Theoretical Strategies and Practical Applications
While the entire world suffers from retaining workers in the healthcare industry, retaining nurses and nursing managers is one of the highest priorities for healthcare facilities. With high burnout rates, high retirement rates, low enrolment rates in nursing schools, low compensations for demanding positions, stressful working environments, and high job dissatisfactions in the nursing field, it is expected that the nursing field will experience high shortages because replacement and retention rates are too low to keep up with retirement rates. It is possible to categorize factors that determine nursing manager retention rates by importance. “Communication, participative management, and effective administration are regarded as the factors that contribute to nurse manager retention" (Parsons & Stonestreet, 2003, p. 126). Of course, the factors identified by Parsons and Stonestreet (2003) are considered and supported by other researchers as the most influential determinants for nursing manager retention rates, but it is not possible to neglect other minor factors as insignificant. Each factor contributes to nursing retention rates, so successful retention strategies should be designed to solve all issues surrounding nursing manager retention rates.
The Most Accountable Factors for Nurse Manager Retention
Communication quality. Communication quality between managers and the staff is considered the most important aspect that directly influences workplace performance and job satisfaction. The availability of managers, effective communication, clear expectations, and providing feedback were listed as the most important aspects of communication that influence the nurse managers’ satisfaction at the workplace . Furthermore, effective communication is a factor that improves the position of the nursing staff in healthcare organizations, so the employees have more control over their environment. Approaches that are based on alleviating decision-making responsibilities of nurse managers, such as the self-scheduling model, improve the well-being and retention rates of both the nursing staff and nursing managers in healthcare facilities. Those models improve communication, and they are held highly accountable for solving contemporary issues in the nursing field.
Participation in the decision-making process. According to Parsons and Stonestreet (2003), participation in decision-making was the second most prevalent topic in their qualitative study. Other researchers confirmed that improving the influence of the nursing staff increases workplace and job satisfaction for both the staff and managers . For example, the shared governance model allows the staff to participate in interviewing and recruiting new workers, and similar approaches provide nurses with more empowerment and increase their job satisfaction . While several organization models are used in healthcare organizations to promote nurse involvement in the decision-making process, those models were originally developed in business settings. In order to make those models effective in healthcare, the administration is responsible for making adjustments in defining the goals and methods used in those models.
Effective administrative management strategies. Administrative management in contemporary healthcare influences the well-being of nurse managers because it deals with common issues that nurse managers frequently complain about. For example, nursing staff shortage, daily staffing, meaningful orientation, and professional development are often depicted as the most common issues that inflict high burnout rates and low retention rates in the nursing profession. Allen (2008) suggests that nurses should be perceived as professionals who have a broader scope of duties in healthcare than simply caring for patients. Several nurse managers are responsible for research, teaching, and other activities that are not directly related to providing healthcare to individuals. However, the shortage of nursing staff and high rates of health problems among the population often interfere with the well-being of nurse managers and decrease their retention rates. Without effective administrative management systems, it is not possible to establish a working system in healthcare for nurse managers, contribute to solving their issues, and increasing their retention rates.
It is possible to notice that factors usually overlap and cannot be considered separately when dealing with nurse manager retention problems. For example, effective administration cannot exist without developed communication. If staff nurses do not participate in decision-making, they cannot control their workplace environment, so they are prone to job dissatisfaction and communication issues at the workplace. While Parsons and Stonestreet (2003) emphasize only three factors as the responsible factors for nursing retention rates, it is evident that several other factors influence nursing manager retention. It is also not possible to dismiss those factors when focusing on improvement in nursing manager retention rates. For example, it is not possible to improve nursing manager retention rates without improving the workplace circumstances for their nursing staff. With that in mind, successful organizational models in healthcare organizations will influence both major and minor factors equally to improve nursing recruitment and retention rates.
Certification, training, and development. Careers in healthcare are connected to lifelong learning. The nursing field is one of the most neglected fields in healthcare because low wages and inadequate working conditions determine the low nursing school enrolment rates and employee retention in organizations . Furthermore, organizations that promote certification and professional development among their employees often observe positive outcomes on job satisfaction and interpersonal relationships among their employees . While Parsons and Stonestreet (2003) emphasize three factors in nurse manager retention, it is evident that neglecting other factors does not provide a complete solution to nurse manager retention issues.
Personal practices. According to Parsons and Stonestreet (2003), personal practices were one of the most important topics for nurse managers because they often have long working hours and an inadequate balance between their professional and private lives. It is possible to notice that employees in the nursing field are exposed to high amounts of stress, suffer from overworking, and follow obligations other than caring for patients , so their personal life suffers and they lose their motivation to provide healthcare services sooner than other health workers. Several models have been developed to alleviate some of the nurse managers’ obligations and improve the position of their nursing staff, so those models positively influence one of the major factors that determine nurse manager retention rates.
Quality of patient care. The quality of patient care is the most important aspect for nurse managers because those who want to remain in their roles indicate that patient care quality is their main objective in healthcare . While Parsons and Stonestreet (2003) fail to mention patient care quality among their three factors that determine nurse manager retention rates, it is evident from their research that most nurse managers intend to stay in their role only as long as they are able to provide quality care to their patients. Therefore, the quality of care is the main goal when introducing strategies and organizational models in healthcare settings, and all other management practices in healthcare organizations revolve around the idea to improve the staffs’ performance, patient satisfaction, and positive outcomes.
