Retaining qualified nursesRetaining qualified nurses in the intensive care unitin the intensive care unit

YASEMİN ERGÜNYASEMİN ERGÜNMarmara Unıversıty Faculty of Health Marmara Unıversıty Faculty of Health Science, Nursing Depart. İstanbul, TurkeyScience, Nursing Depart. İstanbul, Turkey

IntroductionIntroductionHuman resources is the most importantHuman resources is the most important

power of organizations. power of organizations.

Organizations can make a difference in their Organizations can make a difference in their services only through a qualified work force. services only through a qualified work force.

Even if you have an advanced and expensive Even if you have an advanced and expensive technology / device, it has no importance when technology / device, it has no importance when you do not have a sufficient number of qualified you do not have a sufficient number of qualified manpower to use them for the benefit of patientsmanpower to use them for the benefit of patients..

Also hospitals are the only organizations where Also hospitals are the only organizations where incorrect managerial decisions and defects in the incorrect managerial decisions and defects in the service directly affect the customers even claim service directly affect the customers even claim their life.their life.

Hospitals, especially intensive care units are highly labor intensive and therefore workforce losses seriously affect the services.

Also, the high turnover rates in addition to insufficient number of nurses lead to disruption of patient care and increase of costs (Stordeur, D’hoore, The Next-Study Group 2007; Yaprak and Seren 2007).

Health organizations are faced with the problem of insufficient number of nurses due to limited resources and incorrect manpower policies (Yaprak and Seren 2007).

Insufficient number of nurses is a universal problem. Therefore, in “Working Together for Health” report of World Health Organization (WHO) for 2006, global healthcare workforce crisis was stated as a priority issue by drawing attention especially to nursing deficit

In this regard, International Council of Nurses (ICN) selected “Positive practice environments: Quality workplaces = quality patient care” as their theme of the International Nurses Day in 2007 for drawing attention to serious workforce crisis and to discuss solutions (Türkmen, Badır, Balcı,Topçu Akkuş 2011).

In our country, privatization of health services In our country, privatization of health services accelerated in 2003 within the scope of Health accelerated in 2003 within the scope of Health Transformation Program; nursing workforce Transformation Program; nursing workforce shortage in the private and public sectors shortage in the private and public sectors increased. increased.

On the other hand, competition increased with On the other hand, competition increased with quality efforts in hospitals causing an increase in quality efforts in hospitals causing an increase in the nursing turnover rate the nursing turnover rate (Türkmen, Badır, Balcı,Topçu Akkuş 2011).

Nowadays, the problem of insufficient number of nurses increased as a result of new graduates leaving the profession quickly, not being able to ensure continuity of existing nurses and provide commitment to organization and tending towards non-nursing tasks (Yaprak ve Seren 2007).

Demand to profession is increasing in our country due to job security while decreasing in United States of America. However there are serious problems in retention nurses at work and rational use of resources. Also problem is more deepened as generational factors are added 

In the study of Roche et al. (2004), leaving rate of new graduates in the first 6 month was found to be exteremely high (35-60%).

Such rapid turnover is a condition causing burnout among nurses involved in the orientation of these new nurses.

In addition, there is a high cost of recruitment and orientation program to the organization. In this study, school hospital partnership model was applied to keep new graduates at work and the rate of leave is reduced (7.5%).

In the world and in our country, one of the most In the world and in our country, one of the most important causes of the decrease in the number important causes of the decrease in the number of nurses is voluntary leave of employment.of nurses is voluntary leave of employment.

Managers should understand the leave of Managers should understand the leave of employment process. employment process.

Negative working conditions are among factors Negative working conditions are among factors causing nurses’ leave of employment.causing nurses’ leave of employment.

There are also employee oriented, positive There are also employee oriented, positive working environments attracting staff as well as working environments attracting staff as well as places negatively affecting professional success, places negatively affecting professional success, alienating nurses and mostly draw them away alienating nurses and mostly draw them away (Yaprak and Seren 2007).(Yaprak and Seren 2007).

Job dissatisfaction of nurses, Job dissatisfaction of nurses,

work stress, conflict in physician nurse relations work stress, conflict in physician nurse relations

not being able to receive support from managers, not being able to receive support from managers,

role conflicts, role conflicts,

increased workload, increased workload,

long working hours, long working hours,

lack of supplies, lack of supplies,

generational factos (high turnover rate of young generational factos (high turnover rate of young graduates) and graduates) and negative working conditions including these are negative working conditions including these are among among factors affecting their leave factors affecting their leave (Yaprak and Seren (Yaprak and Seren

2007; Türkmen, Badır, Balcı, Topçu Akkuş 2011). 2007; Türkmen, Badır, Balcı, Topçu Akkuş 2011).

