At the height of the health care workforce crisis, leaders at Franciscan Children’s faced a reality familiar to many hospitals: climbing job vacancy rates, widespread burnout, and no sign things would change on their own.
“We knew this was happening across the industry, but we weren’t going to wait for it to work itself out,” said Elizabeth Smith, RN, the hospital’s chief nursing officer. “We couldn’t afford to.”
Turnover across the specialty hospital had reached 30%. In some roles, the losses were far worse, peaking at double that rate.
“Without these people, we couldn’t care for our kids,” Smith said. “And we couldn’t recruit fast enough to keep up with the attrition.”
Even after the Boston hospital adjusted pay and benefits to match the market, staff continued to resign.
That forced leaders to step back and take a harder look at what was driving people to leave and what would actually keep them.
Within two years, core attrition fell into single digits. High-turnover roles stabilized. And the improvements held.
“It didn’t happen overnight,” Smith said. “But once we got the structure right, the numbers followed.”
Identifying causes
Franciscan Children’s leaders began by breaking down attrition data by role, tenure, and unit. The analysis pointed to clear pressure points: behavioral health, respiratory therapy, and staff within their first 12 to 18 months. Units with high emotional and safety demands were also more vulnerable to turnover.
The data explained where people were leaving, but it did not explain why.
To understand that, Smith and her team went directly to frontline staff, holding listening sessions across disciplines.
“People kept telling us, ‘I don’t want to leave,’” Smith said. “They wanted to grow in their career, they wanted more support, and they wanted more connection.”
Newer staff, especially those within their first year and a half, felt stalled in their careers. Behavioral health teams talked about safety, exhaustion, and the emotional toll of the work. Others described a sense that leadership was too busy to hear them — so they stopped trying.
That feedback forced a reset. “We realized we didn’t need another initiative,” Smith said. “We needed a new structure.”
Starting with leaders
Before launching a new retention program, Smith created a Patient Care Services leadership group that brought together leaders from high-attrition areas, along with quality and safety partners. The group met weekly, with a protected 90 minutes and a shared charge.
That structure changed how problems surfaced and how quickly they were addressed. Leaders could see patterns across units, rather than responding to issues in isolation.
“That group became the place where things stopped getting pushed off,” Smith said. “We could see the same issues showing up in different areas and deal with them together.”
Focusing on mentorship
With leadership infrastructure in place, the hospital launched the MVP (Mentorship, Value and Support, Professional Development) + Joy Program. Its central element was monthly, structured mentorship sessions for every employee.
The sessions, based on the Proctor Model, were designed to consistently cover three areas:
- Support: difficult shifts, team dynamics, and stress points
- Skills: workload, expectations, and support needs
- Growth: short- and long-term goals and sustainability in the role
Mentors were assigned and trained across roles, including directors, clinical educators, charge nurses, and team leads, to ensure coverage across shifts and disciplines.
“We couldn’t fix much of anything until we had a real way to hear what staff were dealing with,” Smith said.
More than 1,500 mentorship sessions have been completed, creating a regular feedback loop between staff experience and leadership decision-making.
“This gave us a way to catch things earlier, before people were already halfway out the door,” Smith said.
Driving operational changes
Themes emerging from mentorship sessions were brought back to the leadership group and translated into action.
Among the changes that followed:
- Stronger night and weekend support through redesigned resource and charge roles
- More professional development opportunities
- Expanded training in areas such as de-escalation, trauma-informed care, and structured debriefings
- Clearer growth pathways, including updates to the clinical ladder beyond nursing
“These changes made staff feel heard, valued, and supported, and they had a positive impact on quality and safety,” Smith said. “We’ve seen a reduction in staff injuries as a result of the focused de-escalation training.”
Reinforcing purpose
Franciscan Children’s also focused on helping staff stay connected to the mission during high-stress periods. Leaders increased rounding and presence on units, shared patient stories as part of daily operations, and created more opportunities for peer connection.
“When people are having a brutal shift, they forget the impact they’re still making,” Smith said. “That’s when leaders have to step in and remind people why they’re here.”
Sustaining improvement
Success took time, consistency, and repeated adjustment. It was nearly a year before they saw a real difference in the turnover rate.
But once the numbers began to drop, they stabilized, including in roles that had historically been hardest to retain.
Franciscan Children’s is now expanding mentorship capacity, strengthening professional governance, and continuing to refine how it supports staff across disciplines.
“This is how we ensure our kids get the highest quality care. That’s what it’s all about,” Smith said.
