The current shortage in the number of registered nurses in the US is expected to increase to more than 500 000 registered nurses by the year 2025 (MacKusick & Minick, 2010). The current nurse turnover rate in the United States, on the other hand, is 16.5%. This rate is also projected to rise over the next decade (Mazurenko, Gupte, & Shan, 2012). High rate of nurse turnover is one of the factors contributing to the nursing shortage in the US. It is estimated that 30%-50% of all new registered nurses change their positions or choose to leave the profession completely within the first three years of clinical practice (MacKusick & Minick, 2010). The other factors influencing the nursing shortage include inadequate enrollments of students into nursing schools, insufficient number of nursing school faculty, an increase in the number of nurses nearing retirement age, advances in technology, and changing patient demographics. Changes in patient demographics and advances in technology are increasing the demand for healthcare and in effect, exacerbating the current nursing shortage. Evidence from research suggests that nursing shortages and high turnover rates negatively affect patient access to care, patient safety, and quality of care provided leading to adverse patient outcomes. Nursing shortage and turnover also affect the remaining nurses as they increase workloads and job-related stress leading to burnout and more turnover. Nurse turnover, on the other hand, affects the bottom line of healthcare organizations by increasing recruitment and replacement costs (Mazurenko, Gupte, & Shan, 2012). Healthcare organizations are also finding it increasingly difficult to recruit new nurses amidst the growing nursing shortage (Baernholdt & Mark, 2009). Nursing shortage and turnover are thus critical issues for nursing leaders and managers. This paper will explore compare and contrast the approaches that nurse leaders and nurse managers are expected to adopt in resolving the two issues. It will first explore the meanings of the concepts of leadership and management as well as the reasons for high nurse turnover in the US.
The concepts of leadership and management are often used interchangeably. The two terms though closely related are different (Kerridge, 2013). Leadership has been defined as the process of using interpersonal and communication skills to influence others towards achievement of specific goals. It involves influencing the beliefs, attitudes, feelings, and behaviors of others. Durnham and Fischer (1990 as cited in Curtis, Vries, & Sheerin, 2011) defined excellent nursing leadership as administrative competence, sufficient business, education, and clinical expertise, and lastly, an understanding of the principles of leadership. Management, on the other hand, refers to the art of getting things done through people so as to achieve stated organizational objectives. It involves the processes of planning, organizing, leading, controlling, budgeting, and staffing. Nurse managers hold designated positions within the hierarchy of organizations and perform specified tasks (Curtis, Vries, & Sheerin, 2011).
There are various types of turnover which include organizational turnover and professional turnover. Organizational turnover refers to a case whereby a registered nurse leaves a given healthcare organization for another. Such turnover creates a shortage in the organization the nurse was working in previously. Professional turnover refers to a case whereby a registered nurse leaves the nursing profession. The latter creates a deficit in the existing labor force (Mazurenko, Gupte, & Shan, 2015). Nursing shortage and turnover are closely linked to job satisfaction and dissatisfaction amongst nurses (Baernholdt & Mark, 2009). A number of factors influence the job satisfaction and dissatisfaction of nurses with either their job or occupation. The working environment in a given organization has an impact on the job satisfaction of nurses. Findings from studies suggest that nurses are more likely to leave organizations with negative work environments. Factors that have been found to affect nurses intent to leave an organization include the social work environment and work organizational factors. On social work environment, studies show that transformational leadership, mentorship for junior nurses, and collaboration amongst employees are associated with reduced nurse turnover rates. Meanwhile, work organizational factors like reduced nurse autonomy, inadequate nurse staffing levels, negative perceptions about career and educational advancement opportunities as well as pay and other benefits have been linked with job dissatisfaction amongst nurses. Factors that specifically influence professional turnover include dissatisfaction with nursing as a career choice, health-related factors such as illness and physical disability, and dissatisfaction with nursing work schedules and levels of remuneration. Individual factors specifically age have also been linked to nurse turnover; younger nurses are more likely to leave an organization than older nurses (Mazurenko, Gupte, & Shan, 2015).
