Nursing retention is essential for healthcare organizations. Nurse retention strategies promote quality care and create a healthy workplace environment for nurses. A positive work environment helps retain experienced nurses and attracts new nurses into the healthcare organization. In this paper, the concepts of nursing retention and turnover are explained in the context of nursing shortage. Theories and concepts that have been proposed about nursing retention are also discussed. In particular, two theories, Kanter’s theory on employee empowerment and Neuman’s framework are discussed. The paper also relies on literature to recommend strategies that can promote nurse retention in health care organizations. The concepts and perspectives on nursing retention and related policies and statistics are also provided. The QSEN and ANA competencies as related to nursing retention are also reviewed. The paper concludes that through enhanced job satisfaction, nursing retention can be enhanced in hospitals. This in turn will result in improved patient and nurse outcomes.
The attrition rate in the nursing sector has been on the rise over the past few years. While the high turnover can be attributed to various factors, its impact on health care delivery is alarming. High nurse turnover has often resulted in poor patient outcomes, reduced access to health care, the decline in profits of an organization and low job satisfaction. High nurse turnover in all nursing specialties is attributed to the nursing shortage currently felt in the healthcare sector (Rosseter, 2012). Given the negative effects of nurse turnover, strategies to reduce turnover and promote nursing retention have been adopted in most provider organizations.
The financial effects of turnover have motivated organizations to begin to explore ways to enhance nursing retention and increase their financial returns. A study by Morgan and Lynn (2009) established that healthcare organizations incur as much as $60,000 for every RN leaving the organization. Thus, the financial implications of turnover are significant. Nurse retention strategies help organizations to improve nurse staffing levels, enhance patient health outcomes and increase financial returns while maintaining a healthy and productive staff.
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.
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.
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.
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 policy aims at enhancing staff retention in hospitals. To promote education and training, the federal government through the US Department of Health Resources and Service Administration (HRSA) has a program known as Nurse Education, Practice, Quality and Retention (NEPQR) that supports nursing schools financially to ensure quality training and enhance nurse retention.
Organizational Retention Policies
Most healthcare organizations have implemented policies to increase nurse retention. The nurse leaders heading healthcare organizations and academic institutions advise policymakers to enact legislations and policies that would enhance nurse retention in provider organizations. Some of the strategies that have been implemented include skill development and continued education, improved employee welfare, maintaining a healthy workforce and delayed retirement for experienced nurses (Jeter, 2008). These strategies are applied at an institutional – level to help reduce the high attrition rates of staff particularly the attrition of RN’s. The American Nurses Association [ANA] (2010) reports that the nursing shortage currently experienced can be attributed to the high attrition rate of RN’s. In light of this, the institutional staff retention policies primarily aim at attracting and retaining skilled and experienced RN’s in the workforce.
Nursing Shortage Assumptions
There are several assumptions and misconceptions associated with nursing shortage currently experienced in the healthcare sector. The assumptions have hampered nurse retention efforts. The rise in the number of nurse graduates and the economic recovery after the recession have led many to believe that there are no challenges associated with nursing retention in hospitals. However, staff retention in nursing homes and hospice facilities is still a major problem. Thus, it is important that nursing shortage in hospitals and other care facilities nationally is investigated in order to determine nurse retention and attrition rates.
Over the past few decades, nursing staffing levels in healthcare organizations has experienced fluctuations raising doubts whether there is any shortage of nurses in the US at all. However, a critical nursing shortage was experienced in the US in the mid 1990’s. As a response, the US government increased salaries, allowed foreign nurses and increased bonuses for nurses to try and raise the staffing levels (Jeter, 2008). However, these strategies did not remedy the situation as nursing shortage continued to affect care delivery in healthcare facilities in the country. In 2007, the US underwent a financial crisis, which increased the recruitment of RN’s and thus, to some extent, helped to reduce the nursing shortage. The recession forced RN’s in employment to delay retirement while others, who previously worked on a part-time basis converted to full-time. Also, due to recession-related effects, RN’s who had gone into early retirement resumed work. This resulted in a sharp rise in staffing levels and helped reduce the nursing shortage. However, as the economy continues to improve, this temporary reprieve may soon go away and cause nursing shortages to arise again.
