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© 2016, MedAssets, Inc. All rights reserved. MedAssets®. Not to be reprinted without permission. For non-commercial use ONLY.
The Challenges of Procuring And Retaining Staff – Effective Leadership Strategies For Nurse RetentionDianna Goodwin MSN RN-BC
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Conflict Of Interest Disclosure
• Dianna Goodwin MSN, RN-BC: No Conflict Of Interest
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Objectives
• Identify Challenges Facing The Nursing Workforce
• Examine The Generational Gap • Discuss The Relationship Between Leadership Behaviors,
Work Environment And The Successful Retention Of Nurses
• Identify Evidence Based Strategies To Retaining Nurses
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Key Words
Leadership Behaviors
Nurse Retention
Nurse Staffing
Transformational Leadership
Generations
Nurse Leaders
Nurse Satisfaction
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Literature Review
I. Title of Article
A. Purpose/Aim
B. Reference
II. Study Sample
III. Methods
IV. Findings
V. Recommendations
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Bariatric Surgery
Obstetrics
Level 3 NICU
50,000 ER Visits/Year
Orthopedic Surgery
Cardiology
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Challenges Facing The Nursing Workforce
• Educating The Next Generation Of Nurses
• Aging Nurses
• Retention Of Experienced Nurses
• Aging Population
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Challenges Facing The Nursing Workforce
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Retention At Dameron
RN Turnover - 2015Turnover # 74Turnover % 24.9%Benchmark 9.1%
Previous Years Turnover %2014 25.7%2013 32.6%
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Retention Priorities For The Intergenerational Nurse Workforce
Wieck, K., Dols J. & Landrum P. (2010) Nursing Forum 45 (1), 7-17.
Purpose: Conduct A Generational Analysis Of Nurse Satisfaction And Management Priorities
Research Questions: 1. What Characteristics Do Nurses Value In Their Managers 2. What Are The Retention Priorities Of Each Generation In The Hospital Setting
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Sample Demographics
Wieck et al. (2010)
22 Southern US Hospitals Available Pool: 5,553 Nurses 2,102 Responses 1,773 Usable Surveys
Average Age: 42.7 Years
Critical Care 21% Med Surg 18% OR 12% ER 10%
Gen Y Gen X Boomersn=124 n=616 n=1033
AvailablePool: 5,553 Nurses 2,102 Resposes 1,773 Usable Surveys Average Age: 42.7
Critical Care 21% Med Surg 18% OR 12% ER 10%
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Methods
Wieck et al (2010)
Focus Groups: “What Is The Best Thing Your
Hospital Could Do To Keep You Working Another 5 Years?”
Survey: 1. Demographic Questions a. Measures Of Job Satisfaction b. Perceptions Of Safety 2. Nurse Manager Desired Traits 3. Nursing Work Index
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• Relationships Between Physicians And Nurses
• Collaborative Environment
• Autonomy And Control Over Practice
Factors Contributing To Nurse Satisfaction
• Safety And Appropriate Staffing
• Meaningful Recognition And Growth Opportunities
• Leadership Behaviors
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30% Of Nurses Under 26 Plan To leave Their Job in The Next 2 Years
40% Of Gen X Nurses Plan To Leave In The Next 5 Years
61% Of All Nurses Plan To Change Jobs In The Next 10 Years
Is Retention Possible?
Wieck et al (2010)
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Desired Manager Traits: Comparison Of Four Generations
Rank Gen Y Gen X Boomers Veterans
1 Dependable Supportive Supportive Supportive
2 Team Player Team Player Trustworthy Dependable
3 Supportive Dependable Professional Professional
4 Available Trustworthy Dependable Trustworthy
Team Player Trustworthy
Professional
SupportiveDependable
Wieck et al (2010)
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Tourangeau A., Thomson H., Cummings G. & Cranley L. (2013) Jorunal of Nursing Management 21, 473-482.
