The Long Goodbye

September 20, 2006

When an employee announces his or her departure, the decision to leave is made months and years before the actual resignation occurs. Because health care is a small world, the departing employee will usually say that the resignation is due to family, pay or opportunity. The real reason for the departure is more than likely tied to some event or action which occurred months or even years ago. Usually it’s something that a leader either missed or saw as inconsequential at the time.

People work in health care primarily because they enjoy the work relationships and have a strong desire to do their job well. Thus when leaving a job, the person knows that they’ll have to develop new relationships and will experience those difficult feelings of not being at one’s best as they become acclimated to their new job.

So why do people leave? Besides the often stated reasons such as family, pay, or opportunity, the most likely reasons are a lack of relationship with their supervisor, systems that are frustrating, not having the tools to do their job, lack of development or training, working with low performers who are not being dealt with and a lack of appreciation. The story below is an example of when that loyalty knot gets loosened.

Not long ago, I ran into a nurse while grocery shopping with my wife. The nurse was disappointed with her current employer. Why? She had applied for a nursing instructor position at her hospital. Someone else got the job.

That hurt, but what hurt even more was the lack of respect she felt because of the way the communication was handled – or, to point more accurately, how communication did not happen. It wasn’t until she read the announcement on the staff bulletin board that she learned she didn’t get the job.

Her comment to me was “I’ve worked there for years and they didn’t even have enough respect for me to call and explain that I wasn’t chosen or why.” Will she walk out right away? No, she is too professional. Will she leave tomorrow? No, again she doesn’t want to leave her teammates and patients in a bind.

Will she return calls from another organization if called? Yes. Will she look online for openings at other organizations? Most likely. Will she leave? Yes, if something doesn’t happen to retighten her loyalty.

So how does a leader become aware of such disconnects and either prevent them or intervene sooner? Here are two possible ways:

  1. Hardwire communication to people not selected for positions. Make clear what are the next steps of the interview process, particularly when the decision will be made and how people will be notified.
  2. Consistent rounding on staff. In the story above, I feel if the manager had rounded on this person with some basic questions, the leader would have been aware of this situation. If an employee quits and the leader is surprised there are two issues – the employee quitting and the leader being unaware of the employee’s feelings.

We at SG have a national lab of leaders dedicated to making health care better. Please let us know:

  1. Any success you are having with staying close to staff that you feel is improving outcomes through increased retention of staff, creating more efficiency, etc.
  2. Do you have a story of something you did and didn’t seem to have an impact at time but found out later it did?

A new leader told me that he once asked a nurse how she was doing. The nurse mentioned a particular supply need on the unit. The leader followed up and got the supplies.A few weeks later the leader was walking through the unit and saw the same nurse. The nurse told the leader that when she mentioned supplies, she had written her resignation letter and planned on turning it in that day. However, she had decided to wait just to see how the leader handled her request. She then thanked the leader for being so responsive and said she was staying. Never under estimate the impact of such actions.

Love to hear your comments on this and your own life’s lessons.

Thanks, Quint


22 Responses to “The Long Goodbye”

  1. Bekki Says:

    This is great. Thank you so much for sharing.

  2. Bonnie Says:

    I feel that the greatest compliment that a leader can receive is the words of loyalty to the leader and the organization…

    I had been told that an employee in one of my support departments was looking for other employment. I was oncerned that something I had done or the work environment was related to this so I approached her. (I am quite open and up front with the staff that I lead and they are all aware/appreciate this style.) I positioned myself so that I was right beside her but a little lower. I spoke softly and told her about the “rumor” that I had heard. She hesitated and answered “yes”. I asked her if there was anything that I had done or anything that I could do to help with the situation. She mentioned that the work environment was sometimes “petty” and could be challenging. I asked her if she thought that it would be different elsewhere and she said “not really”. She went on to discuss what appeared to be the underlying issue and that was her personal situation. She needed to earn more money to take care of her children and provide them with the life they are used to. She
    mentioned that she was looking at a leadership position in another location within the organization. I was familiar with the position and told her that I would support her in any way that I could, if this was what she wanted. I told her that I thought she would be a great leader and I would give her a positive recommendation. I stated to her that I was concerned that she may only be seeking a lateral move which would not benefit her in the ways that she was describing. Her comment back to me was the following…”I wouldn’t seek a lateral move out of this department. You are the reason that I am here and the reason that I stay. I would only leave to advance my career (within this organization).”

