Nursing Retention: Kanter’s and Neuman’s Theory Essay

Explanation of the Key Terms

The key terms used in this report include nurse retention, attrition or turnover and shortage. Nurse retention refers to the strategies adopted by the healthcare organization to prevent turnover and attract a competent workforce (Hayes et al., 2007). On the other hand, attrition or turnover rate describes the rate at which an organization’s workforce leaves the organization to other organizations or sectors. High attrition rates are associated with a poor workplace environment, low remuneration, and lack of staff development opportunities. The last concept is a nursing shortage; it refers to the unavailability of qualified nursing staff in an organization due to turnover (Morgan & Lynn, 2009). An acute shortage of qualified nurses in all the subspecialties is currently being felt in the healthcare sector.

Background

Nursing retention calls for a multi-modal approach that takes into account issues of quality, assumptions and policy. A recent report by NSI Nursing Solutions revealed that, on average, nurse turnover rates stand at 14%, with some hospitals experiencing an attrition rate as high as 20%. Nursing turnover is most prevalent in nursing homes, with some reporting an attrition rate of 34% (Hunt, 2009). From these statistics, one would expect hospitals and nursing homes to have a retention strategy in place to counter the effects of nursing turnover. However, in some organizations, a nurse retention strategy is lacking.

Hunt (2009) associates the nursing shortage in healthcare organizations with a high turnover rate involving qualified staff. Another study by Brewer et al. (2011) established that about 35% of RN’s leave their first job within one year after being employed. This has been attributed to horizontal violence perpetrated by experienced nurses and physicians. In some instances, the attrition rate may be as high as 60% for graduate nurses and newly employed nurses (Brewer et al., 2011). Lack of experience, limited support, and poor working relationships with other staff make new nurses leave their first employment within the first year.

The nursing retention strategies implemented require a change of policy to address the biting nursing shortage. The policies address issues of recruitment, training and skill development and various assumptions related to the nursing shortage and retention. The policies are implemented by the government through its various agencies and organizations. The policies promote staff retention in nursing schools and faculties through increased funding and grants. Also, some federal policies on health reform aim to expand federally-funded health care facilities and institutions. To ensure quality care in these facilities, the government will employ nurses and other healthcare professionals in these facilities.

Method

A computerized literature search of sources published between 2004 and 2012 was conducted on EBSCO, CINAHL and MEDLINE databases. In the search, several MeSH terms were used including ‘nursing retention’, ‘nurse turnover’, ‘nursing shortage’ and ‘nurse attrition’. Advanced searches were done using subheadings derived from the Mesh terms including ‘retention strategies’ and ‘turnover trends’. Moreover, a second search using the terms ‘nurse retention theories’ and ‘impacts of turnover’ was conducted on the three databases.

The inclusion/exclusion criteria were based on the study’s methodology, the sources of data (primary or secondary) and the relevance of the study to the topic. In total, 18 sources met the inclusion criteria and were included in the final assessment.

Results

The 18 sources varied in level of evidence, outcomes and study settings. After analysis, several themes were identified: nursing retention theories and assumptions, policies and predictors of nursing retention, opposing views on retention, horizontal violence and strategies for improving nursing retention. These findings are presented in the following sections.

Government Retention Policies

Government policies address issues of hiring of nursing staff, training and education as well as nurse retention. Many government policies that address retention focus on the recruitment of nursing staff. Federal policies such as the Recovery and Reinvestment Act and the Nurse Reinvestment Act (Kaiser Foundation, 2012) are geared towards hiring of the new health care workforce. Another policy, recently enacted, the Affordable Care Act, promotes the health and safety of the workforce in federal healthcare facilities (Kaiser Foundation, 2012). By improving the welfare and workplace conditions, this po