Healthcare often tries to recruit its way out of a retention problem, and I understand the inclination.
Our aging population needs more nurses at the bedside, and healthcare organizations are right to invest in bringing talented clinicians through the door to help. However, recruitment only answers half the question. What determines whether nurses stay is the environment they walk into on day one, and in elder care, where continuity is part of the care itself, that answer matters more than almost anywhere else.
Consider data on attrition for nurses with less than a year of experience, where roughly 22 to 29 percent leave within their first year. Many organizations invest significant resources to fill a vacancy, only finding themselves refilling it a year later. With every departure, they lose institutional knowledge, team cohesion and continuity of care. These are crucial factors that older adults depend on, particularly when subtle changes in condition may be noticed only by someone who knows them well.
One of healthcare’s most overlooked retention strategies is investing in frontline nurse leaders. Managers shape the daily experience of nurses more than almost anyone else. They influence workload fairness, psychological safety, provide recognition, facilitate communication, support professional development and address concerns before they lead to resignations. Leadership development should not be treated as an optional professional benefit. It is a core workforce investment because leaders who know how to create trust, accountability and belonging build teams that nurses want to remain a part of.
Effective leaders coach before they judge. They seek to understand what is happening before deciding what needs to change.
So, what does that type of investment look like in practice? Strong nursing leadership combines clinical readiness with emotional safety. Nurses need clear expectations, honest feedback and accountability, but they also need leaders who can tell the difference between a competency gap, a confidence gap and an adaptation gap. A competency gap requires training. A confidence gap requires encouragement and coaching. An adaptation gap, particularly for a nurse learning a new clinical system and workplace culture, requires orientation, patience and time. Effective leaders coach before they judge. They seek to understand what is happening before deciding what needs to change.
Emerging leaders need that same mentorship and coaching. That is why we approach leadership development intentionally and in partnership with the healthcare organizations where our nurses are on long-term assignments. Through clinical ladders, professional development and emerging-leader pathways, nurses are given opportunities to grow not only as clinicians but also as future leaders. That investment supports retention, strengthens our healthcare partners and ultimately benefits patients.
Leadership development matters most where the work is complex and elder care certainly qualifies. Intricate comorbidities, cognitive changes, polypharmacy, end-of-life conversations, family dynamics and sustained emotional labor are the daily reality of caring for older adults. Realistic role expectations, thoughtful onboarding and early relationship-building matter for every nurse entering this field of work. They matter even more for internationally educated nurses, who are learning a new clinical system and workplace culture while also navigating a major life transition. They create a sense of belonging and belonging is foundational to retention.
The payoff compounds. Healthcare is facing a widening experience gap as tenured nurses leave the profession, and experience remains one of nursing's most valuable assets. The resources to close that gap already exist; we simply need to recognize and invest in them. Internationally educated nurses are an important part of the solution. Many arrive with years of bedside experience and seasoned clinical judgement. When they are retained beyond their initial assignments and provided with clinical ladders, specialty development and leadership pathways worth staying for, that experience remains on the unit, where it can strengthen teams and help newer nurses grow.
None of this is an argument against recruitment. It is an argument for finishing what recruitment starts. The one with the most at stake is not the healthcare system. It is the older adult who knows their nurse by name and whose care depends on someone noticing the small changes only familiarity reveals. Every nurse who stays means continuity for a patient who needs it.
The next generation of nurse leaders are already at the bedside, caring for our parents and grandparents. We cannot wait for another exit interview to tell us we should have invested in them sooner.
