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Increasing Nursing Staff Retention


A Capstone Presented to the Nursing Faculty

March 31, 2014

Dr. Karen Kapke /Evaluator

Chapter 2: Literature Review

Nursing has been a profession amongst human civilization long beforeit was formally taught as a higher education subject of study.According to the oxford dictionary, the verb nurse holds the meaning:1Try to cure or alleviate (an injury, injured part, orillness) by treating it carefully and protectively. 2Givemedical and other attention to (a sick person). According to thefirst meaning, nursing had been around long before formal trainingwas introduced and continues to be practiced informally many yearsafter development of training courses. From the earliest days,society has been urged to take care of the sick amongst them.Christianity for example has always advocated for the visiting of thesick where one would take food and other necessities during thesevisits.

“I solemnly pledge myself before God and in thepresence of this assembly, to pass my life in purity and to practicemy profession faithfully. I will abstain from whatever is deleteriousand mischievous, and will not take or knowingly administer anyharmful drug. I will do all in my power to maintain and elevate thestandard of my profession, and will hold in confidence all personalmatters committed to my keeping and all family affairs coming to myknowledge in the practice of my calling. With loyalty will Iendeavour to aid the physician, in his work, and devote myself to thewelfare of those commit&shyted to my care” (O’Brien,2002, p. 28).

The above is a pledge written by Lystra Gretter in1893 for the class that was graduating from the Harper Hospital inDetroit, Michigan. It is meant to be a depiction of what FlorenceNightingale, the mother of modern nursing, envisioned of nursing as aprofession.

A very important point to note about Nightingaleis that she was a very religious person, she felt a conviction tocare for others. She believed that God had called on her to helpothers (Woodham-Smith, 1982). Numerousschools have since been established to develop the nursing career andbodies have been formed and mandated to oversee the enrolment,training and practice of nurses. In most countries we have laws thatrecognize the profession and set standards, rules and regulations tobe followed in practice. The nurses are also governed by a code ofconduct that is recognized by their respective governing bodies. Buteven with these developments, nursing is mostly a calling rather thana profession. It is a career path that is more humanitarian thanprofessional. It focuses on the well-being of others. It isselflessness, compassion and love for one another that keeps thenurses doing what they do. The need to alleviate human sufferingthrough injury or illness.

Despite the developments that have taken place in the nursing field,there is still a great shortage of nurses globally due to either lowenrolment into training institutions or high turnover of nurses inpractice. This research paper will seek to address this issues andthe factors behind them, trying to offer lasting solutions.

The issue of nurse retention has long been a steadfast issue in thehealthcare community. While nurses often have a sense that they areoverworked and underappreciated (which invariably leads to low moraleand even lower levels of loyalty), the concept of focusing on theretention of current nursing staff has often been neglected. For anymedical environment to function at its full potential, a competentand dependable group of nurses is required as its foundation. Notonly does the nursing staff decrease wait times for patients, and thegrunt work of patient history and minor procedures for physicians,they also act as a liaison between physician and patient as well asother disciplines contributing to the care of patients. Nurses oftenadd a level of humanity to the healthcare profession that it canotherwise lack. Nursing staff are the primary advocates for patientcare and best outcomes.

In order to encourage an end to the decades long issue of nurseretention in America, a thoughtful study needs to be conducted thatidentifies what affects a nurse’s choice to remain, or leave, theircurrent work environment. Previous studies have examined how trainingpolicies, the facility conditions, and the prestige of anorganization or institute affect nurse retention. The major result ofthis work identified that more research regarding the decisionprocess needs to be made (Shader, 2001). This parcel of researchwill attempt to provide a jumping off point to increased nurseretention by focusing on the opinions of those being researched(staffnurses of the surgical clinic) and then formulating ideas forimprovement based on those opinions shared with the researcher afterdata analysis.

Job Satisfaction and Retention of Staff

Before we can address the retention problem, we need to look atenrolment. Are we enrolling enough nurses into training institutionsto meet the current demand? A research conductedby the American Association of Colleges ofNursing (AACN) on 2012-2013Enrollment and Graduations in Baccalaureate andGraduate Programs in Nursingreported that in America, nursing institutions turned away 79,659qualified applicants frombaccalaureate and graduate nursing programs in 2012. This was mainlydue to an insufficient number of faculty,inadequate clinical sites, low capacity classroom space and budgetconstraints. Of all this factors, faculty shortages was cited byalmost two thirds of the nursing schoolsresponding to the survey as the main reason for notaccepting all qualified applicants into baccalaureate programs.

