Health care is one of the leading labor-driven services not only in the United States but also elsewhere around the world. The success of providing healthcare services depends on the skills and talents of every staff member, whether subordinate or technical. Finding, recruiting and retaining such efficient and talented people is crucial to providing exceptionally efficient healthcare to people. Most healthcare systems strive to ensure a high rate of retention but understanding the real costs of turnover should be the beginning point. Analysing the causes of nurse turnover is another important factor that should inform management on what steps to take to reduce nurse turnover. First, there is a heavy financial burden that negatively impacts the healthcare system. Every time a nurse leaves the organization, advertisements and recruitment have to be done. The exercise is costly and time-consuming. Secondly, organizations with poor nurse retention rates suffer negatively regarding continuity of care. When there is a discontinuity, patients suffer most because they do not receive the requisite good healthcare. Medical staff satisfaction, staff workload, and training costs have a high impact on healthcare provision. Therefore, an in-depth analysis of some of the causes of nurse turnover is necessary before determining ways through which the trend can be reversed.
Causes of Nurse Turnover
Conflict is inherent in human beings because of complex care issues and dynamism especially in the healthcare sector (Mckibben, 2017). Conflict at the workplace is one of the most significant causes of nurse turnover and, therefore, understanding ways through which they can be resolved can be an important step towards reducing nurse turnover. Other than complex care issues, conflicts in the workplace can be attributed to the hierarchical organizational management that is used by many heath care facilities. Some staff members (nurses) may feel as being dominated and do not have a voice which results in a conflict leading to staff turnover (Mckibben, 2017).
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Indeed, modern-day nurse managers have a massive task of managing and supervising nurses from different generations who have diverse personalities, values, characteristics and work ethics (Mokoka, 2015). Managing multigenerational workforce is a daunting task that require better skills to make the people work in harmony. The first generation in nursing is the “silent generation” also called traditionalists who are characterized by patience, respect, and loyalty. Most people of this generation are in senior management positions, but they find it difficult communicating with younger generations. This is because they mix pleasure and work yet young people love working and having fun at the same time. The second generation is “baby boomers” who are characterized as being workaholics, a majority of nursing workforce, communicate freely and they like to challenge hierarchy fearlessly (Mokoka, 2015). Even though baby boomers are considered as hardworking, and they have a stronger personality, they are likely to clash with later generations because of differences in characters.
The third generation is "Generation X" who were born in 1961 to 1981. They are characterized as risk takers, job-focused, family oriented, self-reliant because of their upbringing, direct, and they do not hesitate to tell top management on what they believe should be done (Mokoka, 2015). They often seek to learn and grow which compels them to keep changing jobs for them to develop. To retain them, it is imperative that management must provide an environment where learning, growth, development, and progression takes place. The last generation is “Generation Y" who were born from 1980-2000. This generation is defined by television talk shows, school violence, internet, and multiculturalism. They are diverse, confident, social and diverse in their lives. Research indicates that this generation prefers jobs that give them a variety of careers and a chance to grow (Mokoka, 2015). All these generations pose a more significant challenge to nurse managers because they must ensure that they work together harmoniously.
Nurse staffing levels have a direct impact on patient outcomes. Burnout and job dissatisfaction are also vital elements to be considered in light of nurse staffing. There is a nursing shortage in general for state hospitals meaning management has to find a way of compensating for this shortage (“Management Connections”, 2013). Most hospital administrators use mandatory overtime, night shifts and more extended work shifts which result in a likelihood of medical errors. Desired staff levels need to be achieved through nurse staffing models based on various staffing requirements. Additional staffing does not necessarily reduce profits of health organization instead it increases the operation efficiency thus reducing operating expenses (“Management Connections”, 2013).
The work environment for nurses plays a crucial role in the provision of healthcare services. A poor work environment is one of the major impediments for nurses to enjoy their work which eventually leads to high nurse turnover (Homer, et al., 2014). Some of the factors that contribute to the poor working environment include poor skill mix, increased expectations from patients, shift issues, not involving nurses in decision making, constant change at the workplace and higher patient to nurse ratio (Homer, et al., 2014). As Homer et al. 2014 notes, all the above factors contribute to having a poor work environment for nurses causing most of them to quit or shift to other professions.
Solutions for Improving Nurse Retention
Nurse managers and leaders should have active listening and communication skills. This is because nurses resonate well with their leaders when they learn to listen and address issues that they raise. For instance, when there is a conflict, effective leadership requires listening, transparent communication and understanding where the conflict emanates from (Mckibben, 2017). Transformational leadership is the best according to Mckibben (2017) because it inspires and motivates the team members to achieve higher results thus supporting the vision of the health organization.
A study by Saleh (et al. 2018), indicate that ward nurses regard their relationship with nurse leaders as vital in getting their job satisfaction. A high level of job satisfaction by nurses was attributed to cooperative, understanding and supportive leadership by nurses (Saleh et al. 2018). Nurse leaders need to initiate and develop amicable relationships with nurses by designing leadership training thus increasing the fruitfulness of the organization (Saleh et al. 2018).
Collegial support and perceived autonomy to carry out duties is also another great way of ensuring nurse retention (Takai et al. 2016). A study by Takai (et al. 2016), indicates that nurse managers that supported nurses to gain confidence and be sure about their jobs produced better patient outcomes. Another way of ensuring nurse retention is for nurse managers to have a well-established reward system that focuses on recognition and appraisals (Homer et al. 2014). Management practices also need to be improved so that workers are actively involved in the decision-making process so that there is more responsiveness to nurses’ needs (Homer et al. 2014). This is mostly important when the top management of the organizations introduces changes of the policies or strategies adopted by the facility. Considering that change induces stress on nurses if they are unable to adapt (Mckibben, 2017), nurse managers need to communicate with nurses prior to initiating any change so that every staff member in the organization is well prepared.
References
Homer, C., Roche, M., Dawson, A., Duffield, C., & Stasa, H. (2014). Nursing churn and turnover in australian hospitals: Nurses perceptions and suggestions for supportive strategies. Bmc Nursing, 13 (1), 1-10. doi:10.1186/1472-6955-13-11
Management connections: Nurse staffing levels linked to patient outcomes, nurse retention. (2013). Aorn Journal, 97 (1), 9. doi:10.1016/S0001-2092(12)01300-2
McKibben, L. (2017). Conflict management: Importance and implications. British Journal of Nursing (mark Allen Publishing), 26 (2), 100-103. doi:10.12968/bjon.2017.26.2.100
Mokoka, K. (2015). Managing a multigenerational nursing workforce to strengthen staff
retention: Forum. Professional Nursing Today, 19 (4), 42-45.
Saleh, U., O'Connor, T., Al-Subhi, H., Alkattan, R., Al-Harbi, S., & Patton, D. (2018). The impact of nurse managers' leadership styles on ward staff. British Journal of Nursing (mark Allen Publishing), 27 (4), 197-203. doi:10.12968/bjon.2018.27.4.197
Takai, Y., Yamamoto-Mitani, N., & Noguchi-Watanabe, M. (2016). How does collegial support increase retention of registered nurses in homecare nursing agencies? A qualitative study. Bmc Nursing, 15 (1), 1-8. doi:10.1186/s12912-016-0157-3
