Recruitment and retention of nurses: challenges facing hospital and community employers.
ABSTRACT Understanding nurses' perceptions of their workplaces underpins successful recruitment and retention initiatives, particularly in this time of global nursing shortage. The American Nurses Association and the American Academy of Nursing have identified "magnet characteristics"--organizational factors that support excellent practice and working conditions in hospital settings. Using selected magnet characteristics, this exploratory study examined nurses' perceptions of their work experiences in both hospital and community settings. Mail surveys were completed by community and hospital nurses (n = 1248) selected randomly from a provincial registry in Ontario, Canada. Scales measured organizational factors (organizational and immediate supervisor support, decentralized decision-making, nurse-physician relationships and work-group cohesiveness) and job-related factors (autonomy, job challenge, work demands, fair treatment, work-status congruence; satisfaction with career, salary, working conditions) of nurses' experiences in their work settings. Nurses in both sectors wanted more opportunities to participate in decision-making and recognition for their contributions to their organizations. In the hospital sector, nurses reported significantly lower levels of perceived organizational and supervisory support and autonomy, and were less satisfied with working conditions and scheduling. Nurses in the community sector were most dissatisfied with salary. No cross-sector differences were reported on nurse-physician relationships, degree of job challenge or career satisfaction. Successful recruitment and retention initiatives hinge on the ability (and willingness) of healthcare organizations to attend to the concerns expressed by nurses and create work settings that are attractive to both new recruits and nurses currently in their employ.
- SourceAvailable from: Cheryl Denise Brunoro-Kadash[Show abstract] [Hide abstract]
ABSTRACT: Abstract Purpose - The purpose of the paper is to describe the processes and results of implementing and evaluating the Releasing Time to Care™ (RTC™) model in a 45 bed Neurosciences unit in a tertiary care hospital in Saskatchewan province of western Canada. Design/methodology/approach – Organizational restructuring in healthcare systems has impacted the ability of CRNs in participation and in influencing the decision making that affect the delivery and outcomes of patient-centered care. At the same time, Clinical Registered Nurses (CRNs) work has intensified because of increases in patient acuity, technological advances, complexity of care provided to patient families and communities, in addition to the intensifying demands put on by aging population and dwindling resources. The work reported in this paper shows that significant improvements have been made based on the current needs and the change is forever imminent. Establishing solid people connections and networking opportunities proved valuable for current and future exchange of information and knowledge translation. Findings – Model implementation resulted in positive narrative and empirical data including: improved patient safety, staff engagement, leadership opportunities and an affirmative shift in organizational culture. Improved patient safety was evidenced by a reduction in falls and decreased medication errors. Originality/value – The paper focuses on including the clinical nurse in organizational and system change towards improving patient-centered quality care. Neurosciences 6300 at Royal University Hospital (RUH) in Saskatoon, was viewed as an RTC™ champion and one of the first to implement and complete the eleven module toolkit. Keywords – Patient-centered quality care, Clinical registered nurse (CRN), Lean, Quality improvement. Paper type – Case studyLeadership in Health Services. 04/2013; 26(3):220-231.
