A new study from Crucial Learning and the American Organization for Nursing Leadership (AONL) shows that employee rounding—a common practice intended to help nurse managers connect to their staff with regularity and purpose—has no effect on whether nurses were likely to quit their jobs within the next three years. But while employee rounding isn’t a driver of retention, the study identified leadership practices that do improve retention for burned out nurses.

In their new study conducted in March 2023, Connection is Retention: Lessons from Leaders with Unusually High Nurse Retention, Crucial Learning and AONL studied 1,559 nurse managers and 562 clinical staff at hundreds of US hospitals to understand the drivers behind record-high levels of nurse attrition.

Researchers found that widely adopted practices intended to improve connection and reduce turnover do little to achieve these goals. Specifically, when it came to employee rounding, the practice seemed so irrelevant that employees often didn’t seem to know it had happened. For example:

• 81 percent of managers reported that they round regularly.
• And yet, only 36 percent of clinicians say their managers round regularly.

Joseph Grenny, lead researcher, cofounder of Crucial Learning, and coauthor of Crucial Influence, adds insight into this gap. 

“As we dug into this curious and concerning inconsistency, we concluded that the most likely explanation for the gap is that rounding is being done in a way that is meaningless to the real concerns of frontline nurses,” Grenny said.

And identifying the real concerns of frontline nurses is where the research makes its greatest contribution.

When looking for successful outliers, the study identified select nurse managers who reported higher rates of retention than others in similar sized units and hospitals who faced similar market conditions. Results showed that nurse managers in these surprisingly high retention areas were unusually effective at creating connection by offering three things: care, growth and help.

Ultimately, nurses who reported that their nurse managers offered care, growth, and help were more than 80 percent more likely to intend to continue with their work indefinitely. Here is what offering care, growth and help looked like, according to nurses’ first-hand accounts.

• Care – I feel a sense of belonging and believe my manager cares about me as a person.

“My nurse manager came in on her day off to provide snacks and certificates for Certified Nurses Day. She provided a nice gift to all the staff working that day. This was a thoughtful act that made me feel appreciated.” – Nurse Respondent

• Growth – My manager takes an active interest in my personal and professional growth.

“I had mentioned to Charlene that I wanted to grow in my career. She took initiative to put me in positions to learn new tech, open hearts, etc. Most recently she helped get me into a bachelor’s program.” – Nurse Respondent

• Help – My manager steps in to help when I need it. 

“I couldn’t tell you who the director was at my previous hospital. The managers stayed in their offices. Joe is always walking around and asking me how I’m doing. Last Friday, I had four patients, and one was difficult to turn. Joe [jumped in without being asked]. I’ve never seen anything like it.” – Nurse Respondent

Other related findings included:

• Nurses who planned to stay with their organization three or more years were far more likely to rate their manager highly on care, growth and help:
  • CARE: 3 times more likely
  • GROWTH: 2.5 times more likely
  • HELP: 2 times more likely

And yet, their perceptions of rounding frequency were no different from those expecting to quit much sooner.

• In departments with unusually high stress (due to inadequate staffing, high patient load or challenging shift structure) the differences became even more substantial. For example, there’s almost a 60 percent higher chance that a nurse intends to stay in their job despite being in a high-stress job if they score high on HELP. 

In analyzing the data and fist-hand accounts from 1,090 nurses, Grenny and his co-researchers from AONL, Robyn Begley, DNP, RN, NEA-BC, FAAN, Chief Executive Officer, AONL and Chief Nursing Officer, SVP Workforce, AHA; and Beverly Hancock, DNP, RN, NPD-BC, and Senior Director of Leadership Development at AONL, extracted the following best practices demonstrated by nurse managers for creating a culture of connection—best practices that can be replicated in nursing teams to improve retention.

4 Best Practices for Creating a Culture of Connection in Caregiver Teams

1. Connection is about feeling not frequency. No one reported feeling connected because of a certain frequency of interaction. What they did report was some meaningful moment—an interaction that showed presence, planning, personalization or follow-up.
2. Always be collecting dots (ABCD). Hospitality guru Danny Meyer creates unique moments of connection with his hundreds of thousands of guests by admonishing team members to always be collecting dots—gathering key information about others to build strong personal connection. Great nurse managers do the same. A nurse might mention something about a son studying karate, a new motorcycle, or feelings of inadequacy. These dots are gold when the manager records them, reflects on them, and uses them to inform ways to show care, growth, and help.
3. Connection = Sacrifice. Meaningful moments require sacrifice. People perceive you value them when you show you’re willing to sacrifice things they know are scarce to you: your time, money, ego, or other priorities. This doesn’t mean you have to spend a fortune or an eternity.You just have to use enough of these four scarce resources to show you value care, growth and help.
4. Don’t make promises you can’t keep. Keep the promises you make. Nurses universally equate follow up with sincerity. If you make even the most modest care, growth or help commitments, they backfire if you fail to follow up.

Begley says these recommendations should help overwhelmed nurse managers in what is often the most challenging role of their careers to create teams of engaged and satisfied nurses.

“We recognize these recommendations might sound daunting to already overwhelmed nurse managers. They should not,” says Begley. “The first two don’t require time, they simply require thought. In fact, the first, Connection is about feeling not frequency, suggests that time spent today in ritualistic employee rounding might be recovered and repurposed. Our study suggests that replacing any recovered time with the second two activities will yield dramatically different results in engagement and retention. These are things managers are doing consistently and successfully in units just like yours and if replicated, will make a difference in your team.”

To download the full study, visit cruciallearning.com/connection.

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Media Contact: Brittney Maxfield at 801-755-2809 or Brittney.maxfield@cruciallearning.com.

About Crucial Learning
Crucial Learning offers courses in the areas of communication, performance, and leadership, focusing on behaviors that have a disproportionate impact on outcomes, called crucial skills. Our award-winning courses and accompanying bestselling books include Crucial Conversations® for Mastering Dialogue, Crucial Conversations® for Accountability, The Power of Habit™, Getting Things Done®, and Crucial Influence®. We’ve spent thirty years helping hospitals and health systems around the world reduce avoidable medical errors and improve patient care and staff experience. CrucialLearning.com

About the American Organization for Nursing Leadership 
As the national professional organization of more than 11,000 nurse leaders, the American Organization for Nursing Leadership (AONL) is the voice of nursing leadership. Our membership encompasses nurse leaders working in hospitals, health systems, academia and other care settings across the care continuum. Since 1967, the organization has led the field of nursing leadership through professional development, advocacy and research that advances nursing leadership practice and patient care. AONL is an affiliate of the American Hospital Association. AONL.org.