Overview and Solutions to the Retention of Nursing Staff

Abstract

This research project addresses the tremendous shortage of qualified nursing staff in the healthcare industry. The paper uses a breadth discussion of relevant literature to inform the specific research question of what factors lead to the problem of nurse retention and potential solutions to the problem. It is hypothesized that the aging population, lower nursing graduation rates, and high turnover rates in the nursing field are relevant factors to the problem. As a result, the research project focuses on avoiding a high turnover rate in the nursing profession by asking nurses in a specific organization about job expectations and satisfaction. Ultimately, the paper finds that addressing nursing practice from a governmental, institutional, and personal perspective will best answer the profession’s problem of retention.

Overview and Solutions to the Retention of Nursing Staff

Retention of nursing staff is imperative to managing patient care in any hospital or healthcare setting. Lack of nursing staff causes long wait times for patients needing examinations and treatment. Retaining the nursing staff is nearing a crisis throughout the healthcare industry. This has been an ongoing problem in the US for several decades. Careful study is needed to determine what affects a nurse’s choice to remain in a work environment. Past studies have examined the prestige of the organization or institute, the condition of its facility and training policies. More aspects of nurses’ decision-making processes require analysis (Shader et al., 2001). For instance, what about the overall appeal of the field in a given institution? How is nursing, as a profession viewed by the general population of the institute? What can be done to create a respectful, stimulating and rewarding work environment by nursing management?

Quality healthcare requires providers with skill and experience. Seasoned nursing staff must be available for managing quality patient care in any hospital or healthcare setting. Lack of nursing staff or inexperienced nursing staff members causes long wait times for patients needing examination and treatment. The retention of nursing staff has reached crisis proportions throughout the healthcare industry. Nursing shortages have persisted for several decades. We need to understand what affects a nurse’s choice to remain in the healthcare work environment – which is precisely the aim of this research project.

Previous studies have examined the prestige of the healthcare institution, the condition of the facility, and training policies. Yet, additional aspects of nurses’ career decision-making processes require further analysis (Shader et al., 2001). We may ask about the appeal of this career within a given institution. How is nursing as a profession viewed by the general population of the institution? What can nursing management do to create a respectful can do, stimulating, and rewarding work environment? The following research addresses nursing staff retention, and these questions are used as a guide for the review of literature and analysis of the survey.

The study addresses the industry-wide shortage of nursing staff and offers improved administrative policies. An attempt to understand the reasons behind the lack of skilled nursing staff retention is explored. A thorough analysis of current employee retention policies aids in this understanding. The study will be supported by previously done research in the field and the results of an in house survey. The topic of this research study is nursing staff retention. The purpose of this exploratory, correlational, quantitative research study is to examine the following, “What is the relationship between nurses’ perceived upward mobility, unity and harmony of the workplace and the intent expressed by nurses to stay on the job?” This is a topic of great interest to this researcher and a future as a nurse manager. It is also an important subject in the future of nursing and health care in general.

The project will be outlined in a specific way, to give clarity to the reader and credence to the research. First, the paper gives an overview of the problem that this research project seeks to address. The paper discusses the shortage of nursing staff and the potential solutions to this staffing shortage. Second, the paper discusses the methods for the project. This involves a brief discussion of the participants of the study, followed by an in-depth methodology of the research and subsequent analysis. Third, the paper discusses the relevant literature to the nursing profession and nursing shortages. Doing so gives a clear context to the research project. Fourth, the paper makes recommendations based on the conducted research. Finally, the author gives potential criticisms of the project and connects it to the program of management and leadership more broadly.

Shortage of Nursing Staff

The research problem addresses the tremendous shortage of qualified nursing staff in the healthcare industry. Research uncovered extensive studies regarding nursing and job satisfaction, with high levels of job dissatisfaction among nurses (Manojlovich & Spence Laschinger, 2002). According to Hayes, Bonner, and Pryor "worldwide a shortage of nurses has been extensively reported in many countries" (2010, p. 805). The evidence also overwhelming suggests that:

Nurse employment satisfaction is critical for nurse retention. Much of research into nurse job satisfaction has looked at how to recruit and retain nurses by providing an environment that makes them want to stay in the profession. When nurses experience higher levels of job satisfaction, there is an increase in morale and commitment that makes it more likely that a nurse will stay in the profession (Shields, 2001, p. 800).

