Running head: RETENTION OF NURSES

Retention of Nurses
Jody French-Sroka
Ferris State University

RETENTION OF NURSES
Abstract:
Nurse executives are faced with a number of challenges and issues in their role. The current and
continued nursing shortage along with an aging workforce will require the nurse executive to
tackle the challenge of nurse retention. The traditional methods of retention are outdated and
must be revamped in order to retain the highly skilled and experienced nurses. Nurse leaders will
need to be innovative in their solutions and advocacy of retaining the seasoned nurse at the
bedside.

RETENTION OF NURSES
Retention of Nurses
The noble profession of Nursing is faced with a severe impending shortage of nurses. It is
estimated that 55% of nurses plan to retire between 2011 and 2020 (Hirschkorn, West, Hill,
Cleary, & Hewlett, 2010). This shortage is predicted to be unprecedented in its severity and
length, lasting long into the future (Marshall, 2011). According to Collins, Sharp and Benbow
(2012) the current shortage does not have an end in sight as current healthcare reform has the
potential to add 32 million patients to the healthcare system (p.50). If healthcare leaders are not
successful in retaining some of the aging nurses, the nation could face a major public health
crisis (Collins-McNeil, Sharpe, & Benbow, 2012). Nurse leaders will be forced to look at
successful retention initiatives that will lessen the impact of this impending shortage. Retention
is not a single factorial issue that will be resolved with a blanket solution. Leaders will need to be
creative and innovative if they are to maintain the status quo of quality nurses in their facilities.
Retention of practicing nurses can also affect the finances of the organization, as the hidden and
total cost to replace a registered nurse (RN) begins at $65,000 for a single nurse (Wieck, Dols,
Landrum, 2010). In order to ensure continued safe quality care, nurse leaders will need to amend
outdated concepts of retention and think outside of the box. Leaders must be proactive in
facilitating the retention of the experienced mature nurse in order to maintain a level of
knowledge, skill and quality.
According to Roussel (2013), nurses modify and achieve major career goals four or five
times in their lifetime, this may include change of specialty or role in the profession (p.320). The
average age of RNs working in a hospital setting is 43.4 years and 43.5 years for all working
RNs (Bryant-Hampton, Carroll, Walton, & Strickler 2010). Nurse leaders must examine all
aspects of nurse out migration. This can include age, benefits, leadership style, staffing, hours,

RETENTION OF NURSES
physical factors, communication and job satisfaction. Hirschkorn et al. (2010) states that there is
no silver bullet that alone will greatly improve retention of the experienced RN.
Nurse leaders can control some of the reasons that seasoned nurses choose to leave the
workforce such as recognition, respect and input/feedback on ones performance. Recognition is
one of the easiest and most cost effective methods that could be used to retain mature
experienced nurses (Bryant-Hampton, Carroll, Walton, & Strickler 2010). Respect for the
knowledge and skill a mature nurse has is priceless. Loss of seasoned nurses can be correlated to
loss of efficiency of knowing how to the get the job done safely and economically. Staffing
studies have suggested that loss of older experience nurses may also have a negative impact on
quality outcomes, patient satisfaction and safety, productivity and organizational performance
(Robert Wood Johnson Foundation, 2006). The clinical experience and knowledge of the
organization of the mature nurse is invaluable to the patient, their colleagues and the intellectual
capital of the organization (Bryant-Hampton et al. 2010). Leadership rounding has also been
identified as a method to raise nurse satisfaction, loyalty and retention of high performing nurses
(Baker, 2010). Rounding helps to build relationships with staff and this reduces employee
turnover as having a poor relationship with a supervisor was noted to be a top reason that
employees leave an organization (Baker, 2010). According to Roussel (2013) there is a direct
correlation in retaining nurses and the leadership skills such as transformational leadership style,
extroverted personality traits, fostering of nurse empowerment and autonomy (p. 321).
There are also other factors that can affect retention such as long hours, undesirable
shifts, inadequate staffing, retirement options, lack of continuing education opportunities, and
physical maladies. Nurses are looking for schedules that are more flexible to their familial and
physical needs. This is one area that could be a low financial cost yet yields high returns in

RETENTION OF NURSES
related to job satisfaction. On the overall it appears that positive recognition is highly influential to all
age brackets of nurse and is also a low financial cost with potentially high outcomes.