It can be seen in Figure 1 that leave of employment It can be seen in Figure 1 that leave of employment process is affected from individual, organizational process is affected from individual, organizational and environmental factors and occur and environmental factors and occur in 5 stages. in 5 stages.

Figure 2. Patient Care System and Nurse Turnover Model

(O’brien Pallas, 2010 p.1075.)

In patient care and turnover rate model, patient, In patient care and turnover rate model, patient, nurse, organization and characteristics such as unit nurse, organization and characteristics such as unit represent represent “inputs”, “inputs”,

complexity of environment, use of workforce and complexity of environment, use of workforce and features as turnover rate represent features as turnover rate represent “process”, “process”,

patient, nurse and organizational “patient, nurse and organizational “outputs” outputs” indicate indicate outcome andoutcome and

““feedback” feedback” process.process.

Here, the relationship between input and outputs, the Here, the relationship between input and outputs, the effect of system inputs on process and patient, nurse effect of system inputs on process and patient, nurse and scope of system has been analized in terms of and scope of system has been analized in terms of turnover rate (Figure 2) (O’brien Pallas et al. 2010).turnover rate (Figure 2) (O’brien Pallas et al. 2010).

Patient Care System and Nurse Turnover Patient Care System and Nurse Turnover Model Model

Strategies for Nurse Retaining at Work Strategies for Nurse Retaining at Work

Nursing managers should have some Nursing managers should have some

managerial initiatives in order to retainmanagerial initiatives in order to retain

their employees at work and preventtheir employees at work and prevent

the leave of employment.the leave of employment.

Value and respect staff.Value and respect staff.

Break down any caste system.Break down any caste system.

Empower staff to be involved in decision making that Empower staff to be involved in decision making that directly affects their work and practice.directly affects their work and practice.

Support shared governance within the workplace.Support shared governance within the workplace.

Provide timely coaching and counseling.Provide timely coaching and counseling.

Recognize and reward high performers.Recognize and reward high performers.

Strategies for Nurse Retaining at Work Strategies for Nurse Retaining at Work

Use progressive discipline to remove poor performers Use progressive discipline to remove poor performers who consume too much time and have a negativewho consume too much time and have a negative effect on overall staff morale.effect on overall staff morale.

Work with staff to create unity and harmony and Work with staff to create unity and harmony and promote a sense of teamwork.promote a sense of teamwork.

Treat staff like adults; they do not need a mother or Treat staff like adults; they do not need a mother or father.father.

Establish open and honest communication.Establish open and honest communication.

Treat staff fairly.Treat staff fairly.

Embrace and teach corporate valuesEmbrace and teach corporate values..

Strategies for Nurse Retaining at Work Strategies for Nurse Retaining at Work

Offer educational development.Offer educational development.

Conduct a skills fair annually for all clinical staff.Conduct a skills fair annually for all clinical staff.

Provide paid time off for continuing education.Provide paid time off for continuing education.

Offer residency or internship programs in specialty Offer residency or internship programs in specialty areas.areas.

Offer scholarships or percent reimbursement for Offer scholarships or percent reimbursement for formal career education.formal career education.

Develop leadership opportunities for staff.Develop leadership opportunities for staff.

Be a mentor.Be a mentor.

Assign a consistent preceptor to the new Assign a consistent preceptor to the new orientee.orientee.

Strategies for Nurse Retaining at Work Strategies for Nurse Retaining at Work

Adjust patient assignments of the preceptor to allow Adjust patient assignments of the preceptor to allow ample time for teaching.ample time for teaching.

Create a learning organization.Create a learning organization.

Implement RN clinical/career ladders.Implement RN clinical/career ladders.

Maintain functional and state-of-the-art equipment for Maintain functional and state-of-the-art equipment for staff.staff.

Provide appropriate staffi ng.Provide appropriate staffi ng.

Seek volunteers when overtime is needed.Seek volunteers when overtime is needed.

Listen and take immediate action regarding workplace Listen and take immediate action regarding workplace concerns from staff.concerns from staff.

Strategies for Nurse Retaining at Strategies for Nurse Retaining at Work Work

Offer self-scheduling.Offer self-scheduling.

Offer fl exible work hours and/or job sharing.Offer fl exible work hours and/or job sharing.

Offer competitive compensation and benefi ts.Offer competitive compensation and benefi ts.