Factors that affect a nurse's decision to retain employment at a facility include the results of 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 nursing staff retention (Shields, 2001). The present study hypothesizes that upward mobility also correlates to nursing tenure and suggests that three motivations possibly explain the shortage of nursing staff professionals.

First, the aging baby boomer population demands more nurse-delivered care than is available. People are aging and living much longer today than they have in the past. While this is a good thing, and a testament to modern medicine, it presents a problem when limited staff is available to aid these aging patients. Second, the projections of new nursing school graduates entering the field are lower than what employers need. The nursing field, possibly due to the job pressures, does not attract enough college students. Not only is there a shortage of graduates, but also a shortage of nursing professors, further reducing the number is of nursing school students as well as nursing school graduates with advanced degrees. The last reason for the shortage is the high turnover rate in the nursing field as a whole. Nurses are not remaining on the job because of high job stress and low job satisfaction. Nursing job satisfaction is important to both health care providers and patients.

Studies link nursing satisfaction to positive patient outcomes and a greater quality of care (Adams & Bond, 2000; Aiken et al., 2002; Murrells et al., 2005). Nurse dissatisfaction contributes to the nursing shortage, leading to worse nurse-patient ratios, which creates longer patient waiting lists and ultimately nursing staff burnout. Average turnover rates are 14% in hospitals nationwide (the largest employer of RNs). About 75% of nurses believe that nursing shortages affect their work-life in a negative way and decrease job satisfaction; 55% of nurses in the workforce are currently 55 or older, which infers a need for an increased number of nursing graduates. The projected nursing shortage by 2025 is 260,000. Some measures are being taken to increase retention including universities partnering with institutions to expand educational capacities for nurses, national and state initiatives to fund nursing education for students, and media portrayals shedding a positive light on nursing as a profession (AACN, 2014). However, these initiatives will produce limited increases in retention rates, which justifies the present study.

A Solution to the Shortage of Nursing Staff

Recent studies suggest possible solutions to the nursing shortages in the healthcare industry. Cowden and Cummings point out "researchers generally endorse the decision to remain in one's position as a multi-stage process resulting from reasoned reflection on the employee's cognitive assessment of their work environment and its alternatives" (Cowden, 2011, p. 476). Ultimately, the researchers found that "understanding why nurses choose to stay in their positions and identifying the causal sequences of the development of behavioral intentions will enable nurse managers to identify opportunities to influence intentions and develop strategies to increase nurse retention rates" (Cowden, 2001, p. 647). The present study places the responsibility of improving the lack of nursing staff on the nursing staff managers and/or administrators. It focuses on their ability to impact upward job mobility and their ability to impact the work environment. Although challenging to nurse leaders, actions taken by these leaders can increase the amount of nursing staff available. These leaders can change the nursing job condition to appeal to those who wish to go into the nursing field.

In addition, they can help decrease the turnover rate. Therefore, the solution proposed here is to identify and recommend actions for human resources and nursing managers to develop long-term relationships with nursing staff. Finally, this study also proposes best practice scenarios for the staff and clients. This will help gain insight into the problem from a managerial perspective.

Participants in the Study

The study took place over a series of weeks in one healthcare facility. The specific facility type is unimportant because the insufficient staffing problem occurs throughout the healthcare industry. Research shows that many in the nursing field eventually experience stress in their jobs, and this stress is exacerbated by the lack of support from administrators. Kanter (1993), found "a strong understanding of organizational structures provide employees with the power to accomplish tasks" (p. 65). Here power is defined as “the ability to mobilize resources to accomplish organizational goals" (Kanter, 1993, p. 66). Many times, a disconnect in healthcare facilities occurs between what the nursing staff needs and what the administrators supply. "It is imperative that healthcare employees have access to these resources, including fiscal resources, materials, supplies, and time to accomplish goals" (Lucas, 2006, p. 965). Having the necessary resources helps create an independent, empowered work environment. Evidence suggests that this "encourages original thinking, risk-taking behavior, and autonomous decision making, limiting the layers of required approvals" (Kanter, 1993, p. 66). This sort of independent thinking and working not only helps to relieve some of the administrative burdens but also helps in job retention. To get the best data possible for the study, having the willing participation of members of the nursing staff in the study location was very important.