A Special Survey onVacant Faculty Positions carried out byAACN in October 2013 revealed that a total of 1,358 faculty vacanciesexisted in 680 nursing schools with baccalaureate and/or graduateprograms across the country. Schools also realised the need to createan additional 98 faculty positions to accommodate student demand. Theinformation obtained revealed a national nurse faculty vacancy rateof 8.3% with 86.9% of the vacancies requiring or preferring adoctoral degree. The top reasons cited by schools having difficultyfinding faculty were a limited pool of qualified faculty andnon-competitive salaries compared to positions in the practice arena.

A number of factors are seen to be contributing tothe faculty shortage in the country. These include the fact that theaverage age of tutors in institutions continues to rise thusdrastically decreasing the number of productive years that educatorsteach, higher compensation in clinical andprivate-sector settings is luring current and potential nurseeducators away from teaching and also the fact that master’s anddoctoral programs in nursing are not producing a large enough pool ofpotential nurse educators to meet the demand.

When discussing further research, many questions came to mind.For instance: How does career appeal in a given environment affectretention? How the nursing profession is viewed by the generalpopulation of a particular institute? How does stress affect jobsatisfaction? What types of actions can be taken by nursingmanagement to create a respectful, stimulating, rewarding environmentfor current nursing staff? This study will attempt to answer thesequestions through analyzing the specifics of this particular clinic.How do these staff members view their work environment and what istheir intent to stay?

Necessity for this Study

This study is driven by the growing need to increase the nurses’workforce countrywide and to also retain the already existing workerswith more focus being put into retention. It will focus on thefactors causing the high turnover of nurses from the profession. Thisparticular study will take place in an outpatient surgical facilityover a series of a weeks.Previous studies have shown that nursesbear the highest level of stress out of any of the healthcareprofessions regardless of environment (Wu, Zhu, Wang, Wang, &ampLan, 2007) so this study may have implications that reach beyond thisinstitution as well. Any data that lends itself to increased staffingretention will be of benefit to this surgical center at the veryleast. Data that offers insight into the psyche of nursing staffmembers is of value and warrants the endeavors of this researcher tobetter understand how to manage nurse team members in a way thatallows them to flourish and want to retain their employment.

Inspirational to this research is a study conducted by Kanter foundthat &quota strong understanding of organizational structuresprovides employees with the power to accomplish tasks&quot (Kanter,1993). Kanter’s definition of power translates to “the ability tomobilize resources to accomplish organizational goals&quot (Kanter,1993). Kanter’s observations about workplace empowerment can easilybe observed as lacking in the healthcare environment. Often, adisconnect is observed between what the nursing staff needs, and whatthe administrators supply. This may be a side effect of any number ofreasons: poor communication, bureaucratic issues, and budgetaryconstraints. Research has shown that, &quotIt is imperative thathealthcare employees have access to resources, including fiscalresources, materials, supplies and time to accomplish goals&quot(Lucas, et al, 2006).

By allowing nurses access to proper and adequate tools and materials,administrators are encouraging an independent and engaged staff, onethat feels empowered and competent in completing their job. Otherresearch indicates that a well-equipped staff &quotencouragesoriginal thinking, risk-taking behavior and autonomousdecision-making, limiting the layers of required approvals&quot(Kanter, 1993). This level of independence—in both thought andaction—can act to relieve some of the burdens of administrators,but also acts to promote job retention by providing a respectful,trusting workplace that encourages creative thinking. This study willshed light on the current status of the workplace environment andanalysis will lend evidence based knowledge in formulating protocolsfor improving staff satisfaction and retention.

Staffing Shortage History

The question of the shortage of qualified nursing staff in healthcarestill remains. Studies showing the correlation between nursing andjob satisfaction have observed persistently high levels of jobdissatisfaction among nurses (Manojlovich, 2002). According to Hayes,Bonner, &amp Pryor a &quotworldwide a shortage of nurses has beenextensively reported in many countries&quot (Hayes,et al, 2010).Evidence also suggests that:

&quotNurse employment satisfaction is critical for nurse retention.Much of the research into nurse job satisfaction has looked at how torecruit and retain nurses by providing an environment that makes themwant to stay in the profession. When nurses experience higher levelsof job satisfaction, there is an increase in morale and commitmentwhich makes it more likely that a nurse will stay in the profession&quot(Newman &amp Maylor, 2002).

