs responded with their insights and strategies for holding on to valuable team members.
Below are 16 recommendations from experienced TPMs on how to increase staff retention. All comments are anonymous unless the respondent agreed to be identified. Some comments have been lightly edited for clarity and usage.
1. Hire for fit with the current team
New hires who complement the culture and personality of the current trauma team are more likely to stay long-term.
Linda Meier, trauma program manager at M Health Fairview Ridges Hospital in Burnsville, Minnesota, recommends involving current team members in job candidate interviews. “Being part of the decision making process leads to ‘ownership’ of the success of the new hire,” she wrote.
According to a different TPM, leaders must signal openness to honest feedback: “I learned my lesson once by leaning toward a candidate I thought was a good fit for skills, only to find that the candidate was ultimately unsuccessful in their role.”This TPM’s staff members later admitted they had reservations about the candidate during the interview process. “But I was so firm about the candidate’s fit that they did not voice their reservations.”
2. Provide peer mentoring for new hires
Peer mentoring can help new team members get comfortable in their role and overcome the obstacles that lead to job dissatisfaction. This strategy may become more important as workforce shortages force trauma programs to hire less experienced candidates.
“We typically didn’t hire inexperienced nurses in the past, but we now need to be more flexible with who we consider,” a trauma program manager wrote. “When we do hire a less experienced nurse, we offer additional peer mentoring and orientation so they succeed.”
3. Meet one-on-one regularly
Several TPMs recommend meeting with team members individually on a regular basis.
“We do monthly one-up meetings where I meet with each team member individually,” a TPM wrote. “There are specific questions I ask at each meeting, and I make sure to follow up on any suggestions or needs that the team member may have.”
This manager also provides team members with status updates on any requests. “I think retention is ultimately about listening to your staff and closing the loop with good communication.”
4. Address negatives promptly
Negative behavior will eventually undermine any trauma program team. A number of TPMs wrote about the importance of tackling negatives head-on.
“Addressing negatives as soon as possible seems to be most helpful,” wrote one program manager. But this is often easier said than done. “Sometimes there is no way to change the negative behavior, at which point you need to work with your leader and Human Resources.”
Another TPM offered a strategy for helping staff deal with negatives at work. “Don’t fall into the complaint trap,” the manager wrote. “If someone has a complaint, make them provide possible solutions. This can help them see the other side of the issue.”
5. Support and enable work from home
Many TPMs reported that remote work is now an important element of staff retention, especially for registry staff.
“Our work-from-home option is very popular for my registrars,” wrote Katherine Bendickson, trauma program manager at Valley Medical Center in Renton, Washington. “It helps them balance life and work better.”
TPMs can support work-life balance by setting an example for their team. “I focus a lot of my time on ensuring my staff have a good work-life balance,” a different TPM reported. “I constantly ask them if they need a day to work at home. Each staff member has a home office set up, and I try to model a flexible schedule by working from home when I have no meetings on site.”
6. Be flexible about hours
“We allow our trauma registrars, PI team and injury prevention coordinators flexibility on work schedules,” a program manager wrote. “They are able to arrive and depart around their home schedules.”
7. “Put family first”
According to Robert Dice, MS, RN, trauma program manager at Penn Highlands DuBois in DuBois, Pennsylvania, one key to staff retention is to recognize what team members value most.
“First and foremost, family first,” Dice wrote. “My staff members have the ability to work remotely, so a sick child or inclement weather does not stop productivity. I also insist that my staff attend their children’s concerts, recitals, etc. These things happen infrequently and maybe once in a child’s lifetime. I have one staff member without children but with dogs. If dog care is an issue, she works from home to be with her fur babies.”
8. Recognize staff accomplishments
Several TPMs noted the importance of making sure team members know that they — and the work they do — are valued. These managers shared a variety of approaches to staff recognition:
- “Make sure you share team members’ accomplishments with the rest of the facility and acknowledge everyone’s role in a successful verification,” wrote Jane Smalley, trauma program manager at St. Luke’s Hospital in Duluth, Minnesota.
- “Recognize individuals when they are outstanding — and provide opportunities for their team to do the same,” a different TPM wrote. “We have a recognition card that staff can fill out to give kudos to another team member.” At the end of each month, one recognition card is drawn and the winner receives a gift card to a coffee shop.
- “Make sure team members take credit for all their work,” another program manager wrote. “For example, I have a PI nurse who does bedside rounds and often educates both nurses and patients/families. I encourage her to put that education into an appropriate filter to acknowledge the work she does and to note that the concurrent work makes a huge difference in patient outcomes.”
9. Share information
A number of TPMs noted that sharing information with staff helps individuals feel engaged in their work and part of a team.
“In my opinion, I cannot share enough operational information with my staff, because knowledge is power for the entire team,” one TPM explained. “I have also found that open sharing of information decreases drama because everyone is in the loop, so to speak. We share across all job descriptions, from the TMD and attending trauma surgeons down to the administrative assistant.”
