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00006247-200403000-0001000006247_2004_35_21_martin_staying_3article< 105_0_11_1 >Nursing Management (Springhouse)© 2004 by Lippincott Williams & Wilkins, Inc.Volume 35(3)March 2004pp 21-26Turn on the staying power[Features: Recruitment & retention: CE]Martin, Carolyn A. PhDAbout the authorCarolyn A. Martin is dean of faculty, RainmakerThinking, Inc., New Haven, Conn.The author discloses that she, as dean of faculty at RainmakerThinking, Inc., has a significant relationship with companies that pertain to this educational activity.AbstractAbstract: As a nurse leader, you’re in a pivotal position to influence recruitment and retention initiatives. Here, review best practices.Just when you thought you couldn’t handle one more assignment, suddenly you find yourself challenged by the latest demand on your time and energy: You’ve just been designated the Chief Retention Officer of your department.Senior administrators assure you that the best recruiting strategies depend on the best retention strategies. “An ounce of retention is worth a pound of recruiting,” they claim. They cite current research that says the key to productivity, motivation, and retention lies in the hands of managers. 1 They urge you to reexamine your relationships with your team members, find out what motivates each and every one of them, and craft strategies to maximize retention and minimize turnover.Although this sounds like mission impossible, it’s every manager’s new reality. The fact is, the number one reason people leave organizations—with all other factors being equal—is also the number one reason they stay: the relationship they have with their immediate manager. 2 If you read employee surveys throughout the health care industry—or if you’ve conducted one yourself—you know that staff members, in general, aren’t happy with their managers. In fact, the majority of “opportunities for improvement” within many organizations tend to focus on the manager/employee relationship. Staff members request things like: ♢ more effective, straightforward communication based on trust and honesty ♢ fair performance standards ♢ recognition for ideas or suggestions for improvement ♢ timely performance reviews ♢ encouragement to find better ways to do things. 3 On the other hand, you know that health care organizations generally have a poor track record when it comes to training, supporting, and rewarding those in management positions. As in most industries, health care traditionally assumed that a mastery of technical skills translated into a mastery of management skills. Now everyone is beginning to realize that star performers with technical expertise don’t succeed in management unless they also have “people expertise”—the ability and desire to work closely with others, which includes learning how to motivate and retain individuals, one person at a time, one day at a time.That’s why the American Hospital Association strongly recommends that health care redesigns “the role of front-line supervisors so that they’re on-site and have the time to effectively coach, mentor, reward, assess performance, and hold individuals accountable for results.” 4No one needs to be more “front-line” and “on-site” than nurse managers, the new Chief Retention Officers. You’re the one who must “effectively coach, mentor, reward, assess performance, and hold individuals accountable for results” because you’re at the center of all the action. You’re expected to respond to questions and crises; provide support and coaching; trouble-shoot and problem solve; motivate high performers and rehabilitate low performers; hold everyone accountable for great results; all the while, of course, doing more work with fewer people and resources. You’re the key to creating your organization’s reputation for retaining the best individuals, which makes recruiting so much easier—but where do you start? With the basics, of course. Begin by acting like a Chief Retention Officer.The following best practices, tips, and techniques will help you define—and refine—your new role. None of them requires policy changes or permission from senior management. Each does demand, however, your personal commitment to rolling up your sleeves, getting in there, and becoming a better manager. Once you’ve identified the recommendations that most impact you and your staff, you’ll probably have to negotiate for the time, resources, and training necessary to implement them. That’s the commitment your organization’s administrators need to make to you if you’re going to succeed at the new challenge they’ve assigned you.Best practice 1: Begin retention planning on day oneCountless health care organizations pride themselves on the fact that they conduct exit interviews. Trying to discover why the proverbial horse bolted out of the proverbial barn, they continue this poor practice even though they know first-year nurses begin to think about leaving 180 days into their job and that half of them do bolt after the first year. 5 A better tactic is to guard the barn door by making retention planning part of every new-hire orientation and by holding formal retention conversations every two to three months.What would this conversation sound like? Open with a powerful positioning statement such as: “We’re committed to making your time with us the most positive professional experience you’ll ever have. To do that, we need to know what initially attracted you to this organization and what will keep you engaged, motivated, and productive. This is the first in a series of ongoing conversations I’d like to have with you to ensure that we’re both on track and you’re getting the support and guidance you need to succeed here.”Then, consider