Staff Retention in Nursing

• Arlena Davis,
• Stephanee Thurman

STAFF RETENTION IN NURSING

Introduction

Staff retention is one of the strategies nurse administrators employs in preventing high rates of nurse turnover. Currently, the rate of nurse turnover is quite high, and this problem is more common in nurses at the entry level. The high rate of nurse turnover is one the major contributors of the shortage of nurses experienced throughout the country (Brunetto, 2012). Apart from prevention of nurse turnover, retention of nurses has a lot of benefits accrued to it. The strategy is useful in keeping nurses in a particular organization, and this helps to retain the skills and knowledge accrued in the process of serving at the organization. Other benefits associated with nurse retention include a reduced number of new nurses or “rookies,” thus reducing cost of training, fewer terminations that lead to reduced termination cost and increased productivity. However, the retention of nurses also comes along with increased cost. Some of the nurse retention costs include salary increases, rewards, bonus programs, ongoing “education and promotion,” among others (Ley, 2007). Therefore, as a nurse manager, it is essential to devise ways of dealing with challenges that arise as a result of nurse retention. Possessing the knowledge on nurse retention is vital for career development as a nurse manager. Hence, this paper provides an analysis of research articles regarding the issue of nurse retention.

Staff Retention in Nursing

Part A: – Summary of Each Study

Article 1: Retention Priorities for the Intergenerational Nurse Workforce by Wieck et al., 2010

The researchers in this particular study focused on the retention priorities for nurses belonging to different generations. The purpose of the study was “to conduct an assessment on the environment, job satisfaction, and desired traits of managers in a bid to improve nurse retention” (Wieck et al., 2010). As mentioned earlier, nurses’ retention is important in any organization since it helps reduce the problem of nurses’ shortages that is felt across the whole country. Work environment, job satisfaction, and qualities portrayed by nurse managers have direct impacts on nurse retention.

As part of the methodology, this study was purely quantitative and entailed collection of data from 1,773 nurses from 22 hospitals. The survey was conducted online and included aspects such as “nurse manager desired traits, safety perceptions, nursing work index and job satisfaction” (Wieck et al., 2010).

The findings of this research indicate that the satisfaction with work environment were high among all the participants. The satisfaction was highest where there existed nurse-physician relationship, and lowest where there was nurse control of practice, and younger nurses were less satisfied compared to nurses aged over 40 years. 40% of nurses involved in the sample expressed safety concerns. Additionally, 61% of all the participants indicated that they were planning to leave their jobs within the next ten years (Wieck et al., 2010).

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In order to halt the alarming findings contained in this research, the researchers assert that health organizations should create model managers since the characteristics of the manager are among the major factors influencing nurse retention. Hence, it important for nurse managers to possess qualities that promote a good working relationship with the nursing staff. The nurse managers should empower the staff nurse councils, which are very useful in advancing the grievances raised by nurses, hence improving job satisfaction. The other recommendations are revamping of the incentives, stabilizing staffing, and focusing on their safety during service delivery (Wieck et al., 2010).

Article 2: Study on Nurse Retention by Brunetto

The study aimed at improving the rates of nurse retention by focusing on the factors that make nurses stick into their professions (Brunetto, 2012). The study took three years, and it sought to determine nurses’ satisfaction levels concerning the relationship with supervisors, ability to solve problems during service delivery, and communication structures (Brunetto, 2012).

The findings of the study show that nurses leave their jobs due to lack of autonomy. 20% of the nurses involved in the study felt that they did not possess the relevant skills to solve the problems they were facing, thereby forced to consult from their superior. This practice leads to erosion of the autonomy in nursing. Other findings indicate that younger nurses are faced with the greatest challenges of retention. Another factor that contributes to nurses leaving their job is random changes in the hospital management that complicate the work relationships between the nurses and supervisors. Well-organized structures in the hospital have the potential to reduce the number of nurses leaving their jobs (Brunetto, 2012).

