Ask Before They Decide: A Stay Interview and Manager Action Project for Early-Career Nurses on Three Medical Units, With a Change Model, Targets and a Budget
Student Name
American College of Education
NUR5094: Capstone Practicum Experience for Role of the Nurse Administrator
Module 3 Assignment
Instructor Name
February 13, 2029
The Problem
Module 2 found that nearly a quarter of the three units' registered nurses had left within a year, well above the hospital-wide figure; that early-career and night-shift nurses were overrepresented among those who left; that scheduling, relationships with managers and workload were the leading reasons; that the units scored lowest on the manager support subscale of the practice environment survey; and that managers had no routine conversation with nurses about staying. The annual cost of the service line's turnover was estimated at about 1.9 million dollars.
What the Evidence Offers
Two bodies of evidence are relevant. The first concerns leadership and retention. Across the 129 studies Cummings et al. (2018) reviewed, leaders who focused on people and relationships were linked with more satisfied nurses who were more likely to stay, while leaders who focused mainly on tasks were linked with the opposite. The manager support finding in Module 2 suggests that the units' managers, absorbed by staffing tasks, have had little room for the relational work the evidence favors.
The second concerns stay interviews, structured conversations in which a leader asks a nurse who is still on staff about reasons to stay, reasons that could lead to leaving and help the leader could give. Wang et al. (2023) describe stay interviews as a proactive, relationship-building approach that helps nurse leaders learn the specific actions that would strengthen each nurse's engagement, and outline how to implement them. When leaders at one hospital interviewed 75 nurses on a cardiothoracic telemetry unit and a surgical intensive care unit, the nurses credited the unit's culture, their colleagues and their schedules for keeping them, and named pay, career growth and travel contracts as the pull to leave (Snyder et al., 2023). The evidence is promising but limited: published reports are mostly descriptive, and none provides strong evidence that stay interviews reduce turnover. The case for stay interviews rests less on proof that they work than on the plain fact that the managers are currently learning why nurses leave only after they have gone.
The Intervention
The project has three components. First, stay interviews. Each nurse manager will hold a 20- to 30-minute stay interview with every registered nurse on their unit who has less than three years' tenure, 49 nurses in all, during weeks seven to eleven, using a five-question guide adapted from published toolkits: what do you look forward to at work, what would make your job more satisfying, what frustrates you here, what might tempt you to leave, and what can I do to keep you here. Night-shift nurses will be interviewed at the start or end of their shifts, with managers arriving early on scheduled mornings, and each nurse will be paid for the time.
Second, action. Within two weeks of each interview, the manager will record one or two commitments, discussed with the nurse, and report back on them within a month. Themes that recur across interviews will be brought to the managers' meeting the author leads, where managers will choose one change for each unit that is within their authority, for example publishing clear rules for how schedule requests are approved, or setting a monthly recognition practice.
Third, manager preparation. The mentor and the author will run a two-hour session for the managers on conducting stay interviews, including how to listen without defending, how to respond when a nurse raises a concern about the manager personally, and how to avoid promises the manager cannot keep.
Leading the Change
The account of social change given by Lewin (1947), often summarized as unfreeze, change and refreeze, holds that a group must first be loosened from its current equilibrium, then helped into a new way of working, and finally supported until the new way becomes the norm. The project follows that sequence. Unfreezing will come from presenting the Module 2 data to the three managers and the mentor, especially the finding that two managers learned of dissatisfaction only through resignation letters, which the managers found uncomfortable to see but agreed was accurate. Moving will come through the preparation session, the interviews and the first commitments, with the author checking in with each manager weekly. Refreezing will come through making stay interviews part of each manager's annual goals, adding them to the orientation of new managers and scheduling a stay interview at each nurse's first and second work anniversaries, so that the practice outlasts the practicum.
Objectives, Evaluation and Budget
The project's objectives are that by week twelve at least 90% of eligible nurses will have had a stay interview and at least 80% of recorded commitments will have been reported back on; that on a brief anonymous survey at week twelve, the proportion of early-career nurses who say they intend to stay at least another year will rise from the baseline measured in week six; and that the manager support subscale will be remeasured with the next hospital survey. Annual turnover will be tracked for twelve months, since it cannot change meaningfully within one semester.
The direct costs are modest. Paying 49 nurses for 30 minutes each at an average of 55 dollars an hour costs about 1,350 dollars. Managers' time, about 25 hours each for interviews, preparation and follow-up, is absorbed within their salaried roles, although the mentor has agreed to cover one of each manager's weekend on-call shifts during the interview weeks. The preparation session and materials cost about 600 dollars. Against the estimated cost of 61,000 dollars for each registered nurse who leaves, the project would pay for itself if it prevented a single departure.
Risks and Safeguards
The project carries three risks that the mentor and author discussed before approving the plan. The first is that stay interviews raise expectations the managers cannot meet. A nurse who says a higher salary would keep them cannot be given one by a unit manager, and a conversation that ends in silence on that point may do more harm than no conversation. The preparation session therefore teaches managers to acknowledge what is outside their authority, to explain honestly what happens to that feedback, which will be passed to the director and the human resources compensation team in aggregate, and to focus commitments on what they can control. The second risk is that nurses will not speak candidly to their own manager, particularly about the manager. The guide gives nurses the option of answering the question about what frustrates them in writing, anonymously, through the author, and the author will pass themes, never individual comments, to the managers. The third risk is that the managers, already stretched, will treat the interviews as another task to complete rather than a conversation to have. The weekly check-ins will ask managers not how many interviews they have done but what they learned, and the managers' meeting will open each time with one thing a nurse told them that surprised them. If a manager falls behind, the mentor has agreed to join that manager's interviews for a week rather than extend the deadline.
References
Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P. M., & Chatterjee, G. E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 85, 19-60. https://doi.org/10.1016/j.ijnurstu.2018.04.016
Lewin, K. (1947). Frontiers in group dynamics: Concept, method and reality in social science; social equilibria and social change. Human Relations, 1(1), 5-41. https://doi.org/10.1177/001872674700100103
Snyder, A., Whiteman, K., DiCuccio, M., Swanson-Biearman, B., & Stephens, K. (2023). Why they stay and why they leave: Stay interviews with registered nurses to hear what matters the most. Journal of Nursing Administration, 53(3), 154-160. https://doi.org/10.1097/NNA.0000000000001261
Wang, A., Devine, C., Hamilton, L., & Layton, M. (2023). Do not wait until it is too late: Using stay interviews to engage and retain nursing staff. Nursing Leadership, 36(1), 46-56. https://doi.org/10.12927/cjnl.2023.27124
How this NUR 5094 Module 3 example is structured
NUR 5094 Module 3 usually proposes a change project with evidence, a change model and budget impact; your classroom's instructions decide the format. This example summarizes the problem, reviews relevant evidence with its limits, describes the intervention, applies a named change model, states measurable objectives and evaluation, and presents costs and expected return in terms an executive can approve.
NUR5094 Module 3 questions, answered
What does NUR5094 Module 3 usually ask for?
NUR5094 Module 3 usually asks you to propose a change project for the problem you identified, with supporting evidence, a named change model, resources and budget impact, and measurable objectives. Your classroom's instructions decide the format.
What if the evidence for my intervention is limited?
Say so, explain why the intervention is still reasonable for your setting, and design the evaluation so that your project adds to the evidence. Honest framing is more persuasive to executives than overstated claims.
How detailed should the budget be?
Itemize the main costs with their basis, include staff time, and compare the total with the cost of the problem, for example the cost of one nurse leaving. A simple break-even calculation is often enough.
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