Enhancing Nurse Retention by Providing Professional Support and Development Interventions in Hospital Settings
Nurses form one of the most important cadres of healthcare workers. Their absence has the potential to paralyze healthcare activities in any hospital. Thus, many health institutions have made it a priority to ensure that their nurses are satisfied at all times. Nurse satisfaction ensures that the nurses not only give their best but also have a low turnover rate. A low nurse turnover confers many advantages to a health institution – most notably, it ensures that the nurses at the institution are settled and appreciate the culture of the institution. Moreover, a low nurse turnover reduces the cost that the institution incurs while hiring new nurses. These benefits of a low nurse turnover inform inquiries into nurse retention and how to improve it. This paper evaluates the value of providing professional support and development interventions in a hospital setting in enhancing nurse retention.
The problem of high nurse turnover and low retention rates is not new in healthcare. Over the years, nurses have continually felt unsatisfied and unappreciated by their organizations. These feelings compounded by low remuneration and a hope of finding greener pastures have led to continual nurse migration in health institutions hence a high turnover. In many hospitals, nurses have a higher turnover rate compared to any other healthcare workers. With an increased cost of living and an increased need for a wider nursing staff in many hospitals, institutions have felt the negative effects of poor nurse retention. Moreover, the menace has kept growing as the nursing profession kept growing and nursing specialties emerge – nurses with specialties have higher chances of finding greener pastures and are thus more likely to express their dissatisfaction hence triggering the ultimate exodus.
Currently, nursing shortages and poor distribution are important priorities to the healthcare sector in many countries (El-Jardali et al., 2013). Although the nurse turnover in the USA has kept decreasing, at 16.2%, it is still high (Duffield et al., 2014). Smaller hospitals who operate on non-for-profit bases have the lowest turnover rates. This difference suggests that higher workloads and work demands tend to increase the nurse turnover. Larger hospitals whose target is to make profit have more patients and thus a higher workload. Moreover, their intention to seek for profit means that the hospitals impose greater demands on the workers. The higher number of nurses needed in these hospitals also causes a breakdown in the communication hierarchy and generally decreases the quality of leadership. Additionally, the tendency of these hospitals to edge towards making profit at the expense of professional support and development also contribute to lower levels of nurse satisfaction hence a higher turnover.
Problem statement: Many hospitals have struggled to retain their nurses and have hence incurred huge costs and lost a competitive edge due to high nurse turnover.
Over the past few years, nursing departments which have higher workloads and higher work pressure have experienced the highest turnover rates. These departments include the emergency department and behavioral change departments. Departments with lower workloads and lower job demands such as women’s health have lower turnover rates (Duffield et al., 2014). High nurse turnover rates are costly to the hospital. Moreover, the author asserts that the problem of high nurse turnover is one that is likely to remain with us for a long time as the demand for nursing staff keeps increasing (Ritter, 2011). The increase in life expectancy has invariably led to the rise of many geriatric nursing centers and a continuous increase in the number of individuals in these facilities.
Improving nurse retention will confer many advantages to health institutions and the nurses. First, it will decrease the cost incurred by health institutions in hiring nurses. Moreover, it will increase the number of settled nurses in every facility hence improving their productivity. This improvement will, in turn, reflect in improved health outcomes and satisfaction among patients (Di Twigg & McCullough, 2014). Enhanced patient satisfaction will give the facility a competitive advantage over other facilities. As for the nurses, reduced rate of movement will ensure that they are settled and work better. Moreover, staying in one facility for a longer time enhances their chances of professional development.
Research Question: What is the evidence that providing professional support and development interventions in hospital settings effects a change in retention?
P – Hospital registered nurses
I – Provision of professional support and development programs
C – Nurses not exposed to the professional support and development programs
O – Improved nurse retention
Literature review
Buffington et al. (2012) conducted a study to identify the factors that contribute to high or low nurse turnover. Their study also theorized that improvement of the work environment could enhance a culture of nurse retention and hence reduce nurse turnover. Their study identified significant differences in the responses of nurses working in various departments to various questions thus confirming the importance of the workload. Among the areas where differences in responses emerged were job satisfaction, educational programs, and mentorship. Overall, the nurses involved in the study by Buffington et al. (2012) felt that they got little recognition and little support from their managers – a factor which they said contributed to their wish to move to other places.