Factors that affect a nurse`s decision to remain at a particular jobinclude the results of their input in decision-making and level ofengagement. Respect, team relationships, shift schedules, andworkloads are also factors (Shields &ampWard, 2001). How do thenurses at this surgical center see their work environment? Insightvia the questionnaire will provide facts that can offer ideas forimproved nursing management naturally leading toward better jobsatisfaction.

When working to further identify the reason for turnover, it can besuggested that there are a variety of external motivations that onecan offer up for consideration. For instance, the aging population inthe United States has become of increasing concern when consideringhealthcare. With the “Baby Boomer” population on the cusp ofretirement, healthcare is seeing an increased need for nurses andphysicians. Concerns have also been raised that the increases inhealthcare availability due to Obamacare have the potential to leadto an increase in nurse shortages (one could argue that this is apositive problem). This issue leads into the current projection thatthe supply of new nursing school graduates is lower than employerdemands (AACN, 2014).

Why, in this increasingly difficult job market, are studentsavoiding the profession of nursing? This problem can be traced backto the inherent stressors that nursing seems to encompass: longhours, high physical demands, and low pay. There is also anincreasing need for nursing professors. This educational issue leadsto the obvious conclusion of a decrease in students at both theundergraduate and graduate level.

The high turnover rate in the nursing field needs to be touched uponas one of the final reasons for shortages in this profession. As pastresearch has shown again and again, nurses are not remaining on thejob because of high levels of stress incurred, which lead to low jobsatisfaction. This focus on job fulfillment is particularly importantto the field of nursing because of its correlation to the level ofcare patients end up receiving. Studies link a nurse’s jobsatisfaction to positive patient outcomes and a greater quality ofcare (Adams &amp Bond 2000, Aiken et al. 2002). In other words,nurse dissatisfaction contributes to shortages, which results inoverworked staff, which in turn equals lower levels of patient care.

On a practical level, the lopsided nurse–patient ratios end upmaterializing into longer waits for patients, shorter times forpatient care, less rest for nursing staff, and the inevitable nursingstaff burnout ( Manojlovich,et al. 2003). The statistical evidence that supportsthis issue is astounding. The average turnover rates are 14% inhospitals nationwide (the largest employer of RN’s), 75% of nursesbelieve that nursing shortages affect their work life in a negativeway and decreases job satisfaction, 55% of nurses in the workforcecurrently are 55 or older (which assumes a need for an increasednumber of nursing graduates), and it is projected that by 2025 theshortage of nurses in America will reach 260,000 (AACN, 2014).

There have been some measures taken to increase an interest in thenursing profession: universities partnering with institutions toexpand educational capacities for nurses, national and stateinitiatives to fund nursing education for students, and an increasein positive media portrayals of the nursing profession (AACN, 2014).However, these actions aren’t aimed at increasing the retentionrates of current nursing staff, the main reasons for the shortages,adding to the ongoing necessity of this study.

The Shortage of Nursing Staff

Nursing shortages have adverse and far reaching implications on thehealth of the general population. Studies demonstrate that higherrates of nurse staffs are associated with tremendous reductions inadverse patient outcomes. The shortage limits the public’s accessto healthcare and the best possible outcomes of medical attention.The financial constraints on the nation and the changing needs of anaging population have prompted the need for new healthcare models tomeet the emerging healthcare demands. The employers needs also needto be put into consideration. Employers want a workforce that isadaptable, willing to continue learning and develop their skills tothe requirements of the work environment. Schools however cannotfully prepare the nurses for the industry (Buchan&amp Calman 2006). The healthcare institutions need toprovide feedback to the schools to help improve the curriculum tosuit industry standards, provide placement opportunities so thatstudent nurses can acquire the much needed practical experience.

