Employee engagement in 2024: Trends, challenges, and opportunities

Coauthored by Milissa Eagle, MA, Director of Workforce Analytics.

The past few years have tested the healthcare workforce like never before. The pandemic stretched resources and staff thin, pushing many to the brink of burnout. Employee engagement plummeted to an all-time low, as a retention crisis rocked the industry. And it wasn't just people leaving for greener pastures: Many were leaving healthcare altogether.

In 2023, 20% of healthcare employees who had been at their healthcare organization the previous year made the decision to leave. Among those who’d been there for only two years, that number jumps to 25%. The message couldn’t be any clearer: Our workforce has been hurting.

But finally, some promising news. Despite continued high rates of turnover, for the first time since the pandemic began, employee engagement is showing signs of recovery. We analyzed feedback from 2.2 million healthcare workers to understand the state of employee experience today. What are the biggest trends, and what are their industry-wide implications? Where are we making progress? Who continues to struggle?

Encouragingly, the shift is overall positive. But, as with all things in healthcare, we can’t escape a simple truth: We still have so much work to do.

Employee engagement in healthcare: Bright spots of improvement

Why does employee engagement matter so much? The measure captures an employee’s connection to and satisfaction with the workplace, their intent to stay, and “Likelihood to Recommend” (LTR) the employer. Top-performing organizations with highly engaged employees typically excel in other key areas: They're 3x more likely to be top performers for patient experience (PX), and perform higher in safety, too.

Low engagement can be a drain on workforce morale, employee experience, and, financially speaking, an organization’s bottom line. Disengaged employees are 2x as likely to leave as their highly engaged counterparts. Turnover from non-engaged employees can cost an organization an average of $25 million per year, according to a Press Ganey analysis.

Yet the tide seems to be turning. Nearly half of all healthcare roles improved on engagement since last year. 20% remained stable, and a third declined. Overall, employee engagement increased significantly from 4.02 to 4.04 (out of 5), and our data shows that 69% of all healthcare employees are currently considered “engaged” or even “highly engaged.” This is a much-needed boost for a sector that's historically struggled with low engagement—even before COVID-19 took its toll.

While this news is cause for celebration, we can't stop building upon the momentum. Because the downside is, ⅓ of the workforce is still not engaged. That kind of disengagement comes at a significant cost that ripples outward, leading to lower patient experience scores, greater safety risks, and increased burnout and turnover—a vicious cycle that can cripple healthcare organizations and cause significant financial harm.

For every 1% increase in turnover, patient experience scores drop, on average, 2 percentile ranks for inpatient overall rating of care.

Leaders and RNs: 2 groups that need immediate intervention

While the overall trend in healthcare employee engagement is positive, a closer look reveals a mixed picture across different roles. Particularly, leaders and RNs continue to struggle with engagement.

Healthcare leader engagement

Leaders play a pivotal role in driving and sustaining employee engagement and retention across the organization. But they’ve faced major headwinds in recent years. Prior to the pandemic, leaders’ engagement scores remained relatively flat. Then, in 2020, they started to decline, and have continued on that downward trajectory for three years in a row (falling 3.7% during that time frame). Today, leaders are among the only roles that have yet to reverse negative trends in engagement.

An investment in your leaders is an investment in the organization—and carries significant ROI in the near and long term. 

Registered nurse engagement 

RNs represent approximately 30% of the healthcare workforce. They directly impact the quality of patient care and overall organizational effectiveness. But RNs are still healthcare’s least engaged role. This directly translates to turnover risk: 19% of RNs who were at an organization in 2022 left the following year (25% among other nursing roles, like LPNs and nursing assistants).

Interestingly, RNs saw the second-largest improvement in engagement (up +0.04 to 3.89 out of 5 since 2022). This is a testament to the power of targeted efforts in driving positive change. Keeping the momentum going will be crucial to setting nurses up for success, building RN resilience, and growing a thriving workforce.

The engagement-retention connection

Even before the pandemic, healthcare’s high-stress environment, long, grueling hours, and emotional toll have caused an exodus of talent. But employee engagement and retention go hand in hand. Feeling respected is the #1 driver of employee engagement. And respect begets trust, and trust, retention. 

But thriving workplaces aren't built by chance. Organizations that prioritize trust, respect, teamwork, and inclusion—the building blocks of social capital—to unlock higher engagement and loyalty from their employees. Ultimately, this also leads to lower turnover rates.

Key drivers of engagement:

1. Employee respect and safety: Organizations treat employees with respect, include their perspectives to shape the experience, and care about their safety.
2. Senior leadership: Employees want to feel confident in senior leadership and the decisions they make. They also want to feel that senior leaders’ actions support the mission and values of the organization.
3. Quality: Healthcare organizations need to have a focus on quality improvement and demonstrate care for patients/customers.
4. Satisfaction with job security: Employees want to feel that their job is secure. 

Key drivers of retention:

1. Connection to work: Employees want to enjoy and find meaning in their work. They want to feel their job fully takes advantage of their skills and abilities.
2. Leader behaviors: Leaders need to show respect, treat team members equally, authentically care for their team’s job satisfaction, and encourage a sense of belonging and teamwork within the group. 
3. Commitment to safety: Employees want to feel like the organization provides the highest quality of care possible and that they have a psychologically safe environment to bring up concerns that will lead to positive changes.

Feeling respected at work is the #1 driver of employee engagement. But 26% of healthcare employees don’t feel their organization consistently shows them respect—or one in four members of your team. Building a culture of respect in the workplace requires a concerted effort that prioritizes listening to employees, then acting on what you learn. 

Closing the feedback loop: How continuous listening fuels improvement

Continuously listening to the healthcare workforce is the first step. But listening isn’t enough: Employees need to feel that their input contributes to positive change. They need to be involved in improvement efforts.

A culture of shared ownership and respect undergirds employee engagement and retention. But nearly half of the workforce feels they could contribute more to positive change. Healthcare has a significant opportunity to amplify employee voices. Leaders who embrace transparency see a significant boost in employee engagement. Sharing survey results, involving teams in improvement plans, and providing regular progress updates leads to 23% higher engagement (compared to organizations that do not).

The road to a fully engaged healthcare workforce is long, but the positive trajectory we’re on is encouraging. Drawing on data from 2.2 million employee voices, these insights reveal the keys to accelerating employee engagement and experience. By prioritizing listening, action, creating strong bonds, and fostering effective leadership, healthcare organizations can build a thriving workforce and deliver the best care possible to patients.

To learn more about the results from our study, download our report: “Employee experience in healthcare 2024.” If you’d rather discuss your unique challenges 1:1, reach out to a member of our employee experience team, and we’ll be in touch.