Nurse retention is a serious challenge when hospitals, nursing homes, and home health agencies are competing for a shrinking supply of nurses. La Porte Hospital and Health Services in La Porte, Indiana, faced that competition while preparing to roll out a new vision and mission to its 670 employees. Its experience offers a useful lesson: nurse retention strategies can include the daily work culture around a nurse, not only the offer made when that nurse is hired.
What did La Porte Hospital do to support nurse retention?
La Porte Hospital and Health Services is a full-service, 230-bed healthcare facility that has served its community since 1900. As it prepared to share its new vision with employees, the hospital used FISH! Sticks as “the training vehicle to bring the new vision to life.” The vision was: “To be the number one provider of health care no matter what it takes and to have fun doing it!”
The hospital then gave employees ways to make that vision visible. It created a 15-member Customer Care Committee that included a physician, a board member, department managers, and employees. The committee sponsored a FISH! decorating contest in which over 30 departments in six different buildings competed to be the “big fish” in LRHS’s sea of health-care services.
Employees also explored how to turn the basic tools of their trade into fishy decorations. Aquatic murals appeared on the walls, while fish mobiles and undersea creatures hung from the ceilings.
Melissa Garwood, RN, described the connection between culture and care this way: “The introduction of The FISH! Philosophy has highlighted that we each have unique qualities to contribute. Our new vision encourages us to delight these customers and to be delightful and fun while doing it. Often lightheartedness can be part of our healing environment. We’ve worked hard on our medical/surgical unit to not only anticipate what our customers need but to be more personal with our patients and their families and to ask about and meet their individual needs. Working as a team makes it possible to meet these needs and improve the care we deliver.”
Nurses can anticipate a familiar need and still ask what matters to each patient and family.
The hospital reported an increased retention rate and an “RN turnover rate less than 2%.” Jonathon Goble, CEO, spoke about employees and the vision: “I know that when our employees wake up every morning and know that they can make a contribution to our vision, they’ll bring that energy and enthusiasm to the workplace.” La Porte Hospital is one of many organizations whose results with the FISH! Philosophy have been documented, so its story can be read alongside other workplace examples.
What keeps nurses from leaving?
Nurses stay for practical reasons and human reasons. Fair pay, strong benefits, safe staffing, manageable schedules, wellness support, mentoring, and career growth all matter.
These basics work together with the daily experience of being respected, heard, supported, and able to do good work. Retention efforts are strongest when both sides receive attention.
The National Council of State Boards of Nursing reported in its 2024 National Nursing Workforce Study that more than 138,000 nurses had left the workforce since 2022, and that almost 40% intended to leave the workforce by 2029. NCSBN also described stress, burnout, and staffing challenges as continuing concerns. Those findings help explain why retention is bigger than a recruiting problem: a hospital must make the work sustainable after the first day.
The Agency for Healthcare Research and Quality’s PSNet primer on nursing and patient safety makes the same point from a safety perspective. It connects staffing, workload, interruptions, long shifts, teamwork, leadership, and the practice environment to nurses’ ability to provide safe care. A hospital asking how to retain nurses should therefore ask two questions at once: Are we giving nurses the resources to work safely, and are we creating a place where people want to belong?
FISH! adds a simple lens to that second question. Choose Your Attitude helps nurses and leaders notice how they enter a shift, reset after a hard moment, and model the behavior they hope to see.
Be There brings physical, mental, and emotional attention to another person, while Make Their Day shows through genuine recognition that a person’s effort and presence matter. Play brings curiosity, energy, and creativity to work within clear boundaries, giving teams another way to approach problems.
How can a hospital use its vision to improve nurse retention?
A vision helps retention when employees can see how their work contributes to it. Leaders and teams make a broad statement useful by translating it into everyday behavior.
La Porte Hospital’s vision included being “number one” and having fun. In general, that combination can give a workforce both direction and energy. A team can discuss how it wants to show up under pressure, listen closely to staff, recognize contributions, and solve problems creatively within safe, respectful boundaries.
Why should nurses have a voice in workplace culture?
People are more likely to support a vision when they can help shape how it lives in the workplace. Staff voice matters in hospital culture, and interdisciplinary committees can bring different views of barriers and opportunities into the same conversation. A physician, board member, manager, and employee may each see part of the work, so bringing those views together can make a culture effort more grounded.
A committee that mixes roles can see more of what gets in the way and what could work better.
La Porte Hospital’s Customer Care Committee was a 15-member team that included a physician, a board member, department managers, and employees. A committee with that mix shows how culture can belong to more than one level of an organization. In your own hospital, staff engagement can grow when employees help express a shared goal, listen carefully to one another, and recognize contributions sincerely.