To ensure the most reliable output, the researchers did not restrict the participants to a certain dataset. They come from a wide range of demographics. A randomly selected pool of participants gives the study enough diversity to produce clear results from the study. The nursing staff will consist of both men and women, ranging from ages 23 to 62. Some study participants have many years of job experience, while some have only been working for a few years. Likewise, participants have a diverse range of salary ranges and education levels. Some staff members hold bachelor degrees and others master's degrees. A question on the questionnaire asks if the nursing staff at the study location believes that getting additional education and credentials will increase their job satisfaction.

Discussion on the Study: Methodology and Design

The study gives reliable data, which only comes from choosing the best design and methodology. The chosen design for the study uses exploratory, correlational quantitative research. The research utilizes convenience sampling for the results. The research will identify indicators of incentives for continued employment within the institution (Polit, 2010). As the results will show, the project selects clusters and samples from the individuals within those different clusters for a particular result. All nurses within the studied organization were invited to participate.

The data collection tool is a questionnaire survey. This data comprises responses from an electronic survey questionnaire, which asks the above questions of the staff nurses that fit the criteria outlined previously. An overall view of how those employed assess their working environment is shown through the answers to the questionnaire. The instruments and methods used to collect this data were to disperse the questionnaires to the research participants, complete with instructions. Instructions include completion of the form, anonymity of those participants for confidentiality and time frame for completion. The researcher delivered the questionnaires to the respondents in their workplace email and time for completion will be allowed during their workday. The researcher implemented all data collection, and then entered the data into the software. Lastly, the researcher coded and analyzed the data accordingly.

The research identifies indicators of incentives for continued employment within the institution. The study intends to consider factors such as pay and the institution ranking in comparison to the nurses who hired on within a given data set. By comparing and contrasting the quantitative data, the project makes determinations regarding retention. Factors such as engagement, an opportunity for upward mobility, and work relationships are divided and examined as they relate to a given health care organization. Quantitative study compares and contrasts retention rates to determine which factors correlate with nursing turnover.

IBM's Statistical Package for Social Sciences (SPSS; IBM, 2013) was used to synthesize the data using a statistical program. That program provides simple computations as well as analyses of large data sets. This software program calculates descriptive and inferential statistics (Burrill, 2006). A multiple regression analysis determines the correlations between factors in nursing staff retention probability by studying the association between varying factors and their relationship to nursing job enticement and retention.

The study hypothesizes that higher perceptions of upward mobility are the most predictive variable in determining nursing staff retention. Results from this statistical test attribute a particular predictive value for this variable, indicating the reality of the perception. For example, if the test concludes that upward mobility is associated with a correlation of 0.70 to retention then, 70% of nursing staff retention is related to upward mobility. Seventy percent is a high predictive value. Therefore, the conclusion would be that administrators must place greater emphasis on perceptions of upward mobility in order to retain nursing staff. As another example, if the predictive value for upward mobility is 0.30 then researchers need to look elsewhere to determine work-related factors that equate with nursing staff retention. Multiple regression analysis is appropriate because it analyzes various independent variables in relation to a dependent variable.

The result and findings of the study are both documented and interpreted. "Compatible with the phenomenological perspective and basic to the approach is the assumption that human experience is mediated by interpretation. Objects, people, situations, and events do not possess their own meaning; rather meaning is conferred on them" (Bogdan & Biklen, 2007, p. 27). Given that fact, once the findings of the study have been compiled and categorized, the data is also interpreted by the researchers. For discussion purposes, the qualitative data are categorized in narrative categories and reported using a narrative style.

Literature Review

The shortage of nurses creates a challenging work environment that acts as a deterrent to the recruitment of new nurses and causes a depletion of older, more experienced nurses, some of which decide to abandon the profession altogether so that the working conditions deteriorate furthermore. In the early '90s, the profession did not attract many candidates and employment opportunities were extremely random. However, in recent years, the U.S. government has become aware of the problems and attempted to develop an intensive campaign to attract and retain nurses. A National Nurses Day was created. The campaign focuses on two main areas: getting those who have left to return to the nursing the profession and to attract young people into the field. As the nursing shortage is already a reality, the U.S. government, after an agreement with the Department of immigration, tried to recruit experienced nurses from abroad as well.

What is the cause of these chronic nursing shortages and subsequent burnout? It is very well known that nurses experience a high level of stress and challenges in the workplace. Over the last ten years, budget cuts have greatly affected the nursing profession. The number of dependent patients is becoming higher and patients are more severely ill, requiring higher skill sets and greater levels of care. Nurses are also concerned about the quality of care they deliver and patient safety.

