Recruitment and Retention of the Nursing Workforce Patsy L. Williams, MBA, BSN, RN Florida Atlantic University  Christine E. Lynn College Of Nursing NGR6725 Leadership Nursing Administration: Advanced Nursing Situations Dr. Rose Sherman, EdD, RN, NEA-BC, FAAN November 18, 2017

Current Nursing Situation According to the Bureau of Labor Statistics, in 2016 there were approximately 2.9 million Registered Nursing positions and from 2016 through 2026 there will be a much faster than average growth rate (Occupational Outlook Handbook, 2016). By 2022, the American Nurses Association states there will be an estimated 3.44 million nursing jobs, which translates to an additional 1.13 million or an increase of 20.2% of registered nurses needed; with Florida among the top ten states that account for that growth (Sheffield, 2016).

What's Driving the Shortage? Retirement – in the next ten years, the nursing shortage will be affected by the number of nurses that are retiring (Dent, 2017). ’Nursing Isn’t For Me’/Job Disillusion – after completing a nursing program, passing boards, and working as a nurse, many find it was not at all what they thought it would be especially considering treatment of ’new’ nurses (Dent, 2017). Nurse disengagement – dissatisfaction with your position, your employer, or the patient/family/physician (Dent, 2017) Staff burnout - taking care of patients; imbalanced job and work life; job atmosphere; and lack of support. Photo credit: https://tanjabergkvist.wordpress.com/tag/jenny- teleman/

What’s Driving the Shortage – Retention Statistics… A recent study showed that 17.5% of newly licensed registered nurses leave during their first year of their new nursing job; and 33% leave within the first two years of employment (Robert Wood Johnson Foundation, 2014). Turnover has a significant impact on the hospital system and it is a problem that nursing leadership must find a way to control the revolving doors. From a cost perspective, a turnover for a registered nurse who works at the bedside ranges from $37,000 to $58,400, and can go higher. The highest turnover is seen in Emergency Department, Medical Surgical Units and Behavioral Health; and the lowest seen in Pediatrics and Women's Health (Nursing Solutions Inc., 2016) Photo credit: http://www.archiexpo.com/prod/bauporte-design- entrances-bv/product-140200-1642280.html

Strategies to address Retention With the high cost of staff turnover, nursing leadership must look into ways to retain staff such as: Shared governance programs – work dissatisfaction and nurse disengagement can negatively impact nurses, shared governance programs can devise programs that empower nurses feel as if they are being heard by management (Kerfoot, 2015). Develop quality of life initiatives – leadership should consider changing length of shifts (four 10 hour shifts; five 8 hour shifts) or different shift start times (11am – 11pm; or 3pm – 3am); this adjustments could allow staff to spend more time with their family and improve work-life balances (Kerfoot, 2015) Implement data driven staffing – ensuring you have the right number of staff based on patient acuity levels. This can help to provide equitable staffing and contribute to staff nurses providing quality care (Kerfoot, 2015) Reduce overtime – overtime should the exception, not the rule (Kerfoot, 2015).

Strategies to address Recruitment/Retention via Residency Programs The Institute of Medicine (IOM) in conjunction with the Robert Wood Johnson Foundation multi-year study resulted in the ’Future of Nursing Report’. This report listed evidenced based recommendations of the IOM. IOM Recommendation 3: Implement nurse residency programs. These nurse residency programs are supportive of new nurses as they transition from the classroom to the actual practice of nursing, or into a new practice area (American Nurses Association, n.d.). The American Nurses Association (ANA) states that mentoring programs allow for growth and development of new nurses, and also lead to pathways for leadership development (ANA, n.d.). Photo credit: http://www.residencyprograms.biz/top-residency-programs/new-graduate-nurse-residency-programs/

Residency Programs vs New Grad Programs Newly graduated nurse is hired to a particular unit, goes through orientation, preceptorships and continues to work on the assigned unit. Usually don’t require time commitment; May or may not affect employee retention. Residency Programs A particular unit is not guaranteed; Typically vary in length; Participants focus on learning critical thinking skills, clinical skills; and communication May require a 1 or 2 year commitment from the employer; Can help to reduce new nurses leading within the first year.

Example RN Residency Program (Baptist Medical Center) Baptist Health defines a “new graduate” as a registered nurse who has been licensed for less than 12 months. The residency program will be 12 months in length. During this time, participants must be flexible and willing to work and travel to all Baptist facilities (there are four campuses around Jacksonville, FL). The residency program combines core nursing curriculum, competency development and unit orientations with education focused on clinical skills, critical thinking development, communication skills, and managing patient responsibilities and priorities. Evidenced based best practices in learning and practice development will be employed. Participants will be asked for a two-year commitment to Baptist Health after the residency is completed. Information retrieved from Baptist Health website (https://www.baptistjax.com/about- us/careers/job-listings/new-grad-rn-residency-adult-hospitals-february-2018-30968)

Summary The demand for nurses continues to increase in light of more covered families from the Affordable Care Act, aging baby boomers, patients living longer, and nurses retiring. Nursing leadership must find ways to keep bedside nurses to keep nurses engaged and happy. Nurses who are satisfied and engaged can have a positive impact on position outcomes. Residency programs, shared governance, work – life balances, improved work schedules, reduced overtime are all ways to retain employees and keep turnover rates low. Photo credit: nursingstudentmemoir.blogspot.com

References Baptist Medical Center https://www.baptistjax.com/about-us/careers/job-listings/new- grad-rn-residency-adult-hospitals-february-2018-30968 Dent, S (2017). 4 Reasons Nurses Quit (and What You Can Do Instead). Retrieved from https://nurse.org/articles/reasons-nurses-leave-profession/ Kerfoot, K (2015). Four measures that are key to retaining nurses. Retrieved from https://www.hhnmag.com/articles/3253-four-measures-that-are-key-to-retaining- nurses Nursing Solutions, Inc (2016). 2016 National Healthcare Retention and RN Staffing Report. Retrieved from http://www.nsinursingsolutions.com/Files/assets/library/retention- institute/NationalHealthcareRNRetentionReport2016.pdf Occupational Outlook Handbook (2016). Registered Nurses outlook. Retrieved from https://www.bls.gov/ooh/healthcare/registered-nurses.htm Robert Wood Johnson Foundation (2014). Nearly one in five new nurses leaves job within a year, according to survey of newly-licensed registered nurses. Retrieved from https://www.rwjf.org/en/library/articles-and-news/2014/09/nearly-one-in-five-new- nurses-leave-first-job-within-a-year--acc.html Sheffield, L (2016). Nursing Shortage Statistics. Retrieved from https://peopleelement.com/nursing-shortage-statistics/