Generation Specific Incentives And Disincentives For Nurses To Remain Employed In Acute Care Hospitals
Purpose: 1. Identify The Generation Specific Reasons Why Nurses Leave Or Remain In Their Current Job
2. Develop Evidence Based-Generation Specific Strategies To Retain Nurses
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Sample Demographics
Wieck, K., Dols J. & Landrum P. (2010) Nursing Forum 45 (1), 7-17.
Average Age: 42.1
9904 Canadian Nurses Surveyed 3950 Surveys With Birth Year
Gen Y Gen X Boomersn=536 n=1557 n=1857
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Methods
Tourangeau et al (2013)
Focus Groups: 10 Incentives 15 Disincentives
Survey: 2 Questions
1. Which Of The Following Strategies Entice You to Remain In Your Current Job?
2. Which Of The Following Reasons Make You Think About Leaving Your Current Job?
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INCENTIVES• Reasonable Workload• Manageable Nurse to Patient Ratios• Supportive and Empathetic
Manager/Leader• Flexible Self Scheduling• Higher Pay• Additional Vacation Time• Paid Education Leave for School or
Conferences• Supportive Colleagues• Supportive and Responsive
Organization• Opportunity for Advancement
DISINCENTIVES• Inadequate Staffing
• Unmanageable Workload
• Emotional and Physical Exhaustion
• Opportunities Elsewhere
• Unsupportive Organization
• Poor Leadership
• Scheduling Conflicts
• Family Responsibilities
• Illness
• Inadequate Time to Do Job Well
• Work Place Bullying
• Inadequate Resources
• Poor Work Group Cohesion
• Lack of Educational/Professional Growth Opportunities
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Incentives To Stay In Current JobTop 4
Incentives to Stay
Generation Y Generation X Baby Boomers
1 Reasonable Workload
Reasonable Workload
Reasonable Workload
2 Manageable Nurse-Patient
Ratios
Manageable Nurse-Patient
Ratios
Manageable Nurse-Patient
Ratios
3Higher Pay
Supportive Manager/Leader
Supportive Manager/Leader
4 Supportive Manager/Leader
Flexible Scheduling
Additional Vacation Time
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Disincentives That Encourage Nurses To Leave Employment
Top 4 Disincentives Generation Y Generation X Baby Boomers
1 Opportunities Elsewhere
Inadequate Staffing
Inadequate Staffing
2 Inadequate Staffing
Opportunities Elsewhere
Emotional and Physical
Exhaustion
3 Unmanageable Workload
Unmanageable Workload
Unmanageable Workload
4 Emotional and Physical
Exhaustion
Emotional and Physical
Exhaustion
Unsupportive Organization
Inadequate Staffing
Inadequate Staffing
Unmanageable Workload
Inadequate Staffing
Unmanageable Workload
Unmanageable Workload
Emotional and Physical Exhaustion
Emotional and Physical Exhaustion
Emotional and Physical Exhaustion
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Generation Gap: Canyon Or Crevice?
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Rethinking Generation Gaps In The Workplace
• White, M. (2011) UNC Executive Development.
White Paper: Review Of Emerging Research
1. Highlight Values And Traits Generations Share 2. Using These Similarities To Improve Organizational Culture
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White, M. (2011)
Purpose: 1. How Do The Generations View Each Other 2. What Do They Expect From Their Employers 3. How Do They Define Ideal Leaders
Method: Survey 3 Generations
Sample: 5,400
Ben Rosen: Professor Of Organizational Behavior
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Challenging Work
Adequate Monetary Compensation
Opportunities For Growth And Advancement
Fairness
Work Life Balance.
