Retention of Nurses

Retention of nurses begins with how the organization does or does not value the staff. Rhetoric not withstanding, most healthcare executives view staff as an expense and in times of financial constraint as is currently the state, watch the personnel budget line very closely. It is key that executives reframe how they see staff, all staff. Rather than viewing staff as an expense, seeing them as any asset on the balance sheet will drive different decisions about the work environment. Solution: Healthcare executives including nurse leaders must learn new skills for valuing employees. The chief nursing executive in partnership with the head of Human Resources can facilitate the executive team's discussion of how they are valuing staff and how this is shown in the organization. The increasing union activity throughout the country is an indication that this discussion is needed.

Human resources in the form of registered nurses can arguably make or break an institution's image and competitive edge. Organizations that maintain a market advantage will be those who not only remain competitive from a cost structure, but who also attract and retain talent.

Organizations that give attention to the employee market and understand what people are seeking from the work environment have a better chance to recruit and retain top talent...

People determine organizational effectiveness and allow the organization to thrive in this competitive healthcare environment. Organizations that give attention to the employee market and understand what people are seeking from the work environment have a better chance to recruit and retain top talent, particularly given the current low unemployment. Solution: Identify what benefits would keep nurses in the profession and in a particular work setting. The best source is the nurses themselves as discussed by Eulee Mead-Bennett and Ngozi Nkongho (1990 ). During the previous shortage they interviewed staff nurses in several New York hospitals to learn what nurses saw as the causes of that nursing shortage and suggestions for alleviating it. Then, as today, they found that the following were areas needing short and long term solutions: autonomy, salaries, schedules, credibility gap, and professional respect.

In a more recent study, McNeese-Smith (1999) investigated staff nurse descriptions of job satisfaction and dissatisfaction. For the nurses in the study, salary and benefits were important but mentioned only briefly. A key finding was that the nurses in their study found satisfaction from direct care, yet their role was changing to be the organizer and coordinator of care. Another finding with implications for administrators was that those nurses who provide poor care, have a negative attitude, or are burned out create dissatisfaction for their co-workers. Solution. Administrators and educators must learn what the satisfiers are for staff. When roles are redefined, they must help staff identify new satisfiers. Human resource administrators must be responsive to the individuality of what is important to staff and create flexible and supportive policies and benefits.

Currently, there are critical needs for experienced nurses in the operating room, critical care, and neonatal care arenas. Solution: Hospitals are reintroducing intensive training programs for nurses in these specialties. This helps to retain nurses who are looking for a transfer opportunity as well as to recruit new staff. It also builds a career development path for staff. These training programs are not inexpensive and nursing leaders must be prepared to justify the required budget. Given the cost of temporary staff, this should be a logical solution for the organization's leadership to endorse.

For at least two decades, the literature has promoted the notion that shared governance/shared leadership creates a more satisfying work environment. The research that has been done on magnet hospitals shows that organizational characteristics that attract and retain nurses include professional practice models for delivery of care with autonomy and responsibility for decision-making. Participatory management, enhanced communication, and adequate staffing were relevant features of hospitals that nurses identified as good employers. While few hospitals have Magnet status, the research remains relevant and applicable. Solution: Effective administrative structure, quality patient care, and investment in professional development of nurses are important. Staff must be involved in defining and developing the practice of care in the organization since they are the closest to the patient. This includes participation in the financial management of their unit.