    I can’t think of many other comments that would make a leader feel good about what they do. The loyalty that can be developed and sustained goes both ways. I would do anything to help the staff, anywhere in this organization, develop their skills and advance their career. If they
    choose to be happy where they are at, I would do anything to keep this as positive of a work environment as possible. I am confident that the staff in the areas that I lead would do the same for me.

    I am so lucky and privileged to be able to enjoy working at and being a part of Eastern Maine Medical Center.


  3. Mitchell Ishikawa Says:


    I can relate to this subject since I recently left my management position. I worked in Surgical Services for 28-years, 16-years as a manager. I recently resigned my position and took a position in Finance as an Accounts Payable Specialist. I knew a year ago I was not going to be working in Surgery. I didn’t know specifically when I was going to resign or what career path I was going to pursue however I did know I could not work with a direct report whom I did not respect due to disconnect in communication and difference in values. I made a commitment to see strategic projects were followed through prior to my resignation, however at the end; I was not at my best for the staff and department. I was fortunate to have the support of Human Resources assist me with an internal job search. After three months, I found a position which would sustain my interests and value for respect.

    I have witnessed and weathered many changes in Surgical Services and the organization. Throughout the course of my management career, I was willing to make compromises and changes however my values and importance I put on respect have taken a better path. I am very happy working in Finance. The staff respects each other and their manager. It makes a difference.

    Mitchell Ishikawa

  4. Patricia Hofmaster, Ph.D. Says:

    Thank you for your article, “The Long Goodbye”. I couldn’t agree more, it is usually nota big, hard-to-miss moment that moves an employee out of an organization. I would add one thing to the #2 suggestion. When rounding, the leader not only needs to ask questions but also listen, keep an open mind, and respond–does the leader agree, disagree, need to think about it, etc.

    Thanks and have a great day!-Pat

    Patricia Hofmaster, Ph.D.
    Director, Healthcare Research

  5. Jennifer Says:

    What an amazing article to read! Even though I’m not a “leader”, it put perspective on the way situations are handled. Next time I hear of this sort of situation, I’ll be able to coach a little.

    Thank you!


  6. Lori Swasey Says:

    I have a great story to share.

    In April 1999 I was a new manager for a 17 bed telemetry/step down unit. The staff had previous directors who oversaw many units and leaders who had more than one unit to manage. They really had no one to call their own. At the time we had several nursing assistants who were graduating from nursing school that May. I was excited because we have an outstanding new grad program and what a great opportunity to retain employees. I discovered a few weeks into my job that one of my nursing assistants was applying outside of our organization. I was so saddened
    by that discovery because I really liked this particular employee and I really wanted her to stay. “How can I make her stay?” I made a point to speak to that nursing assistant one evening. I said to her in front of other peers and nurses, “Sue (not her real name), I have really
    noticed the amazing care you provide to our patients in the short time I have been here. I have also heard from the manager of our ICU as well as from your peers that you are an awesome team player and care provider. What do I need to do to make you stay on board as a RN here and not apply to other places?” Sue was shocked. The next day she
    applied to our new grad program and I am happy to report continues to work for our organization. We still see each other every once in a while and she always reminds me of that story and what a huge impact it made on her.

    That was a great lesson for me as a new manager not to ignore those key opportunities.

    Lori Swasey, BA, BSN, MS
    Director of Accreditation and Organizational Excellence
    Quality Division
    Exeter Hospital

  7. Lorie Khorsand Says:

    Interesting discussion. I’d love to share this about folks leaving our institution.

    You know that for years, I have valued the middle and high performers as one of our team. What everyone who retires has in common, when you see that post-retirement, is that they don’t miss the job, but they miss the people. I try to show my dedicated, loyal employees that worked until
    their last days in healthcare as valued team members. We invite them to potlucks, other folks’ retirement parties, Christmas parties… I believe it is something we do out of respect for our colleagues and motivates others to work longer, into retirement years knowing that they will have that supportive sense of community, even after they retire.