The temporary shortage recovery seems to affect new nurse graduates who cannot find a job due to the rise in staffing levels. A survey carried out between 2009 and 2010 revealed that there is a reduction in the number of newly licensed RN’s entering the practice (Jeter, 2008). This finding implies that the economic recession affected labor demand in the healthcare industry leading to high unemployment rate of new nurses. Thus, the rise in RN’s recruitment adversely affected the employment prospects of new nurses. However, this effect may be temporary and it is projected that nursing shortages will rise again.
The recession has helped to address the issue of nursing shortages. However, the nursing shortage is still a major concern affecting the healthcare sector. The concerns may be attributed to the aging population of baby boomers (Daley, 2012). It is projected that demand for nursing staff will rise to provide care for the aging American population. Also, aging nurses may soon retire creating yet another shortage in the healthcare sector. It is projected that by 2020 about 40% of nurses will have reached the retirement age. Besides these concerns, nurses often leave nursing practice because of stress and work overload. Stressful working conditions also discourage students from choosing nursing as a career (Morgan & Lynn, 2009). The enrollment rates in nursing schools are low and may not meet future demand for nurses. Also, the proposed reform plans in the healthcare sector will expand the healthcare sector and make services accessible to all people. This will lead to a rise in demand for nurses. In this regard, the nursing shortage is projected to rise posing many challenges to quality health care delivery.
Besides nursing shortages, issues of quality and safety also affect the healthcare industry. A high RN turnover affects quality care deliver, recruitment and retention of skilled and experienced nurses. Nursing shortage leads to reduced staffing levels, which has adverse effects on patient and nursing outcomes. Increased medication error incidences, low quality care, a rise in infection cases and sometimes patient mortality may arise due to low staffing. Also, understaffing can lead to high workloads, work stress and burnout leading to high attribution rates.
Theories of Nurse Retention
There are several theories and concepts that attempt to explain nursing turnover and retention. In this essay, two theories relevant to nursing retention will be discussed. These include Kanter’s theory of empowerment and Neuman’s systems theory. The Neuman’s approach is interdisciplinary; it minimizes common workplace stressors and empowers the nurse as a way of increasing nursing retention. Neuman’s model is derived from Kanter’s theory on employee empowerment.
Kanter’s Theory on Empowerment
This management theory, which was put forward by Kanter Moss, states that an organization’s management should equip employees with the skills and tools necessary to perform their duties. In other words, employees are empowered by creating a positive workplace environment. The theory postulates that, in any organization, employees can either have power or opportunity. Employees in administrative positions such as technical support, information specialists and resource managers have access to training opportunities to develop their career (Nursing Theories, 2012). On the other hand, employees who have access to opportunity excel in problem solving and implementation of the new changes. In this regard, the theory states that, workforce with access to both power and opportunity tend to be motivated and high performers and exhibit high job satisfaction rates (Nursing Theories, 2012). Thus, in the healthcare sector, power and opportunity in the workplace enhance nurse job satisfaction and promotes nurse retention.
This model was proposed by Betty Neuman, a nurse theorist. It is based on strategies to reduce stress associated with an employee. It examines four aspects of an individual’s response to stress in the workplace settings. These include the individual, the workplace conditions, the individual’s health and the nursing profession (Nursing Theories, 2012). These factors interact to determine a nurse’s response to stress and how the nurse will adapt to the stress. Newman states that, in a stressful workplace environment, a nurse first response would involve coping mechanisms to protect oneself from the effects of stress. If this response fails, the nurse would be prone to fatigue, burnout and emotional stress (Hayes et al., 2012). This will result to increased absenteeism, lack of interest in one’s job and employment change.
Predictors of Nursing Turnover
Nursing turnover poses challenges to quality healthcare delivery in hospitals and other care facilities (Hayes et al., 2011). Medication errors, infections and mortalities related to understaffing can result to poor patient outcomes. Also, stress, burnout and fatigue associated with understaffing can affect the productivity of nurses and result in huge losses to the organization. Turnover in the healthcare settings has multiple causes (Hayes et al., 2011). Organizational factors such as stressful work environment, heavy workload and low remuneration can lead to high turnover. Also, personal factors can make an individual to leave his or her job leading to high turnover rates.
