Nursing Shortages and Nurse Turn-Over: Effective Approaches in Leadership and Management

“Nursing is informed caring for the well-being of others” (Swanson, 1993, p. 352). Kristen Swanson’s relationship-based caring theory encompasses maintaining belief, knowing, being with, doing for, and enabling. Nursing is a profession with vast opportunities for growth and development. Each nurse has his or her individual passions; mine reside within obstetrics, women’s health, and nursing leadership. Nurse leaders play an integral role in the success of healthcare organizations. Nurse leaders shape the roles of nurses within their organizations. Nurse leaders seek methods to improve patient care. They also use innovation to gain efficiencies in care delivery and decrease healthcare cost. Many nurse leaders have an ultimate goal to aspire to be a chief nursing officer in a healthcare

This paper aims to address and discuss about the leadership and management of the nurse leader interviewed. This experience was a great opportunity to witness first hand how a nurse leader cultivate and manage their staffs in real life setting. Moreover, it provides a great access to gain insight and knowledge about nurse leaders’ vital responsibilities and role diversities in the organizations they work with. Nurse leaders pay more specific and close attention in handling the staffs and most importantly, patient care.

In today’s healthcare system, effective leadership is essential to improving and reaching organizational outcomes. A leader is someone with the ability to influence others but, an effective leader uses positive strategies to inspire employees to work towards the same goal. Leadership in nursing requires a constant effort to motivate others to become part of the organizational transformation. This can be achieved using a transformational leadership style with a focus on communication, motivation, and empowerment.

There are many challenges facing today’s nursing leaders and managers. From staffing and scheduling, to budget cuts and reduced reimbursements, today’s nursing leaders must evolve to meet the ever changing health care environment. Constance Schmidt, Chief Nursing Officer at Cheyenne Regional Medical Center (CRMC), identified retaining experienced registered nurses (RN) as one of the biggest problems she faces as a nursing leader. She went on to state “Nationally, most hospitals have more than 60% of their nurses with at least 5 years of experience. At CRMC, it’s the reverse. We have more than 60% of our nurses with less than 5 years of experience” (personal communication, March 28, 2014). The two largest factors affecting those numbers are the nursing shortage and nursing retention. The first, the nursing shortage, was identified years ago and has been researched countless times. Some projections indicate the number representing the gap between available registered nurses, and the positions needing to be filled, could be over a million before the end of the current decade. The latter, retention of nurses, is a problem in every health care facility in the nation. Nursing turnover results in both a significant financial cost to hospitals, and a significant impact on the community through its effects on patient outcome.

Nurse leaders are the background to the nursing care. Effective nurse leaders can promote a positive workforce and a healthy work place for other nurses. Workplace dynamics is an essential part of how each nurse functions. Nurses, being mentally and physically stressed, need to have support and guidance from a nurse leader to feel confident about performance. The impact of nursing leaders can be a positive and guiding force for the younger or more inexperienced nurse. Having strong relationships with solid leaders can instill values in the beginning stages of a newer nurses’ career. Gaining insight and core concepts from a more experienced leader can make a world of difference in the way a new nurse performs, provides patient care, and sets future goals for themselves. A newer nurse with a positive role model and nurse leader can model themselves to become a leader for future nurses.

Every day, a set team of nurses and nursing managers set out to ensure the health and well-being of their patients. To achieve this goal, a nurse manager must adhere to a specific style of nursing leadership. There are many different styles of leadership in the healthcare field. Bass and Barnes (1985) stated that the two most common are transformational and transactional (as cited in Frankel, 2008, p.24). This paper will define leadership, the two different styles, how each are executed, as well as pros and cons of each.