    It is also great to see our younger nurses look up to the role models that came before them. Nursing, right now is experiencing a tremendous shortage. Every nurse we can encourage and support for another year, helps to alleviate that shortage. Granted a party isn’t going to keep them, but sense of value and of belonging does help.

    Thank you for the continuous reminders via these emails.

    Lorie Khorsand RN BSN CNOR
    Surgical Services Director
    Providence Centralia Hospital
    Centralia, WA

  8. Pamela Says:

    Wow! What a powerful article! It’s so true. Sad, but true. And the story at the end just proves it’s those little things that you don’t think make a difference that really do! Thank you for sharing this article.
    I’ve passed it along to several people in the facility.

    Customer Service Manager
    Emanuel Medical Center

  9. Eva Canals Says:

    Just wanted to share with you that I have been a Nurse Manager for 2 years in a 12 bed Trauma ICU and an 8 bed Burn Unit and since I began working as Nurse Manager I have had a very low associate turn over and I have been fully staffed with a waiting list of other staff that would like to transfer into my unit. I believe that the reason the staff stay is because of two things. First, they love Trauma Nursing, they become addicted to it and second is because of the fact that they know that if they are going to be working hard, I will work hard right along with them. If I see the staff having a bad day and they are all running I just go in and help do small things like start IV’s, help with procedures and change out IV bags, anything that will keep them from running. My staff also know that if they are short staffed or a big emergency happens and there’s not enough staff, I will come in and work right besides them. Like I said, if they are working hard, I will work hard with them, they know that if I’m working hard and they’re not, then there’s a problem. I never expect any one in my unit to do anything that I wouldn’t be able to do.


    Eva Canals RN
    Nurse Manager
    Trauma ICU 2/ Burn Unit

  10. James Says:

    Thanks for the insightful information.

    I would like to share briefly that a team that plays and works together stays together. Quite often I make sure as a manager that I keep my team members close to not only me but all as a team. We foster this growth and closeness by engaging in after work activities such as golfing, golf driving range, fishing, etc. I have found that this does not affect the professional relationship side and it helps to keep us all together as a cohesive unit.

    I enjoy letting my team know that I truly care about all aspects of their life and that we are in this life together to make it best possible for best results and outcomes.

    Just some quick thoughts!

    Best Regards,

    James J. Ruff, CBET, MAOM
    Manager, Clinical Eng.

  11. Jim Summers Says:

    Good essay. I became really clear on the situation with the following two line comments from a seasoned executive. “I had trouble keeping and retaining good workers. Then I realized I was hiring human beings. If all I wanted was workers I would use robots.”

    Jim Summers
    Department of Health Administration
    Texas State University.

  12. Chris Says:


    Thanks – wow, a great story, especially this part: Her comment to me was “I’ve worked there for years and they didn’t even have enough respect for me to call and explain that I wasn’t chosen or why.”

    I know, I know, no one likes to deliver the Bad News; however, it takes courage and vision to do so.

    When “outsider” Carly Fiorina became CEO of H-P, chosen over several other fine in-house candidates, she made a point of speaking to each candidate individually, emphasizing why their continued presence was crucial to the management continuity and long-term success of H-P – and those people stayed on to support the greater good and, frankly, their own self-interests.

    She COULD have treated them as losers and also-rans, but that would have been wrong, short-sighted and insensitive.

    Thanks again,

    Christopher Springmann, Executive Producer
    San Francisco CA 94103-3822 USA

  13. Roxanne Cobb Says:

    I have known a Business Partner (unit secretary) for over 20 years. I watched her go to school after raising 4 children and get her RN. The last three years, I have cheered her on and let her know how proud I was of her making a new life for herself. I offered her a job on my neuro unit before graduation. When she accepted, I sent her a welcome letter
    again stressing how proud I was of her accomplishments. She told me how much it meant to get that letter. “Even though we have known each other for years; it was nice to be welcomed into the neuro unit as an RN. I knew then that I had made the right decision because of all the support that had been offered to me over the years. Your confidence in me has been a constant as I struggled through school.” It as just a simple note thanking her for joining our neuro team and welcoming an old friend to a new life.

