Experienced Nurse Retention Strategies: What Can Be Learned From Top-Performing Organizations

"Let Them Know That They're Appreciated": The Importance of Work Culture on Direct Care Worker Retention

Retaining direct care workers (DCWs) in all areas of long-term services and supports (LTSS) remains an unending challenge. The current study purposively selected 12 high-performing LTSS communities (e.g., nursing homes, assisted living, home care agencies) in Ohio with high family satisfaction and staff retention. Qualitative interviews were conducted in 2022 with 21 personnel in leadership positions and 16 DCWs (e.g., certified nursing assistants, personal care aides). Interviews were audio recorded, transcribed, and a team of two coders conducted the thematic analysis. Three themes of work culture emerged as important for retention: (1) Family-Like Organizational Approach, (2) Supportive Working Conditions, and (3) Worker Empowerment. DCWs valued empathic relationships with their clients and supervisors. Favorable working conditions consisted of choice, participative leadership, and effective communication. DCWs experienced empowerment through appreciation, financial incentives, and career advancement opportunities. Findings suggest practical changes for person-centered care practitioners that are feasible across any organizational work culture setting. [Journal of Gerontological Nursing, 49(8), 7-13.].

The Distinguished Nurse Clinician Academy: An Innovative Recognition Program for Frontline Clinicians

The complexity and growth of healthcare systems provide nurse leaders an opportunity to recognize and facilitate professional development for experienced frontline clinicians and to create formal structures that give expert direct care nurses a stronger voice. The purpose of this article is to describe how one health system developed and implemented an innovative Distinguished Nurse Clinician Academy. This elite academy demonstrates the longitudinal impact of a health systems' Magnet culture.

Interventions to Reduce Adult Nursing Turnover: A Systematic Review of Systematic Reviews

BACKGROUND

Nurse turnover is an issue of concern in health care systems internationally. Understanding which interventions are effective to reduce turnover rates is important to managers and health care organisations. Despite a plethora of reviews of such interventions, strength of evidence is hard to determine.

OBJECTIVE

We aimed to review literature on interventions to reduce turnover in nurses working in the adult health care services in developed economies.

METHOD

We conducted an overview (systematic review of systematic reviews) using the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, Applied Social Sciences Index and Abstracts, CINAHL plus and SCOPUS and forward searching. We included reviews published between 1990 and January 2015 in English. We carried out parallel blinded selection, extraction of data and assessment of bias, using the Assessment of Multiple Systematic Reviews. We carried out a narrative synthesis.

RESULTS

Despite the large body of published reviews, only seven reviews met the inclusion criteria. These provide moderate quality review evidence, albeit from poorly controlled primary studies. They provide evidence of effect of a small number of interventions which decrease turnover or increase retention of nurses, these being preceptorship of new graduates and leadership for group cohesion.

CONCLUSION

We highlight that a large body of reviews does not equate with a large body of high quality evidence. Agreement as to the measures and terminology to be used together with well-designed, funded primary research to provide robust evidence for nurse and human resource managers to base their nurse retention strategies on is urgently required.

Assessing and addressing moral distress and ethical climate, part 1

BACKGROUND

There is minimal research exploring moral distress and its relationship to ethical climate among nurses working in acute care settings.

OBJECTIVES

Objectives of the study were to explore moral distress, moral residue, and perception of ethical climate among registered nurses working in an academic medical center and develop interventions to address study findings.

METHOD

A mixed-methods design was used. Two versions of Corley and colleagues' Moral Distress Scale, adult and pediatric/neonatal, were used in addition to Olson's Hospital Ethical Climate Survey. Participants were invited to respond to 2 open-ended questions. This article reports the results for those nurses working in adult acute and critical care units.

RESULTS

The sample (N = 225) was predominantly female (80%); half held a bachelor of science in nursing or higher, were aged 30 to 49 years, and staff nurses (77.3%). The mean item score for moral distress intensity ranged from 3.79 (SD, 2.21) to 2.14 (SD, 2.42) with mean item score frequency ranging from 2.86 (SD, 1.88) to 0.23 (SD, 0.93). The mean score for total Hospital Ethical Climate Survey was 94.39 (SD, 18.3) ranging from 23 to 130. Qualitative comments described bullying, lateral violence, and retribution.