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ABSTRACT: General practice has undergone considerable change in the last two decades. New roles for nurses working in general practice have extended to include tasks that were previously delivered by general practitioners, in particular chronic disease management, and the development of new, advanced roles such as independent nurse prescribing. There have been few research studies investigating the impact of these changes, especially after the introduction of the new General Medical Services contract in April 2004. The overall aim of the work presented in this thesis was to examine the emerging roles of practice nurses, the forces influencing that development, and the effects of these changes on doctor-nurse skill mix in general practice within NHS Scotland. The work employed a mixed methods approach, with three inter-linked studies. The first study was a quantitative, desk-based analysis of workload and clinical activities of doctors and nurses working in 37 practices across Scotland for the year 2002. The second study was a postal questionnaire to all practice nurses working within NHS Greater Glasgow (n=329), conducted in autumn 2005 and achieving a 61% response rate. The third study was a qualitative study, consisting of eighteen interviews with a doctor and nurse inform each of nine general practices. The interviews were conducted between January and July 2006 and practices were selected according to the number of partners and the deprivation status of the practice population. Analysis of workload data showed that practice nurses and general practitioners dealt with 27.5% and 72.5% of total face-to-face encounters, respectively. Many of the encounters with nurses involved chronic disease management, with 20% of such encounters appearing similar in content to the work of GPs. The postal survey found that one third of practice nurses were aged over 50, and will be approaching retirement within 10 years. The majority worked in small teams of nurses, although 31% worked alone. This may have contributed to the finding that 52% (n=103) reported feeling isolated in their workplace. Many had attended CPD training on chronic conditions, but identified minor illness treatment as an area for future training. The qualitative study showed that the Quality and Outcomes Framework of the 2004 contract had been a key driver of changes in general practice service delivery. This has led to an increasing shift in routine care from doctors to nurses. As new roles for practice nurses have evolved, GPs have been able to focus on treating complex morbidities that need medical diagnosis and intervention. The incentivised targets of the new contract have made chronic disease management a predominant activity for practice nurses, with treatment room and non-incentivised activities featuring less and increasingly being provided by new, lower grade nurses or nurse replacements such as Health Care Support Workers (HCSW). There was no consensus between interview participants in terms of the most appropriate use of doctor-nurse skill mix in general practice. Nor did they agree on the merit of advanced roles for practice nurses. However, respondents did emphasise that nurses who wanted to have an independent/advanced role in the practice would need to combine three competencies (independent nurse prescribing, triaging, and minor illness treatment). Most practice nurses interviewed were concerned with obtaining a fair financial return to match their increasing responsibilities, especially after the introduction of the nGMS contract. GPs, however, tended to believe that nurses were appropriately remunerated for the level of responsibility they had within the practice. The continuing role of the GP as the employer of practice nurses was problematic for some nurses and many felt there would be advantages to being employed on Agenda for Change terms and conditions. However, the majority of nurses interviewed preferred being employed by a GP rather than the Health Board. There was little support amongst either nurses or GPs for the notion of nurse partners within practices. Overall, these studies provide lessons which will be of value in planning the future training and development of practice nurses. It suggests that practice nurses should obtain proper training and support in order to meet their individual needs and to carry out new responsibilities and roles. In addition, the impending shortage of practice nurses due to retirement, lack of retention and potential recruitment difficulties needs to be addressed urgently at the level of primary care policy and manpower planning.
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ABSTRACT: To assess Malaysian nurses' perceived job satisfaction and to determine whether any association exists between job satisfaction and intention to leave current employment. There is currently a shortage of qualified nurses, and healthcare organisations often face challenges in retaining trained nurses. Job satisfaction has been identified as a factor that influences nurse turnover. However, this has not been widely explored in Malaysia. Cross-sectional survey. Registered nurses in a teaching hospital in Malaysia completed a self-administered questionnaire. Of the 150 questionnaires distributed, 141 were returned (response rate = 94%). Overall, nurses had a moderate level of job satisfaction, with higher satisfaction for motivational factors. Significant effects were observed between job satisfaction and demographic variables. About 40% of the nurses intended to leave their current employment. Furthermore, age, work experience and nursing education had significant associations with intention to leave. Logistic regression analysis revealed that job satisfaction was a significant and independent predictor of nurses' intention to leave after controlling for demographic variables. The results suggest that there is a significant association between job satisfaction and nurses' intention to leave their current employment. It adds to the existing literature on the relationship between nurses' job satisfaction and intention to leave. Methods for enhancing nurses' job satisfaction are vital to promote the long-term retention of nurses within organisations. Attention must be paid to the needs of younger nurses, as they represent the majority of the nursing workforce and often have lower satisfaction and greater intention to leave than older nurses do. Strategies to nurture younger nurses, such as providing opportunities for further education, greater management decision-making capabilities and flexible working environment, are essential.Journal of Clinical Nursing 11/2013; 22(21-22):3141-3152. · 1.32 Impact Factor