    Roxanne Cobb, Providence St. Peter Hospital, Olympia, Washington

  14. Kay Says:

    Studer Group,

    Unfortunately, this just recently happened in our own organization. Please help us “not be another story”. The impact of missing communication always comes back to haunt us.

    Thanks for all you do,

  15. Holly Brush Says:

    Good Morning Mr. Studer!

    I have to tell you this email letter could not have come at a better time for me. As a relatively new nurse manager (2. 1/2 years), I am still in the stage where I take it personal when a staff member leaves, regardless of the reason. I had two nurses turn in their resignations since Friday and have pondered what I did wrong as a manager and what could I have done differently that might have changed their mind. Then I realized that their reasons for leaving may have nothing at all to do with me but that I have the opportunity now to make a difference in the staff still with me. I have been reading a great mentoring book, “Monday Morning Meetings” which has given me some wonderful tips and advise to carry with me. One being that people don’t quit organization they quit people first — meaning the manager. I plan to talk with my two nurses to get honest feedback about why they are leaving and offer them words of support and encouragement in their new endeavors. I still want to know if I am the reason but know that I cannot own all of it. I can only own what is mine to own and they have to do the rest. Resignations, no matter how painful and no matter the reasons, are great lessons and opportunities for learning. Thanks for sharing your wisdom with new people like me.

    A huge fan,

    Holly Brush, RN, BSN, OCN
    Oncology & Palliative Care Nurse Manager

  16. Reb Says:

    Hi Quint- thanks for the reminder of this. It is exactly what I’ve found, and validates what Leigh Branham writes about in his book “7 Hidden Reasons Employees Leave.” It is that process of “disengagement” – that occurs over time and rarely is a single event. This is the problem I have with exit interviews (being on the HR side) is that we try to narrow down “why you left” to a single reason, when there are multiple factors that affect a person’s decision to leave.

    I’m struggling with trying to a) get “leaders” here to get it and b) get them to understand the importance. As an organization, we haven’t struggled with high turnover- its almost the opposite that we have people who have stayed so long that they develop an “entitlement” attitude or resistance to change.

    I wish I had a great story to tell you- I’ll keep looking…. thanks for the reminder!


  17. Monte Says:

    Hello and my most favorite thing to do is give an associate their “FIRST SPIKE”, the reward and recognition tool we use at Sumner. I was privilege to give one to Kim Adkins last week for coming in immediately to cover for an ill co-worker. Kim has only been here for 30 days but came in to save the day. I started by asking her if she knew about “spikes” and she told me it was a new hairdo! Well, that gave me a great opportunity to explain our whole program and why we reward people for such behavior. I gave her a round of applause when I finally told her of the whole program, presented her a spike and told her that this was probably the first of many she would receive. She was beaming when I left her and I felt good because I not only rewarded her but also had a chance to do some teaching along the way.

    I am also in responsible for our Hospitality House (similar to Ronald McDonald House) and while I was rounding on CCU, noticed an issue with a family who was staying at the House. The family was in discussion with a Nurse trying to “go around the rules”. The Nurse was frustrated because she did not want to break the rules for using the House. I told the Nurse to go ahead and grant the request of the family even though it was “against the rules”. As it turned out, the family member’s father passed away shortly after this incident but the Nurse looked me up later and thanked me for helping this family in a big time of need. As Outback says “No rules, just right!” and that’s what we did.

    I probably have a thousand of these stories but just wanted to share these 2. Have a great day! Monte

  18. Gail Elliott Says:

    Thank you for the note about “The Long Goodbye” Our director of nursing sent all the department managers a copy.
    .I accepted the position of the unit director at a time when many nurses were frustrated. To pull the unit together and provide some hope I held two “Solutions Meetings.” Staff were invited to came with solutions to problems. The meetings were optional for those who wanted to invest in their future. I promised to stay and listen as long as they needed to talk. Each meeting lasted two hours. The time staff donated to these meetings helped them feel vested in making a difference. Often initial thoughts were expounded upon as the team worked together to solve frustrating problems. They came up with several pages of suggested ways to improve their unit. This list was then typed and sections are posted periodically to give employees a chance to implement the remedies. If I had to implement all the details of every change many would never get done. The list allows staff to follow instructions and initiate the change. A simple solution was concerning continued missed charges. It had been noted that the bar codes for the charges were on opposite sides of the department than the items were used. Simply by moving the bar codes to the department side where the items are used we are not missing these charges. As changes are implemented I post new portions of the list. This helps prevent overwhelming the unit with too many changes at once. The staff understand that there may be reasons why some solutions will not be implemented. But usually a variation of them may be. It is amazing how this ownership has helped to boost team moral on our unit.