In addition to the administrative and paperworkburdens that they bear, nurses are daily exposed to significant risksto their personal health and safety. Beyond the chronic fatigue,job-related injuries, including needle sticks, back injuries andphysical assaults are common experiences on the job. According to arecent study by the American Nurses Association, more than 70 percentof surveyed nurses indicated that continuing severe stress andoverwork were among their top health-related concerns. Forty percentof nurses reported having been injured on the job 17 percentexperienced physical assaults while working. Seventy-five percent ofnurses surveyed stated that unsafe working conditions interfere withtheir ability to provide quality care.36 Nearly 90 percent ofsurveyed nurses indicated that health and safety concerns influencethe type of nursing work they do and their likelihood to continue topractice (AmericanAssociation of Colleges of Nursing,2014). Among the many nurses whohave left the direct patient care setting to seek “more regularhours,” many now work for managed care plans and insurancecompanies, pharmaceutical firms, health care technology and medicaldevice vendors, and consulting firms, among others. These positionsoften offer nurses the opportunity for professional stimulation aswell as a regular business week. No nights. No weekends. No mandatoryovertime. These alternative nursing career options raise the level ofcompetition for recruiting nurses to and retaining them in directpatient care settings. One major source of nurse overwork anddissatisfaction is overtime. With many shifts short-staffed, nursemanagers face the dilemma of either overworking staff or having toofew nurses to care for patients. Sometimes the overtime shifts thatresult are explicitly mandatory nurses are threatened with dismissalor with reporting to the State Board of Nursing for patientabandonment. But, more often, overtime is mandated through not-sosubtle coercion – “How can you leave your overworked colleaguesand patients in such dire circumstances?” The use of overtime as astaffing shortage “solution” is pervasive. On average, nurseswork an extra eight-and-a-half weeks of overtime per year. There arecircumstances in which mandatory overtime may provide necessary andappropriate coverage, for example, in response to a disaster or masscasualty event. But in too many hospitals, overtime is routine, evensought after by some nurses who depend on overtime wages tosupplement their income. However, even these nurses considermandatory overtime without advanced notice dangerous for themselvesand for their patients because they cannot plan for enough sleep inadvance.

Solution to the Shortage of Nursing Staff

There has been some current research that has worked to identify theimbalance in nurse to patient ratios through retention. Cowden andCummings state that &quotresearchers generally endorse the decisionto remain in one`s position as a multi-stage process resulting fromreasoned reflection of the employee`s cognitive assessment of theirwork environment and its alternatives&quot (Cowden and Cummings,2011). Ultimately, they found that &quotunderstanding why nurseschoose to stay in their positions and identifying the causalsequences of the development of behavioral intentions will enablenurse managers to identify opportunities to influence intentions anddevelop strategies to increase nurse retention rates&quot (Cowdenand Cummings, 2011). When taking the finding of Cowden and Cummingsinto consideration, this particular study will assume that theresponsibility of maintaining retention levels lies with theadministration.

First, addressing supply side issues: improvingrecruitment, retention and return- getting, keeping and keeping intouch with these relatively scarce nurses. Research indicates thatnurses are attracted to work and remain in work because of theopportunities to develop professionally, to gain autonomy, and toparticipate in decision making, while being fairly rewarded (see e.g.Buchan &amp Calman 2006). Factors related to work environment can becrucial, and there is some evidence that a decentralised style ofmanagement, flexible employment opportunities, and access tocontinuing professional development can improve both the retention ofnursing staff and patient care (see e.g. Aiken etal. 2008). Some countries also havescope to widen the recruitment base by opening out access routes intonursing for a broader range of recruits, including mature entrants,entrants from ethnic minorities, and entrants who have vocationalqualifications or work-based experience to compensate for fewerconventional academic qualifications. ‘Returners’ can also beattracted back into the profession. Most countries have relativelylarge pools of former nurses with the necessary qualifications tore-enter nursing (Buchan &amp Calman 2006).

One aspect of recruitment that requires carefulconsideration because of its potential impact is active internationalrecruitment – where an organisation or system in one countryactively recruits nurses from another country. This has been growingfeature of global nursing labour markets, as developed countriesexploit ‘push’ factors, which make some nurses in developingcountries willing to cross national boundaries (see WHO 2006). Thesefactors include relatively low pay, poor career structures, lack ofopportunities for further education, and in some countries, thethreat of violence. The danger is that this action may just displacethe shortage to another country, which may be less resourced to dealwith it. There is growing debate about how countries can be moreeffective at addressing issues of ‘self-sufficiency’ in relationto producing sufficient nurses and other health professionals to meettheir own needs (Aiken et al. 2007,Little &amp Buchan 2007).

By focusing on their ability to impact upward job mobility, and thework environment in general, actions taken by administrators have thepotential to increase current staff retention. Nursing administrationcan also work to change job conditions to appeal to both current andpotential nurses. This change in work environment can aid in theprevention of a high turnover rate. Taking these proposed actionsinto consideration, a solution for study must be proposed to identifyand recommend specific actions for both human resources, and nursingmanagers, to develop engaging relationships with nursing staff thatresult in changed work environment. This study goes on to propose arevamp of best practice scenarios for the staff. This allows forincreased insight into the problem of retention from a managerialperspective, and may also lay enough groundwork for advances innursing management protocols geared toward maintaining staff.