Employment factors can also affect nursing retention. Organizations can directly influence nursing retention and employee turnover. Factors such as workloads, team support, limited time to ensure high quality care, interpersonal conflicts in the workplace and poor remuneration all contribute to high turnover rates (Hayes et al., 2011). Employee appraisal and challenging tasks may not lead to increased attrition rates. Most nurses prefer more control and challenging tasks as they allow them to grow and develop in their career. In fact, nurses who encounter challenges and difficult tasks in their workplace report a high job satisfaction (Hayes et al., 2011). In contrast, lack of control over issues such as patient discharges, admissions and transfers may lead to high turnover intention among nurses.
Personal factors such as nurse’s intention to leave his or her job can be predicted based on the nurse’s job satisfaction level, workplace conditions and availability of support programs within the organization (Jeter, 2008). Personal factors also determine nursing retention in a particular organization. It is important to note that new graduate nurses and licensed nurses tend to change employers within the first few years after employment (Hayes et al., 2011). Thus, a nurse’s intention to stay in a given organization depends on his or her commitment to the organization and the availability of support for new employees. Graduate nurses are more likely to change jobs compared to older and experienced nurses. The new nurses take time to adjust to their new career and choose a specific practice area. During this period, these nurses need support from senior and experienced nurses to make them more committed to the healthcare institution (Hayes et al., 2011). Other factors such as pay and job satisfaction also influence new nurses’ intentions to stay in the organization.
It is important to note that generational differences exist with regard to nurses’ intention to stay in a given healthcare organization. Older nurses (50 years or older) are often loyal to their employer and are less likely to change employers. Additionally, older nurses who have attained the retirement age may opt to delay retirement and stay longer in the organization. Retirement may be influenced by organizational and personal factors (Hayes et al., 2011). Nurses with familial responsibilities may decide to delay retirement because of the need to provide for their children. This has a positive impact on nurse retention rates. However, nurses can leave an organization if they are dissatisfied or lack opportunities for career development. Besides pay and work conditions, graduate nurses look for opportunities for career growth. Organizations that support their employees to pursue further education enhance their intention to remain in the organization. Other personal factors that may influence a nurse’s intention to leave or stay in an organization include educational level and one’s ability to balance between work and life tasks (Jeter, 2008). Thus, personal factors and organizational factors have a high impact on nurse retention and turnover rates.
Viewpoints on the Impacts of Turnover
Some researchers hold different views regarding nursing turnover. While most researchers agree that nursing turnover is the major cause of nursing shortage in health care organizations, others hold the view that high turnover has benefits to an organization. Nurse turnover can enable an organization to maintain a lean and effective workforce by getting rid of ineffective employees. In addition, organizations experiencing high attrition rates can save by paying lower wages and bonuses for new nurses and better remuneration to experienced employees. However, care must be taken to avoid losing talented and experienced employees as the cost of hiring qualified nurses to replace them may adversely affect the productivity of the organization (Hayes et al., 2011). Others argue that by providing training opportunities to enhance skills of nurses, organizations risk losing such employees as training makes them to seek for a better pay in other organizations. Thus, on-job training can negatively impact on retention. Also, the organization can incur losses as investment in employee training is often not paid back.
On the other hand, high turnover rates can negatively impact on organizational performance. High turnover leads to understaffing, which overloads the remaining staff. This in turn leads to job dissatisfaction, poor performance and reduced organizational productivity. Reduction in profitability can make the remaining employees to leave the organization leading to further turnover (Rosseter, 2011). High workload due to understaffing increases stress and burnout of employees, which in turn affects individual mental health. This can lead to increased intent to leave the organization for organizations with better working conditions.
Ultimately, it is the patient who loses when turnover rates are high. In particular, nursing turnover in care homes and hospices can negatively affect patient outcomes. Understaffing and loss of specialized skills through turnover increases medical errors and infections, which may lead to fatalities. Patient falls and other adverse events can also arise when the organization is not sufficiently staffed (Rosseter, 2011). From a financial point of view, healthcare providers may incur costs associated with turnover, which can lead to a reduction in profitability for such organizations. Loss of productivity can arise when skilled and experienced nurses leave a healthcare organization.
