Nursing Retention : A Demand For Change

The U.S. Bureau of Labor Statistics (USBLS) estimates the need for 439,300 registered nurses (RN) from 2014 to 2024, equating to a 16% increase in employment opportunities (USBLS, 2015). Approximately 30% of new RNs leave their first jobs with less than a year of hire and 525,000 nurses are expected to retire from 2012 to 2022- a demand totaled to around 1 million jobs by 2022. This increase is attributed to retiring baby boomers, turnovers, healthcare reform, and the increasing aging population (Kiel, 2012; USBLS, 2013). Control over the retirement of baby boomers is unrealistic, however, nursing turnover can be regulated.

The U.S. Bureau of Labor Statistics (USBLS) (2015) estimates an additional of 439,300 more registered nurses (RNs) for 2014 to 2024, equating to a 16% increase in employment. Approximately 30% of new RNs leave their first jobs less than a year upon hiring, while 525,000 nurses are expected to retire until 2022- a demand totaled to around 1 million jobs by 2022. The increase is attributed to retiring baby boomers, turnovers, healthcare reform, and the increasing aging population (Kiel, 2012; USBLS, 2013). Control over baby boomer retirements are unrealistic, however, nursing turnover can be regulated to aid the growing needs of the society.

Prevention measures are readily available and can be used to reduce nurse retention rates. Multiple studies have been conducted consisting of various surveys that evaluate the reasoning behind nurses leaving the profession completely, their intention to leave the healthcare facility or department, and factors contributing to burnout. By identifying the factors and weak points of the healthcare facilities from the results of the surveys conducted in each study, ideas of implementations arise in efforts

may assist in the needs of nurses by considering the needs to both educate and retain nurses in the field. The expected more effective recruitment and retention is better patient outcomes, as units will not be understaffed resulting in less fatigue and burnout which can ultimately lead to errors. (http://qsen.org/competencies/) The purpose of this synthesis paper is to provide a better understanding on the methods of recruitment and retention in Newfoundland, Canada, which has implications for nursing research throughout the world.

Schaufeli, and Michael P. Leiter, they say "Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job and is defined by the three dimensions of exhaustion, cynicism, and inefficacy." (Maslach, Schaufeli, & Leiter, 2001, p.397). Burnout is time and time again being associated with an intention to leave in nursing (Heinen et al., 2013). Job burnout is common in caring professions such as nursing and it can involve reduced efficiency in various aspects of the job (Bobbio & Manganelli, 2015). The nursing shortage is seen as a worldwide problem affecting health care systems in many ways (Flinkman, Leino-Kilpi, & Salanterä, 2010). We know that creating longer hours for nurses are in no way beneficial to their mental health. Longer hours are associated with higher levels of burnout. A study on nurses working long hours across all shift lengths burnout, specifically emotional exhaustion, is reported in 25% of participants or higher (Dall'Ora, Griffiths, Ball, Simon, & Aiken, 2015). The percentage of participants who reported burnout goes up with the length of shift increasing. 29% of participants working 8 or fewer hours intended to leave the job within the following year compared to 42% who work 10 or more hours. Exhaustion is a prominent result from a nursing shortage. Their study being one of the first of its kind can be a base point for employers to look at the length of a shift

A 2014 research study conducted by Debra C. Hairr, Helen Salisbury, Mark Johannson, and Nancy Redfern-Vance examine the relationships between nurse staffing, job satisfaction and nurse retention in an acute hospital environment. Their goal is to define the relationship between job satisfaction and nurse retention, to analyze the data to see if the economy is a factor in nurses remaining in their current positions despite the job satisfaction, and to recommend implications for future practice.

The purpose of this study was to understand the factors influencing the decision of registered nurses (RNs) to leave clinical nursing. This research has lot of significant for nurses and other people in medical profession. In United States and in other parts of the world, there has been a shortage of Registered Nurses. It has been anticipated that this shortage would increase to 500,000 in US alone by 2025. Therefore, research must be undertaken to determine the underlying factors that force nurses to leave.

Change is constant and occurring at a faster rate today due to increasing computer technology, medical, surgical, and pharmacological advances that will change the nursing role into a broader one requiring more responsibility, education, and accountability (Blais & Hayes, 2016). In my role at United Health Group, we see changes almost daily in order to keep up with the evolving health care industry. Many nurses are reluctant to change, especially as the result seems to be a “do more with less” environment creating more stress on already overworked and overstressed nurses. Nurses working in hospitals as well as non-traditional roles are consistently looking for a “way out” or a new position to decrease the stress from increased demands and rapid changes. When my husband was hospitalized a few years ago, his nurse sat with me and tearfully confided that she had been nursing for 18 months and wanted out. Bedside patient care was not what she had “signed up for” when she decided to make nursing a career. She described how she had not thought about the physical and mental strain on her body or the worry with being around infectious diseases that she could potentially infect her family with. This is just one nurse’s story. As the increased demand for nurses to achieve higher levels of education are met with resistance from nurses not yet ready for retirement and those coming into the field finding dissatisfaction with the profession, what will happen to the forecasted nursing shortage if these nurses leave the profession?