Research Question for the Solution To Staff Retention

How does perceived satisfaction of the workplace culture (factorslike respect, resource support and decision making involvement)affect nursing retention? Data will be collected through a surveythat will offer answers to be analyzed to this question. Theresearch problem addresses the tremendous difficulties in retainingnursing staff. Research uncovered extensive studies regarding nursingand job satisfaction, with high levels of job dissatisfaction amongnurses (Manojlovich, et al, 2002). Factors that affect a nurse`sdecision to retain employment at a facility may include the resultsof their input in decision making and level of engagement. Respect,team relationships, shift schedules, and workloads are also factors.These are noteworthy aspects to consider when researching nursingstaff retention (Shields, 2001). The present study will allowcurrently employed nursing staff to offer their valued input intowhat makes a nurse stay and therefore offer management evidence baseddata by which to operate. Nursing job satisfaction is important toboth health care providers and patients. Studies link nursingsatisfaction to positive patient outcomes and a greater quality ofcare (Adams &amp Bond, 2000 Aiken et al., 2002). Nursedissatisfaction contributes to the nursing shortage, leading to worsenurse–patient ratios, which creates longer patient waiting listsand ultimately nursing staff burnout.

The rewards for their hard work are also lacking.Only 57 percent say that their salaries are adequate only 32 percentreport having advancement opportunities and over 50 percent say thatthey have been subjected to verbal abuse on the job. Overwhelmingly,nurses report that the most enjoyable aspect of being a nurse ishelping patients and their families. The majority of nurses (74%)said they would stay at their jobs if changes were made. Top amongthe identified desirable changes were increased Staffing, lesspaperwork, and fewer administrative duties.

According to a Peter D. Hart Research Associates study (A 2001), thetop reason why nurses leave patient care, besides retirement, is toseek a job that is less stressful and less physically demanding(56%). The Hart study also found that a significant number, 22percent, are seeking more regular hours 18 percent desire moremoney and 14 percent want better advancement opportunities. Whenasked what the biggest problem with nursing is, respondents who werein active nursing practice cited understaffing (39%) and the stressand physical demands of the job (38%).Nurses have been described asthe “canaries in the coal mine.” Many have been sacrificed beforethe now widespread realization that there is something wrong with thework environment. Nurses leave hospitals because they are overworkedand overburdened, often with tasks that were once theresponsibilities of less skilled workers. They similarly have neitherthe managerial support nor the control over their environments –through delegated authority — to marshal and deploy scarce resourcesin order to manage the often challenging, and sometimes criticalpatient care situations which they may face at any hour of the day ornight. In one study, only 29 percent of nurses reported that theiradministrations listen and respond to their concerns.

Average turnover rates are 14% in hospitals nationwide (the largestemployer of RNs). About 75% of nurses believe that nursing shortagesaffect their work life in a negative way and decreases jobsatisfaction 55% of nurses in the workforce are currently 55 orolder, which infers a need for an increased number of nursinggraduates. The projected nursing shortage by 2025 is 260,000. Somemeasures are being taken to increase retention including universitiespartnering with institutions to expand educational capacities fornurses, national and state initiatives to fund nursing education forstudents, and media portrayals shedding a positive light on nursingas a profession (AACN, 2014). However these initiatives will producelimited increases in retention rates, which again justifies thepresent study.

“According to the “United States Registered Nurse WorkforceReport Card and Shortage Forecast” published in the January 2012issue of the American Journal of Medical Quality, a shortage ofregistered nurses is projected to spread across the country between2009 and 2030. In this state-by-state analysis, the authors forecastthe RN shortage to be most intense in the South and the West.”

In March 2008, The Council on Physician and Nurse Supply, anindependent group of healthcare leaders based at the University ofPennsylvania, called for 30,000 additional nurses to be graduatedannually to meet the nation`s healthcare needs, an expansion of 30%over the current number of annual nurse graduates. These statisticspaint a grim picture of the situation on the ground and tell of aprofession in dire need of reforms.

Research Outline

The study should give reliable data, which only comes from choosingthe best design and methodology. The chosen design for the study willuse exploratory, correlational quantitative research. Conveniencesampling will be utilized by the researcher. The research willidentify indicators of incentives for continued employment within theinstitution. The researcher will invite all nurses within theorganization to participate. The data collection tool will be aquestionnaire survey. This data will comprise responses from anelectronic survey questionnaire which will ask relative questions toworkplace satisfaction. An overall view of how those employed assesstheir working environment will be shown through the answers to thequestionnaire. The instruments and methods used to collect this datawill be to disperse the questionnaires to the research participantscomplete with instructions. Instructions will include completion ofthe form, anonymity of those participants for confidentiality andtime frame for completion. The researcher will deliver thequestionnaires to the respondents in their workplace email and timefor completion will be allowed during their work day.Theresearcher will implement all data collection, and then enter thedata into SurveyMonkey. Lastly, the researcher will analyze the datafor conclusions it may offer.