Can lightheartedness help a nursing unit keep its people?
Lightheartedness can help a unit feel more human, but it has to fit the moment. It must respect grief, exhaustion, safety concerns, and a patient’s fear. Play brings curiosity and creative energy to work while keeping the boundaries of care clear, and it works alongside adequate staffing and rest.
Garwood’s comment that “lightheartedness can be part of our healing environment” gives that idea a careful frame. Warmth, personality, and connection have a place when they help patients, families, and coworkers feel more supported, even though every moment will not be cheerful.
A unit could apply this by inviting staff to suggest small, appropriate ways to make the work environment more welcoming, then agreeing on what is in bounds and what is not. The FISH! practice of Play works best when people feel safe enough to offer an idea, learn from an attempt, and adjust without embarrassment. Choose Your Attitude keeps the effort grounded, while Be There helps staff notice whether a gesture is actually helping.
How do teamwork and recognition affect nursing turnover?
Turnover affects the people who remain. A 2023 peer-reviewed study in Frontiers in Public Health examined 264 staff nurses and found that higher nurse turnover was associated with lower job satisfaction and weaker team cohesion. It also found that nurse-nurse collaboration and team cohesion were associated with better job satisfaction, making nursing unit culture worth attention after someone leaves.
Teamwork grows through dependable actions and specific recognition. Help during a difficult stretch can make a nurse experience the unit as a team, while a manager’s timely thanks shows that good work is seen. When a cross-department partner follows through, friction eases and the demanding job becomes more workable; together, these actions bring Make Their Day to life without making appreciation feel forced.
Recognition means more when it is timely, specific, and sincere.
The financial case matters too. The 2026 NSI National Health Care Retention & RN Staffing Report said the average cost of turnover for a bedside RN was $60,090 in its survey.
A vacancy also brings recruitment, orientation, and disruption for the existing team. Hospitals can respond with fair compensation, safe staffing, flexible scheduling where possible, wellness support, mentoring, and clear paths for career growth alongside culture work.
What can a hospital try first?
Start with a focused conversation on one unit or team. Ask what helps people stay and what makes the work harder than it needs to be, then review the answers alongside staffing, schedules, pay, workload, and development opportunities.
Track retention and RN turnover while listening for changes in teamwork, patient experience, psychological safety, and the reasons employees give for staying or leaving. La Porte Hospital’s reported results show how a clear vision and visible culture can contribute to nurse retention while the hospital also provides the conditions nurses need to do their jobs well.
A simple culture conversation can become a retention strategy
Nurse retention grows from many choices made over time: paying fairly, staffing safely, supporting professional growth, listening to employees, and making the daily work feel worth staying for. La Porte Hospital’s experience shows one way a vision can become more than a statement.
Choose one team conversation this week. Ask, “Who do we want to be while we’re doing this work?” Then listen for one change that would help nurses feel supported in living that answer.
Try the FISH! Philosophy with your team
If your hospital or healthcare team is working on nurse retention, the FISH! Philosophy upgraded trial gives your team 30 days of access to the FISH! film and its digital guides. Use that time to give your team a shared language for vision, presence, recognition, attitude, and creative energy, then connect those ideas to the practical conditions that help nurses stay.
Frequently Asked Questions
How can recognition help nurses feel valued without becoming routine praise?
Make recognition specific, timely, and sincere by naming the action and its effect on patients, families, or teammates. Offer it in a form the person can receive comfortably, whether that means a private thank-you or public appreciation.
Why does patient-centered care matter to nurse retention?
Nurses are more likely to find meaning in work when they can respond to patients’ and families’ individual needs and see how teamwork improves care. Patient-centered care also gives a shared purpose that can connect daily effort with the hospital’s larger vision.
What is the difference between nurse retention and nursing turnover?
Nurse retention describes an organization’s ability to keep nurses, while nursing turnover describes nurses leaving a role or organization over a given period. They are related measures, but a retention rate and a turnover rate may use different definitions and time periods, so they should not be compared without checking how each was calculated.
How can leaders tell whether a culture effort is helping?
Look at retention and turnover alongside staff feedback, teamwork, workload concerns, patient experience, and the reasons employees give for staying or leaving. A single number cannot explain why nurses remain, so leaders should combine measures with regular, honest conversations.
Can the FISH! practices be used outside hospitals?
Yes. Choose Your Attitude, Be There, Make Their Day, and Play describe everyday ways to shape a workplace culture, so they can apply to healthcare, education, service teams, and other organizations. The practices work best when they support real operating needs and are used alongside them.
