The Nurse Retention Problem in the US
The nurse retention crisis has become a pertinent issue that must be addressed sooner rather than later for the welfare of the American people. The role of nurses in the healthcare process cannot be overlooked and their retention is a priority to prevent a full-blown overload of the entire American healthcare system. The turnover of nurses into other careers following their resignation from nursing-related fields despite adequate qualifications leaves hospitals massively understaffed. Some of the solutions geared towards fixing the nurse retention crisis include reducing overtime for nurses, sufficiently staffing hospitals, and developing a shared governance structure. Developing a workplace culture of cooperation and recognizing the need for a work-life balance for nurses is also crucial.
Review of Literature
Strategy for Searching/Retrieving Articles
The articles included within this section will be acquired through a thorough search of major online databases. The databases included include Google Scholar and BMC Nursing amongst others. The keywords for the search are nurse turnover and nurse retention. The search will be limited to articles from within the last five years to boost relevance and within the United States of America for the same reason. The articles will be included within the study when their titles and abstracts meet the criteria of covering the required topic. An acute reading of the articles selected will ensure they are eligible for inclusion in the final paper if their content corresponds with the required information.
Scope of the Problem
Nurse retention has been a massive challenge for the US healthcare system in the last few years, with sufficient reason for the rate to increase in the future. NSI Nursing Solutions, Inc, (2020) indicate that nurses are most likely to resign from their positions within the first year after employment, with 24.1% quitting (p. 10). Additionally, nurses who have worked for between two to five years at a health facility have a second-highest probability of resigning at 23.7% (NSI Nursing Solutions, Inc, 2020). This indicates that nurses who are new to the career have an immense rate of resigning due to the initial difficulty associated with the job hence loss of energetic workforce. The resignation of nurses with about 5 years’ experience indicates the loss of a crucial workforce with a massive understanding of the profession. NSI Nursing Solutions, Inc, (2020) also discovered that nurses working in step-down, behavioral health, emergency, and surgery specialties recorded high rates of resignation at 18.5%, 20.6%, 18.5%, and 17.5% respectively (p8). Advance practice nurses were also recorded to massively resign from their positions to pursue alternate careers. A certified nursing assistant at 26.5% was the highest, followed by patient care tech at 26.4%, then speech therapist and registered nurse at 15.9% (NSI Nursing Solutions, Inc, 2020, p. 9).
The research indicates that hospitals in the US have been and continue to face the danger of losing vital staff due to various factors. The loss of crucial healthcare workers is critical due to the roles performed by nurses within the healthcare facilities and the difficulty likely to occur if nurses are absent. Additionally, nurses within the American healthcare centers are already overworked, owing to understaffing. The exit of present nurses implies that this problem continues to become aggravated. The population of the American people continues to become an aging one due to the minimal increase in births compared to other decades. The ability of the healthcare system to handle chronic conditions and have patients living longer with them is also noteworthy. The two factors enlisted above mean that the nurses are poised to have greater responsibilities in the future to care for patients. There is a need for the US healthcare system to cushion its healthcare system from foreseeable overworking conditions by ensuring nurses are retained.
Causes of the Turnover
One of the major reasons why turnover is popular within the US healthcare system and retention is low is the presence of long shifts for nurses. Nurses mostly spend 12 hours on average at work in the hospital due to overtime as compared to other workers who spend eight hours per day (Stimpfel et al., 2019, p. 317). This is the major reason for turnover and has been blamed by former US nurses (Munro & Hope, 2022). They claim that the long periods they spend at the healthcare facilities are not well compensated and this means their lives are affected in the process. The role of the nurse in healthcare cannot be ignored when they save the lives of patients. At the same time, their role in their own lives and healthcare, including mental health, cannot be ignored. The nurses cannot spend sufficient time with their families and loved ones hence challenging social lives.
Nurses also attribute the high levels of turnover to the poor working conditions within the healthcare facilities. These conditions are characterized by the understaffing within the hospitals hence overworking of some nurses as the facilities do not meet the recommended patients to nursing ratio. The overworked nurses also face the challenge of having to carry out procedures that are not within their professional qualifications (Collard et al., 2020). The inadequate number of doctors means that the nurses have to take up double tasks. This makes the job of a nurse difficult to perform and prompts them to resign and pursue careers that are more fulfilling and considerate of their welfare. Hospitals are sometimes also characterized by management that shows minimal regard for their staff through poor and inhumane management. The nurses are not involved in the decision-making process despite their massive contributions.
The rate of turnover can be reduced through decreased overtime that ensures the nurses do not work beyond the normal time. This is likely ensure that the nurses do not view the profession as an exploitative field (Watanabe & Yamauchi, 2018). Additionally, this should provide the nurses with sufficient time for rest, hence minimizing cases of mental illnesses amongst these professionals. The decreased overtime is intended to refocus the nurses so they pursue the career as a passion choice rather than a financial-oriented choice. Nurses are poised to benefit from the reduced overtime which ensures that they can pursue other passions that can use their spare time. The additional passions can be side, money-generating ventures, or mere hobbies that better their lives.