DISCUSSION

Inadequate staffing and perceived incompetent coworkers were the most distressing items. Almost 22% left a previous position because of moral distress and perceived the current climate to be less ethical compared with other participants. Findings may potentially impact nurse retention and recruitment and negatively affect the quality and safety of patient care. Interventions developed focus on the individual nurse, including ethics education and coping skills, intraprofessional/interprofessional approaches, and administrative/policy strategies.

Nurse managers’ role in older nurses’ intention to stay

Purpose

– The purpose of this paper is to propose and test a model of the underlying mechanisms linking perceived availability of human resource (HR) practices relevant to older nurses and older nurses’ intentions to stay with their hospitals.

Design/methodology/approach

– Quantitative data were collected from randomly selected older registered nurses (N=660) engaged in direct patient care in hospitals in Canada. Structural equation modelling was used to test the hypothesized model.

Findings

– The relationship between perceptions of HR practices (performance evaluation, recognition/respect) and intentions to stay was mediated by the perceived fairness with which nurse managers managed these HR practices and nurse manager satisfaction. When nurse managers were perceived to administer the HR practices fairly (high perceived procedural justice), older nurses were more satisfied with their nurse manager and, in turn, more likely to intend to stay.

Research limitations/implications

– The cross-sectional research design does not allow determination of causality.

Practical implications

– It is important that nurse managers receive training to increase their awareness of the needs of older nurses and that nurse managers be educated on how to manage HR practices relevant to older nurses in a fair manner. Equally important is that hospital administrators and HR managers recognize the importance of providing such HR practices and supporting nurse managers in managing these practices.

Originality/value

– The findings increase the understanding of how HR practices tailored to older nurses are related to the intentions of these nurses to remain with their hospital, and especially the crucial role that first-line nurse managers play in this process.

Using gainsharing to increase electronic end-of-course evaluation submissions

The adoption of electronic course evaluations has resulted in a decrease in completed evaluations at colleges and universities. Gainsharing is used in hospitals to provide an incentive to meet organizational goals. The author describes gainsharing and its use to provide a grade incentive for nursing students to submit electronic end-of-course evaluations. The effect of the incentive on student grades is also examined.

Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies

Background

This study aimed to reveal nurses’ experiences and perceptions of turnover in Australian hospitals and identify strategies to improve retention, performance and job satisfaction. Nursing turnover is a serious issue that can compromise patient safety, increase health care costs and impact on staff morale. A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories.

Method

A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories.

Results

Key factors affecting nursing turnover were limited career opportunities; poor support; a lack of recognition; and negative staff attitudes. The nursing working environment is characterised by inappropriate skill-mix and inadequate patient-staff ratios; a lack of overseas qualified nurses with appropriate skills; low involvement in decision-making processes; and increased patient demands. These issues impacted upon heavy workloads and stress levels with nurses feeling undervalued and disempowered. Nurses described supportive strategies: improving performance appraisals, responsive preceptorship and flexible employment options.

Conclusion

Nursing turnover is influenced by the experiences of nurses. Positive steps can be made towards improving workplace conditions and ensuring nurse retention. Improving performance management and work design are strategies that nurse managers could harness to reduce turnover.

Interventions that promote retention of experienced registered nurses in health care settings: a systematic review

AIM

The aim of this review was to report the effectiveness of strategies for retaining experienced Registered Nurses.

BACKGROUND

Nursing researchers have noted that the projected nursing shortage, if not rectified, is expected to affect healthcare cost, job satisfaction and quality patient care. Retaining experienced nurses would help to mitigate the shortage, facilitate the transfer of knowledge and provision of quality care to patients.

EVALUATION

A systematic review of studies on interventions that promote the retention of experienced Registered Nurses in health care settings.

KEY ISSUES

Twelve studies were included in the final analysis. Most studies reported improved retention as a result of the intervention. Team work and individually targeted strategies including mentoring, leadership interest and in-depth orientation increased job satisfaction and produced higher retention results.

CONCLUSIONS

Few published studies have examined interventions that promote the retention of experienced Registered Nurses in healthcare. Retention was highest when multiple interventions were used. Further research is needed to inform nurse leaders of ways to retain nurses and to maintain quality care in health care settings.

IMPLICATIONS FOR NURSING MANAGEMENT AND LEADERSHIP

Programmes targeting the retention of experienced nurses need to be considered when implementing measures to decrease the nursing shortage and its effects on quality care.