The implementation of the Affordable Care Act (ACA) and the influx of millions of
additional consumers to the healthcare system can only magnify the current nursing shortage and
amplify the need to address nursing retention now. Reduction of staff turnover by half could save
an organization potentially hundreds of thousands of dollars. This will become significant with
complete implementation of the ACA and reimbursement reductions from the Centers for
Medicare and Medicaid Services (CMS). Hospital leaders are challenged to recruit and retain
clinical nurses during a period when turnover rates average over 20% (Force, 2005). Nurse
executives must take a stance in regards to the leadership methods used in their organization as it
has been noted that the management behavior and leadership style directly reflect on job
satisfaction and the desire to leave or stay at an organization (Force, 2005). As leaders we will
need to engage staff to become involved in areas that may have historically been considered to
be management only. Organizations need to become more transparent in once coveted areas so
that staff is armed with the knowledge and resources to take care of the patients and provide safe
and quality outcomes. Nursing leaders must also design succession planning strategies as in the
next decade approximately one-third of nurse over age 40 will be leaving (Wieck, Dols, &
Landrum, 2010).
Leaders will need to blend leadership styles to include complex adaptive systems and
complex systems. According to Force (2005) the transformational leader will provide individual
attention to the nurse acknowledging their strengths and weaknesses (p.337). This leader will
recognize the staff for contributions and outcomes and have a personal relationship with the
staff. Nurses will feel empowered and autonomous to make decisions in regards to processes

RETENTION OF NURSES
and unit decisions. Staff will become inspired and take ownership and accountability when they
feel they have input into the unit, this is particularly true for experienced nurses. Promoting a
culture that values the knowledge and experience of mature nurses is pivotal in creating an
environment that promotes retention and satisfaction (Spiva & Johnson, 2012). Leaders that are
viewed by staff to be charismatic, visionary and loyal encourage autonomy, critical thinking and
valued staff contribution to the organization (Force, 2005). As part of a system, a leader may not
be able to change the design of the organization but may be able to incorporate some flexibility
in the design to make this more appealing to the seasoned nurse. This could be developing
incentives for career enhancing education such as a certifications or graduate studies.
Leaders that seek out and value and contributions from staff via a shared decision making
model have proven higher retention rates (Force, 2005). There is a need to share information
effectively, influence the day to day operations and have influence on job satisfaction (Force,
2005). The type of leadership style that is exhibited by the nurse executive can be an essential
component of a nurses decision to remain within an organization. According to Force (2005),
nurse executives by use demonstrated individualized consideration has correlated higher
retention rates (p. 340).Whereas transactional leadership characteristics, such as recognition and
reward of successes and day-to-day behaviors, also impact the desire to say (Force, 2005). The
use of a transformational or participatory leadership model allows for the spread of formal power
that supports that nurses control over their own work environment and allows flexibility so that
the can act on their expert judgment to solve patient care issues (Force, 2005). Nurse executives
and leaders must create an atmosphere of autonomy and empowerment for nurses if we are
expecting them to excel and maximize their education. According to Wieck, Dols, and Landrum

RETENTION OF NURSES
(2010) the newer workforce wants to be led, not managed and mangers will need to transform
management skills into leadership skills (p.13).
Nurse leaders in all types of healthcare systems will need to look at new and innovative
ways to retain the seasoned experienced nurse. The mature nurse brings knowledge, experience,
improved patient satisfaction scores, patient outcomes, and safety outcomes. Leaders will need
to use a combination of complex adaptive systems and complex systems as healthcare can be
described within both arenas. The leaders will need to keep pace with the frequent changes that
are evolving in healthcare and must stay abreast of needs and the dynamics of those involved at
all levels. Retention of seasoned nurses will also be a financial measure that nurse leaders will be
measured against.

RETENTION OF NURSES
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RETENTION OF NURSES
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