Also, the organization can incur direct costs associated with recruitment of new staff to replace employees that have left the organization, training costs for the new employment and overtime paid to nurses working beyond their scheduled shifts due to understaffing (Hayes et al., 2011). Indirect costs to the healthcare organization include loss of talent and reduced productivity, which will ultimately lead to a reduction in profitability. Healthcare organizations need to implement strategies to attract and retain experienced nurses in their workforce. These can serve as nurse leaders and motivators of new nurses in the organization.
Horizontal Violence and Nursing Retention
Horizontal violence has been identified as a leading contributor of turnover especially for new nurses. It refers to workplace harassment involving two nurses or between a healthcare specialist and a nurse (American Nurses Association [ANA], 2010). Horizontal violence can take different forms including threats, verbal abuse, humiliation, exclusion and bullying (ANA, 2010). Negative effects associated with horizontal violence have been reported in healthcare settings. Horizontal violence creates a poor working environment for nursing students, new nurses, patients and even family. A poor working environment in turn leads to low job satisfaction levels, emotional stress and sometimes clinical errors (ANA, 2010). This contributes to high nursing turnover among new nurses and discourages student nurses from seeking employment in the institution.
Horizontal violence has far-reaching implications on nursing retention in health care organizations. Over the last decade, horizontal violence has grown significantly in scope. A study by Harder (2008) established that over 75% of nurses have been victims of harassment at one time during their career. An additional 80% have been bullied by senior nurses or other healthcare professionals. Another study by the Institute for Safe Medication Practices [ISMP] (2004) established that physician bullying of nurses is widespread, with 69% of nurses experiencing pressure to administer an unsafe therapy to a patient. Besides physicians, other healthcare professionals such as social workers and pharmacists also perpetrate horizontal violence against new nurses (ISMP, 2004). Despite the fact that horizontal violence has become widespread in health care organizations, no clear strategies exist for disciplining the perpetrators. This has contributed to low levels of satisfaction among new nurses leading to high turnover levels.
Subtle forms of horizontal violence such as intimidation or verbal abuse discourages teamwork in the healthcare environment and creates an unhealthy work environment for nurses (Bigony et al., 2009). An unhealthy work environment stifles innovativeness, hampers professional growth and causes burnout and low job satisfaction. This increases the intentions of new nurses to leave the organization. Bigony et al. (2009) also observe that horizontal violence affects nurses’ self-esteem, breeds negative thoughts about their career and creates a feeling of inferiority among nurses. If unaddressed, these problems create an unhealthy environment that has a spiral effect on the organization. An unhealthy environment reduces job satisfaction, which adversely affects the quality of care and may lead to medication errors. A hostile workplace environment also influences a nurse’s decision to quit and seek employment in a different organization or sector.
A study by Longo (2007) established that horizontal violence has adverse impacts on staff recruitment and retention. This has severe implications for future nursing demand as it discourages students from joining the nursing profession. In this study, 50% of the respondents (graduate nurses) reported experiencing various acts of harassment including humiliation, intimidation and verbal abuse. Student nurses fail to report these incidents to the authorities as the offender is often their supervisor. In such cases, the nurses choose to quit their job. This contributes to low staffing levels and high attrition rates among new nurses.
Another study by Stanley et al (2007) established that new nurses experience harassment with 60% of the victims leaving their jobs within the first year of employment. The study also found out that 34% of graduate nurses contemplate leaving nursing practice for another profession with 14% of the new nurses taking more leave days because of the effects of horizontal violence. Thus, horizontal violence has implications for staffing levels in health care organizations.
The analysis of nursing retention and turnover has revealed that nursing retention is associated with quality care delivery and improved nurse and patient outcomes. Studies have shown that nursing retention is influenced by multiple factors ranging from organizational to personal factors. In the present state, nursing retention varies depending on specialty and care setting. In general, nursing homes and hospice settings experience the least nursing retention rates. This may be attributed to low job satisfaction in nursing homes compared to hospitals. In fact, most RN’s prefer hospitals to nursing homes because of the poor workplace conditions associated with nursing homes (IFAS, 2007). Also, as indicated, new nurses have different perceptions and preferences from those of older nurses.