The insights contained in this study can be very beneficial if they are applied in a hospital. First of all, increasing the autonomy of nurses can help lower nurses turnover and retain more nurses in the hospital. In the cases where nurses lack autonomy due to lack of knowledge on how to deal with certain situations can undergo further in training to increase their knowledge (Brunetto, 2012). The supervisors should create proper working relationships with nurses. Good relations between the nurses and their supervisors will help reduce the rate of nurse turnover.

Article 3: “Keeping Nurses on the Job: Retention is part of the Answer to the Nursing Shortage” (New York University, 2009).

The purpose of this study was to “establish the factors that can help keep new nurses from leaving their jobs” (New York University, 2009). The topic of study was important because nurses turnover not only results in a shortage of nursing staff in the hospital, but also results increased hospital budget as the hospitals tries to cater for turnover costs (New York University, 2009). This study was funded by the Robert Wood Foundation, and it incorporated a sample size of 1,933 newly licensed nurses that were sampled from various hospitals across 34 states in the USA” (New York University, 2009).

The results of the study showed that nurses stayed on their jobs based on factors that included perceptions of the working conditions, job opportunities available, personal characteristics and specific workplace attributes. According to the researchers, nurse retention can be useful in cutting the costs of running the hospitals. Nurse retention is also useful in improving patients’ outcomes since it increases the staff stability. Whenever the nurses are satisfied with their jobs, bear the organizational commitment, possess autonomy, and have opportunities for promotion, such nurses have minimal chances of leaving their job (New York University, 2009).

The knowledge contained in this research article is applicable in addressing problems with nurses’ retention. Health organizations should try to create equal chances for promotion for the nurses. Some nurses should not feel sidelined for promotions whereas others are favored. As the results of the study show, the hospitals can reduce high workload for nurses in a bid to increase job satisfaction. Increasing job satisfaction can result in the high rate of nurses’ retention. The nurse managers should provide supervisory support in the efforts to increase the organizational commitment among younger nurses. Nurse Managers should also avoid some practices such as mandatory overtime since they lead to reduced organizational commitment (New York University, 2009).

Article 4: “Effective Strategies for Nurse Retention in Acute Hospitals; A mixed Method Study” by Koen et al., 2013

Nurse retention is one of the best strategies in countering the problem nurse shortage within the organization. Therefore, “the purpose of this study was to examine the impact of nurse education, nurse staffing and nursing practice environment on the nurse reported intention to leave the hospital” (Koen et al., 2013). The study also sought to “provide best practices in the nursing care that can lead to a sound practice environment and thereby improving nurse retention rates” (Koen et al., 2013). The study involved 3186 bedside nurses drawn from 56 Belgian acute hospitals.

The results show that 29.5% of the participants were planning to leave the hospital. “Two factors, namely, nurse work environment and patient-to-nurse ratio were among the leading reasons for the intentions of nurses to leave” (Koen et al., 2013). Further results indicate, “high performing hospitals with high rates of nurse retention had a participative management style, structured education programs, and career opportunities for nurses” (Koen et al., 2013). However, the study contains several limitations. The RN4CAST nurse survey conducted did not cover all the components. Important elements like magnetic force 11 were locked out of the study. The qualitative data was collected from six Flemish hospitals and thus it hard to make generalizations of the findings.

Therefore, the knowledge contained in this research article is applicable in addressing problems with nurses’ retention, and this can be achieved by mentoring nurses and addressing their dissatisfactions in a timely manner (Koen et al., 2013).

Article 5: “Exploring the Key Predictors of Retention in Emergency Nurses” by Sawatzky & Enns, 2012

The objective of this study was specifically “to explore and describe the influencing and intermediary factors that predict the retention of nurses working in the emergency departments” (Sawatzky, & Enns, 2012). The researchers employed cross-sectional survey designed in the collection of the data (Sawatzky & Enns, 2012).