The researcher will use a quantitative research methodology for thisstudy. Data will be reviewed in an unbiased fashion using thequestionnaire replies to formulate answers. The researcher will useconvenience sampling of the nursing population of all units. Theresearch will identify indicators of incentives for continuedemployment within the institution. By comparing and contrasting thequantitative data, determinations will be made about retention. Factors such as engagement, opportunity for upward mobility, and workrelationships will be divided and examined as they relate to thegiven health care organization. Quantitative study will compare andcontrast retention rates to determine which factors correlate withnursing turnover.

Definition of Terms

Workplace Harmony: A sense that one is respected and able towork in concert with other nursing staff members.

Upward Mobility: Options to advance one’s career inposition, economic reward or both.

Respect: Admiration for one’s abilities, qualities and/or achievements.

Literature Review

There are many resources for this area of study and sources suchas CINHAL and Google were utilized to find current resources. Theones selected offered the best information for the goal ofdetermining better retention of nurses through improved nursingmanagement protocols. The effects of nursing leadership on nursingstaff retention is found in the research of Cowden, Cummings andMcGrath which talks about the effects nursing leadership has onwhether or not a nurse plans to stay in her career. Strong, inclusiveand supportive leadership increases the odds greatly that a nursewill stay. Lucas, Laschinger and Wong discuss the empowerment ofnurses through compassionate and intelligent management as a tool toincrease retention. What a nurse manager does to relate to andrespect staff members makes a difference in turnover rates.Manojlovich and Laschinger support these same ideals as a means ofretaining nursing staff. The behavior of nursing management to createa positive work environment and give nurses the tools to do theirbest work will improve retention rates. All of the articles utilizedin regard to the topic of insightful empowerment of those one manageswere very helpful in formulating the questionnaire and fortifying thepurpose of the study as valid to the researcher. They offered greatinspiration to the ideal of nursing management as a great asset inthe retention of nurses if approached in an empowering and thoughtfulmanner.

Shields and Ward discuss broader aspects of nursing retention relatedto job satisfaction overall and how that effects a nurses decision tomaintain employment or quit. Shader, Broome, Broome, West and Nashalso discuss the broader subject of job satisfaction as it relates toretention or turnover (M A Shields, 2001). Other articles like theone by Hayes, Bonner and Pryor spoke to overall nurse jobsatisfaction as a general topic. Newman and Maylor discussed qualityof care issues as they relate to nursing job satisfaction andretention. This is an area of concern as it can be part of a negativecycle for both nurses and patients when quality of care is lacking. Apart of nursing job satisfaction is the satisfaction of the deliveryof quality care. Kanter discusses the strength of good leadership,especially by women in business generally. The application to nursingmanagement is easy to understand.

A research conducted by Hayes, Bonner, &amp Pryor stated “aworldwide shortage of nurses has been extensively reported in manycountries&quot (2010, p. 805). Nurse Employment satisfaction iscritical for nurse retention. Much of research into nurse jobsatisfaction has looked at how to recruit and retain nurses byproviding an environment that makes them want to stay in theprofession (Newman &amp Maylor, 2002)When nurses experience higherlevels of job satisfaction, there is an increase in morale andcommitment which makes it more likely that a nurse will stay in theprofession (Shields, 2001).

The Bureau of Labour Statistics’ Employment Projections 2010-2020released in February 2012 showed that the Registered Nursingworkforce is the top occupation in terms of job growth andopportunities through 2020. The projections highlighted that thenumber of employed nurses is expected to grow from 2.74 million in2010 to 3.45 million in 2020, an increase of 712,000 or 26%. Theprojections further explain the need for 495,500 replacements in thenursing workforce bringing the total number of job opening for nursesdue to growth and replacements to 1.2 million by 2020. A differentstudy published in the January 2012 issue of the American Journal ofMedical Quality stated that the shortage of nurses was expected tocontinue all through to 2030.

Angela and McBride argued that nurses` care givingabilities are highly correlated with the required leadershipessentials. They dwelt on the point that, nursing equals leadershipand hence the future of medicine stipulated that nurses should beprepared and enabled to lead change so as to advance health. Theyurged nurses to have more than the purview of nursing so as to havetransformative leadership. Arriving to this point requiredunderstanding that nursing greatly contributes to the world of ideasthen development of character and personal reputation for beingaccomplished and finally participating increasingly in policy makingand interdisciplinary forums.