The Workplace

Caring for the sick and dying has never been easy. It weighs on one’s spirit and mind. However, this profession affords a stable job environment, respect in the community, is intellectually regarded and is engaging and can be highly rewarding. How can those in the profession advertise for their own profession? One must recognize that, in turn, this type of avocation would benefit the environment in which all nurses work.

Nursing could take charge of its own future by advocating for one another and their own careers simultaneously! Although the provision of care for people who need remains very rewarding for nurses, research shows that nursing today provides little benefit in relation to the many problems associated with it. These problems are related to each other in the heavy workload, overtime in excess of rigid schedules and unpredictable work, concerns about health and safety, inadequate support from management, the relationship physicians and other healthcare professionals who are far from being full of collegiality, as well as rare opportunities for leadership development and professional development, are available to nurses. Nurses, as a whole, need to think as a whole and advocate for themselves, which is also advocating for their patients. Indeed, a healthier nursing force in the U.S would improve healthcare and outcomes for all while in cyclical fashion would create a better workplace for nurses.

In the meanwhile, it is not surprising that so many frontline nurses are anxious, discouraged and on the verge of exhaustion or burnout. Meanwhile, these problems also affect people who are considering a career in nursing but have not yet made their decision. In fact, the current framework is often cited as one of the main factors that discourage students to choose nursing as a career in America. This can be changed if nurses openly and frequently advocated for their profession and its wonderful offerings.

Research attributes many of the problems currently experienced with cuts and restructuring that have been made during the 1990s through today when hospitals have closed or reduced their staff and the number of nurses has decreased all while the acuity and numbers of those in need rise. The problem goes further, indeed, poor relationships with colleagues, lack of control over the exercise of the profession and demonstrations of ineffective management problems whose causes are much deeper. Thus, the nursing profession is still perceived as a predominantly female profession that applies the principle of equal work, unequal pay. Significantly, just over 5% of nurses are men. Nurses must take their own profession seriously and approach it with the utmost of professional attitudes in order for real change to ever occur.

Unfortunately, the overuse of available nurses is one of the only means used by senior nurse managers and CEOs of hospitals to cope with cuts and shortages in the nursing labor market. This means that nurses must work overtime and in circumstances of overwork that are undesirable and discouraging. Studies reveal that overtime in excess increases absenteeism, illness and injury as well as causing faster depletion of nurses.

But more importantly, overworked nurses are not beneficial for patients. Nurses from the United States, the United Kingdom, and Sweden have said that work pressure was detrimental to the delivery of care and strong evidence supports their claims. Thus, according to a study (Rogers et al., 2004), the hospital nurses who work more than 12.5 consecutive hours were three times more likely to make mistakes, including medication administration. In fact, the errors increase significantly when nurses work overtime or by working more than 40 hours per week. According to the study, medical incidents such as falls or medication errors can occur when nurses cannot perform their tasks or are delayed in their work, and these incidents are most frequent in the long care sector. Heavy workloads also affect nurses' perceptions of the quality of their work and thus their public opinion of their own profession. This can lead to a negative ideal of the profession on the whole as a career choice. Other workload constraints include time constraints, competing demands, interruptions, the intensity of concentration required by the work, gaps in skills and knowledge of and/or insufficient resources available or not.

Studies show that the more experienced nurses are less likely to qualify the care they provide as good or excellent. These results are due in part to the fact that older and more experienced nurses expect their clinical practice to include mentoring and administrative duties in addition to patient care (Needleman, 2003). However, nurses must be able to do their job well in order to feel satisfied in their careers. However, only those able to perform their tasks in a timely and complete manner feel they offer good or excellent nursing. In contrast, nurses who work in departments where the number of patients per nurse is higher than it should be are unlikely to have a high opinion of the care they deliver and their career. As can be expected, few hospital nurses believe that patient care has improved over the years. Few hospital nurses have a positive view of their career and advocate for the profession.

Any discussion of issues related to workload leads us to wonder about how to measure the load accurately. Until now, however, the measurement systems workload failed to provide an accurate measure of the work done by nurses. Indeed, rather than looking at the complexity of the medical and nursing care for patients (Needleman, 2003), as well as characteristics of nurses who provide the care and the environment in which care is provided, the measurement systems include only basic nursing tasks. The effort and skills required of nurses are insufficiently evaluated, recognized and rewarded. However, there is one aspect that is clear from the research, and that is that the current workload of nurses - whether or not measured - is too heavy. Nurses need to take an active participation in the evaluation of patient care workloads in order to make them more accurate and appropriate to the realities of care delivery.