It is important to note that past trends in the nursing shortage and the predicted nursing shortages would inform retention strategies. Nurse turnover is directly related to nursing retention and as such, nurse retention strategies must aim at reducing turnover. As explained, multiple factors influence nursing retention. Similarly, turnover is influenced by several factors. Nurses’ intention to leave employment arises when the factors that enhance retention are lacking. Brewer et al (2012) also note that the nurses intention to quit determine nursing turnover in organizations. However, there are many factors in play here. Patient outcomes can improve when an organization is well-staffed with skilled and competent nurses. This ultimately results to positive patient and nurse outcomes. However, there is limited research on the correlation of adequate staffing on medication errors and mortality rates among patients.
From a clinical perspective, nurses need good composition and bonuses and a workplace environment where they feel valued and supported. This enhances their commitment to the organization and reduces the intent to leave. However, research to find out how the interaction among all these factors leads to high nursing retention is lacking. Additionally, research shows that several factors, in combination, influence nursing retention and turnover. However, literature on the actual relationship between retention and turnover is scanty.
Strategies for Improving Nursing Retention
Retention of qualified and experienced nurses can contribute to quality patient care and improved patient outcomes. In addition, implementing retention mechanisms will result to sufficient staffing levels, improve nursing outcomes and ultimately reduce turnover. Thus, nurse leaders and providers should adopt nurse retention mechanisms as a way of mitigating the acute shortage of nursing professionals. Strategies that improve job satisfaction, enhance teamwork and mitigate shortages should be implemented in healthcare organizations to promote staff retention.
Strategies to Improve Job Satisfaction
One way employers can encourage nurses to remain in the organization is by ensuring adequate staffing. Sufficient staffing will ensure that nurses do not experience fatigue or burnout due to heavy workloads. Also, nurses will have adequate time to attend to the patient resulting in improved patient outcomes. Employers should also implement policies that empower the workforce to promote quality care delivery in the organization. Nurse empowerment involves strategies such as mentorship programs, education and training opportunities and involvement of nurses in decision making. Hayes et al. (2011) further state that support and motivation are essential in nursing staff development. In light of this, experienced nurses should be encouraged to stay in the workplace to mentor and support new nurses.
Also, nurse supervisors and leaders have a noble role of encouraging and supporting nurses under their supervision. This will enhance job satisfaction of nurses and influence their intention to remain in the organization. At the same time, efforts must be made to discourage horizontal violence as it impedes innovativeness and increases stress. In order to increase staff retention, nurse managers should create a healthy work environment where each nurse is supported and motivated. Also, interventions such as allowing some level of control or independence and effective communication can promote nursing retention (Rosseter, 2011). Organizational values and culture that reflects nursing values can also promote nursing retention.
Strategies to reduce Nursing Shortage
Nursing retention is negatively related to the nursing shortage. In other words, by increasing nursing retention in health care organizations, adequate staffing levels are maintained, which reduces nursing shortage. To reduce nursing shortage incentives and financial grants should be awarded to nursing schools to hire teaching staff and ensure quality training. More funding for programs in the nursing faculty will attract more students to pursue nursing programs and lead to more nurse graduates entering the job market. Also, nurse leaders should encourage senior and experienced nurses to continue working in the organization by giving them administrative roles. This will influence them to delay retirement and continue working with the organization. For new nurses, induction and training programs should be offered to enhance their skills and ensure quality care delivery. Mentorship programs will also encourage new nurses to remain in the profession.
Strategies to Improve Nursing Competencies
Essential nursing competencies are acquired through education and training. According to the Quality and safety Education for Nurses [QSEN] (2012), core nursing competencies include safety, teamwork and quality improvement. Teamwork refers to collaboration in teams including interdisciplinary teams. It requires nurses to possess effective interpersonal and communication to him or her to effectively participate in clinical decision-making. Thus, health care organizations should promote teamwork and inclusivity in decision-making to attract and retain nurses.