Patricia Benner classified nurses` leadershipstating that one moved the lowest level which she called the noviceto the expert level, which is the highest. It was supported by theargument that leadership is a development process and for it tooccur, it must be a feature of every work setting and alsoprofessional association. However, she mentioned that this change wasnot rapid and hence no one nurse could be a finished product. Shelater on added that each step built on the previous one and thelearner gained clinical expertise. Her study introduced the notionthat nurses through their day to day life in their practice could andshould inform the theory in nursing rather than having all the theorydeveloped by scholars and researchers.


As revealed in the literature chosen and utilized, nursing studies ofthe past have revealed a number of issues related to nursing staffretention such as career image and shortage of nursing students,burnout, respect, and aging staff members. The shortage creates achallenging work environment that acts as a cycle and fuels thedifficulties of retaining nursing staff. A survey of nurses currentlyworking may add insight and offer evidence based ideas for increasedretention of nursing staff by nursing management. The knowledge andinsight gained through the survey will yield information that can beincorporated into a nurse manager’s strategy for retaining staffmembers.

Overall, it seems clear that nursing must take the lead and anactive role in reforming the workplace. The cycle of change that canensue will create better job satisfaction, more qualified nurses andcare givers and more retention of seasoned nurses and staff withoptions to successfully integrate new hires. Although researchexists that discusses aspects of the present research problem, it isfar from complete and neglects a full set of sufficient solutionsevidenced by the ongoing issue of shortages and short term retention. The current literature reviewed for this study offers many importantinsights into the problem and a great foundation for further study toimprove the ongoing nursing retention issues.


Adams, A., &amp Bond, S. (2011). Hospital nurses’ jobsatisfaction, individual and organizational characteristics. Journalof Advanced Nursing, 32(3), 536-543.

Aiken, L. H., Clarke, S. P., Sloane, D. M.,Sochalski, J., &amp Silber, J. H. (2012). Hospital nursestaffing and patient mortality, nurse burnout, and jobdissatisfaction. Journal of the American Medical Association,288(16) 1987-1993.

Allison Smith (2010). The Current Nursing Shortagein the United States. Retrieved from&lthttp://www.indiana.edu/~spea/pubs/undergrad-honors/volume-4/smith_allison.pdf&gt

American Association ofColleges of Nursing(2013). 2012-2013Enrolment and Graduations in Baccalaureate andGraduatePrograms in Nursing,Retrieved from &lthttp://www.aacn.nche.edu/research-data&gt

American Association ofColleges of Nursing(2013). 2012-2013Salaries of Instructional and Administrative Nursing

American Association ofColleges of Nursing(2013). Special Survey on Vacant Faculty. Retrieved from&ltwww.aacn.nche.edu/IDS&gt

American Association ofColleges of Nursing(2014). Nursing FacultyShortages Factsheet.Retrieved from&ltwww.aacn.nche.edu/Publications/WhitePapers/FacultyShortages.htm&gt

American Association of Colleges of Nursing (2014). Nursing Shortage.Retrieved from: &ltwww.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage&gt

American Association ofNurse Practitioners (2013). Thehealth practitioner’s wage. Retrievedfrom &ltwww.aanp.org/research/aanp-research&gt

Association of AcademicHealth Centres (2010). Surveyon shortage of health faculty.Retrieved from&ltwww.aahcdc.org/policy/reports/AAHC_Faculty_Shortages.pdf&gt

Buchan J &amp Calman L(2004). The global shortage of registered nurses: An overview ofissues and actions. Geneva, International Council of Nurses.

C. I. MacKusick &amp P. Minick (2010). Why AreNurses Leaving? Findings From an Initial Qualitative Study on NursingAttrition. Retrieved from&lthttp://www.amsn.org/sites/default/files/documents/practice-resources/healthy-work-environment/resources/MSNJ_MacKusick_19_06.pdf&gt

Canadian Federation ofNurses (2010). The Nursing Workforce. Retrieved from&lthttp://nursesunions.ca/sites/default/files/2012.backgrounder.nursing_workforce.e_0.pdf&gt

Centre for State HealthPolicy, Rutgers University (2011). TheNurse Faculty Query – NuFAQs.Retrieved from&lthttp://evaluatinginnovationsinnursing.org/nufaqs-nurse-faculty-data-query.&gt

Cowden, T., Cummings, G. G., &amp Profetto-McGrath, J. (2011)Leadership practices and staff nurses` intent to stay: A systematicreview. Journal of Nursing Management, 19, 461-477

Dr. J. Allan and J. Aldebron(2010). NursingOutlook: ASystematic Assessment ofStrategiesto Address the Nursing Faculty Shortage, U.S.Retrieved from&ltwww.nursingoutlook.org/article/S0029-6554(08)00266-2/abstract&gt

Gretter, L. E. (1893). The Truth About Nursing. The AmericanJournal of Nursing, (1949), v. 49, issue 6, pp. 344-48.