The results indicate, “Engagement emerged as the most convincing predictor for intermediary factors” (Sawatzky & Enns, 2012).The intermediary factors use in this case included job satisfaction, fatigue, and burnout. An inverse relationship was evident between “engagement and influencing factors such as nursing management, collaboration with nurses, available resources, and shift work” (Sawatzky & Enns, 2012).There are limitations contained in this work. The purposive sampling method used can elicit biased findings. The other limitation is that the despite the fact that framework used in the research was “based on scientific evidence,” it had not been tested (Sawatzky & Enns, 2012). In addition, since the subjects used in the study were drawn from the nurses operating in the emergency departments, the findings of the study cannot be applied in the entire nursing population. According to the findings of this study, engagement is a key factor in retaining nurses working in the emergency departments. Hence, nurse managers should work on factors that increase engagements. Some of these factors include engaging the nursing management in providing guidance, collaboration with physicians, and shift work.

Article 6: “The Mediating Role of Organizational Subcultures in Health Care Organizations” by Lok et al., 2011

The objective of this study was “to investigate the mediating role of the organizational subculture between job satisfaction, organizational commitment and leadership culture in health care organizations” (Lok et al., 2011). The study used nurses drawn from 26 wards in indifferent hospitals (Lok et al., 2011).

The results obtained “shows that in the innovative ward, subculture was found to bear greater impact on nurses’ commitment and retention. In the bureaucratic ward, “subculture had a significant negative direct relationship with commitment” (Lok et al., 2011). On the supportive ward, “subculture had small but positive indirect relationship with job commitment, and this was achieved through job satisfaction” (Lok et al., 2011). Some limitations contained in this research calls for further research. In the first instance, this research is only applicable in Australia due to differences in culture across the different countries of the world. Another limitation is that the study was conducted in a hospital in which nurses spend long periods in the ward. Hence, in organizations where nurses move more frequently, they may not have adequate time to form subcultures that influence commitment (Lok et al., 2011).

The findings of this research can be applied in healthcare organizations by creating an environment that promotes commitment. Servant leadership is critical in increasing the level of commitment among the employees. Hence, the nurse managers should embrace a transformative style of leadership in order to boost the level of commitment among the nurse

Article 7: “Which Organizational Culture Moves Towards Organizational Excellency” by Gogheri et al., 2013.

The overall objective of this study was to evaluate “the relationship of types of culture and the execution of organizational excellencies based on the EFQM model in government organizations” (Gogheri et al., 2013). 311 questionnaires were used to collect the data contained in this study (Gogheri et al., 2013).

According to the descriptive data collected by the researchers, culture is a major determiner of the organization’s boundaries (Gogheri et al., 2013). Culture creates a stable and sustainable social system. The result findings found out that the majority of the respondents viewed culture as a label that is capable of connecting components of the organization through proper standards. The findings found it essential for nurse managers to understand culture issues in groups and the organization at large. However, the study was faced with several limitations. One of the limitations was lack of cooperation from personnel and organizations during the process of collecting. There were also some previous studies conducted on “the relationship between organizational culture and organizational excellence performance” that made the findings no original (Najmi & Hosseini, 2006).

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According to the findings of this study, organizational culture is important in any organization since it affects goals and strategies set by the organization. Organizational culture can be a strength or weakness in the organization. Since nursing managers have an essential role of developing organizational culture, they should ensure they develop positive organizational culture that will impact the organization positively (Najmi & Hosseini, 2006).

Part B. Critique and Overall Summary

The above articles address the issue of nurse retention in health organizations. The information contained in this articles can be successfully applied in addressing problems associated with retention of nurses in health care organizations. In the first article, the knowledge can be applied in health organizations by creating model nurse leaders and empowering the nursing councils. In the second article, the application of the insight collected can be done through increasing the autonomy of nurses, and this strategy can help lower nurses’ turnover rate and eventually retain more nurses in hospitals. The supervisors should also create good relationships with the employees.

