What Factors Contribute to Retention of APRNs and PAs
Author Noelle Kohles MSN, RN, CPN and Jill Gilliland
Editor Elizabeth Moran, MSN, RN, CPNP-PC
APRN (Advanced Practice Registered Nurse) and PA (Physician Assistant) retention have been a constant struggle and financial strain for healthcare systems. In fact, data show that the cost of APRN and PA turnover is 2 to 2.5 total compensation. The Average APRN and PA salary is $120,000, plus an additional 30% on average in benefit, calculates to a typical total compensation of around $170,000. Organizations across the country often strategize ways to recruit top candidates, offering competitive salaries and even sign-on or referral bonuses. At first glance, money may attract APRNs and PAs, but equally important—what makes an employee stay?
The work of an APP (Advanced Practice Provider) can be challenging, no matter the setting, but APRNs and PAs who enjoy their work environment are more likely to remain employed over time. A positive, supportive work setting helps to prevent provider burnout. Recently, the COVID-19 pandemic has become an added burden on employees, requiring greater flexibility of APPs in the face of uncertainty, fear, and ever-changing protocols. It is of no surprise, then, that healthcare employee burnout is on the rise. Employers must seek creative, sustainable ways to promote retention.
We at Melnic are here to help! We’ve identified the 4 key factors to help retain your best and brightest APP staff: engagement, support, professional growth, and a culture of respect.
How to Engage APRN and PAs:
Staff engagement requires support and commitment on an institutional and leadership level. Organizations can engage APRNs and PAs through investment in programs that recognize their value. This includes not only clinical initiatives, but also opportunities to participate in research, quality improvement projects, education, and leadership development. Feeling recognized for their own value can inspire employees to go above and beyond in their work.
All employees want to have an impact and to feel that they are valued. Not valuing APRNs and PAs can lead to disengagement. The cost of disengagement can be higher than the cost of turnover. Therefore, it is crucial to invest time and money in recognizing, appreciating, and valuing the work of APRNs and PAs.
Organizations invest thousands of dollars on employee engagement surveys yearly. This investment is lost if the organization does not then use that feedback to create an action plan. For example, employers may learn that even the small things, such as APP professional or appreciation days, awards, name badges, or even visibility on organizational, websites lead to greater employee satisfaction. Ultimately, the more APRNs and PAs feel valued, the more engaged they will be.
How to Build a Support Structure for APRNs and PAs:
Support systems for APRNs and PAs include reporting structures, new grad orientation, feedback processes, role clarity, team integration, and other important systems. When employees are supported, they feel valued and less stressed. It can also have a positive impact on their overall productivity and efficiency. Caring about employees can lead to a higher level of joy in the workplace, ultimately engaging them to stay with the company longer.
To build a support system APRNs and PAs need clinical support for their role including leadership that advocates for their scope of practice, team development, and a sustainable schedule. Additionally, new grads need an orientation of at least 4-6 months that includes a gradual patient load, training, and feedback, dependent upon their previous experience and patient acuity.
Additionally, APRNs and PAs need support for growth in leadership roles. Organizations that have well-defined APP structures provide more opportunities for progressive leadership roles. To become a successful leader, APPs need training in communication, personal assessments, and leadership skills. Growth within an organization can provide a higher level of retention.
How to Set up a Professional Growth Model for APRNs and PAs:
To set up a professional growth model for APPs, organizations must provide the funding, leadership, and pathways for APPs to engage in such opportunities. This includes funds for continuing education, time to attend or present at conferences, and protected time to engage in research, quality improvement projects, and opportunities for educating others. Organizations who do not invest in professional development for APPs get a lower return on their employee investment. It is more valuable to utilize the expertise of APPs in projects that improve patient care or achieve organizational goals than to utilize them 100% clinically, if the APP is so inclined. Clinicians who feel valued when they are supported to grow professionally are more engaged and more likely to stay.
Why is it Import to Build a Culture of Respect:
A culture of respect for APPs provides a sense of being valued, and a safe and positive work environment. Respect is a feeling of being valued or admired by someone else. This may be due to their skills, characteristics, or achievements. The number one way to show respect is to express appreciation verbally, non-verbally, or through written communication. It is important to build a culture of respect for APPs. A culture of respect provides necessary feedback and a sense of safety in a very challenging environment.
Feedback is important for clarity and direction. Lack of feedback leads to uncertainty and eventually distrust. This destabilizes the environment which is very dangerous in healthcare. Feedback that is regular, honest, and bi-directional builds a foundation for trust and confidence in the organization, team, and individual. APPs who receive regular feedback experience a higher level of satisfaction, engagement, and productivity. Feedback gives APPs respect for their work, character, skills, and abilities. This honest communication creates a safe environment.
Safety in healthcare is critical. APPs need to practice safely, communicate safety, and feel safe. Safety at work means that there are clear processes for elevating issues, for communicating successes, processes for change, and treatment of people. Organizations that know how to create a safe environment will retain employees. Ultimately, a culture of respect for healthcare employees leads to better patient outcomes, too.
APRN and PA engagement, support, professional growth, and a culture of respect complement each other and can positively affect retention. Healthcare organizations that invest in retention save money, can provide better patient care, and attract talented new hires.
If you have questions or want to discuss attracting, hiring, and retaining APPs please contact Jill Gilliand, jill@Melnic.com, 303-803-4470.
If you are looking for an APRN or PA job at leading healthcare organizations, please visit Jobs.melnic.com.
Noelle Kohles is a Director in Nursing with a background in Pediatric Critical Care. Noelle coaches and mentors emerging leaders to develop the skills they need to lead successfully. She has over 15 years working in the hospital & health care industry. Skilled in Critical Care Nursing, Healthcare Management, and Healthcare. Noelle holds a BSN and MSN degree from the University of Phoenix. In her free time, Noelle loves spending time with her husband and four children. Every season she volunteers her time and is the head coach for her son’s youth soccer, flag football, and basketball team. She also loves to hike, traveling, and spending time at the ocean
Co Authors :
Elizabeth Moran joined the Melnic team in 2019 as a Copy Editor Contractor. She uniquely holds a Bachelor of Arts in English from the University of Connecticut and a Master of Science in Nursing from Boston College. She is currently working fulltime as a Pediatric Primary Care Nurse Practitioner in Boston.
Prior to becoming a nurse practitioner, Liz worked for a number of years in clinical research where she participated in the writing and editing of grants, protocols, and scientific articles for publication. She also has experience copy editing and proofreading for a nonprofit. Liz is excited to now blend her English and healthcare background at Melnic Consulting Group.