asking the following questions: ♢ What were the most important factors that determined your position acceptance? ♢ What role can we play in your career as you move from one stage of life to the next? ♢ What employer/employee issues are most important to your willingness to stay in this position? ♢ What employer/employee issues would prompt you to leave this position? ♢ Would you feel comfortable enough to speak to me as soon as the thought of leaving crosses your mind? If not, what can I do to make you feel more comfortable?Create an easy method for recording and tracking responses—for example, a notebook, database, or computer file. This documentation will keep you on track with each person and provide the agenda for ongoing retention discussions.And remember, you need to ask these kinds of questions on day one, not on day last. Then, schedule a retention conversation formally every two to three months and informally whenever important issues arise. Create a trusting environment where your staff members feel comfortable coming to you as soon as thoughts of leaving arise. Don’t wait for a 180-day crisis or an open barn door.Best practice 2: Maximize everyone’s knowledge, experience, and skillsResearch suggests that most people use only 20% to 25% of their talents and skills at work every day. 6 That’s a lot of wasted potential. Now, consider that when people spend more time doing what they love to do and are good at doing, motivation and morale soar.How do you enhance everyone’s potential and offer them the opportunities to do what they love? Hold a team meeting during which you encourage participants to break out of their “boxes” by putting aside their job descriptions—at least for the sake of discussion. Ask them to tackle the following questions: ♢ What work would I enjoy spending more time doing? ♢ What talents, experience, or skills am I presently not using that would benefit the team? ♢ What tasks and responsibilities for which I’m presently not accountable would maximize my strengths?Obviously, all departmental tasks and responsibilities require coverage, but this conversation will allow surprising and energizing “trade-offs.” As one nurse manager in a Midwest health system reported, “I was amazed when my team had this discussion. What I thought was an unenjoyable job, someone else really wanted to do. For example, some nurses disliked making follow-up calls to families, but loved doing analytical paper work, or vice-versa. The result was a series of trades that boosted morale and productivity for everyone. We’re still covering all the bases, but my team members are so much more motivated to come to work.”The impact of this best practice on retention is invaluable. When you encourage individuals to maximize their strengths and spend more time doing what they love to do, you’re actually creating their ideal position. It’s not just a “job”; it’s a customized professional opportunity that’s hard to walk away from. Not many organizations can boast this retention strategy.Best practice 3: Become a coaching-style managerNo matter what their age or position, the most talented people no longer want a “boss” at work. They want a coach. They want someone who sets clear expectations, teaches them how to get and stay on track, and helps them master the competencies that will make them more successful. 7 Becoming a coaching-style manager is one of the best ways to get the best work from the best people and retain them in the process. Your team members need to know you care about their work; you know their goals; you deliver clear, direct, honest feedback; you hold them accountable every step of the way; and you reward them for their performance. This doesn’t mean that you’re their therapist or personal coach. (Both functions are outside the realm of most nurse managers’ expertise.) It does mean that you’re a performance coach whose job is to help everyone become a high performer. Becoming a coaching-style manager takes lots of practice and requires a new set of actions and ways of talking with staff members. Here are several basic techniques you can begin to practice immediately. The more of them you implement, the more you’re acting like a coach. The more you act like a coach, the better relationship you’re building with your team.1. Hold people accountable for high performance.Creating a reputation for retention demands creating a culture of excellence. Your best performers strongly dislike working with low performers. Just ask them. They even have a low tolerance for mediocre people who are allowed to remain mediocre.Therefore, one of the best strategies to retain the best people is to raise the bar. Make high performance a non-negotiable condition of employment. Let your team know that you’re committed to becoming a high performance nurse manager and that you’re going to ask for their high performance in return. That means everyone—from charge nurses to unit receptionists—remains accountable to committing to and working toward raising the bar. So, how do you manage this?Your ability to raise your own bar of responsiveness is a core competency of the coaching-style manager. You serve no one if you’re delaying constructive feedback.Schedule 10-minute meetings with each team member two to three times a week. Let them know that you’re going to be more involved in their work—not through micromanagement—but through setting clear expectations through ambitious goals, deadlines, and guidelines. Assure them that you’re going to provide the support and coaching they need to succeed and that you’re going to hold -them accountable for their performance every step of the way.Some meetings will involve goal setting for the coming week; others will focus on