Stay conversations: what to ask, and what to do with the answers

Why have them

An exit interview tells you why someone left. A stay conversation asks the people who are still here, while you can still do something about it. Writing in the journal Nursing Leadership, Wang and colleagues describe stay interviews as structured talks between leaders and staff about what would keep them engaged.

They matter most early. In an average week, about 15% of nursing hours are worked by someone hired in the last 90 days, and many new hires leave before they ever count in CMS’s turnover numbers.

What people say keeps them

We found little published research on stay conversations in nursing homes, but a few studies show what nursing staff say about staying.

On two hospital units, nurse leaders held 75 stay interviews. Nurses said unit culture, their team and peers, and scheduling mattered in deciding to stay. They considered leaving for salary, growth and development, and travel jobs.

In interviews with ten nursing assistants at for-profit skilled nursing facilities, self-confidence, appreciation and positive relationships supported their intent to stay. Frustration, a lack of support and limited chances to advance worked against it.

It also helps to make retention someone’s job. In a randomized trial in 30 nursing homes in New York and Connecticut, buildings that trained a staff member to lead retention work saw turnover fall compared with buildings that didn’t.

Who to talk with, and when

• New hires, early: in their first week or two, and again a few weeks later.
• Anyone whose work just changed: a new unit, a new shift, a new supervisor or a stretch of extra shifts.
• People who’ve been with you for years. They carry a lot, and they’re rarely asked.
• Everyone, in time. If you only talk with the people you’re worried about, the conversation starts to feel like a warning.

How to hold one

• Fifteen minutes is enough. Find a quiet spot away from the floor, during paid time.
• Keep it apart from performance reviews and discipline. It’s about support.
• Ask a few open questions, then listen more than you talk.
• Take short notes, and say what you’ll do with them.
• Don’t promise what you can’t deliver. It’s fine to say you’ll find out.
• Never use what someone tells you against them.

What to ask

Pick three or four of these, and leave room for whatever comes up.

• What’s the best part of your work here?
• What’s the hardest part of your shift right now?
• Is your schedule working for you? What would make it work better?
• Do you have what you need to do your job well?
• Who here helps you most?
• Do you feel your work is noticed?
• Where would you like to grow from here?
• What might make you think about leaving?
• What’s one thing I could do this month that would help?

What to do with the answers

• Sort what you hear into what you can fix this week, what will take longer and what you can’t change.
• Follow up within a week or two, and say what happened. If you can’t change something, say so, and say why.
• Look for patterns across conversations and buildings: workload and staffing, schedules, recognition, support from supervisors.
• Bring the patterns to the people who can act on them, like your administrator, director of nursing, HR or scheduler.
• Share themes, not names. What someone tells you stays between you unless they say otherwise.
• Talk again in a few months. A second conversation shows the first one counted.