Nursing job satisfaction continues to rank high as an area of concern for Nurse Executives. Dissatisfied nurses can lead to a decreased ability to recruit nurses and increased turnover (Ruggiero, 2005), leading to lower patient satisfaction. The costs of nursing turnover has been hard to measure and varies from study to study (Li & Jones, 2013), however Brewer, et al. (2011) estimates $856 million per year as the cost of new nurse graduate turnover to health care organizations. Additionally, Jones (2005) found that the cost for RN turnover is 1.3 times the cost of average salaries of hospital RN’s. These costs, coupled with the pure loss of nursing experience that comes with turnover, continues to put nursing satisfaction in the forefront of issues for nursing executive practice.

According to journal of the American Medical Association (JAMA), adding one patient-per-nurse to a hospital’s staffing level increased nurse job dissatisfaction by 15 percent. The data indicate that more than 40 percent nurses who reported high burnout on the job dissatisfaction intended to leave their job within the next year.” Before, burnout on the jib can be also a direct problem of inadequate staffing since many hospital administrations ensure adequate staffing ratios. Besides poor staffing the nurses lack of autonomy at the bedside contrib. In a 2001 United States of America Nurses affiliation survey, Nurses were asked how it felt when he left their duties each day. The advantage of nurses responded those felt about to die out dis talking

This starts with nurses declining assignments when they know they are unable to provide optimal care having worked extended hours. It is the employers responsibility to take into account nursing schedules to accommodate a healthier work culture where there is an equal life work balance and nurses are given enough time to recuperate from prior shifts. The ANA has made recommendations to nurses and employers to combat this problem. Nurses are suggested to receive 7-9 hours of sleep in a conductive sleeping environment, take account commute to work prior to accepting a job offer, as well as alternative transportation to and from work such as taxi bus, car pooling. As for the employers, limit work weeks to 40 hours, work shifts to 12, and utilize predicable schedules so nurses plan accordingly.

Many organizations have realized the key to their effectiveness lies in their ability to recruit and retain capable nurses. Retention is a process that should be started before a nurse is hired and needs to be continued until the nurse resigns.

The global nursing shortage is resulting in the need to find multiple solutions to providing adequate numbers of nursing personnel. The shortage is exacerbated by nurses leaving the profession and their current positions. Globally, nursing turnover rates range from 10–21% per year, with countries such as the USA and Australia reporting turnover rates of over 20% per year. Retaining nurses in their current positions will reduce the magnitude of consequences associated with the nursing shortage (Cowden and Cummings, 2012).

In 2013, 90% of RNs reported satisfaction with their career choice, but only 70 percent were satisfied with their current job (AMN Healthcare, 2013). Over 50 percent fear that their job is affecting their health and slightly under 50 percent feel they have adequate time to spend with patients (AMN Healthcare, 2013). Further, more than 43 percent of nurses work up to 50 hours a week, while eight percent report work weeks greater than 50 hours (AMN Healthcare, 2013). This report illustrates a growing level of job dissatisfaction among nurses. Job dissatisfaction has the potential to inculcate negative attitudes in nurses, which in turn, is communicated through their interactions with

Work related factors can cause many effects within an organization and many times these go unidentified until a problem becomes so evident that it requires a study to find the cause. A study was conducted by Han, K., Trinkoff, A., & Gurses, A (2015). Han, et al (2015) state that “the objective of the study was to examine the relationships of work-related factors (e.g. autonomy, work schedule, supervisory and peer support) to nurses ' job satisfaction and intent to leave their current position” (p. 3224). The problem revolves around low job satisfaction and high turnover among nurses in the health care industry. The study was conducted in order to investigate the work related factors of job satisfaction and the factors surrounding low retention numbers among nurses. The study surveyed 5000 licensed nurses from Illinois and North Carolina in a cross-sectional data analysis. According to Han, et al (2015) “nurses who were dissatisfied with their jobs reported significantly higher psychological demands and lower autonomy than nurses that were satisfied” (p. 3224). Factors that attributed to low job satisfaction were psychological demands, autonomy, long working hours, and lack of supervisor/ peer support. Factors that attributed to intent to leave were job autonomy and lack of peer support. The study concluded that if addressed these factor can be modified to create an environment that would give the nurses a higher level of job satisfaction and