Shared Work Expectations
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Leads by Example
Is Accessible
Helps Others See How Their
Roles Contribute To
The Organization
Acts As A Coach and
Mentor
Challenges Others and
Holds Others Accountable
Shared Ideal Leadership Characteristics
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Desire For Organizations To Succeed
Good Leaders
Success In Careers
Cannot Outrun Time
Unknown Future
Shared Values
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All Generations HaveA Desire To Work and
Are Committed ToGood Employers
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Nursing Unit Managers, Staff Retention And The Work Environment
Purpose: What Specific Aspects Of Leaders Performance Promote A Positive Work Environment
Duffield C., Roche M., Blay N. & Stasa H. (2010) Journal of Clinical Nursing 20, 23-33.
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Sample And Method
Sample: 21 Hospitals In Australia 3099 Potential Responses 2141 Responses
Method: Survey Nursing Work Index
Duffield et al (2010)
RN LPN CNA 72% 24.8% 2.4%
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1. Managers Who Consult With Staff On Daily Problems
2. Managers Who Are Good Leaders
3. Flexible Or Modified Work Schedules Are Available
4. Praise and Recognition For A Job Well Done
5. Senior Leadership Who Are Visible And Accessible To Staff
Top Five Leadership Behaviors
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The Relationship Between Managerial Leadership Behaviors And Staff Nurse Retention
Purpose: 1. Connect Perceived Leadership Behaviors With Staff Turnover
2. Compare How Managers Perceive They Exhibit Leadership Behaviors With How Nurses Perceive Managers Exhibit Leadership Behaviors
Kleinman C. (2004) Hospital Topics: Research and perspectives on healthcare 82 (4), 2-9.
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Study Sample And Method
Sample: 475 Bed Hospital In North East US
79 Nurses
10 managers
Method: 331 Leadership Questionnaires
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Does Leadership Style Drive Turnover?
1. Managers Perceived They Demonstrated Transformational Leadership Behaviors But Staff RN’s Did Not Concur
2. Managers Have More Contact With Dayshift And Evening Staff Than With Weekend And Night Shift Staff
3. Negative Leadership Behaviors Correlated With Staff Turnover
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Implications for Practice
Self Awareness Is
Critical
Visibility Is Valued
Empowered Staff Are Satisfied
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Transformational Leaders
Visionary Expert Achiever
Critical Thinker Communicator Mentor
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1. There Is A Positive Effect Between Healthy Work Environments And Retention Of Nurses
2. Healthy Work Environment Improves Patient Outcomes And Patient Satisfaction.
3. The Responsibility Of Creating A Healthy Work Environment Lies With The Leadership Team
The Relationship Between Healthy Work Environments And Retention Of Nurses In A Hospital Setting. Ritter, D. (2011)
The Link Between Work Environment And Retention
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AACN 6 Standards Of A Healthy Work Environment
Skilled Communication
True Collaboration
Effective Decision Making
Appropriate Staffing
Meaningful Recognition
Authentic Leadership
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Nurse Retention: A Review Of Strategies To create And Enhance Positive Practice Environments In Clinical Settings. Twigg D. & McCullough K. (2014)
• Nurse Participation In Hospital Affairs
• Nursing Foundations For Quality Of Care
• Staffing And Resource Adequacy
• Collaborative Nurse Physician Relationships
• Leadership And Support Of Nurses
If Leaders Build It. They Will Stay.
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Leadership Training
Generational Awareness
Emotional Intelligence Awareness
Positive Reinforcement
Servant Leadership And
Customer Service
Conflict Management
Collaborative Leadership
Skills
Understanding System Change
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Nurse Participation In Hospital Affairs
• Union• Visible Leadership
Collaborative Nurse Physician Relationships • Protocol Order Sets• SBAR Communication
Staffing And Adequate Resources
• Resource Team• Ratios• Pyxis System
Nursing Foundations For Quality of Care
• Professional Practice Committee• Developing Clinical Ladder• Encourage Education• Daisy Award
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Leadership And Support Of Nurses
1. Daily Stand Up Huddle 2. Leadership University 3. Weekly One on One With VP 4. Week in Review With Assistant CNO 5. Quarterly Assistant Nurse Manager Meetings 6. Preceptor Training 7. New Grad Program
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Leadership Rounding
Connect With Every Staff Member On A Monthly/Bimonthly Basis
Engage The Employee In A Conversation
Create A Stop Light Report Demonstrating Action
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Leadership Rounding
Name 3 Things That Are Working Well
Do You Have The Tools To Do Your Job?