Offer a package that includes health, education, and Offer a package that includes health, education, and retirement benefi ts.retirement benefi ts.

Take ownership for retention in your area of Take ownership for retention in your area of responsibility.responsibility.

Engage staff in taking ownership for workplace Engage staff in taking ownership for workplace retention.retention.

Encourage collaborative relationships between Encourage collaborative relationships between physicians and nursesphysicians and nurses..

Strategies for Nurse Retaining at Strategies for Nurse Retaining at Work Work

Provide challenging work opportunities for Provide challenging work opportunities for professional growth.professional growth.

Work with multigenerational issues.Work with multigenerational issues.

Inject some spontaneity in the staff work day with Inject some spontaneity in the staff work day with FUN.FUN.

Celebrate successes (e.g., high patient satisfaction Celebrate successes (e.g., high patient satisfaction scores) with simple things such as pizza or an icescores) with simple things such as pizza or an ice cream treat, theater tickets, a spa day, or a fi tness cream treat, theater tickets, a spa day, or a fi tness center membership.center membership.

Decorate your unit during holidays and enter contests Decorate your unit during holidays and enter contests if sponsored by the institution.if sponsored by the institution.

Strategies for Nurse Retaining at Strategies for Nurse Retaining at Work Work

Enter your unit in contests such as “Best Nursing Enter your unit in contests such as “Best Nursing Team Contest” sponsored by a nursing magazine.Team Contest” sponsored by a nursing magazine.

Write articles about your unit for celebrations and Write articles about your unit for celebrations and recognitions received and publish it in your recognitions received and publish it in your institution’sinstitution’s

newsletter.newsletter.

Conduct exit interviews and make personnel and/or Conduct exit interviews and make personnel and/or environmental adjustments as needed.environmental adjustments as needed.

ReferencesReferencesStordeur S., D’hoore W. & The Next-Study Group (2007) Organizational Stordeur S., D’hoore W. & The Next-Study Group (2007) Organizational configuration of hospitals succeeding in attracting and retaining nurses. configuration of hospitals succeeding in attracting and retaining nurses. Journal of Advanced Nursing; 57(1): 45-58.Journal of Advanced Nursing; 57(1): 45-58.

Yaprak E., Seren Ş. Yaprak E., Seren Ş. Hemşirelerin işten Ayrılma Niyetleri ve Örgüt ikliminin Hemşirelerin işten Ayrılma Niyetleri ve Örgüt ikliminin HemşireHemşire

istihdamına Etkisiistihdamına Etkisi. . Hemşirelikte Eğitim ve Araştırma Dergisi 2010; 7 (1): 28-Hemşirelikte Eğitim ve Araştırma Dergisi 2010; 7 (1): 28-33.33.

Roche JP, Lamoureux E., Teehan T. A partnership between nursing education Roche JP, Lamoureux E., Teehan T. A partnership between nursing education and practice using an empoverment model to retain new nurses.. JONA, and practice using an empoverment model to retain new nurses.. JONA, 2004, 34(1):26-32.2004, 34(1):26-32.

Kocaman G, Seren Ş, Kurt S, Daniş B, Erer T. Üç üniversite hastanesinde Kocaman G, Seren Ş, Kurt S, Daniş B, Erer T. Üç üniversite hastanesinde hemşire devir hızı. hemşire devir hızı. Hemşirelikte Eğitim ve Araştırma Dergisi 2010, 7(1), 34-8.Hemşirelikte Eğitim ve Araştırma Dergisi 2010, 7(1), 34-8.

WHO (2006) The world health report 2006 – working together for health WHO (2006) The world health report 2006 – working together for health [Electronic version]. Retrieved October 20, 2014, from [Electronic version]. Retrieved October 20, 2014, from http://www.who.int/whr/2006/en/  

Türkmen E, Badır A, Balcı S, Topçu Akkuş S. Hemşirelik iş indeksi Hemşirelik Türkmen E, Badır A, Balcı S, Topçu Akkuş S. Hemşirelik iş indeksi Hemşirelik çalışma ortamı değerlendirme ölçeğinin Türkçe’ye uyarlanması: Güvenirlik ve çalışma ortamı değerlendirme ölçeğinin Türkçe’ye uyarlanması: Güvenirlik ve geçerlilik çalışması. Hemşirelikte Eğitim ve Araştırma Dergisi 2011, 2:5-20.geçerlilik çalışması. Hemşirelikte Eğitim ve Araştırma Dergisi 2011, 2:5-20.

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