Nurse Managers can apply the findings of the third article by providing supervisory support to nurses during service delivery in the efforts to increase the organizational commitment among younger nurses (New York University, 2009). Nurse Managers should also avoid some practices such as mandatory overtime since they lead to reduced organizational commitment, and thus increased turnover. In the fourth article, the knowledge obtained can be applied by creating a more participative work environment where nurses collaborate freely with the management (Koen et al., 2013). Nurse Managers can apply the knowledge on the fifth article in healthcare organizations by working on factors that increase engagements. Some of these factors include nursing management, collaboration with physicians, shift work and resources (Sawatzky, & Enns, 2012). The findings of the sixth and seventh research article can be applied in health care organizations by creating an environment that promotes commitment and as well as cultural sensitive work environment (Manojlovich, 2006).

In summary, all the summarized articles are very credible, and they provide evidence-based practices that can be applied by nursing managers to avert the increasing problems associated with retention of nurses. Apart from the interventions identified in the articles, nursing managers can also address problems of retention among nurses by addressing shortages of nurses, adopting top-notch recruitment and retention policies, effective planning and use of the available nursing resources, and providing incentives that motivate nurses. Therefore, all the strategies identified in the articles when implemented effectively can increase nurses’ job satisfaction thus reducing problems of retention (Ley, 2007).

Conclusion

Nursing retention is an effective measure in curbing the problem of nurses’ shortages in heath care organizations. For nurse managers, understanding the mechanisms of retaining nurses is essential for the purposes of career development. This research paper has provided five articles addressing the issue of nurse retention, and two articles addressing organizational culture and it influence on retention. In regard to nurse retention, the style of leadership adopted by nurse administrator has direct impacts on the nurse retention. Hence, nurse administrators should create an environment that promotes commitment. In regard to organizational culture, leaders are largely responsible for developing an organizational culture and it important for nurse managers to use their positions to develop a positive culture that promote retention of nurses.

References

Brunetto, Y.( 2012). Study on Nurse Retention. The Journal of Nursing Scholarship, 34, 28-38.

Duffield, C. M., Roche, M. A., Blay, N., & Stasa, H. (2011). Nursing unit managers, staff retention and the work environment.Journal of clinical nursing,20(1‐2), 23-33.

Gogheri, A. S., Nawaser, K., Vesal, S. M., Jahanshahi, A. A., & Kazi, R. (2013). Which organizational culture moves towards organizational excellency. Asian Social Science, 9(11), 221-236.

Koen, V., et al. (2013). Effective strategies for nurse retention in acute hospitals: A mixed method study. International Journal of Nursing Studies. 50(2):185–194

Ley, L. (2007). ‘Shortage of Nurses.’ Journal of medical practice. 3(1), 23-43.

Lok, P., Jo, R., & Westwood, B. (2011). The mediating role of organizational subcultures in health care organizations, Journal of Health Organization and Management, 25(5): pp.506 – 525.

Manojlovich, M. (2006). Enhancing nurses’ job satisfaction through improvements in the practice environment and effective nurse physician communication. Journal of Nursing Administration, 36(5), 229-230

Najmi, M., & Hosseini, S. (2006). EFQM Excellence Model, From Idea to Execution. Ronas (6th ed.). Tehran, Iran.

New York University. (20130). Keeping Nurses on the Job: Retention Is Part Of The Answer To The Nursing Shortage. ScienceDaily. Retrieved August 29, 2014 from www.sciencedaily.com/releases/2009/03/090330154802.htm

Sawatzky, V. & Enns, C.(2012). Exploring the key predictors of retention in emergency nurses. Journal of Nursing Management., 20(5); 696-707.

Wieck, K., et al. (2010). Retention priorities for the intergenerational nurse workforce. Nursing Forum, 45(1), 7-17.