Term Paper on "Nursing Retention Strategies"

Term Paper 6 pages (1811 words) Sources: 4 Style: APA

[EXCERPT] . . . .

Nursing Retention

It is true that hospitals suffer from high turnover of nursing staff. However, studies show that does not need to be the case if the organization's management recognizes the personal and occupational needs of their nursing staff. In the business setting, empowerment has proven to be a positive employee motivation and increased retention rates. Empowerment programs in healthcare facilities can have similar results. The nature of nursing work environments is believed to contribute substantially to the current nursing shortage (Buerhaus et al. 2003).

A large number of the studies conducted on nurse retention are based on the theory of structural empowerment, developed by Kanter (1979), who saw employees' work behavior developing from workplace situations, not from personal characteristics. She defined four structural conditions as key contributors to empowerment: opportunity to advance or be involved in activities beyond one's job description and access to information regarding all facets of the organization, support for job responsibilities and decision making, and resources as needed. Empowerment is on a continuum, with the environment offering relatively more or less empowerment. Kanter's theory of structural empowerment places the responsibility completely on the organization. It stipulates powerless individuals have not been exposed enough to the four empowering workplace structures.

Research shows that workplace empowerment strongly impacts factors related to retention, particularly, job satisfaction. Employees who have access to empowering structures in the workplace have more positive attitudes towards their work, in this case, feelings of personal empowerment and respect. Structural empowerment is a particularly important factor in determining how hospital nurses perceive respect within their work setting. For example, in a study by DeCicco et al. (2006) nurses employed in nursing homes felt more respected because they were generally afforded more professional autonomy, formal and informal access to power, consistent with a leadership role.

Similarly, Ulrich et al. (2005) found that nurses had a greater feeling of empowerment where effective collaborative relationships were built on mutual respect.

Since the responsibility lies on the organization instead of the nurses, themselves, to feel empowered, it is often the way that these individuals believe that they are perceived that increases or decreases their job satisfaction. Studies, as one done by Sarmiento et al. (2004), have found that when nurses perceive only moderate levels of empowerment in their workplaces, there is still room for additional perceptions of access to opportunity, information, resources, and support. Nedd (2006) looked at how perceived formal power, informal power, and access to work empowerment structures relate to the nurses' self-reported intent to remain in their job.

The results of Nedd's study (2006) supported Kanter's theory that access to empowerment structures do relate to employees' behaviors and attitudes including the intent to stay. The findings suggested a positive relationship between the nurses' perceptions of their access to opportunity, information, support, resources, and their intent to stay with their place of employment. This is also in line with Kanter's theoretical belief that work behavior and attitudes, such as intent to stay, are not as related to personal attributes as they are to the nurses' perceived access to workplace empowerment structures.

Similarly, Faulkner and Laschinger (2008) studied the interconnection between structural and psychological empowerment and the ultimate influence on hospital nurses' perceptions of respect. Respect, or lack of respect, has been identified as a major factor that impacts the degree of quality of the nurses' work life, as noted also by Milton (2005). The nurses' perceived lack of respect is found to be associated with poor job performance and lower perceptions of the quality of patient care on their units (National Advisory Council on Aging 2003-2004). Nurses in the study by Faulkner and Laschinger (2008) considered feedback from supportive managers and peers as demonstrations of respect; this highlights the importance of constructive feedback among nurses in encouraging a sense that one is valued in the workplace. The extent to which nurses felt they were more visible and critical to the attainment of organizational goals was significantly related to feelings of being respected. Employees who believe they are respected are more apt to have job satisfaction, trust their employer and be committed to remain with the organization.

Upenieks (2003) likewise reported that nurses experience less stress from a long day of work if they receive positive feedback and support for the work they have accomplished. By providing a supportive environment to nurses, the retention rate can be increased dramatically. Upenieks stressed that hospitals would retain more highly qualified nurses if they provided nurses with open communication channels to supervisors and if the healthcare organization ensured that there were enough nurse leaders present. As a result, nurses will more successfully complete their jobs and obtain greater job satisfaction. In addition, decentralized decision making and shared governance increase the nurses' control over their work environment, as it supports autonomy and improves relationships. In Upenieks' study, supportive management was often described as a motivating factor for staying with a position.

It is therefore essential that the healthcare organizations' managers and leaders do what ever they can to ensure their nurses believe they are getting the respect they deserve in their working environment. Hospital and nurse managers have the resources to encourage work conditions that support empowerment for nurses and that can increase the nurses' personal feelings of being valued by others. Research demonstrates that promoting collaborative professional relationships and assuring continuous support to nurses are especially essential strategies for establishing and increasing respect.

Providing these structures as noted by Kanter and making them accessible, as well as ensuring that nurses recognize them as accessible can be an attained goal by nurse managers and administrators. To some degree, the perceptions of the nurses' access to workplace empowerment structures are controllable by organizational managers. Healthcare administration has the authority to enhance access to work empowerment structures and nurses' perceptions of them.

To begin with, administrators can gain insights into their employees' perceptions of access to workplace empowerment. The results of such a survey would provide the organization with baseline information about current employee perception of the ability to access workplace empowerment structures. Once the hospital administrators clarify issues impacting the nurses' intent to stay, they can develop and implement interventions.

Administrators can create work situations that relate to the nurses' intent to remain on the job. For instance, these administrative leaders can facilitate access to the organizational structure of opportunity by giving nurses a chance to be involved with work groups, team projects, committees, and organization programs. Likewise, nurses can act as resources and mentors to other nurses in order to further advance skills and knowledge in the organization (Laschinger & Sabiston, 2000). One way to facilitate access to resources, for example, is to involve nurses in decisions regarding obtaining supplies and equipment for the unit. Other empowering strategies include rewarding nurses for a job well done. This measure could be as simple as providing verbal praise to providing on-the-spot recognition for a job well done.

The American Nurses Credentialing Center (ANCC) developed the Magnet Recognition Program to recognize health care organizations that provide nursing excellence. The program provides a vehicle for disseminating successful nursing practices and strategies. It has been found that those organizations that work toward being recognized as a Magnet organization have higher retention rates. This is not always the case that the retention came first and then a decision to apply for the recognition.

One of the values of pursuing Magnet designation is that it gives nurses and leaders a means of working together toward common goals. The nurses learn to work on the most significant areas, benchmark results, and take pride in their achievements. The work of benchmarking with national databases develops a system of knowledge and helps nurses reframe how they describe their role. As a result, retention is strengthened due to a form of shared governance, which communicates an understanding that nurses are important partners and need to participate in making decisions, especially at the bedside. Being involved in decision-making improves job satisfaction for nurses because they become masters of their environment (Pinkerton, 2006).

The Magnet application process has a multifaceted influence on staff nurses. They are able to clearly describe what they do, measure it, and then boast about the results because they have measured and promoted it. This then becomes the staff nurses' process. When the Magnet surveyors visit the organization, everyone on the staff is very involved in the visit and their process; they reflect their practice and take pride in their accomplishments.

Many factors will encourage nurses to remain with their organizations to varying degree. The main point is that healthcare organizations have to put together plans that directly look at the ways that the challenge of ongoing retention problems can be faced. Many of the factors suggested as influencing nurses to remain in their positions relate to interpersonal relations, as well as leadership and management style and action. It is also clearly recognized that responsibility to improve job satisfaction, offer challenges and create opportunities for nurse development lie with the organization's… READ MORE

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