Summary week 4

Instructions for Continuing Nursing Education Contact Hours

Nursing Staff Turnover Survivor Strategies Deadline for Submission:

August 31, 2020

MSNN1804

To Obtain CNE Contact Hours 1. For those wishing to obtain CNE contact hours,

you must read the article and complete the evaluation through the AMSN Online Library. Complete your evaluation online and print your CNE certificate immediately, or later. Simply go to www.amsn.org/library

2. Evaluations must be completed online by August 31, 2020. Upon completion of the evaluation, a certificate for 1.1 contact hour(s) may be printed.

Fees Member: FREE Regular: $20

Learning Outcome After completing this continuing nursing educa-

tion activity, the learner will be able to describe strategies that have been identified as providing support to the nursing staff and combating the nursing retention issue.

Learning Engagement Activity After reading this article, respond to the fol-

lowing self-assessment questions: • Is nurse retention a priority in your organization? • Does your organization have a Nurse Residency

or Mentoring program? • What strategies does your organization use to

maintain and support nursing staff? • Is your manager or administration actively

involved in these strategies?

The author(s), editor, editorial committee, con- tent reviewers, and education director reported no actual or potential conflict of interest in relation to this continuing nursing education article. This educational activity is jointly provided by

Anthony J. Jannetti, Inc. and the Academy of Medical-Surgical Nurses (AMSN). Anthony J. Jannetti, Inc. is accredited as a

provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Anthony J. Jannetti, Inc. is a provider approved

by the California Board of Registered Nursing, provider number CEP 5387. Licensees in the state of California must retain this certificate for four years after the CNE activity is completed. This article was reviewed and formatted for

contact hour credit by Rosemarie Marmion, MSN, RN-BC, NE-BC, AMSN Education Director.

4

Nursing Staff Turnover Survivor Strategies

CNE CONTINUING

NURSING EDUCATION

Sherry Barnard, Ed.D, MSN, RN

Nurse Retention, Survival Strategies

Nursing continues to face ongoing staffing shortages in many areas, includ- ing medical-surgical units (Wieck, Dols, & Landrum, 2010). The recently gradu- ated nurse will take a job in a hospital to gain experience only to leave within one year to pursue opportunities else- where (Kovner et al., 2016). This trend disrupts the staffing mix and results in inadequate nurse staffing ratios, ulti- mately affecting patient care. Negative outcomes have been linked to having inadequate nurse staffing ratios (Stanley, 2010). Many factors contribute to staff shortages and turnover such as high workload expectations, long hours, working off shifts, lack of sup- port, challenging or complex patient care, overall job dissatisfaction, genera- tion differences, perceptions of a lack of power, and incivility (Chan, Tam, Lung, Wong, & Chau, 2013; Hairr, Salisbury, Johannsson, & Redfern-Vance, 2014; Creakbaum, 2011). Ultimately, hospitals and nurse leaders must be strategic in their hiring practices to avoid spending countless hours and thousands of dol- lars on training new nurses just to have them quickly leave (Kovner et al., 2016).

Nurse Mentor or Residency Programs

Nurse residency programs can help solve retention challenges. Hospitals have developed nurse mentor or residency programs in an effort to improve new nurse retention. Nurse mentor or residency programs have been shown to improve nurse reten- tion rates. D’Ambra and Andrews (2014), described how the experience of new nurses can improve significantly when they are part of a nurse mentor training or residency program. Both mentoring and residency programs can

help new nurses effectively manage the challenges they face.

Residency or mentor programs use their most experienced nursing staff to train and guide new graduate nurses (Cochran, 2017). The new nurse follows and works with the experi- enced nurse and slowly increases the workload of the new nurse as comfort levels increase. Flexibility is often built into the programs so the new nurse can guide his or her residency length based on their individual comfort level or prior experience. Education is also typically provided for unit specific skills along with simulation scenarios for more challenging skills. New nurses learn about time management, practice their newly learned skills with support, and get socialized to their new role. Additionally, incivility or lateral violence courses are included in most of these programs. There is greater retention and length of commitment when new nurses are provided residency or men- toring type programs and training (Cochran, 2017). A residency program is a survival strategy that all hospitals should pursue to be competitive in hir- ing and retaining staff.