In healthcare it is very important to have strong leaders, especially in the nursing profession. A nurse leader typically uses several styles of leadership depending on the situation presented; this is known as situational leadership. It is important that the professional nurse choose the right style of leadership for any given situation to ensure their employees are performing at their highest potential. Depending on which leadership style a nurse leader uses, it can affect staff retention and the morale of the employees as well as nurse job satisfaction (Azaare & Gross, 2011.) “Nursing leaders have the responsibility to create and maintain a work environment which not only promotes positive patient outcomes but also

I agree that an organization’s structure plays an influential role in a nurse’s overall satisfaction. In fact, Buffington, Zwink, and Fink (2012) concur stating, “Creating an organizational culture committed to registered nurse (RN) retention is a strategy to reduce nurse turnover” (p. 273). Research reveals numerous hospitals today are restructuring their organizations to try and increase overall nurse satisfaction and retention. This “new recipe for healthcare leadership and organization is needed,” according to Miners, Hundert, and Lash (2015), not only to improve nurse satisfaction, but ultimately to improve quality of care and increase patient outcomes (p. 114).

The nursing shortage is no longer a projected problem in the healthcare industry in the United States, this problem is present and is not phasing out anytime soon. Addressing this challenge would improve job satisfaction, reduce burnout in the profession and ultimately improve retention.

Nurse turnover is defined as “the number of nurses changing jobs within an organization or leaving an organization within a given year” (Baumann 2010). Retaining nurses is one of the most important issues in health care as its effects range from challenges in human resource planning, to high costs in financial and organizational productivity (Beecroft et al, 2008), to workgroup processes and morale, to patient safety and quality of care (i.e. patient satisfaction, length of patient stay, patient falls, and medication errors) (Bae et al, 2010). Nursing Solutions Inc (NSI) reported the national average turnover rate for hospitals increased from 13.5% in 2012 to 14.7% last year. Nurses working in Med/Surg had more turnover

The ongoing instability evidenced from the high mobility of qualified nurses in the nursing workforce has raised many questions about the issue of nursing shortage and nurse turnover (Gates & Jones, 2007). The paper below discusses the issues of nursing shortage and nurse turnover. The paper also describes how leaders as well as managers in the nursing fraternity and other leaders can resolve those problems effectively and the different applicable principles, skills, roles of the leader, and theories of leadership and management.

In the healthcare field, nursing leaders and managers face consistent issues in their respective practices that force them to alter the way they work and the way they think. In taking on a role as a leader within the field, nursing leaders and managers also take on the role of ensuring that work within an organization runs smoothly regardless of new issues that may arise in the healthcare arena. For instance, in today's healthcare environment, the issues of nurse shortage and nurse turnover have the capacity to alter the healthcare field and many of its respective branches and organizations should these problems not be managed properly by the leaders in the field. In viewing the issue at hand and in discovering how nursing leaders and managers are expected to act, and do act, in order to approach this issues, along with pinpointing the best approach possible to aid this issue, one can better understand which leadership styles are necessary for leaders to function.

Nursing is a very complex career that at many times requires one to be a leader. Nurses can be leaders in formal roles and also on the unit during any given shift. Nursing is a career that truly tests the character and attributes of those who choose to enter this career. Leadership in nursing is vital in creating a successful environment for patients. According to Stichler (2006), “effective leadership is essential to transforming organizations into environments that are safe for both patients and staff” (p. 422). Therefore, it is vital that as new nurses start out his or her careers that they learn from great leaders who are already in the profession. There are several great leaders working in the field who have a plethora of

By empowering the community of nurses and sustaining employee engagement, patient and employee satisfaction would remain the same, if not increase (6 Leadership strategies for navigating perpetual change in healthcare, 2015). Change is tough for most people and the time to adjust varies with each individual. Taking some time to acknowledge each individual and their needs is an important factor to being a great leader (6 Leadership strategies for navigating perpetual change in healthcare, 2015).

Before I started this leadership/management coarse I had no idea what qualities a good leader manager needs to hold. I had no idea a registered nurse was considered a leader/manager. Now that I have reviewed all the chapters in the Leadership Roles and Management Functions in Nursing (Marquis & Huston, 2015) I have a full understanding of how important leadership/management functions play in a nurse’s career. Chapters 12-25 describe roles and functions that are needed for a nurse to become a successful leader/manager. These chapters discussed the roles and functioning of organizing, staffing, directing, and controlling.