The recruitment of Registered Nurses (RN) by a facility and then the retention of those RNs are major challenges in today's nursing shortage environment. There are many factors that enter into why an RN chooses to accept a particular job and whether to stay at the facility once being employed there.
Factors, among others, that influence recruitment include the facility's reputation, salary, union status, and autonomy. Factors influencing retention include practice autonomy, inclusion in decision making, management's respect of workers, work load, and shifts worked. As can be seen, there are overlapping concerns between the RN being recruited and the RN considering remaining employed there. Consideration of those factors which draw RNs and then make their employment fulfilling must be attended to if a facility is to obtain and retain an adequate nursing staff.
Recruitment of RNs is expensive for any facility. A recent study by Jones, CB, The Cost of Nurse Turnover, Part 2, Journal of Nursing Administration, 35(1), 41-49, estimated a total cost of between $62,100 and $67,100 to replace a single RN. When vacancy rates reach high single or double digits, the cost to the facility is significant and its likely impact on other resources such as workload, overtime, nurse replacements, etc. will be significant.
An additional cost not often discussed is the human costs of turnover and subsequent recruitment on the nursing staff. While a position is empty, the workload of the missing nurse must be absorbed into others' workload. Should a new nurse be hired, the nursing staff usually does a good deal of orientation of the new employee to the particular unit and its culture. Temporary employees also require additional work by staff RNs since they must provide support to the temporary employees in becoming familiarized with the new environment and patients. Yet more work for the staff RNs!
Retention is also a major challenge since once an RN is recruited and hired; the facility wants to retain that employee. Many factors play into the retention of any single nurse. Such things as feeling they have autonomy over their professional practice decisions; that they are a part of decision making at the unit level; that they have reasonable workloads; that they receive continuing education; that they have flexible scheduling; that they receive competitive pay, etc. effect the RN's decision to stay or leave their place of employment
With expectations such as those laid out above, management at all levels of the facility must work to try to meet the basic expectations of the professionals they employ. The success of facilities in meeting such expectations varies widely as seen by turnover rates from near zero to near 100%. Management must realize that RN recruitment and subsequent retention are competitive aspects of the health care business.
Listed below are some articles which speak to different aspects of the recruitment and retention process. These articles can be found at many public libraries or health sciences/medical libraries:
Aiken, L., Sloane, D.M. 1997. Effects of organizational innovations in AIDS care on burnout among urban hospital nurses. Work and Occupations 24 (4): 453-477.
Finn, CP. 2001. Autonomy: an important component for nurses' job satisfaction. International Journal of Nursing Studies 38: 349-357.
Force, MV. 2005. The relationship between effective nurse managers and nursing retention. Journal of Nursing Administration 35 (7/8): 336-341.
Halm, M, Kandels, M, Blalock, M, Gryczman, A, Krisko-Hagel, K., et al. 2005. Hospital nurse staffing and patient mortality, emotional exhaustion, and job satisfaction. Clinical Nurse Specialist, 19(5): 241-251.
Hart, SE. 2005. Hospital ethical climates and registered nurses' turnover intentions. Journal of Nursing Scholarship, 37(2); 173-177.
Jones, CB. 2005. The costs of nurse turnover, part 2. Journal of Nursing Administration 35(1): 41-49.
Koelbel, PW., Fuller, SG, and Misener, TR. 1991. Job satisfaction of nurse practitioners: an analysis using Herzberg's theory. Nurse Practitioner 16(4):43, 46-56.
Stone, PW; Clarke, SP; Cimiotti, J., and Correa-de-Araujo, R. 2004. Nurses' working conditions: implications for infectious disease; International Conference On Women and Infectious Disease. Emerging Infectious Diseases 11(10):1984-1997.
Ulrick, BT; Buerhaus, PI; Donelan, K; Norman, L; and Dittus, R. 2005. How RNs view the work environment: Results of a national survey of Registered Nurses. Journal of Nursing Administration 35(9); 389-396.
Other articles can be found using bibliographic search terms such as nursing turnover, nursing retention, nursing shortage, patient safety, professional autonomy, management and retention.
The following articles are available at health sciences libraries.
Connelly, LM. 2005. Welcoming New Employees. Journal of Nursing Scholarship, 37(2), 163-164.
Hart, SE. 2005. Ethical Climates and Registered Nurses' Turnover Intentions. Journal of Nursing Scholarship, 37(2), 173-177.
Brooten, D., Youngblut, J., Blais, K., Donahue, D., Cruz, I. and Lightbourne, M. 2005. APN-Physician Collaboration in Caring for Women with High Risk Pregnancies. Journal of Nursing Scholarship, 37(2), 178-184.
Rambur, B., McIntosh, B., Palumbo, MV and Reinier, K. 2005. Education as a determinant of Career Retention and Job Satisfaction Among Registered Nurses. Journal of Nursing Scholarship, 37(2), 185-192.
Sadovich, J.M. 2005. Work Excitement In Nursing: An Examination of the Relationship Between Work Excitement and Burnout. Nursing Economics, 23(2), 91-96.