Hayes, B., Bonner, A., Pryor, J. (2010). Factors contributing tonurse job satisfaction in the acute hospital setting: a review ofrecent literature. Journal of Nursing Management, 18 (7),804-814.

Herrin, D., Hathaway, D., Jacob, S., McKeon, L., Norris, T., Spears,P., &amp Stegbauer, C. (2009, December). A model academic-practicepartnership [abstract]. The Journal of Nursing Administration,36(12), 547-550.

J. Buchan, MA(Hons), PhD &ampL. Aiken, PhD (2010). Solvingnursing shortages: a common priority. Retrieved from&lthttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858425/pdf/nihms107153.pdf&gt

Kanter, R.M. (1993). Men and women of the corporation (2nded.). New York: Basic Books.

Little L &amp Buchan J(2007). Nursing Self Sufficiency/Sustainability in the GlobalContext. Geneva, International Centre on Nurse Migration.

Lucas,V and Laschinger, S and Wong, C. (2009). The impact of emotionalintelligent leadership on staff nurse empowerment: the moderatingeffect of span of control. Journalof Nursing Management,16:8, 964 – 973

M A Shields, M. W. (2001). Improving nurse retention in the NationalHealth Service in England: the impact of job satisfaction onintentions to quit. Journal of Health Economics, 20(5),677–701. doi:10.1016/S0167-6296(01)00092-3

Manojlovich, M. (2002). Power and Empowerment in Nursing: LookingBackward to Inform the Future. doi:10.3912/OJIN.Vol12No01Man01

National Advisory Council on Nurse Education and Practice (2010). TheImpact of the Nursing Faculty Shortage. Retrieved from&lthttp://www.hrsa.gov/advisorycommittees/bhpradvisory/nacnep/Reports/ninthreport.pdf&gt

National league for Nursing(2010). Nurse Educator Shortage Factsheet. Retrieved from&lthttps://www.nln.org/governmentaffairs/pdf/NurseFacultyShortage.pdf&gt

Newman, K., &amp Maylor, U. (2002). Empirical evidence for “thenurse satisfaction, quality of care and patient satisfaction chain.”International Journal of Health Care Quality Assurance, 15(2),80–88. doi:10.1108/09526860210421482

O’Brien, M. E. (2002). Prayer in Nursing: The Spirituality ofCompassionate Caregiving. Jones &amp Bartlett Learning.

Robert Wood JohnsonFoundation (2010). Initiative on the Future of Nursing, at theInstitute of Medicine. Retrieved from&lthttp://www.jointcommission.org/assets/1/18/RWJ_Future_of_Nursing.pdf&gt

Shader, K., Broome, M., Broome, C., West, M. &amp Nash, M. (2011)Factors influencing satisfaction and anticipated turnover for nursesin an academic medical center. Journal of Nursing Administration,31(4), 210-216. Retrieved from:&lthttp://www.journals.lww.com/jonajournal/Abstract/2001/0400/Factor.&gt

The Robert Wood JohnsonFoundation (2010). ChartingNursing’s Future:“Expanding America’s Capacity to Educate Nurses: Diverse,State-Level Partnerships Are Creating Promising Models and Results.”Retrievedfrom &ltwww.rwjf.org/files/research/20100608cnf.pdf&gt

University of Nebraska –Lincoln (2012). United States Registered Nurse Work force Report Cardand Shortage Forecast. Retrieved from&lthttp://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1148&ampcontext=publichealthresources&gt

Woodham-Smith, C. (1982). Florence Nightingale: 1820-1910.Constable &amp Robinson Limited.

World Health Organization(2006). World Health Report 2006: Working Together for Health.Geneva, WHO.

Wu, S., Zhu, W., Wang, Z., Wang, M., &amp Lan, Y. (2007).Relationship between burnout and occupational stress among nurses inChina. Journal of Advanced Nursing, 59(3), 233–239.doi:10.1111/j.1365-2648.2007.04301.x