Ritter (2011) develops the idea of the impact of the environment on the retention of nursing staff. In the background to their paper, Ritter (2011) assert that the high nurse turnover impacts patients and health institutions negatively. The paper found out that an unhealthy work environment in the health sector is dangerous to the patient, the health workers, and the institution. According to the author, a healthy work environment for nurses is one which allows and encourages them to communicate openly and collaborate with fellow nurses and with other healthcare staff; the environment should also promote and support the nurses’ professional development. An unhealthy work environment tends to decrease the productivity of the health workers hence decreasing the quality of service that the patient receives; this invariably interferes with patient outcomes hence their satisfaction. As for the health worker, especially the nurse, an unhealthy work environment curtails their professional development thus causing them to be dissatisfied. The author theorizes that nurse dissatisfaction is at the center of their high turnover. Movement is, however, not all good news for the nurse as they have to adjust to new environments and new challenges each time they move. As for the institution, unhealthy organizational culture and working environment tend to lower their competitive edge and causes them to incur costs of replacing staff who are on the move. Ritter (2011) also introduces the role of leadership styles in improving the work environment and enhancing nurse retention. They also allude to the role of the Magnet guidelines in the creation of good work environments and leadership styles that promote the good environments. Di Twigg and McCullough (2014) also emphasize the importance of a positive work environment on nurse retention. The two also specify a number of factors which constitute and contribute to the achievement of a positive work environment for nurses. These factors include nurse empowerment programs, shared governance structures, professional development programs, collegial relationships, autonomy, and leadership support. Again, the role of interaction and collaboration with fellow nurses and other health workers comes up strongly. Moreover, the role of leadership in enhancing the creation of a perfect work environment and the enhancing nurse retention also features strongly.
Fardellone et al. (2014) identify this leadership style which is suitable for modern nursing practice and professional development as transformational leadership. The authors assert that nurses are expected to have leadership qualities. Even the nurses who run the hospitals day-to-day activities and have no other registered nurses as subjects need to have perfect leadership qualities. Transformational leadership is important in the creation of a positive work environment which can enhance professional support and development and by extension nurse retention. Transformational leaders involve their subjects in decision-making and emphasize the importance of open communication and collaboration. Open communication and enhanced collaboration, in turn, improve the environment and make it good for nurse retention. Transformational leaders also appreciate the role played by each member of the team that they build and this value professional development of each member. In other words, transformational leadership in nursing has the potential to enhance the professional development of the nurses. Professional development then enhances nurse retention.
The hospital setting is important in the creation of a process that can enhance professional development and nurse empowerment (Mbemba et al., 2013). Good leadership is also important in yielding nurse empowerment. A good work environment also has the added advantage of enhancing the lifetime learning outcomes of nurses thus contributing to making them better professionals.
This detailed literature review reveals a few key gaps in the subject area that the current study can address. Although it is evident that a good work environment enhances professional development, the literature reviewed have not sufficiently evaluated the exact impact of professional development opportunities on nurse job satisfaction and resultant retention. Moreover, the papers reviewed do not expound the issue of professionals support and its role in nurse retention. Further, although it emerges strongly in the review, there is need to provide more evidence on the role of leadership in enhancing professional development and the creation of a positive job environment.
Professional Support and Development in Current Practice
It is time that health institutions prioritized professional support and development to lower their nurse turnover rates. According to the evidence in the articles reviewed and many other articles, professional support and development as an intervention for lowering nurse turnover rates is ready for implementation. For a health institution to be ready to implement this intervention, they only need a few prerequisites; these prerequisites include a good leadership, good communication strategies, and a friendly organizational culture. These prerequisites interlink with each other to result in an environment that can allow the achievement of the best results of the intervention.
By insisting on team building, transformational leadership enhances good communication among the nursing staff. Moreover, transformational leadership allows the nursing staff to open up to its leaders and inform its leaders of the various areas where they require professional assistance (Mbemba et al., 2013). The leaders in an organizational culture that is friendly and responsive to staff requirements will then organize for programs that will enhance professional development and support. Professional development programs include those that aim at increasing the knowledge of nurses in various areas and updating them on the latest developments in health technology and practice. Professional support is much wider. Although factors like remuneration and incentives can be considered to be part of professional support, for this study – emotional and social support of the nurses are the key components. Thus, transformational leaders directly enhance professional support by listening to their subjects and ensuring that they feel appreciated.
Although the implementation of the proposed interventions is likely to cost the institution, it is worth. The institution is likely to incur costs of buying the presentation materials and inviting specialists occasionally. However, the costs incurred are too low compared to the long-term benefits of the implementation of these programs.
