Running head: THE ROAD TO RETENTION 1

The road to retention

Edward Struzinski

Kaplan University

THE ROAD TO RETENTION 2

The road to retention

Nursing is a difficult job and comes with some very trying moments involving patients,

their diagnosis and progression of care, families, and also the collaborative health team members

themselves. This opening statement is something that I feel is well-appreciated by all nurses.

And so is it any wonder that, in some areas of nursing, the turnover rate can be quite high and/or

be staffed with unhappy personnel? Now add the concept of attrition into the equation. Attrition

is the gradual decrease and loss of workforce size over time but without the replacement of those

who have gone, either by resigning or through retirement. The workforce becomes lower, though

this does not mean there is an equal reduction in payload, which could remain the same. Raising

the patient to nurse ratio is unsafe and is burdening on current staff. This leads to undue stress,

unhappy personnel, fatigue, errors, and eventually burnout and quitting. Burnout and turnover of

nurses is an ongoing problem in nursing and quite costly for employers. “Recent research

reported a whopping 27.1% average voluntary turnover rate among new graduate nurses during

their first year of employment” (Christmas, 2008). To this end, the issue of how to retain nurses

becomes a stronger focus, because it has the benefits of strengthening the workforce,

relationships, and maintaining a safer caring environment for patients. Three ways that attrition

can be minimized is by keeping the workplace free of hostility, improving the orientation phase

of new employment, and assigning mentors for new graduates and less-experienced staff.

“When opportunities abound … it is usually the best and brightest who are first to depart

(Christmas, 2008). Seeing this occur has effects on other staff as they re-visit their own personal

goals and decide if they should make changes in life. The road to retention is narrow while the

highway to greener pastures is wide. In review of this week’s assignment, it states a problem

with no loyalty among new nurses and describes it as part of the cause for retention loss. One

THE ROAD TO RETENTION 3

reason may be environmental hostility between co-workers. There is evidence supporting that

this has a negative effect in the workplace. “If peer behavior is threatening, isolating, or hostile,

then this negativity can also drive turnover” (Christmas, 2008). I have already mentioned my

own experience of being driven out from a secure job that I enjoyed due to the overwhelming

hostility that was a near-daily occurrence. Workplace hostility and violence is not uncommon,

but it is illegal; fortunately, it is also gaining more attention. “Recent studies and the Healthy

Work Environment initiative by the American Association of Critical-Care Nurses address how

behavior and communication among peers must be as blameless and outstanding as are clinical

skills” (Christmas, 2008).

Another reason for high turnover rate is thought to be poor orientation to the real world of

patient load and responsibilities. In school, you generally have a one to one patient assignment,

maybe two. While in reality, the patient to nurse ratio can be much higher, sometimes ten to one.

According to Lee, Tzeng, Lin, and Yeh (2009) “it has been suggested that a well-designed

preceptorship programme [sic] could decrease the turnover rate among new staff” (Lee et al,

2009). The study found a statistically significant drop in results after implementing the program.

The results showed “the turnover rate was 46.5% less than the previous year. The turnover cost

was decreased by US$186,102. Additionally, medication error rates made by new nurses

dropped from 50–0% and incident rates of adverse events and falls decreased” (Lee et al, 2009).

In reviewing the schedule for the nursing orientation, I feel I would adjust the times on the actual

floor/ unit by just two hours or more to provide the most experience-learning possible. In doing

so, the same amount of hours could be deducted from the didactic portion of the orientation,

which is generally familiarizing with policies and paperwork. Although this is an important part

of the new orientation process, who remembers it or is really paying attention?

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It is not enough to just adjust the orientation phase and provide more time to the clinical

portion of nursing. Graduate nurses and others with considerably less experience or who

demonstrate poor judgment and/or skills should have the opportunity of a mentor for improved

learning. This is different than a preceptor. A preceptor is an experienced person who assists new

employees in acquiring the knowledge and skills needed to function effectively in a new

environment (Blais & Hayes, 2011). They are generally assigned to work with new hires.

Mentors, on the other hand, are sought out or requested by the person who wants to learn.

Mentors are experienced and competent persons who develop a closer relationship with a

beginner in order to provide individualized support, give advice, encourage their growth and

professional development (Blais & Hayes, 2011). Upon graduating nursing school and entering

the workforce, I was assigned different nurses who were considered qualified preceptors. I do not

know what made them “qualified” except to say that in this particular small community hospital

there is often subjective selection through perception and/or who is friends with who. I was quite

fortunate to work with some street-smart, reality-based nurses during my three-month

orientation. I also worked with one or two bedside nurses but who were also involved in the

management side: despite their impressive thirty-year commitment to nursing, this did not make

them any better at teaching than the younger nurses with experience on various units. Again, I

was fortunate to have been assigned a strong role model for my night shift position; as time

passed, our working relationship strengthened and eventually transformed from one of preceptor

to that of mentor. She was nurturing while also showing clear boundaries of discipline. I still

hear her voice today providing guidance when I need to make decisions. Her legacy of

compassionate care and advice lives on, as she died suddenly last year while I was volunteering

on a medical mission in Africa, taking things she taught me to a different level.

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The rate of nursing turnover is high and the cost of dealing with it reflects this. “Recent

studies of the costs of nurse turnover have reported results ranging from about $22,000 to over

$64,000 (U.S.) per nurse turnover” (Jones & Gates, 2007). This can be further broken down to

include retirement or severance pay, overtime to fill vacancies, and the cost of advertisement for

new hires. Retaining nurses in the workforce is equally difficult but the benefits of keeping

quality nurses outweigh the stress of dealing with its aftermath. This can be achieved through

fostering a non-confrontational and bonding atmosphere, modifying the didactic and clinical

portions of nursing orientation to provide more bedside experience, and providing new nurses

with mentors to lead by example. Price (2009) states “in future recruitment and retention

strategies to address the critical nursing shortage, it is important to consider the role of mentors,

peers and role models …” (Price, 2009). In taking these steps, the nurse manager can help to

build a collaborative team of nurses/ staff who may feel more confident and develop loyalty

through relationships and bonding. This may reduce burnout and attrition in the workplace,

minimizing the costs from the same. Because “from an economic perspective, the current nursing

shortage is being driven more by the supply side of the supply/ demand equation than the

demand side” (Marquis & Huston, 2012).

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References

Blais, K., Hayes, J. (2011). Professional nursing practice: concepts and perspectives.

(6thed.) Upper Saddle River, NJ: Pearson.

Christmas, K. (2008). How work environment impacts retention. Nursing Economic$,

26(5), 316–318.

Jones, C., & Gates, M. (2007). The costs and benefits of nurse turnover: a business case for nurse

retention. Online Journal Of Issues In Nursing, 12(3). Retrieved from

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/

ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NurseRetention.html

Lee, T., Tzeng, W., Lin, C., & Yeh, M. (2009). Effects of a preceptorship programme on

turnover rate, cost, quality and professional development. Journal Of Clinical

Nursing,18(8), 1217–1225.

Marquis, B., Huston, C. (2012). Leadership roles and management in nursing. (7th ed.)

Philadelphia, PA: Lippincott Williams & Wilkins

Price, S. (2009). Becoming a nurse: a meta-study of early professional socialization and career

choice in nursing. Journal of Advanced Nursing. 65(1), 11-19.

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2008.04839.x/

abstract;jsessionid=ED79EA3E3A01C5B862FE53581787DEA6.d03t04?

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