A brief essay discussing the difficult issue of retention of nurses in healthcare, including cause & effect of loss, and possible solutions.

1. Running head: THE ROAD TO RETENTION 1
The road to retention
Edward Struzinski
Kaplan University

2. 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

3. 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?

4. THE ROAD TO RETENTION 4
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.

5. THE ROAD TO RETENTION 5
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).

6. THE ROAD TO RETENTION 6
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.d03
t04?deniedAccessCustomisedMessage&userIsAuthenticated=false