The work environment has been found to influence the rate of attraction and retention of registered nurses (Mazurenko, Gupte, & Shan, 2015). Nurse managers, on account of the authority granted to them by their organizations, can address the issue of nurse turnover related to work environment by establishing mentorship programs for new nurses and preceptor ship programs for newly graduated nurses. They can advocate for older nurses acting as preceptors and mentors to be reimbursed for this service. In addition, they can adopt management styles such as transformative leadership that encourages retention of nurses by allowing nurses to participate in decision making at all levels. Further, they can recommend changes in the job descriptions of nurses to give nurses more autonomy in their nursing practice. To address the issue of physical demands of the job, nurse managers can promote the concept of team work and collaboration in the work place. In addition, they can request the management to hire adequate numbers of registered nurses as well as nurse assistants. Nurse assistants assist nurses in performing physically demanding tasks such as lifting of patients and non-essential tasks such as transportation of patient meals and supplies. On the issue of mitigating the emotional demands of nursing, nurse managers can foster the creation of a work environment that fosters partnership between the various health professionals and advances nursing practice. This can be done through nurse managers acting as equal partners with physicians and other professionals in the making of organizational decisions as well as system level decisions. They can also empower nurses providing direct care by giving them more autonomy in their practice. Nurse managers can address the issue of career progression by coming up with or lobbying organizational leadership for flexible nursing work schedules that allow nurses to pursue further education and at the same time do not disrupt the work of the organization.
Nurse leaders at the organizational level can promote retention of staffs by precepting younger nurses even if they have not been officially appointed to do so. In addition, they can speak out and advocate for changes in the practice environment for instance, they can agitate for improved nurse staffing levels. Moreover, they can help improve the practice environment by leading by example for instance providing support and assistance to other staff members for instance in lifting of patients even when not specifically requested to do so. Nurse leaders can also help address the issue of emotional demands of nursing by acting ethically and demanding the same of their co-workers for instance, advocating for patient involvement in the making of care decisions. They can also actively participate in the making of standard operational procedures on issues that cause emotional distress amongst nurses such as termination or withholding of life support. Nurse leaders can help nurses pursue further education by advocating for flexible work schedules at the organizational level. At the state and national level, nursing leaders can lobby the government and relevant bodies such as educational institutions for help in the funding of higher education for nurses for instance through full or partial scholarship programs. On the issue of reimbursement, the pay rates of nurses are influenced by reimbursement rates of healthcare organizations by bodies such as Medicare and Medicaid. Nurse leaders can influence the pay rates of nurses by lobbying policy makers on issues such as scope of practice and pay rates for advanced practice nurses. In so doing, they would be making the nursing profession attractive to new as well as already qualified nurses and in effect, improve retention of nurses in the profession. On the issues contributing to deficits in the nursing labor force, nurse leaders can come up with strategies for recruitment of more student nurses, expansion of nursing faculty, retention of nurses who are past their retirement age, and retention of nurses within the nursing profession (American Nurses Association, 2016; American Association of Colleges of nursing, 2014).
References
American Association of Colleges of Nursing (2014). Nursing shortage. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage
American Nurses Association (2016). Strategies to reverse the new nursing shortage. Retrieved from http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workfor ce/NursingShortage/LegislationStrategies/NursingShortage.html
Baernholdt, M. & Mark, B. A. (2009). The nurse work environment, job satisfaction, and turnover rates in rural and urban housing units. J Nurs Manag., 17(8), 994-1001.
Curtis, E. A., Vries, J., & Sheerin, E. K. (2011). Developing leadership in nursing: Exploring core factors. British Journal of Nursing, 20(5), 306-310.
Kerridge, J. (2013). Why management skills are a priority for nurses. Nursing Times, 109(9), 16- 18.
Mazurenko, O., Gupte, G., & Shan, G. (2015). Analyzing nurse turnover : Are nurses leaving their jobs or the profession itself? Journal of Hospital Administration, 4(4), 48-7.
