the challenges of procuring and retaining staff.final2

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The Challenges of Procuring And Retaining Staff – Effective Leadership Strategies For Nurse RetentionDianna Goodwin MSN RN-BC

2© 2016, MedAssets, Inc. All rights reserved. MedAssets®. Not to be reprinted without permission. For non-commercial use ONLY.

Conflict Of Interest Disclosure

• Dianna Goodwin MSN, RN-BC: No Conflict Of Interest


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


Key Words

Leadership Behaviors

Nurse Retention

Nurse Staffing

Transformational Leadership

Generations

Nurse Leaders

Nurse Satisfaction


Literature Review

I. Title of Article

A. Purpose/Aim

B. Reference

II. Study Sample

III. Methods

IV. Findings

V. Recommendations


Bariatric Surgery

Obstetrics

Level 3 NICU

50,000 ER Visits/Year

Orthopedic Surgery

Cardiology


Challenges Facing The Nursing Workforce

• Educating The Next Generation Of Nurses

• Aging Nurses

• Retention Of Experienced Nurses

• Aging Population


Challenges Facing The Nursing Workforce


Retention At Dameron

RN Turnover - 2015Turnover # 74Turnover % 24.9%Benchmark 9.1%

Previous Years Turnover %2014 25.7%2013 32.6%


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


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%


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


• 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


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)


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)


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


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


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?


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


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


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


4 Emotional and Physical

Exhaustion

Emotional and Physical

Exhaustion

Unsupportive Organization

Inadequate Staffing

Inadequate Staffing


Inadequate Staffing



Emotional and Physical Exhaustion




Generation Gap: Canyon Or Crevice?


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


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


Challenging Work

Adequate Monetary Compensation

Opportunities For Growth And Advancement

Fairness

Work Life Balance.

Shared Work Expectations


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


Desire For Organizations To Succeed

Good Leaders

Success In Careers

Cannot Outrun Time

Unknown Future

Shared Values


All Generations HaveA Desire To Work and

Are Committed ToGood Employers


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.


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%


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


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.


Study Sample And Method

Sample: 475 Bed Hospital In North East US

79 Nurses

10 managers

Method: 331 Leadership Questionnaires


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


Implications for Practice

Self Awareness Is

Critical

Visibility Is Valued

Empowered Staff Are Satisfied


Transformational Leaders

Visionary Expert Achiever

Critical Thinker Communicator Mentor


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


AACN 6 Standards Of A Healthy Work Environment

Skilled Communication

True Collaboration

Effective Decision Making

Appropriate Staffing

Meaningful Recognition

Authentic Leadership


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.


Leadership Training

Generational Awareness

Emotional Intelligence Awareness

Positive Reinforcement

Servant Leadership And

Customer Service

Conflict Management

Collaborative Leadership

Skills

Understanding System Change


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


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


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


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?


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


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


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


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.


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.


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.

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