Nurses play an invaluable role in health care. In collaboration with other disciplines in the health care field, nurses help populations attain satisfactory levels of health and wellness both in the absence or presence of disease. With the graying of society, the demand for nursing care is expected to increase. Individuals are living longer lives but often with chronic illnesses such as diabetes and heart disease that require acute and preventive care. As such, the ongoing nursing shortage is a serious concern with its negative impact on health. While the current recession pulled nurses back into the health care field and encouraged many more to pursue nursing education, the shortage is still expected to reach 260,000 in 2025 based on current demand (AACN, 2013).
There are several factors contributing to the shortage. The aging of the nursing workforce has and is expected to result in the mass retirement of registered nurses (RNs) in both the hospital setting and academe each year. Inadequate faculty resulted in thousands of applicants being turned away from nursing programs (Duvall & Andres, 2010). Coupled with the long and difficult process of producing nursing faculty, a bottleneck in the RN pipeline exists. The work environment is also a significant contributor to the shortage. Recruitment and retention levels are lower than what is currently needed. As such, hospital vacancy rates are estimated to reach as high as 22% within a decade (Huggins, 2012). Clearly, an analysis of the factors leading to high turnover is warranted.
Reasons for the High Nurse Turnover
Job satisfaction is a multidimensional, positive, and affective response to a particular nursing role while career satisfaction is a similar response to the nursing profession (Horat, 2008). Favorable regard of the role and the profession promotes continued role performance in this field that, in theory, should affect the intent to continue employment and a career in nursing. Thus, conceptual models relate job and career satisfaction to a nurse’s commitment and both are regarded as reliable indicators of retention (De Gieter, Hofmans & Pepermans, 2011). Job and career satisfaction, as a complex phenomenon, is thought to be influenced by the work environment. Such models, however, have been empirically tested. In literature, there is abundant evidence of the strong association between job and career satisfaction and commitment resulting in registered nurses’ intent to remain in the clinical setting. Strong links between job and career satisfaction and factors in the work environment have also been established.
Summary of the Article
In the assigned article by Laschinger (2012), the author conducted a survey of 342 newly-graduated RNs working in hospitals to determine the factors predicting job and career satisfaction and intent to leave within the first two years of employment. Based on a review of literature, the author proposed that there are three categories of predictive factors. Personal disposition pertains to the nurse’s personality and include self-esteem, self-efficacy, emotional stability, and locus of control (Laschinger, 2012). Situational factors refer to empowerment, leadership, and worklife that contribute to work engagement or the nurse’s dedication to work. Empowerment is the nurse’s ability to access resources, support, information, and opportunities that foster learning which enables personal as well as professional growth.
Leadership pertains to the professional integrity of managers and behaviors that foster transparency and optimism. Worklife on the other hand encompasses workload, rewards, organizational values, fairness, sense of community, and control. Lastly, support structures are programs that facilitate newly-graduated nurses’ transition and adaptation into the workplace. The predictive factors influence intermediate outcomes such as burnout, incivility, physical health, and psychosocial wellbeing (Laschinger, 2012). These intermediate outcomes, in turn, affect retention outcomes measured as job and career satisfaction as well as intent to remain in the job and in the nursing profession.
In other studies, the link between job satisfaction, commitment, and retention has been firmly established. In their survey of nurses, De Gieter, Hofmans & Pepermans (2011) found that global satisfaction and commitment, each measured using different tools, was associated with turnover intention. Another survey by Ramoo, Abdullah & Piaw (2013) showed results leading to the same conclusion. Similar to the findings of the study by Laschinger (2012), Ramoo, Abdullah & Piaw (2013) also found that job satisfaction was influenced by empowerment manifested as opportunities for learning and career advancement as well as participation in decision making.
The predictive factors that correlated significantly with job satisfaction and retention outcomes in studies are modifiable. This implies that if organizations are to reduce turnover rates, it is possible to develop strategies that will improve job satisfaction and retention. In fact, this is a recommendation of the studies discussed. Nurses are a human resource that enables the delivery of sufficient and high quality patient care. First and foremost, organizations must institute a culture that values the contribution and role of nurses. A human resource focused culture must be adequately supported by internal systems, programs, and policies. For example, leadership styles, communication, interpersonal relationships, and decision making must align with the human resource development of nurses.
Retention programs include preceptor or mentoring. A systematic review of 16 studies that investigated the retention strategies of different health care organizations showed that such a program was the most commonly implemented (Salt, Cummings & Profetto-McGrath, 2008). The preceptor programs either focused on the new graduate, the preceptor, or on needs as these arise. Those focusing on the preceptor aimed to improve the capacity of the nursing staff to function in this role. The model that focused on new graduates for 3 to 6 months proved to be the most effective in increasing retention rates (Salt, Cummings & Profetto-McGrath, 2008).
A study of the impact of a mentorship program also showed an increase in new nurses’ job satisfaction and retention (Halfer, Graf & Sullivan, 2008). Mentoring relationships further promote collegiality that mediates the incidence of incivility or bullying in the workplace. By focusing on the learning and career needs of new nurses, mentoring also has the potential to improve the empowerment of newly-graduated nurses. However, these programs are typically effective in the context of a compatible organizational culture and must be situated as such to attain positive retention outcomes.
The current nursing shortage is a multifaceted issue. Organizational factors are associated with the problem by reducing job satisfaction and commitment that leads to a high turnover. Therefore, health care organizations have a role to play in easing the shortage. Assessing the structural factors correlated with dissatisfaction and intent to leave is the first step. In literature, these factors are modifiable. Organizations must institute change in culture to address structural issues. Much of available research on retention strategies focused on preceptorship and mentorship programs which have potential to increase nurse retention when aligned with organizational culture.
American Association of Colleges of Nursing (2013). Nursing shortage. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage
De Gieter, S., Hofmans, J., & Pepermans, R. (2011). Revisiting the impact of job satisfaction and organizational commitment on nurse turnover intention: An individual differences analysis. International Journal of Nursing Studies, 48(12), 1562-1569. doi:10.1016/j.ijnurstu.2011.06.007.
Duvall, J.J., & Andres, D.R. (2010). Using a structured review of the literature to identify key factors associated with the current nursing shortage. Journal of Professional Nursing, 26(5), 309-317. doi:10.1016/j.profnurs.2010.02.002.
Halfer, D., Graf, E., & Sullivan, C. (2008). The organizational impact of a new graduate pediatric nurse mentoring program. Nursing Economics, 26(4), 243-249. Retrieved from http://www.medscape.com/viewarticle/580649
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Huggins, S.E. (2012). Promoting successful nursing retention using orientation programs (Graduate thesis). Retrieved from http://gradworks.umi.com/35/08/3508892.html
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Ramoo, V., Abdullah, K.L., & Piaw, C.Y. (2013). The relationship between job satisfaction and intention to leave current employment among registered nurses in a teaching hospital. Journal of Clinical Nursing, 22(21-22), 3141-3152. doi: 10.1111/jocn.12260.
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