your assessment of their work; others might include both. You decide the purpose of each meeting and create an agenda to maximize the use of your time. Consider the following topics: —a brief reminder of performance standards that apply to their accountabilities (Doing the work isn’t sufficient; doing the work to higher standards is.) —goals, deadlines, and guidelines for the coming week —the support, guidance, or resources they’ll need to succeed —trouble-shooting before the fact to avoid pitfalls or hurdle obstacles —assessment of the previous week’s commitments: —What’s this team member doing well? —Is he or she exceeding expectations in any area? What can you do to reward this? —What’s this person not doing well? What can you do to resolve this? —Overall, what’s your ongoing assessment of this employee’s performance?Whatever the purpose of your 10-minute meeting, keep written contemporaneous records for each person. Take some brief notes, including the date and time of every meeting and the goals and deadlines you’ve agreed upon. Also note any special requests an employee makes. Finally, note your ongoing assessments of the employee’s performance. This will help you identify patterns of behavior that are red flags—either for praise and reward or for more formal performance improvement discussions in the future. (See “Sample performance tracking form.”)FORM. Sample performance tracking formCommit to using whatever system works best for you and make it a non-negotiable management activity. This extra step of keeping records won’t only help you track each relationship and hold each person accountable, it will also help protect you in case of any disputes with employees down the road.2. Follow up with clear, honest, timely feedback.Your best efforts at clarifying expectations, creating performance standards and goals, and holding people accountable will prove ineffective unless you develop the skill of delivering clear, honest, timely feedback. Performance reviews, even if given quarterly, are no longer sufficient in the current fast-paced work-place. People need to know STAT when they’re off track or on track. They need you to respond daily to their actions so they can move on to the next opportunity. Your ability to raise your own bar of responsiveness is a core competency of the coaching-style manager.Consider the following suggestions for making your daily feedback more effective: ♢ Ask yourself: What does this person need to hear from me, versus what do they want to hear? Be kind, but have the courage to be honest. You serve no one if you’re hedging or delaying constructive feedback. Let everyone know that your intention in giving feedback is to help them get better at their job. ♢ Be sure your feedback is accurate, that is, thoughtful, balanced, and true. Every time you deliver feedback, your credibility is on the line. If a person perceives your feedback as unfair, unbalanced, or factually inaccurate, the credibility of your relationship is undermined. On the other hand, he or she will trust and value you if you take the time to be thorough, sensitive, and instructive. Therefore, be aware of your own knee-jerk reactions. Before delivering feedback, stop to reflect: What do you really know? Are your assumptions valid? Do you have all the facts? Should they be double-checked? Is there another response to the situation that would impact your feedback? Try opening feedback conversations with such statements as: “Tell me more about…,” “Help me to better understand…,” and “I need your insights into what happened….” Then, you’re in a better position to make an accurate assessment of the performance or behavior you’re addressing.Next, balance praise and criticism. When the point of your feedback is to correct an employee’s performance, think about that person’s valuable contributions before proceeding. While it may not be appropriate to praise them in the moment, it’s important to keep the bigger picture of their positive contributions in mind. Don’t allow the need to discuss performance improvement overshadow their overall value. Above all, focus your comments on the performance, not the person.On the other hand, if the focus of the feedback is praise, be careful about over-praising, especially when the person clearly has room for improvement. Although people love praise, they don’t appreciate insincerity; it dilutes their genuine accomplishments and makes them question your judgment about what’s valuable. Practice balance and you’ll stay on track. ♢ Make coaching part of every feedback discussion. Simply telling people what they’re doing right and what they could do better isn’t the same as coaching them to their best performance. After receiving your feedback, your team members should know precisely what they’re expected to do next. Your positioning statement should be, “Now here’s what I need you to do….” Then fill in the blank with how they can improve performance, adjust goals or deadlines, or move on to new opportunities. Then pose a closing question: “What do you need from me in return in terms of coaching, support, resources, recognition, and incentives?”That’s the ongoing coaching dialogue: “Here’s what I need from you. What do you need from me to succeed?” By engaging in this conversation, not only are you holding your team members accountable for delivering results, but also you’re holding yourself accountable for being a hands-on coach. (See “Evaluate your feedback competency.”)3. Customize incentives and use them to drive high performance.Coaching-style managers know that one-size-fits-all incentives are out and customized incentives are in. They learn how to drive high performance through negotiation, rather than just relying on “being