Another nursing competency that promotes retention is safety. QSEN (2012) defines safety as the measures that protect the welfare of patients. Nurse turnover reduction strategies increases staffing levels and promote safety and quality practice in healthcare settings. Safe and quality patient care reduces medication error incidences and saves on costs associated with medication error lawsuits. QSEN (2012) also advocates for quality improvement in the healthcare sector. Quality improvement refers to the mechanisms that monitor and evaluate care delivery to ensure improvement in quality and safety. Based on research findings about nursing retention, an organization can develop and implement quality improvement measures in the healthcare organization.
Besides quality improvement, nursing standards as outlined by ANA can promote retention by creating a healthy working environment in the organization. Three ANA standards are relevant to nursing retention and turnover. These include communication, quality practice and leadership. The ANA (2010) states that RN’s should engage themselves in activities that promote the quality of patient care. RN’s must also embrace evidence based practice to improve patient outcomes. Nursing retention contributes to quality improvement by ensuring that experienced and skilled nurses remain in the organization.
Communication is another important ANA standard. ANA (2010) states that an RN should participate in activities that promote his or her communication and interpersonal skills. One way of enhancing nursing retention is by creating a healthy work environment. Nurse Managers can create a healthy environment for nurses through positive interpersonal communication and interaction. Another ANA standard is leadership. Nurse leadership should be promoted in healthcare organizations and academic institutions as a way of enhancing nurse retention. Mentorship programs that promote nurse leadership should be promoted in nursing schools and healthcare organizations.
Nursing turnover is a major problem affecting the healthcare sector. Turnover affects nursing retention in healthcare organizations leading to low staffing levels. Nursing turnover is influenced by labor demand and supply factors (Brewer et al., 2011). During nursing shortage, organizations must implement strategies that retain nurses in the organization as the demand for nurses is normally high. Nurse turnover is associated with understaffing, which has adverse effects on patient and nursing outcomes. Thus, nursing retention is important for healthcare organizations as it promotes quality patient care and increases productivity in healthcare organizations.
American Nurses Association [ANA]. (2010). Nursing: Scope and standards of practice. Silver Spring, MD: Nursesbooks.org.
Brewer, C. S., Kovner, C. T., Greene, W., Tukov-Shuser, M., & Djukic, M. (2012). Predictors of actual turnover in a national sample of newly licensed registered nurses employed in hospitals. Journal of Advanced Nursing, 68(3), 521-538.
Daley, K. (2012). From your ANA president. American Nurse Today, 7(7), 20-23.
Hader, R. (2008). Workplace violence: Survey 2008. Nursing Management, 39(7), 13–19.
Hayes, L. J., O’Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., & North, N. (2012). Nurse turnover: A literature review – An update. International Journal of Nursing Studies, 4(3), 887-905.
Health Resources and Services Administration [HRSA]. (2012). Nurse education, practice, quality and retention (NEPQR). Web.
Hunt, S. T. (2009). Nursing turnover: Costs, causes, & solutions. Web.
Hutchinson, M., Vickers, M., Jackson, D., & Wilkes, L. (2006). Workplace bullying in nursing: Towards a more critical organizational perspective. Nursing Inquiry, 13(2), 118–126.
Institute for Safe Medication Practices [ISMP]. (2004). Intimidation: Practitioners speak up about this unresolved problem (Part I). Web.
Institute for the Future of Aging Services [IFAS]. (2007). The long term care workforce: Can this crisis be fixed? Web.
Jeter, L. (2008). National nurse leaders discuss retention issues. Web.
Kaiser Foundation. (2012). Nursing workforce. Web.
Longo, J. (2007). Horizontal violence among nursing students. Archives of Psychiatric Nursing, 21(3), 177–178.
Morgan, J. C., & Lynn, M. R. (2009). Satisfaction in nursing in the context of shortage. Journal of Nursing Management, 17(3), 401-410.
Nursing Theories. (2012). Betty Neuman’s System Model.
Quality and Safety Education for Nurses [QSEN]. (2012). Competency KSAs (Graduate). Web.
Rosseter, R. J. (2012). Nursing Shortage Fact Sheet. Web.
Stanley, K. M., Martin, M. M., Michel, Y., Welton, J. M., & Nemeth, L. S. (2007). Examining lateral violence in the nursing workforce. Issues in Mental Health Nursing, 28(9), 247–265.