At a time when we seem to respect and expect decisions and care to be based on evidence, the dissatisfaction of nurses in America is growing more because policymakers do not act according to the abundance of data linking safe levels of nurse staffing and better patient outcomes. Nurses need to create a plan of action, based on evidence to combat this trend once and for all. This will improve the profession as a whole along with healthcare. According to Bazdek (2010):

Two decades of national and international studies have a consistently, very clear link between inadequate nurse staffing and poor patient outcomes, including increased mortality and morbidities such as pneumonia acquired in the hospital, urinary tract infections, sepsis, hospital infections, pressure ulcers, peptic bleeding, shock and cardiac arrest, medical errors, failure to rescue, and longer than planned hospital stay times. There are also relapse related admissions related to inadequate nursing interventions, care and teachings during the first admission that stem from shortages (p. 42).

The findings of these reports are consistent. Using expressions or phrases such as untenable crisis, urgent need to repair the damage and concern about the deterioration of the quality of health care system of the country, these reports require action to resolve the problems of the nursing sector with the ultimate goal of improving patient care along with the workplace (Badzek, 2010). Nurses can be the driving force and resolve of such actions.

The recommendations contained in these reports fall into two broad categories: improving the workload of nurses and to improve the work-life of nurses. Ultimately, these would improve the odds of eliminating the chronic nursing shortage and break the cycle. Most recommendations target the following: relevant staffing twinning scope to patient needs, solutions to the increased pace and complexity of work, reduced absenteeism and fatigue among nurses and better integration of care between health care institutions, and between institutions and the community. Reports indicate repeatedly recommendations targeting the creation of workplaces that are respectful of nurses and their professional care and intelligence through participation in decisions about patient care. Also, more funding for training and professional development and recruitment would be of great benefit. They emphasize the importance of increasing enrollment in nursing schools to improve the situation because of cuts motivated by the budget in the 1990s and targeting nursing education. Professional nurses should be involved in the recruitment and advocacy for their own profession as well as personal careers. Unfortunately, few of these recommendations have been implemented, except for an increase in the number of seats in nursing schools and some pilot projects on healthy workplaces. Because of this inaction, the problems related to workload and work life of nurses are always present. In fact, they fester. Nurses need to take action to end this through their organization. One such organization is the American Association of Nurses.

Currently, the problems associated with overloading nursing staff in hospitals have only exacerbated the crisis of nursing in the early 2000s. Overcapacity has led the nursing in the corridors, i.e., care in hallways, patient lounges, and other inappropriate places, poorly equipped and exposed. Overcapacity occurs mostly because of a lack of other levels of care in the community, including lack of care homes, community services and home care. Included in this situation is the lack of insurance for many Americans who seek care in emergency rooms that should have been dealt with in non- urgent settings. Overloading is linked to an increased risk of morbidity and mortality in the hospital, including increased incidence of pneumonia, poor pain management, poor management of acute chest pain, and delay in the administration of antibiotics compared to recommended protocols, increasing the number of hospital readmissions, and decreasing the degree of patient satisfaction. This is directly related to an increase in career dissatisfaction in nursing.

The unhealthy work environments continue to threaten the safety of care provided by nurses. Frequent interruptions, confusion about roles, technical support and limited human resources, lack of integration and coordination within the system, the continuous increase in the acuity of patients, lack of decision-making independently and to participate in decisions about the care of patients continue to have a negative impact on nurses and their patients. Today, nurses display a high degree of exhaustion, absenteeism, and turnover and job dissatisfaction. Studies establish a direct link between the degree of satisfaction of nurses and that of patients as well as the inverse, dissatisfaction. (Jones and Gates, 2007).

According to surveys conducted among nurses in primary care in America, the problems related to the workload and safe staffing problems occur on a daily basis. The study of nurses mentions being out of patience because of inaction or change despite evidence linking staffing to secure positive outcomes for patients.