Applying Nurse Manager Retention Strategies
In healthcare facilities, nursing managers who want to remain in their role list the opportunity to help their patients and encourage positive outcomes in the community . However, providing quality care without supporting the nursing managers through effective administration, deserved benefits, and communication quality cannot solve the current issue in retaining workers in nursing. Furthermore, staff shortage is a serious issue that most nurse managers deal with because it implicates their objective to provide quality care, the main reason why some nursing managers choose to remain in their positions.
Contemporary surveys indicate that higher statuses, better working conditions, influences in decision-making within organizations, professional development, improvements in communication, and staff retention have not been resolved in the nursing field . Job satisfaction levels, interest in nursing careers, hospital capacity, and the quality of care are currently promising as they appear to have decreased during the early 21st century . However, the healthcare industry is still faced with the low capacity of education programs for nursing, retaining older nurses, and alleviating the major workplace challenges for nurses . Consequentially, nurse retention strategies should be applied in both educational institutions and healthcare facilities to promote staff employment and retention because delivering quality care will otherwise become impossible.
High-performance work systems (HPWS). Several studies failed to find the correlation between human resource management (HRM) strategies and positive outcomes for nursing manager retention rates. However, it is possible that those studies focused on methods that originated in business settings, so it is not possible to judge those practices by using the same standards when testing them in healthcare. In fact, several international studies found that practices, such as HPWS, are positively correlated to patient outcomes and associated with lower mortality rates . Apart from improving the quality of care, HPWS potentially solves workplace issues that are considered the most important factors in nurse manager retention, such as communication and effective administration.
The study by Tzeng and Yin (2009) identified productivity, workflow organization, and workplace safety as the most common historical themes in the nursing occupation. However, research clearly indicates that it is possible to overcome those issues by supporting HRM practices in healthcare settings . At the organizational level, HPWS are concerned with hiring, training, and retaining employees, so it is possible to select or train existing nursing managers in translating the role of human resources from business to clinical settings . While HPWS are focused on providing support for business strategies in companies, the role of HRM practices in healthcare settings will focus on selecting and fostering employees to support their objective in delivering high-quality healthcare. If the quality of care increases because of HRM practices, it is evident that the highest motivation for nursing managers to retain their positions will be resolved.
Empowerment strategies. Both structural and psychological empowerment are linked to job satisfaction, a key factor that influences nursing manager retention rates. Structural empowerment is related to various resources, training opportunities, and availability of information that nurses require to perform their jobs adequately . On the other hand, psychological empowerment is a cognitive construct that enables individuals to control their roles and contexts in the working environment. Overall, both structural and psychological empowerment are directly linked to quality of care delivery and job satisfactions in the nursing field, and there are several methods that can be applied to allow individuals to participate and contribute collectively in their workplace.
Apart from HPWS, several organizational models aim to improve nursing manager retention rates. For example, organizational structures aim to create decentralized decision-making, so nurse managers could provide more empowerment to their staff . With better workplace conditions and more involvement in patient-related decision-making, it is possible that job satisfaction and retention rates will rise. Another method that promotes empowerment in the workplace is certification. By facilitating certifications, several organizations were capable to influence the overall job satisfaction and decisional involvement of the nursing staff . By promoting workplace interactions and involvement, the organizations can improve the retention rates of their nursing staff and nursing managers.
Improving decisional involvement. Because research indicates that involvement in the organizational decision-making process influences performance and job satisfaction, several healthcare facilities are implementing models that improve the staffs’ involvement in making decisions . For example, the shared governance model is often implemented for that purpose, but a socialization process for nurse managers is required to allow them to develop a leadership style suitable for involving their staff into making decisions for improving the workplace . Self-scheduling is another example of promoting the involvement of the nursing staff in making decisions. It aims at increasing communication skills regarding problem-solving and negotiating. The managers only assist the staff with the problem, but they never take absolute control in situations.
Research indicates that staff involvement and independence often alleviate a lot of pressure from nursing managers . While most nursing managers have complained about lack of personal time and ineffective administration policies , improving decisional involvement is considered a factor that positively influences both nursing managers and their staff , so it is a crucial factor in retaining nurse practitioners in the healthcare industry.
Suggestions for educational institutions. Although educational institutions are separate from healthcare facilities, low admission rates are one of the factors that contribute to staff recruitment issues, one of the problems nursing managers are confronted with in the workplace. Allen (2008) suggests that providing care for dying patients is one of the most stressful areas of healthcare for both experienced nurses and nursing students, so it is possible to use Mezirow’s Transformative Learning Theory to encourage students to engage in self-reflection about their beliefs on death and dying. Most importantly, improving the nurses’ status and working conditions in healthcare facilities should be considered to solve the shortage of staff and applicants in nursing schools.
The best applications of nursing manager retention strategies include working on both organizational and individual levels. By improving the positions and workplace conditions for the nursing staff and nursing managers, healthcare organizations are capable of recruiting, developing, and retaining their nursing employees. Furthermore, it is also evident that all factors responsible for low nursing manager retention rates are related. It is not possible to categorize issues regarding nurse manager retention into communication, inclusive management, and effective administration because they overlook several important factors, such as quality of care, that determine nurse manager retention. Approaches that solve all issues in the nursing field simultaneously should be practiced to employ and retain more nurses in healthcare facilities.
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