Retention is part of the answer to the nursing shortage

Mar 30 2009

A new research study, published in the March/April issue of the journal Nursing Economics, has determined what factors can help keep new nurses from leaving their jobs and - in doing so - save health systems money.

When nurses leave for another position or retire early, it dramatically affects a hospital's bottom line - as much as 5 percent of a hospital's budget may go to paying for nursing turnover costs.

The study, funded by the Robert Wood Johnson Foundation, reports on 1,933 newly licensed registered nurses working in hospitals in 34 states and Washington, DC. The researchers found that nurses' intent to stay is influenced by their perceptions of their working conditions, specific workplace attributes, as well as their personal characteristics and available job opportunities.

"If nurses stay in their jobs, hospitals and the health care system will realize significant savings on costs associated with replacing nursing staff," said Christine Kovner, PhD, RN, FAAN, professor at New York University's College of Nursing and lead author of the study. "More importantly, patient outcomes are at stake because when the nursing staff is destabilized by frequent resignations and high turnover, the disruption and inconsistency of service can have a negative impact on patient care and safety."

In addition to the challenges facing individual hospitals, the unprecendented nationwide nursing shortage means that the U.S. health care system will be unable to meet the projected shortfall of up to half a million nurses by 2024. Kovner said that knowing what positively or negatively affects new nurse retention can help hospital managers better direct their resources and keep their workforce stable.

The study showed that satisfaction, organizational commitment, autonomy, opportunities for promotion and fewer outside job opportunities were related to intention to stay. The researchers also studied factors related to satisfaction and organizational commitment and found the following characteristics increased the likelihood that these new registered nurses would be satisfied with their jobs and committed to the organization:

• Variety
• Autonomy
• Supervisory support
• Workgroup cohesion
• Procedural justice (rights are applied universally to all employees)
• Promotional opportunities
• Collegial nurse/doctor relations

The study also found that high workload and organizational constraints decreased new registered nurses' satisfaction with their jobs. Those variables, in addition to mandatory overtime, also decreased new nurses' commitment to their organizations.

"Hospitals and the government need to know how to influence RN satisfaction and organizational commitment because of the impact of these attitudes on registered nurses' intent to stay where they are," said Carol S. Brewer, PhD, RN, of the School of Nursing at the University at Buffalo - State University of New York, and co-author of the study. "If satisfied RNs stay in their jobs, patient care will be more consistent and safe. Newly licensed registered nurses are needed to replace the nurses who retire in the next 10 years."

This research used a sub-set of nurses involved in a larger RWJF-funded study by Brewer and Kovner, which tracks changes in the careers of a group of newly licensed nurses over 10 years. The study is funded through 2016.