Generational Influences Generational differences are

another part of the retention issues that hospitals are facing. A mix of nurs- ing staff from a variety of generations is a common scenario in hospital units. Understanding the needs, differences, and values of each nurse generation is a critical step in retaining nursing staff. Valuing generational differences can result in nurse retention. Nurses that change jobs frequently describe that they do not find the environment to be rewarding or satisfying (Scammell, 2016). These influences merit a better understanding of the differences in gen- erations. A review of the generational

5

866-877-2676 Volume 27 – Number 4

differences and how these can be blended in the workplace is outlined in Table 1.

Finding the Common Ground

It is important for nurse managers and nurse leaders to embrace the com- monalities in the generations instead of focusing on the differences. Nurse lead- ers can do this by adopting a collabora- tive environment that promotes the strengths of the individual nurses. Each generation can offer value to the work- place and can play a key role in optimiz- ing healthy practice environments. Experienced nurses often have solid and irrefutable experiences to bring to the table. They are experts in the work- force and are often able to mentor future generations. New nurses often come to the workplace with vitality, energy, and are technologically savvy. The inexperienced millennial genera- tion is the future of the nursing profes- sion and they must be nurtured in order to develop them into expert nurses. Nursing and healthcare cannot survive without generationally diverse nurse groups. Nurse managers must promote respect, be courteous, and have a personal interest in each nurse to develop the blend of generations and each unique contribution to the work- place (Stichler, 2013). Fostering the gen- erational differences can enhance nurs- ing environments and promote a colle- gial and supportive culture (Wieck, Dols, & Landrum, 2010).

Combating Incivility Nursing is a challenging profession.

Demanding hours, highly acute patients, new technologies, declining resources, and a continuously evolving healthcare environment are only a few factors that nurses deal with daily. These factors can create a toxic work environment, quickly devaluing staff and morale and increasing the costs of unwanted turnover. Facilities can combat incivility by developing a “no tolerance” policy which may promote a safer and more inviting environment (Hoffman & Chunta, 2015).

Promoting a positive workplace can also help tackle this problem. Some

strategies to promote positive work environments include displays or bul- letin boards on nursing units to post positive notes to nursing staff. Hospitals using positive display board methods have named such displays “appreciation board” or “recognition board.” Staff can put up a card with comments such as “thank you for helping me with my admission” or “you were a big help to me when I was overwhelmed, you are

awesome!” (Pan, 2014). This positive feedback has been shown to improve the staff morale and work environment because it encourages teamwork and support.

Ongoing staff education can also combat incivility by showing value and investment in the nursing staff. One example is a journal club where nurses meet once a month after reading assigned evidence based practice arti-

Veterans Born 1925-1942

Baby Boomers Born 1943-1960

Generation X Born 1961-1981

Millennials Born 1982-2000

Age range 75-92 57-74 36-56 17-37

How many in the workforce currently (2017)

5% or less 40% 40% 15%

Characteristics to consider

Loyal, dedicated, hardworking, strong work ethic

Productive, workaholic, opti- mistic

Independent, cyn- ical, informal

Confident, impa- tient, social

Generational specifics

They grew up dur- ing World War II, patriotic, loyal, understand rules, dislike waste

Deemed the most productive workers, they grew up during the Vietnam War, presidential assassinations, peace and love movements, are over achievers, work is impor- tant to them

Born during the fall of the Berlin Wall, Music Television (MTV), Aids epidemic, many of these children had divorced parents, latchkey genera- tion, going home after school with both parents working, less dedicated to work, would rather work to live than live to work