Develop Shared Governance Programs
The incorporation of nurses within the decision-making circles through government programs is a vital method of ensuring increased retention. The shared governance program should include all shareholders and staff within the healthcare centers, with adequate representation (O’Grady & Clavelle, 2021). This ensures that nurses view the healthcare center as an entity invested in their wellbeing. Additionally, the needs of the nurses within the hospital can be presented first-hand by the aggrieved party, preventing decision-making based on hearsay. Apart from the retention of nurses increasing, the hospital benefits from greater holistic leadership and management (Ayaad et al., 2018). Shared governance also entails including nurses in regulations that involve their employment and remuneration for greater understanding.
Ensure Adequate Staffing Levels
Adequate staffing levels are a strategy geared towards ensuring the massively overworked nurses have minimal workload. This also ensures that the understaffed hospital is more effective at providing healthcare services for its patients. Increased staffing is an effective solution in increasing the performance of other sectors of the economy. Adequately staffing the hospitals with a sufficient number of nurses involves ensuring the hired nurses retain their jobs and that the newly employed ones are willing to hold their positions. This can be achieved through the establishment of enticements that encourage the nurses such as healthcare coverage, regular promotions, and sufficient remuneration.
Recognize Nurses’ Need for Work-Life Balance
Hospitals and other healthcare centers that rely on the expertise of nurses must recognize the humane aspect of their lives. This means treating the nurses as regular people with normal lives to attend to in their time outside the work environs. The nurses must be allowed regular leaves like other professions to ensure they can spend sufficient time with those who matter to them (Cox, 2019). Additionally, this can be achieved if hospitals emphasize the working hours for various nurses and set clear timelines for their shifts. This guarantees that nurses are not called from their free time to attend to patients as the hospital has adequate workers during such periods.
A Workplace Culture of Collaboration
The relationship between nurses and physicians is often usually a tense one with the two conflicting over the roles performed. Nurses find it difficult to work in an environment where doctors belittle them and their contribution to healthcare (Lin et al., 2019). This is a reason for turnover and can be eliminated by encouraging cooperation between the two parties. Nurses and doctors can be trained to coexist peacefully and in the best interests of the patients (Jones et al., 2019). The existence involves either party correcting the other and offering leadership within the wards whenever it is lacking.
Solution by Nurse Leader
The solutions mostly employed by the burse leader were a collaboration of most of the solutions provided. The identification of overtime as a major factor was a driving factor for the leader to suggest an increase in the number of nurses within the hospital. This solution has been gradually employed with the hospital drafting a 5-year plan that is geared towards increasing the number of nurses in the healthcare facility to meet the required number. Additionally, the hospital has prioritized the inclusion of nurses within the decision-making spheres, a move that offers them a voice in determining the fate of the hospital. This move has had the nurses’ welfare developed by the nurse leader and this has bettered the hospital.
In conclusion, nurse retention is an important part of US healthcare and must be given sufficient weight to prevent a collapse of the sector. The role of nurses in the health process cannot be overlooked and must be addressed with the seriousness it warrants. Nurses mainly leave the nursing profession in favor of other careers due to being overworked. This is due to the challenge of understaffing within various hospitals. Nurses are also challenged with striking a workplace-life balance and this causes massive resignations with the fresh and energetic members of the force being the highest quitters. The decreased number of nurses means the healthcare centers are ineffective and people suffer. Increasing the number of nurses and including them in the decision-making process is key in solving the challenge of turnover.
Ayaad, O., Alloubani, A., Thiab, F., Yousef, D., & Banat, B. (2018). Adopting a shared governance model to improve nurses’ working environments. British Journal of Healthcare Management, 24(12), 594–602. Web.
Collard, S. S., Scammell, J., & Tee, S. (2020). Closing the gap on nurse retention: A scoping review of implications for undergraduate education. Nurse Education Today, 84, 1-8. Web.
Cox, C. A. (2019). Nurse manager job satisfaction and retention. Nursing Management (Springhouse), 50(7), 16–23. Web.
Jones, A., Rahman, R. J., & O, J. (2019). A crisis in the countryside – Barriers to nurse recruitment and retention in rural areas of high-income countries: A qualitative meta-analysis. Journal of Rural Studies, 72, 153–163. Web.
Lin, C.-F., Huang, C.-I., Yang, C.-M., & Lu, M.-S. (2019). The relationship between work environment satisfaction and retention intention among nursing administrators in Taiwan. Journal of Nursing Research, 27(5), 43. Web.
Munro, C. L., & Hope, A. A. (2022). Improving nurse well-being: The need is urgent and the time is now. American Journal of Critical Care, 31(1), 4–6. Web.
NSI Nursing Solutions, Inc. 2020 NSI National Health Care Retention & RN Staffing Report. Web.
O’Grady, T. P., & Clavelle, J. T. (2021). Transforming shared governance. JONA: The Journal of Nursing Administration, Publish Ahead of Print. Web.
Stimpfel, A. W., Fatehi, F., & Kovner, C. (2019). Nurses’ sleep, work hours, and patient care quality, and safety. Sleep Health, 6(3), 314-320. Web.
Watanabe, M., & Yamauchi, K. (2018). The effect of quality of overtime work on nurses’ mental health and work engagement. Journal of Nursing Management, 26(6), 679–688. Web.