Hiring a competent nurse staff is only half the battle. The other half is keeping them. A new study published in Nursing Ethics found the turnover rates for RNs is 16.5%, with each resignation costing a hospital between $44,380 to $63,400 a nurse. Furthermore, newly licensed nurses scored lower on job satisfaction and were more likely to leave their job within two years.
The Nursing Ethics report found that intergenerational conflict was a big part of nurse dissatisfaction; with millennials, Gen Xers, and baby boomers butting heads at the hospital.
“Younger generation nurses feel like they don’t have power over their practice, they’re not in charge, and that is logical because they are novice practitioners,” study author Charleen McNeill said in a press release. “However, they bring a knowledge of technology that seasoned nurses may lack. In turn, more experienced nurses support the clinical learning and professional role formation of new nurses. Successful nurse-leaders find ways to garner the strengths of each generation of nurses to achieve the best patient outcomes.”
McNeill said instead of looking at it as conflict, nurse-leaders need to leverage the strengths of each generation and determine strategies to empower all generations of nurses. Their research suggested a strong correlation between professional values and career development. They also found that both job satisfaction and career development correlated positively with nurse retention.
“The work culture that leaders create – the environment that nurses are working in – is the most important thing related to retention,” McNeill said. “It’s very expensive to hire new nurses. When we have good nurses, we want to keep them so we need to understand what’s important to keep them.”
For more tips on retention, conflict resolution and recruitment, check out the following articles from our Strategies for Nurse Managers site!
Kathleen Bartholomew, RN, MN, is a nationally recognized expert on healthcare communication and patient safety. She is the author of the groundbreaking books Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other and Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication. She’s extremely well respected by other nurses, is considered a thought leader, and has spoken to tens of thousands of nurses and healthcare leaders in speeches, conferences, and seminars across the world.
If you’re interested in nominating Kathleen, copy and paste the link below into a web browser. Kathleen’s email address is email@example.com.
Hierarchy of Voice
Excerpted from Ending Nurse-to-Nurse Hostility, Second Edition, by Kathleen Bartholomew
Try the following exercise that I often use to encourage nurses’ self-esteem. I call it a “hierarchy of voice” because each step results in greater empowerment. Addressing specific behaviors that are a challenge to a nurse stimulates meaningful conversations about that individual’s stumbling blocks to empowerment and self-esteem.
In performance evaluations, share the following list and ask team members to pick 10 meaningful actions that they would like to [more]
Listening, validating and asking for a commitment
From Team-Building Handbook: Accountability Strategies for Nurses, by Eileen Lavin Dohmann, RN, MBA, NEA-BC
When working with a group, I assume that people are rational and logical.
So, if I want them to do something, I just need to explain it and they’ll do it. When I don’t get the results I am seeking, I tend to think “Oh, I must not be explaining it well. Let me try it again.”
It’s taken me a long time to realize that what I was hearing as “not understanding me” was often someone’s polite way of telling me no. So, now when I find myself explaining the same thing to someone for the third time, I stop and ask the person what he or she is hearing me request. If I can validate that the person is hearing me correctly, I ask for the commitment: yes or no.
Validating… and asking for a yes or no
We can hold ourselves accountable, but holding other people accountable can be much more difficult. Consider this nurse-physician scenario and ask yourself [more]
Power can be taken, but not given. The process of the taking is empowerment in itself.
In a recent post, I promised a free tool adapted from The Image of Nursing.
If you’d like to download SAY THIS, NOT THAT: An Empowerment Glossary for
Nurses, you’ll find it here. And while you’re waiting for the download, try this:
If you hear yourself saying:
No one notices my contributions
Say this instead:
I’d like to share with you how I’ve handled this situation
In a comment on one of my posts last week, Stefani suggested (strongly) that to improve the image of nursing, we need to speak up. I’m reposting her comment below to draw your attention to it.
I’d like to hear your thoughts about why nurses might not speak up when, by staying silent (out of fear?), their personal self-esteem takes a hit and—more importantly—care standards aren’t maintained. Have you developed techniques that help you overcome fear of confrontation so that you can truly speak up?
Here are a few resources related to speaking up:
- A terrific article from Susan Gaddis, PhD: Positive, Assertive “Pushback” for Nurses
- A table you will be able to download from our reading room in a few days: Say This, Not That: An Empowerment Glossary for Nurses. Look for it on or before 3/19/15.
- Books written by Kathleen Bartholomew, RN, MN, including Speak Your Truth and Team-Building Handbook: Improving Nurse-Physician Communications.
As a leading publisher of nursing and other healthcare products—including books, newsletters, webinars, and online training—HCPro is a great place to publish. If you have an idea for a book or other product that will benefit the profession of nursing, we would like to hear from you.
At HCPro, we value our expert authors as the foundation of our business and strive to build long-term relationships with them. We collaborate with our authors—a diverse and knowledgeable group of people focused on creating a personally satisfying and improved healthcare workplace for themselves and their colleagues. The nurses, nurse educators, and nurse managers who read our books appreciate our focus on quality, from project inception through collaborative development, publication, and distribution.