    I am a firm believer that as a unit director I must set high standards and enable my staff to do their job. They are demonstrating more unity and job satisfaction which naturally improves all areas of our department. Our director of nursing has implemented “Solutions” notebooks throughout the hospital for nurses to continue writing their solutions to problems. Solutions are only implemented after department director’s approves them and post the changes. Allowing our nurses to solve their own problems demonstrates we value them and what they do.

    Gail Elliott R.N.
    Director Women’s Center
    Jordan Valley Hospital

  19. Karen Says:

    I spent 2 years as a Nurse Recruiter and I watched exactly what you describe. I heard the likely excuses, i.e. more pay, better hours, etc. but in reality when I spoke with these nurses personally these were in most instances just that, excuses. They wanted to feel valued for the time and effort they exerted, to feel appreciated. This was as simple
    as a thank you for the extra shift, the interest in their needs or just acknowledgement. Managers tended to wait until the nurse was leaving to ask questions. By this time it was too late, their decision was made.

    I repeatedly encouraged 30-60-90 day follow up post hire. This did not happen consistently and we continue to see turnover. I am now the Service Excellence Manager for our “system. I use your “hardwiring” on a
    daily basis. This may be as simple as saying “thank you” for a simple task someone completed or making time to listen to someone in need.

    Being accessible and interested in the needs of our employees has allowed me to develop trusting relationships with them and find they share with me when they will not with others. I am currently attempting to “hardwire” rounding with employees. I am struggling to engage management to realize the impact of this process. It works!

    Thanks to you and your staff. You truly inspire me to keep trying on a daily basis! I can make a difference!

    Karen Harris, RN
    Quality/Service Excellence Mgr.
    Columbia Regional Hospital

  20. Cindy Says:

    Thank you. I thought you were writing about me. I didn’t leave my facility
    but left my position. I was struggling for 2 years with the negative parts of my job as a low level manager and when I scheduled a meeting with my boss, he was flippant with me. He said something to the effect that if I didn’t like something, I could always be a staff nurse. I thought and thought about that snide remark, finally deciding “Maybe that’s not such a
    bad idea.” So, I made a change.

    I have a wonderful boss now that has clear expectations, gives me the tools
    to accomplish my goals, offers support, and lets me do my job. Then, as if she’s not already wonderful enough, she gives me credit for my work. I have come to realize that she is the first good director that I have worked for in 25 years of nursing. I did not recognize how bad the others were until I worked for someone so good.

    Thank you for recognizing the painful process of quitting that people go
    thru and offering education to those that can prevent this from happening.

    Cindy RN

  21. Roger Says:

    I became a member of the Management Team on December 12th, 2006 at SEHC.
    This decision was made after spending 28 years with another Hospital system. Your comments are “right on” for the reasons for my departure as well as others that I used to work with. Although frustrating and challenging, I continued to have hopes that my previous Employer would improve some of the issues that you have mentioned. I enjoyed my job, the people I worked with on a daily basis, and caring for our patients. I could share “many stories” that support your comments but I won’t take the time now. I am very happy and feel appreciated and valued at SEHC. It has and continues to be right decision that I have made.

  22. Kenda Hilleke Says:

    About a third of the labor market today is composed of the Gen X demographic… That’s me. Studies show we seek experiences and opportunities more than money. I can attest to the fact that if my employer doesn’t offer me meaningful work and room to grow, no amount of money could get me to stay. I have in fact walked away from opportunities that paid considerably more than I currently make simply because the experience wasn’t attractice. Our generation looks for purpose and value at work. Leadership development is a critical piece of that. Companies who focus on discovering and developing the natural strengths that their employees have will keep our generation engaged and excited to come to work every day. Companies that move slowly and change seldom will lose the future leaders that they desperately need. That’s just one more way that managers might rein in those folks considering “the long goodbye.”

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