Stress & Burnout

Stress and compassion fatigue is constant in nursing and health care. It has been considered a professional risk since the mid-1950s. Furthermore, working circumstances appear to be worsening at the same time that a relentless and prolonged nursing shortage is taking place (Poghosyan et al., 2010). Leaders of health care organizations can no longer delay a real action plan with measured results to these findings. This action is no different than what we take for our patients, which is now accepted as the standard of care. As institutional leaders need to manage their financial resources, they also need to review how environmental stress is influencing patients and staff and take action to correct the detrimental circumstances. What is the ultimate cost of an overworked nursing staff to an institution and those it serves?

Medication Errors

A recent study by Statistics America found that nurses who work extra shifts due to staff shortages are more likely to make medication errors. The study is based on a survey from 2005, conducted among 19,000 nurses, where 19% of respondents reported having committed frequent medication errors during the previous year (Tourangeau et al., 2006). The study notes that, in most cases, these errors had occurred during overtime, increased workload, staff shortages, or in conditions where peer support was non-existent and labor relations with physicians were poor. In fact, among nurses who regularly work overtime, 22 percent of respondents reported medication errors, compared to 14 percent for staff that is not working overtime or overloaded.

At the beginning of the millennium, the American government, and those of other countries recognized the crisis in the health care sector. Because of the nursing shortage internationally, and evidence that nurses are exhausted, stressed and overwhelmed by their workplace, ten major national reports were commissioned between 2000 and 2006 in order to better understand the problems of nurses in the health care system.

Nurses everywhere want solutions to these problems. They turn to the solutions implemented in California and some states of Australia where nurses were able to push and get nurse-patient ratios prescribed by laws and collective agreements through bargaining. Such ratios limit the number of patients to be addressed by a nurse. For example, in California, a 1:4 ratio is prescribed by law for patients needing a high level of care. Scientific data using measurable outcomes dictate a nurse to patient ratio based on factors such as the intensity of care. (Spetz, 2004).

An alternative to prescribed ratios is a dynamic model of shared decision-making with respect to staffing (American Nurses Association, 2005). This model takes into account both the characteristics of patients and nurses and includes a process by which the nurse frontline staff directly involved in decisions about staffing. The synergistic model of care for the American Association of Critical Care Nurses has been adapted to decisions relating to sectors other than intensive care and was implemented in British Columbia and Saskatchewan. The shared decision-making has increased the participation of nurses in decisions about staffing, and they give a very good rating in the process. There is an increase in workplace satisfaction!

The nurse-patient ratios prescribed, and dynamic models of shared decision-making, are encouraging for nurses on the front lines are out of patience because of the inaction to improve the workload and life nursing work and the experience of patients and their families. Nurses want to act immediately to establish a safe staffing process. Nurses need to ask, earnestly, that policymakers implement immediately mechanisms and procedures for data collection to record the expected improvement in patient outcomes related to nurse-patient rations. In addition, funding institutions and health programs should be based on improvements in patient outcomes and indicators of care and working conditions of nurses that create job satisfaction (MacPhee et al., 2010).

In this same vein, the DHSS (Defense Health Services System) has developed and funded a training program to facilitate the integration of auxiliary nurses in the operating room, this measure with the goal of reducing the waiting time for some surgeries. It is clear that this program has had little effect. There were 292 nursing assistant candidates entering between 2008 and 2011; only 93 had completed training on 30 September 2009 and, of those, only 60 were employed in this sector. Training is not enough. The utilization of trained auxiliary nursing personnel is the key to success.

Finally, we need to agree to recognize the immense contribution of health professionals as a whole, especially in the difficult circumstances that we know today. The incentives must be fair to all. Although incentives, such as remuneration, will vary depending on skill level it should not vary in recognition of contribution and respect for the jobs of a team well done.

Given the urgency of the situation, it is necessary for the government to act quickly by investing additional funds to improve the quality of our health care system and to fully utilize each resource based on skills, including nursing assistants, and offer attractive working conditions and competitive remuneration. These are solutions that we must take into action with a defined purpose and measurable goals along with evaluation and adjustments as needed during the process.

Results of the Study

Overall, the results confirmed what was expected – however, the issue at the organization under study does not seem to reflect the overall problem of nursing shortages and staffing retention. Of those surveyed, 75% of respondents somewhat agree that they have workplace encouragement, feel accomplished and have the tools necessary to do their job effectively. Of those who answered in the affirmative, it is apparent that their skills are used and goals are clear. 10% strongly agree with the same while 6% neither agree nor disagree. The other 9% disagree – not a high percentage, given the relevant literature that the paper discussed above.

