May 3, 2013
What makes nurses want to stay put? The reasons might surprise you
Long hours on your feet. Dealing with intense life-or-death situations. Combine that with recent changes in equipment, technology and an aging population, and the job of nursing -- one of the most vital roles in the health-care system -- has become increasingly high-stakes and complex.
So what are employers doing to recruit, retain and reward the indispensable nursing workforce?
While much has been written about happiness in the workplace, when it comes to nursing, perks like pool tables in break rooms and dress-down Fridays don’t really apply. It is in caring for people in times of their greatest vulnerability and need that nurses find joy and meaning in their work.
“The work is wonderful and rewarding, but it is very hard,” says Linda Tieman, executive director of the Washington Center for Nursing, an organization focused on ensuring that the nursing workforce meets the state’s current and future health-care needs.
Patient care has become more complicated, Tieman says. The population is aging. There are more moving parts when it comes to medications, charting, and internal and external communications. “Nurses have to manage all of that,” says Tieman.
The job also comes with inherent hazards. A recent report released by the Lucian Leape Institute at the National Patient Safety Foundation found that the prevalence of physical harm was striking. “Up to a third of nurses experience back or musculoskeletal injuries in a year, and many have unprotected contact with blood-borne pathogens,” the report states.
National Nurses Week 2013
When: The annual celebration begins May 6, which is also National Nurses Day, and ends May 12, the birthday of Florence Nightingale.
2013 theme: Delivering Quality and Innovation in Patient Care
Source: American Nurses Association
Several studies have linked healthy work environments with patient safety, nurse retention and recruitment. In other words: Happy, healthy nurses equal happy, healthy patients. Other factors, such as fatigue, adequate staffing, autonomy, collaboration and effective systems for communication are critical components as well.
“We’re the ones at the bedside [who] have the primary contact with the patient,” says Tiffany Johnson, a registered nurse at Swedish Medical Center in Seattle. As liaisons to doctors, pharmacists and other medical staff, nurses are often the glue that holds all the moving parts of the health-care system together.
Sources of contentment
So what makes a nurse satisfied with his or her career? According to Tieman, citing nurse-related human resources studies, workplace autonomy is the No. 1 factor: “Do I have control over my practice? Can I shape my work involvement and control my daily flow and routine?” she says.
Next is the quality of supervision by the nurse managers and other administrators who set policy and standards regarding patient care. Orientation, mentorship and on-the-job training are a close third. Also high on the list: professional development and education, adequate staffing, and team-oriented collaborations with medical staff. Pay is ranked fifth.
Lindsey Sharp, a labor and delivery registered nurse at the University of Washington Medical Center, cites control over her schedule and teamwork as the top perks of her job.
“One of the biggest satisfiers is when everyone is on the same page, and nurses are included in the bigger conversations,” she says.
Factors affecting job satisfaction
In 2010, a landmark consensus report -- “The Future of Nursing: Leading Change, Advancing Health,” released by the Robert Wood Johnson Foundation and the Institute of Medicine -- looked at the key factors that affect job satisfaction, including training, education, professional leadership and workforce policy.
The main calls to action focus on:
• Increased education and training for nurses.
• Placing nurses as full partners with physicians and other health-care staff in redesigning health care in the United States.
• Requiring better data collection and information infrastructure in creating effective workforce planning and policymaking.
Not on the list of satisfiers? Being taken for granted, not being treated with respect, getting left out of the loop, having to work overtime without pay, and not being included on policy decisions regarding nurse schedules or patient-care standards.
Recruitment and turnover
Already the largest segment of the country’s health-care workforce, nursing jobs were projected by the Bureau of Labor and Statistics to grow 26 percent from 2010 to 2020 to 3.45 million jobs nationwide.
Will a nursing shortage hit the Northwest? Open positions are increasing, especially when it comes to specialized positions such as intensive care, surgical, ER, and labor and delivery, according to Tieman.
“The demand is huge,” says Josh McIntosh, manager of business operations and recruiting for Maxim Healthcare Services in Seattle, a company that employs nurses in hospitals and other health-care settings in the area.
That doesn’t mean it’s necessarily easy to get a job. Johnson, the RN at Swedish, has also worked at Virginia Mason and Harborview Medical Center. She took a few years off from nursing after she had children, and found it difficult to re-enter the workforce.
“Employers are very selective,” she says. “They want specific experience.”
Attrition is also a consideration. According to a recent KMPG survey, the annual rate of attrition among nurses at U.S hospitals is about 14 percent. A separate, ongoing study examining turnover rates, the RN Work Project, reveals that 17.3 percent of new nurses leave their first employer within a year of starting a job, and more than half (54.5 percent) leave within six and a half years.
Locally, the numbers are better. Tieman cites investment in the education and retention of new graduates as a key initiative. Swedish Medical Center, for example, boasts a strong partnership with Seattle University in recruiting new graduates, including a mentorship program and nursing residency. As a result, its turnover rate is about 4 percent, much less than the national average.
“We have nurses who have been with us for 30, 35 years,” says Valda Upenieks, a research scientist at Swedish. “We are really looking to support our nurses’ professional development." This means sending nurses to conferences, giving them research opportunities, recognizing their achievements and allowing them opportunities to get involved in the bigger picture of the organization.
All of these things go a long way toward creating a satisfied workforce, says Tieman. “People like to know that their work contributes to the higher good," she says.
A simple “thank you” can also make a nurse’s day. “Nurses aren’t in the profession to be liked,” says Tieman. “They’re doing it to make a difference.”
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