For this study, I would implement professional support and development interventions through enhanced continuous medical and nursing education programs. Nurse leaders would choose the topics for discussion in these programs. As transformational leaders, the nurse leaders would seek the opinions of their subjects before settling on the topics. After selecting the topics, as a way of enhancing the communication and research skills of the nurses, the nurse leaders assign these topics to specific nurses. The nurses who are assigned the topics conduct a detailed research on the given topic and present it before the rest of the nurses. Although it seems like an extra duty, asking a nurse to conduct in-depth research on a certain topic is something that should be taken positively by the nurses since it improves them professionally (Mbemba et al., 2013). Moreover, it helps them to fulfill their professional duty as to conduct research continually to enrich the body of knowledge that informs nursing and to ensure full utilization of the available evidence. The presentation process horns the communication skills of the presenter hence their efficiency as nurses. As a way of enhancing the efficiency of the program, specialist of certain areas should be welcomed to reinforce certain ideas in the presentations. Additionally, continuous education sessions are best held per department as this reduces the audience that the presenter has to face. A reduced audience not only enhances the confidence of the presenter but also the effectiveness of the presentation. The presenter can attend to the questions of a smaller audience in full hence the increased efficiency.
The topics chosen for these programs should be related to the latest changes in the nursing field and the various challenges that nurses face. Nurse leaders should also choose topics to ensure tabling, discussion, and utilization of the latest evidence in nursing. This utilization of evidence will ensure the continuation and the development of evidence-based practice. The continued tabling of evidence will enhance the professional levels of the nurses in the institution. On the other side, topics on the common challenges that face nurses are likely to equip the nurses with skills in dealing with common problems hence decreasing their need for professional support. Furthermore, these sessions can help nurses and nurse leaders to realize how to support one another in different circumstances. The time of these presentations can be selected based on the departments. The frequency of the sessions shall also depend on the number of topics for discussion and the schedule of the department.
The implementation of these interventions would mark the beginning of a change process. Based on the model proposed by Lewin (1943), the change process begins by unfreezing (Shirley, 2013). At this stage, one deals with the factors that they think have the potential to interfere with the changing process. For this study, the unfreezing stage would involve radical changes in the organizational culture; this would involve the encouragement of transformational leadership. A negative organizational culture is likely to be a major restraining force in the achievement of the desired changes in nurse professional support and development. Implementation of actual change occurs in the second stage (Shirley, 2013). In this case, the continuous education sessions are launched and maintained. Here, a good attitude among the nurses can be a major driving force. Good transformational leadership and radical changes in the institution’s organizational culture can enhance good attitudes among nurses. A restraining factor could be lack of financial support by the institution. In the final of Lewin’s stages, the new policy is reinforced, stabilized, and solidified (Shirley, 2013). At this stage, the financial support by the institution would be of high importance. The organizational culture of the health institution could still be a restraining force at this level while a good attitude among the nurses and their leaders can be a good driving force.
As a way of measuring the effectiveness of this intervention, one way would be to measure the annual nurse turnover rate and compare it with previous years or with that in the departments that do not implement the intervention (Duffield et al., 2014). However, many compounding factors would reduce the accuracy of this method. An alternative method is the measurement of nurse satisfaction using the benchmarked nurse job satisfaction measurement tools. A decrease in turnover rates and an increase in nurse job satisfaction rates and their intentions to stay at their current institutions would point to the success of the interventions.
This intervention is simple and quite easy to initiate. At the time of initiation of the program, it is important to explain to the nurses the detail of the program and it is perceived benefits to buy them into the idea. An innovative way of increasing the interest on the nurses and enhancing the effectiveness of the project would be to involve technology heavily. For instance, integration of the details of the topics to be covered, the time, and the venue into the pager system that nurses use for communication would ensure that all nurses are there in time and are ready for the session. Maintenance of the program is also easy. The program itself keeps the nurses interested and gives them a sense of responsibility since they are heavily involved. In addition, the success of the program and its positive impacts are likely to encourage the nurses to participate in the program more.
References
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Duffield, C. M., Roche, M. A., Homer, C., Buchan, J., & Dimitrelis, S. (2014). A comparative review of nurse turnover rates and costs across countries. Journal of Advanced Nursing, 70(12), 2703-2712. DOI: 10.1111/jan.12483
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Ritter, D. (2011). The relationship between healthy work environments and retention of nurses in a hospital setting. Journal of Nursing Management, 19(1), 27-32. DOI: 10.1111/j.1365-2834.2010.01183.
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