Grew up with more culture, international ter- rorism, tend to be protective and careful, social media is impor- tant, they are computer savvy, they have the least religion but are the most educated, they crave instant gratification, are very impatient, will leave if not happy

Workplace strategies

Allow them to work part-time in supportive roles, and or mentor roles, provide roles that are less physi- cally demanding, provide traditional rewards

Encourage men- toring or pre- cepting new graduates, pro- mote retirement goals, offer pri- vate feedback for criticism, but praise them for a job well done in front of their peers

Allow flexible scheduling (i.e. 12 hour shifts), pro- vide opportuni- ties for skill or leadership devel- opment, involve in decision mak- ing, avoid micro- managing

Provide frequent and immediate feedback, praise them in front of their peers, pro- vide use of social media and build on their technol- ogy expertise, develop their skills and intro- duce leadership

Table 1. Characteristics of Nurses by Generation

Stichler, 2013; Tourangeau, Cummings, Cranley, Ferron, & Harvey, 2010

cles to discuss the material and the possibility of implement- ing a new practice related to the article. Reading discussions promote critical thinking and up to date knowledge that nurses can apply to their valued workplace such as the med- ical surgical floor (Wiggy, 2012).

Staffing Ratios and Retention There is a direct correlation between nurse to patient

ratios and nurse retention (Van den Heede et al., 2013). When nurses are expected to take high acuity patients in large numbers due to staffing shortages, there are higher lev- els of burnout and decreased job satisfaction. Improving staffing ratios has been shown to improve patient outcomes, safety, and satisfaction (Hairr et al., 2014). Nurse leaders need to be mindful of nurse satisfaction when it comes to patient and staff ratios. The unit or nurse manager must have a keen knowledge of the staffing mix and utilize more experienced nurses when more difficult patients are on the unit. There are acuity tools and models that help charge nurses plan assign- ments, but each unit is unique and should develop a tool that includes skills and procedures specific to that unit. Jones (2015) developed a tool that uses color coding for patient acuity which can easily identify patients that need more care and can allow for planning for nursing assignments. Using an acuity tool for nurse staffing that matches complicated pro- cedures and patient needs with assignment numbers can pro- vide an evidence-based way to plan assignments (Jones, 2015). Matching experience with acuity can also help with reducing burnout and job dissatisfaction (Needleman, 2013). New nurses are not always prepared or ready to take on patients that need a great deal of care. Added support and flexibility with staffing can be useful strategies to retain an adequate nursing workforce. A supportive staffing model can be another survival strategy nurse managers can commit to in order to retain nursing staff.

Conclusion There are many areas to consider when combating

nurse retention and staffing issues. Retaining nurses should be a goal of nurse managers. Preventing new nurses from quickly leaving their positions due to poor staffing, lack of supportive environment, and overall job dissatisfaction is essential to healthy work environments. Nurse managers should make it a priority to implement strategies to preserve and support all nursing staff. Several ideas have been pre- sented such as having a nurse residency or mentoring pro- gram, using positive display boards, increasing experienced nurses when acuity increases, sensitivity to generational dif- ferences between nurses, no tolerance for lateral violence or nurse incivility, appropriate nurse-patient ratios, and journal discussion clubs. Programs that invest in new nurses are often more successful in retaining them (Cochran, 2017; Hoffman & Chunta, 2015). Finding ways to use the unique qualities of each nurse promotes a sense of belonging and team work (Stanley, 2010). It is the ultimate responsibility of the nurse manager to have full awareness of the staffing abil- ity, experience, and quality to be strategic in guiding assign-

ment planning. These survival strategies to combat nursing retention issues are essential in making staff consistency and job satisfaction for all nurses the new normal.