Who Can You Recommend For Great Work? Why
Are There Any Safety Issues?
Any Processes We Can Improve On?
Anything I Can Do To Support You?
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Stop Light Report
ACCOMPLISHED IN PROGRESS
NOT AT THIS TIME
ISSUE
Nurses have no place to
have lunch
ACTION
Created Nurses Lounge
DATE
3/25/16
ISSUE
New Pyxis
Machine
ACTION
Educating staff
TARGET DATE
5/1/16
ISSUE
Raises
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Magnetic Workplace
Improve Nurse Physician Relationships
Standardize Processes
Revamp Incentives
Promote Autonomy Of Practice
Implement Evidence Based Practices
Develop Shared Governance Programs
Foster Professional Development
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In Summary
The Key To Improving Nurse Retention Is To Develop Effective Leaders Who Work
Collaboratively With Front Line Nurses To Build Healthy Work Environments
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References
• Brunetto Y.,Shiriberg A., Farr-Wharton R., Shacklock K., Newman S & Dienger J. (2013) The importance of supervisor-nurse relationships, teamwork, wellbeing, affective commitment, and retention of North American nurses. Journal of Nursing Management 21, 827-837.
• Cicolini G., Comparcini D., & Simonetti V. (2014) Workplace empowerment and nurses’ job satisfaction: a systematic literature review. Jorunal of Nursing Management 22, 855-871.
• Cottingham, S., DiBartolo M., Battistoni S. & Brown T. Partners in Nursing: A mentoring initiative to enhance nurse retention. Nursing Education Perspectives 32 (4), 250-255.
• Duffield C., Roche M., Blay N. & Stasa H. (2010) Nursing unit managers, staff retention and the work environment. Journal of Clinical Nursing 20, 23-33.
• Gambino K. (2010) Motivation for entry, occupational commitment and intent to remain: a survey regarding Registered Nurse retention. Journal of Advanced Nursing 66 (11), 2532-2541.
51© 2016, MedAssets, Inc. All rights reserved. MedAssets®. Not to be reprinted without permission. For non-commercial use ONLY.
References
• Kleinman C. (2004) The relationship between managerial leadership behaviors and staff nurse retention. Hospital Topics: Research and perspectives on healthcare 82 (4), 2-9.
• Lartey S., Cummings G. & Profetto-McGrath J. (2014) Interventions that promote retention of experienced registered nurses in healthcare settings: a systematic review. Jorunal of Nursing Management 22, 1027-1041.
• Ritter D. (2011) The relationship between healthy work environments and retention of nurses in the hospital setting. Jorunal of Nursing Management 19, 37-32.
• Tourangeau A., Thomson H., Cummings G. & Cranley L. (2013) Generation Specific incentives and disincentives for nurses to remain employed in acute care hospitals. Jorunal of Nursing Management 21, 473-482.
52© 2016, MedAssets, Inc. All rights reserved. MedAssets®. Not to be reprinted without permission. For non-commercial use ONLY.
References
• Twigg D. & McCullough K. (2014) Nurse Retention: A review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies 51 85-92.
• 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. International Journal of Nursing Studies 50, 185-194.
• Wallis A. & Kennedy K. (2013) Leadership training to improve nurse retention. Jorunal of Nursing Management 21, 624-632.
• Wieck, K., Dols J. & Landrum P. (2010) Retention priorities for the intergenerational nurse workforce. Nursing Forum 45 (1), 7-17.
© 2016, MedAssets, Inc. All rights reserved. MedAssets®. Not to be reprinted without permission. For non-commercial use ONLY.