“Share information, even if you don’t think it applies to the registrars or other staff,” wrote Jane Smalley of St. Luke’s Hospital. “The team needs to know what is happening in the program to understand their role and how it supports the program. The same is true as to what is happening in the facility, as everything affects the trauma program.”
10. Foster a learning environment
Staff members who are constantly learning are less likely to become bored with their job.
“I find that an important part of retention is fostering a learning environment that is open and fun,” wrote one TPM. “We all make mistakes — it is how we manage the results that really matters. With this outlook, I have been very successful with regard to retention.”
Another TPM suggested: “Make sure staff are able to have a role in projects that are meaningful to them.”
Other recommendations include rewarding team members who receive professional certifications and simply making sure staff understand the “why” behind their work.
11. Focus on the truly important
Many jobs in trauma are detail-oriented and process-driven, but it can be discouraging when minor details eclipse important goals. Program leaders shared several strategies for keeping the focus on the truly important:
“Align resources to volume,” wrote Carolynn Morris, MN, RN, division director of trauma services at Virginia Mason Franciscan Health in Seattle, Washington. “Letting some non-essential tasks go will allow you to focus on CORE trauma standards.”
Another program leader recommended a results-oriented approach: “Use data and targets to evaluate productivity rather than set hours.”
12. Be open to staff ideas and offer them autonomy
Several individuals said trauma program managers should be as flexible as possible and open to staff input.
“Encourage team members to share ideas,” wrote Sarah Eason, trauma program manager at MercyOne in Des Moines, Iowa. “TPMs should be willing to do trial periods for staff ideas and show team members why something may or may not work. I worked hard for bosses who did that for me in the past, so I show my team the same work ethic.”
Staff may have useful suggestions on shift timing, education needs, distribution of workload, team meetings, paid time off, how to make their jobs easier, and other issues.
“Offering autonomy is also important,” another TPM wrote. “The job has to get done, but allowing creativity for the team to get it done in a way that works for them leads to greater job satisfaction.”
13. “Keep it fresh”
“Keep trauma updated and interesting,” wrote Katherine Bendickson of Valley Medical Center. “Changing up audits and ‘who does what’ adds fresh eyes and something new. Patient comments and outcomes make staff feel involved and provide a sense of completion.”
Bendickson noted that community outreach opportunities are a great way to keep the job fresh for trauma staff. “We have a 9/11 BBQ for first responders thanking them each year, and everyone gets involved,” she wrote. “Working with marketing is also popular with the team.”
Another TPM recommends occasionally getting the team out of the office: “We have bimonthly team meetings, and one of those meetings is always held off site. It gives us the chance to get away from the office/hospital, have time to decompress and just spend time as a team without the distractions of work. Once that meeting is over, we all go home early on that day.”
14. Pay attention to staff wellbeing
Several TPMs said they try to support the overall mental health of their team. Carolynn Morris of Virginia Mason Franciscan Health recommends creating forums that allow team members to build resilience.
“These forums allow staff to safely talk about resilience or the ability to recover from setbacks, adapt to change, and work together to understand and implement strategies to keep going in the face of adversity,” Morris wrote.
Another TPM says that wellbeing is an investment. “Invest time in the wellbeing of the ones you have in front of you. Be aware of their mental health and provide resources when needed. Check up on the ones that are struggling either in person (when on shift) or by phone. Stop and ask the ‘quiet ones’ how they are doing.”
15. Get into the trenches with your team
Many TPMs said leaders who “get their hands dirty” build the loyalty that can keep staff turnover in check.
“Lead by example — and not just the cliché,” wrote Sarah Eason of MercyOne. “Do the work, and show your team that the work is expected and you are willing to be in the trenches with them.”
“Get down and dirty with your staff,” wrote Krista Norrid, RN, BSN, trauma program manager at St. John Health System in Tulsa, Oklahoma. “Show them you can work with them from taking care of a patient all the way to getting the patient into the registry. We all have to be reminded why we do what we do and it takes a team to make it work!”
Other comments:
- “Be present. Listen. Push a stretcher. Be active as a part of the team when they are shorthanded.”
- “I make sure I am willing to and know how to do everything my team does.”
16. Build a culture of retention
A common theme across all the recommendations was the importance of organizational culture. Trauma programs with a positive team culture are better able to retain valuable staff.
“We have little to no turnover in our experienced trauma nurse leads (TNLs), and that is attributed to the culture within our trauma department,” wrote a TPM who leads a top-level trauma center. “They stay because of their team, the culture that we all worked hard to create and foster, love of the trauma nurse role, and passion to give the best Level I care to our community and state.”
While experience is essential in this TNL program, new hires are also selected for fit with team culture. “The culture we support is one of accountability, autonomy, self-governance with democratic decisions, and treatment of all with respect, honesty and compassion,” the TPM wrote.
Leaders in this trauma program are expected to embody the desired culture. “As leaders … we demonstrate transparency, place importance on work-life balance and taking PTO regularly, fight for wages, share the victories and losses with staff, work at the bedside to keep our clinical skills up, and be on the front line with the team during chaos. We promote an environment that will allow each nurse to be their best.”