The Retention and Shortage of Nurses in Healthcare

The current nursing shortage and high turnover rate among nurses is a great concern, not only for health care organizations but also for the general population. The increase in an older population, as the “Baby Boomers” approach retirement age will add to this shortage, leaving many to wonder who will take care of them in their golden years. Subsequently, many of these “Baby Boomers” are nurses themselves and will be retiring, adding to the shortage. The Current trend for recent nursing graduates is that they do not last long on the job and the high financial cost of rapid turnover of the nursing staff is a driving force behind the need to effectively retain new nurses. One article, from Nursing Economics suggest that one of the predictors to a registered nurse remaining in nursing is scheduling.

In their survey, they questioned over 8,000 nurses in Maine. They asked them to determine the weekly number of hours they were “hired” to work, the number of hours they “actually” worked, the number of hours they would ideally “like” to work, and the number of hours they work providing direct care to patients. After analyzing this data, it was compared to the nurses’ answers on the survey of whether they planned to continue working in the nursing profession. The result of the survey concluded that when scheduling and hours were within the nurses’ expectations, retention of the nurse was more likely (Andrews et.al, 2011)

After years of working in the health care field it didn’t seem unusual to me that scheduling and hours worked played a huge impact on retention of nurses and nurse turnover, as it can certainly influence a person’s overall well-being. However, I never really considered the ways in which we, in the health care field or those who are educators could enhance job satisfaction so that the retention of nurses increase and turnover decreases. The researchers in this article also identified strategies to help, not only, individual nurses and managers, but nurse educators as well. They concluded that:

1. Management should find ways to meet nurses’ requests for scheduling change.
2. Nurses should clearly understand the expectations the employer has regarding scheduling.
3. Nurse educators can be critical to orienting student nurses about the work demands and expectations that come with a career in nursing. (Andrews et.al, 2011)

Although scheduling can play a major impact on a nurse’s longevity with a company, another research proposal attempts to investigate relationships between work environment, job satisfaction, and leadership involvement. This proposal is the Magnet Hospital Prevention Model. The purpose of this study was to “present a prevention model that can assist nurse executives in attracting and retaining nurses” in the hospital and Dr. Office setting (Upenicks, 2005). A magnet hospital is stated to be one where nursing delivers excellent patient outcomes, where nurses have a high level of job satisfaction, and where there is a low staff turnover. The idea of this model is that nursing leaders’ value staff nurses, involve them in shaping research-based nursing practices, and encourage and reward them for advancing in nursing practice.

Also, of great importance, this model attempts to give health care organizations prevention strategies and cost analysis for achieving these goals. The method used in this study actually began in the 1980’s and was conducted by the American Academy of Nursing (AAN). The AAN attempted to identify hospitals across the United States who were successful in recruiting and retaining nurses. This was an extensive research project, which involved 41 hospitals in the United States that met the criteria for being a good place to practice nursing, having the ability to recruit and retain nurses, and the hospital being located within a city with a competitive marketplace. Administrators of these hospitals were asked to fill out comprehensive forms that covered questions about demographics, leadership, and staffing.

A ranking system was used to identify those hospitals that displayed organizational skills in management that supported nurses. In time, these hospitals were the front runner of today’s interview-based research project for “magnet hospitals”. Over time, studies have been conducted to compare magnet hospital turnover rates and job satisfaction with that of nonmagnet hospitals (Upenieks, 2005). It was concluded from this study that hospitals and other health care organizations, who use the Magnet Hospital Prevention Model have been associated with higher levels of job satisfaction and lower turnover, and that the initial cost of implementing and maintaining this program is far less expensive than the cost of hiring and training new employees The model also recommended implementing retention strategies such as, bonuses for longevity, tuition reimbursement, and increased staff to patient ratios. (Upeniecks. 2005)

Given the challenges presented by the projected nursing shortages and aging nursing staff, healthcare organizations need to ensure that they are providing their nurses with job qualities, rewards, and work environments that increase their nurses’ job longevity, job commitment, and job satisfaction while accommodating their desires to work flexible shifts and reduce the physical demands of providing care. A lot of this role is placed on the nurse manager or nurse supervisors shoulders. Therefore, organizations should ensure that their nurse managers are well equipped and prepared to help support and retain the nursing staff. As seen in many organizations communication, or lack of is the number one problem in achieving success and with the increase in medical technology demands, the increase in an older population requiring care, and the decrease of those seeking degrees in nursing, retaining nursing staff is of the utmost importance.

Nursing managers / supervisors should recognize when perceptions of the workplace appear to be causing nurses to leave. Recognizing when nurses appear to be stressed, frustrated, or socially isolated, may help to retain future nurses. Effective mentoring programs that fully support the transition into the nursing practice may ease the transition and assist in long-term retention strategies. Developing cultures that embrace diversity, have a zero tolerance for hostile workers, and provide support programs for nurses experiencing emotional stress may enhance retention of nurses. Both, the study done by Nursing Economics involving nurse scheduling and the Magnet Hospital Prevention Model provide conceptual ideas of why nurses leave clinical practice. Exploring these concepts in more detail is necessary and will benefit every nurse, every patient, and every family, and ultimately improve quality of care, increase retention of nurses, and decrease turnover.

References
Andrews, B., Colgan, C., & Kirschling, J.M. (2011 May – June). Predictors of registered nurses’ willingness to remain in nursing. Nursing Economics, 29 (3), 111+ Carswell, J., & Webb, J. A. K. (2000). The true value of professional nurses. PN – Paraplegia News, 54 (7), 63. Cates, E., & Gaddis,S. (2008, December). Should I stay or do I go now: eight ways to
increase loyalty and retention. Oklahoma Nurse, 53 (4), 23. Evans, J.D. (2013). Factors influencing recruitment and retention of nurse educators reported by current nurse faculty. Journal of Professional Nursing, 29 (1), 11+ Gipson, G. (1999, May). Building a network of stayers. Contemporary Long Term Care, 22 (5), 61 Upenieks, V. (2005 April). Recruitment and retention strategies: a Magnet Hospital Prevention Model. MedSurg Nursing, 14 (2), 521+