When asked if they understood why it is so important for the organization to value diversity (defined as recognizing and respecting the value of difference), over 90% said that they did. In contrast, only 70% agree or somewhat agree that the organization in question actually values diversity. Roughly the same percentage said that they had a positive feeling about managements' communications, the level of input employees have in the workplace decision making, and understanding of change, expectations, and commitment to quality care. 5% somewhat disagree with this, while 20% neither agree nor disagree and 5% strongly agree. Despite some of the misgivings reflected in the above results, overall, 80% state that they somewhat agree to a continuation of employment with the company, 10% strongly agree and another 10% neither agree nor disagree. Surprisingly, no one was in the ‘disagree’ or ‘strongly disagree’ category in regard to continued employment probability. The same was true for overall job satisfaction.

Under the “Job Passion & Self-Evaluation” section, the results were not as heartening. For categories of management, supervision, and personal growth, the range of those who either agreed or strongly agreed with the statement that these expectations were being met was between 50% and 70%. However, the ‘overall value of service’ was closer to 80%. The implications of these results will be discussed below, including the recommendations that should follow from the results.

Finally, under the ‘Job Retention’ portion, participants’ responses reflected what would be expected from the rest of the questionnaire. While very few indicated that they ‘Strongly Agree’ or a ‘Very Satisfied’, almost all (more than 80%) of respondents said that they feel satisfied with their position at the organization and that they are recognized as individuals. Even more telling, less than half (43 percent) of respondents said that they ‘Agree’ or ‘Strongly Agree’ with the statement that “The company clearly communicates its goals and strategies to me,” while almost double that amount (82 percent) said that their job requirements are clear. This may reflect a larger issue with the organization’s management and leadership, which is discussed below.

Recommendations

The overall point of this research project is not simply to provide a description of the problem of nurse staffing shortages. Instead, it provides suggested solutions to the problem. More specifically, two questions are addressed through the Literature Review, research design, and research results. What are the possible scenarios of nursing shortage solutions? What can the government, associations and nurses do to prevent a crisis in our profession from escalating? These solutions are given under the governmental, professional, and individual headings specifically.

Government Bodies

It is necessary to upgrade the nursing profession and make it desirable for young people who want a career in the field of health care. The government must have a vision and a strategic action plan to meet the needs of nurses. Nursing associations like the ANA need to interface with the government (both local and national) and institutions of higher education and those who hire nurses to campaign for a positive light on all the profession has to offer. They also need to formulate a national plan spanning from locale to locale to model the best that nurses and their care have to offer. With this model of performance on stage, the profession and workplace satisfaction can become a reality nationwide.

Professional Associations

Professional representatives can participate in solutions to this crisis. During the past decade, professional associations, speaking in a loud voice, were more politically active. They took the opportunity to assert ideas and concerns. Involving the general population of nurses would go a long way to advocate for the profession.

Given the severe shortage looming, the role of the nurse in the health care system needs to be rethought. We have too long denounced the hiring of paraprofessionals who were replacing nurses. It might be time to examine the contribution of these and their relationships with nurses? Thus, the nurse could act as a coordinator of care, management if you will, and

as a care team leader. Team is the idea here. The expanded role of nurses reduces the overall number needed to deliver the best care and addresses the shortage as well. Moreover, with an increasing number of graduate nurses or holders of master's and doctoral degrees, the profession is expected to further specialize, to develop and grow in leadership.

The value of the profession by nurses themselves and the government would probably create a renewed interest on the part of young people. But we must also work to keep nurses with experience (the ultimate educator) on the job. Retention strategies for nursing staff must also be developed or renewed in this area. Studies suggest that hospitals that have a high rate of job satisfaction have fewer retention and recruitment problems. They also have more favorable outcomes and community opinions. These strategies include an active monitoring of continued satisfaction and a continued view to improving from a management perspective. This means that the organization must remain respectful and inclusive of nurses in decision making. Even more specifically, it would serve staff retention rates to learn the career and advancement goals within the given organization.

Individual Nurses

Individual nurses can do their part in improving the overall situation. As the results of this research project reflect, nurses have an overall understanding of the importance of their care and the organizations that they are working for. Despite this understanding, their honest reflection on their personal performance and provision of service shows that there is much to be worked on. While the governmental and institutional solutions suggested above will prove to help the situation, it is up to individual nurses to ensure that the service that they provide and the culture that they create is helpful to the nursing profession. This paper cannot suggest specific solutions – creating this beneficial atmosphere will be up to the individual nurse in an individualized setting.