the boss.” How? By discovering each employee’s unique needs and wants—whether it’s a choice assignment, a training opportunity, a Thursday afternoon off, a gift certificate to a restaurant, or a onetime bonus for exceptional work—and using those incentives to drive and reward the best performances.Obviously, you can’t give everything to everybody, but you can try to do as much as you can for every high performer. And that’s the key: The prerequisite for recognition and reward is high performance. Of course, you’re offering coaching, support, and training to your lower and mediocre performers, pushing them toward optimal performance. But you also have to be wise enough to know when to let go of uncoachable players; when it becomes obvious that they can’t or won’t play on an optimally performing team, keeping them is a disservice to them, your team, and your organization.How do you go about customizing incentives? First, find out what you can offer. What are the bargaining chips your organization has readily available above and beyond basic salary and benefits? What are those incentives team members know are there for the taking in return for their meeting ambitious goals and deadlines, maximizing their strengths and contributions to the team, and taking accountability for their high performance? If you don’t know what’s on the table, ask your facility’s human resources department. Poll other managers, too. What are they doing? How are they pushing the envelope of their authority to create customized arrangements that work for the individual, the team, and the organization? Then, ask yourself: “What am I willing to try today, tomorrow, and next week to customize incentives?”Secondly, listen closely to what team members tell you is important to them, with the understanding that what motivates them this month may not next month. That’s why you must be ready to engage in ongoing negotiations to keep the drive toward high performance alive. If you have team members who are quiet or shy, set aside one of your 10-minute meetings for a discussion of what you can do to reward and drive their performance. Make a note in your contemporaneous records so you remember what’s important to each person.The impact on retention? When people feel listened to and seen as individuals with specific needs and wants, when they perceive that their manager not only expects high performance, but rewards them in personally meaningful ways, it enhances that sense of creating the ideal professional opportunity. Not only can they optimally use their strengths, talents, and skills every day, but also they’re recognized and rewarded in the process.Be realistic, but optimisticWhen it comes to retention, there are no 100% solutions. But what if, as the new Chief Retention Officer, you began practicing some of the aforementioned tips and techniques and you improved your retention rates by 50%, 20%, or 10%? Would it be worth the investment? The alternative is living with the status quo—and that won’t serve you, your team, or your organization in health care’s challenging future. In fact, if you embrace the rigors of becoming a Chief Retention Officer, you’ll not only earn a reputation for creating a culture of excellence and a team of high performers, but you’ll never again have to worry about recruiting people. In fact, the best of them will be knocking down the door of your department, scrambling to get in.Evaluate your feedback competencyWant to know how expert you are at delivering effective feedback? Try interviewing key team members who’ll be genuinely honest with you about your current practices. Position this as a “help me become more effective at delivering the feedback you need to become more effective” conversation. 1. Do you feel that you need, in general, more feedback or less feedback than I currently give you? Are there certain tasks, responsibilities, or projects for which you need more, or perhaps less, feedback than usual? 2. Do you generally prefer receiving feedback in writing? Orally? In person? By voice mail? By e-mail? Are there certain tasks, responsibilities, or projects for which you have different preferences? 3. What time of the day are you busiest? Least busy? What’s generally the best time for me to give you feedback? Are there certain tasks, responsibilities, or projects for which you have different preferences? 4. Are you clear on your goals or next steps after I give you feedback? If not, what are some ways I could clarify them? 5. Do I balance praise and criticism? Do I over-praise or over-criticize? If so, when does this happen? 6. Do I seem to put thought into feedback? Do I make false assumptions or act on incorrect information? If so, how can I check my facts so that this doesn’t happen? 7. Do I follow up on feedback after I give it to make sure you’re back on track or moving ahead? If not, what would be the best time for me to follow up with you?References1. Buckingham, M., and Coffman, C.: First, Break All the Rules. New York: Simon and Schuster, 1999. [Context Link]2. Ibid. [Context Link]3. RainmakerThinking, Inc.: Ongoing research. Available online: . [Context Link]4. The American Hospital Association’s Commission on Workforce for Hospitals and Health Systems: In Our Hands: How Hospital Leaders Can Build a Thriving Workforce, p.33. April 2002. [Context Link]5. RainmakerThinking, Inc.: loc cit. [Context Link]6. Martin, C., and Tulgan, B.: Managing the Generation Mix. Amherst, Mass: HRD Press, 2002. [Context Link]7. RainmakerThinking, Inc.: loc cit. [Context Link]Employee performance and departmental productivity hinge on your relationships with staff members.Turn on the staying powerMartin, Carolyn A. PhDFeatures: Recruitment & retention: CE335