Sherry Barnard, Ed.D, MSN, RN, is an Assistant Professor of Nursing, Vermont Technical College, Randolph Center, VT. She may be contacted at [email protected]

References Cochran, C. (2017). Effectiveness and best practice of nurse residency

programs: A literature review. MEDSURG Nursing, 26(1), 53-63. Chan, Z. Y., Tam, W. S., Lung, M. Y., Wong, W. Y., & Chau, C. W. (2013). A

systematic literature review of nurse shortage and the intention to leave. Journal of Nursing Management, 21(4), 605-613. doi:10.1111/j.1365-2834.2012.01437.x

Creakbaum, E. L. (2011). Creating and implementing a nursing role for RN retention. Journal for Nurses in Staff Development: JNSD: Official Journal Of The National Nursing Staff Development Organization, 27(1), 25-28. doi:10.1097/NND.0b013e318199459f

D’Ambra, A. M.  &  Andrews, D. R. (2014). Incivility, retention and new graduate nurses: An integrated review of the literature. Journal of Nursing Management (22), 735–742. 

Hairr, D. C., Salisbury, H., Johannsson, M., & Redfern-Vance, N. (2014). Nurse staffing and the relationship to job satisfaction and reten- tion. Nursing Economics, 32(3), 142-147.

Hoffman, R. L., & Chunta, K. (2015). Workplace incivility: Promoting zero tolerance in nursing. Journal of Radiology Nursing, 34, 222-227. doi:10.1016/j.jradnu.2015.09.004

Jones, P. (2015). What works: Measuring acuity on a medical-surgical unit. American Nurse Today, 10(8). Retrieved from https://www.americannursetoday.com/works-measuring-acuity- medical-surgical-unit/

Kovner, C. T., Djukic, M., Fatehi, F. K., Fletcher, J., Jun, J., Brewer, C., & Chacko, T. (2016). Estimating and preventing hospital internal turnover of newly licensed nurses: A panel survey. International Journal of Nursing Studies, 60, 251-262. doi:10.1016/ j.ijnurstu.2016.05.003

Needleman, J. (2013). Increasing acuity, increasing technology, and the changing demands on nurses. Nursing Economics, 31(4), 200-202.

Pan, K. (2014). 6 ways to show nurses appreciation. Retrieved from http://www.mightynurse.com/6-ways-to-show-nurses-apprecia- tion-stories/

Scammell, J. (2016). Should I stay or should I go? Stress, burnout and nurse retention. British Journal of Nursing, 25(17), 990.

Stanley, D. (2010). Multigenerational workforce issues and their implica- tions for leadership in nursing.  Journal of Nursing Management, 18(7), 846. doi:10.1111/j.1365-2834.2010.01158.x

Stichler, J. F. (2013). Healthy work environments for the aging nursing workforce. Journal of Nursing Management, 21(7), 956-963. doi:10.1111/jonm.12174

Tourangeau, A., Cummings, G., Cranley, L., Ferron, E., & Harvey, S. (2010). Determinants of hospital nurse intention to remain employed: Broadening our understanding. Journal of Advanced Nursing, 66(1), 22-32. doi:10.1111/j.1365-2648.2009.05190.x

Van den Heede, K., Florquin, M., Bruyneel, L., Aiken, L., Diya, L., Lesaffre, E., & Sermeus, W. (2013). Effective strategies for nurse retention in acute hospitals: A mixed method study. International Journal of Nursing Studies, 50(2), 185-194. doi:10.1016/j.ijnurstu.2011.12.001

Wieck, K. L., Dols, J., & Landrum, P. (2010). Retention priorities for the intergenerational nurse workforce.  Nursing Forum,  45(1), 7-17. doi:10.1111/j.1744-6198.2009.00159

Wiggy, Z. (2012). Journal clubs can improve nurse involvement and patient care. AORN Journal, 96(2), C5. doi:10.1016/S0001- 2092(12)00722-3

Academy of Medical-Surgical Nurses www.amsn.org

6

Copyright of Med-Surg Matters is the property of Jannetti Publications, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.