Criticisms & Connections

Of course, any research project is left with room for improvement. For this particular case study, this means a more generalized approach and more content to include in recommendations. A more generalized approach could be reached by expanding the scope of the respondents. As noted earlier, the analysis of just one health organization should give insight into the field as a whole. However, to ensure statistically accuracy and professional relevancy, a research project that expands beyond the walls of just one organization could improve this existing research project.

In addition to adding numbers, a more generalized approach could be reached by increasing the scope of the questionnaire. Secondly, if researchers had more content available for analysis, more specific (or more accurate) recommendations could be made. Including additional research methods in the project – for example, case studies of specific practices and panel sessions to glean more specific insight. Including these additional methods could attain the content needed for a deeper analysis of the problem and potential solutions. Including these methods in an overarching project would help in getting to the root of the nursing profession’s problem of staff shortages.

Despite these potential limitations, the above research project is pertinent to the Master’s level study of Management and Leadership. Any study of Management & Leadership requires the analysis of a ‘real-life’ situation. This is precisely why the study of the nursing profession – and even more specifically, the problem of nursing retention – helps to confirm and reinforce knowledge gleaned from a Management and Leadership Master’s program. The long-term benefits of this understanding of the nursing profession have been made clear in the discussion section. However, this section discusses the benefits of Management and Leadership overall. This research project helped in this understanding in two specific ways, each of which is discussed in turn below.

First, the research design was aimed at addressing the problem of nurse retention from a Management and Leadership perspective. The questions that were asked and measured in the questionnaire specified areas of satisfaction and dissatisfaction within the organization, methods of support, levels of feedback, expectations from the management and leadership, etc. This specification helped in narrowing down what the potential causes of the problem could be and specify potential solutions. Addressing the problem of a management and leadership perspective required these specific questions. The questionnaire design could be applied across other management fields as well.

Second, it is clear that nursing retention is relevant to the question of effective management. The results and subsequent discussion noted that the major part of any given solution to the problem of nurse retention ought to be from a management perspective. Organizations and institutions must do their part to ensure that their nurses are receiving an adequate level and fair balance of support, supervision, and feedback. This is the clearest part of the results. While the suggestions outlined above are more general in nature, the most specific aspect is the discussion of better management in nursing facilities. This research project found that better nursing practices and professions require better management in nursing facilities – exactly what these management styles should look like is a question for a subsequent research project.

Conclusion

Everything is not bleak in the world of nursing. Indeed it has been on the move to educate and advance itself through advancements in expectations. It is now known that a bachelor's degree is most desired as a criterion for admission to the practice of the profession. Master's programs and doctoral degrees are increasingly popular with nurses who wish to deepen their knowledge in nursing and advance their careers as well as the profession. At the same time as the causes of shortages are comprehensive, and there is no particular national measure of their level, there are growing factors indicating the negative impact of comparatively smaller staffing levels in health care delivery.

Of course, each of the elements discussed above is critical in their influence over a nurse’s decision to stay with a given institution. However, the project’s research results show that the most important aspects of nurse retention are also the most personal aspects. Professionals and academics alike must consider a nurse’s workplace accomplishments, the tools they need to do the job, and encouragement in their field. It is in process and needs to be celebrated and promoted not only from external entities but from those who practice as well (Speybroeck et al., 2004). Nurses can be their own champions to repair the system in which they work and can flourish.

Overall, it seems clear that nursing must take the lead and an active role in reforming the workplace. The cycle of change that can ensue will create better job satisfaction among nurses, more qualified nurses and, as a matter of consequence, more retention of seasoned nurses and staff. This will improve both the health care profession as a whole and, more specifically, the clients that health professionals serve. This project leaves more questions to be answered, but the questionnaire and its results give a good starting point for making the changes needed for an effective profession.

The goal of this project was to provide insight into the shortages of nursing staff and to provide initial suggestions for improving organizational and administrative policies. Both the review of relevant literature and a discussion of the survey conducted for this project support the contention that nursing organizations must encourage collaboration and participation in their nursing staff, in order to avoid a high turnover rate and subsequent staff shortages. Further research into this initial suggestion will prove beneficial for the future of the nursing profession.

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