Whether you want to write a book, blog post, or article, or create a webinar, we’ll provide you with the feedback and tools you need to be successful. Contact us for more information.
Some topics we’re interested in: Managing intergenerational teams, delegation and supervision across the care continuum, charge nurse insights, creating a culture of safety, effective communications.
Care provided by nurse practitioners (NP) is comparable to care provided by physicians in terms of patient satisfaction, prescribing accuracy, preventative education, and time spent with patients, according to a literature review conducted by the National Governors Association. The group examined 22 articles and studies regarding scope-of-practice for NPs.
The review found that NPs could successfully manage chronic conditions such as hypertension, diabetes, and obesity, and rated favorably in gaining patients’ compliance with recommendations and reductions in blood pressure and blood sugar. The report notes that patients often stated a preference for a care from a physician when it came to medical aspects, but had no preference with regards to nonmedical aspects of care.
NPs are currently allowed to practice and prescribe independently in 16 states and the District of Columbia, while NPs in the remaining 34 states must have some level of physician involvement in order to practice. The authors of the report note that expanding scope-of-practice laws for NPs could help states meet the increasing demands for primary care services. The debate over whether or not NPs should be allowed to practice independently has been ongoing for several years, with many physicians groups opposing NP independence. However, those states and healthcare systems that have expanded the role of NPs have reported positive results, according to the report.
The debate about who is qualified to provide primary care rages on this week, following the release of the report Primary Care for the 21st Century: Ensuring a Quality, Physician-led Team for Every Patient from the American Academy of Family Physicians (AAFP). In the document, the AAFP advocates for a team-based approach to primary care–in which a physician leads a groups of nurses, nurse practitioners (NP), physician assistants (PA), and other healthcare professionals to provide comprehensive and high quality care –while criticizing proposals to allow NPs to practice independently.
A national shortage of primary care physicians has led to efforts to substitute independently practicing NPs for physicians, but the AAFP points out that NPs “do not have the substance of doctor training or the length of clinical experience required to be doctors.” While it is an inarguable fact that physicians receive several years of training and clinical experience beyond that of NPs, the debate centers more around whether NPs and PAs can provide the necessary healthcare services that patients require while maintaining a high quality of care, without the direct supervision of or collaboration with a physician. Some states, such as Massachusetts, have already granted a greater degree of independence to advanced practice professionals.
While the AAFP’s argument for solving the primary care gap by instituting ideal ratios of NPs to physicians is compelling, and the model of physician-led healthcare teams does hold promise for improving the healthcare system, the report nonetheless seems to fan the flames when it comes to practitioner qualifications. NPs are referred to as “less-qualified health professionals” and “lesser-trained professionals” who are able to handle only patients with “basic,” “straightforward,” and
“uncomplicated” conditions. The language of the report does not seem to give NPs much credit when it comes to their training and education.
While the AAFP rules out the idea that two models of healthcare–physician-led teams and independently practicing NPs–could coexist harmoniously, one has to wonder whether ultimately the patient should be allowed to decide which model best meets his or her needs. Shouldn’t patients be trusted to make informed decisions about their healthcare? If a patient is aware of the amount of training an NP has received, is aware that it does not equal that of a primary care physician, and is comfortable with that concept, why shouldn’t a patient be able to seek those (potentially more convenient) services rather than hunt for a physician-led team model? The issue is complex, but a solution that allows all Americans to receive quality healthcare must be reached.
What are your thoughts on the AAFP report, and the debate about granting NPs autonomy? Share your comments with us!
Nurses’ adoption and use of clinical practice guidelines is largely affected by external barriers such as social and organizational factors, according to a study published in this month’s issue of American Journal of Nursing. Clinical practice guidelines, which the Institute of Medicine defines as “systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances,” are designed to close the gap between evidence for best practice and actual patient care. Researchers chose to focus on nurses’ applications of clinical practice guidelines due to several previous studies that found that nurses were most often identified as being primarily responsible for ensuring patient safety.
Researchers examined responses to open-ended survey questions asking nurses about barriers and facilitators to using clinical practice guidelines. The top three most-identified categories for facilitating the use of guidelines were education/orientation/training, communication, and time/staffing/workload; similarly, these were also identified as categories in which there were barriers to guideline use. 44% of nurses responded that their ability to use guidelines was impeded by a lack of time and a heavy workload, while 25% cited a lack of education, orientation, and training and 22% cited poor communication as barriers. Researchers found that 91% of nurses identified at least one external barrier, or those outside of the individual nurse’s control, and 53% of nurses identified more than one external barrier. Fewer than 10% of nurses identified internal barriers such as lack of awareness of guidelines or willingness to change practice to better adhere to guidelines.
The research suggests that social and organizational factors can be crucial in the use of clinical practice guidelines. Organization leaders should find ways to ensure that nurses receive sufficient education and adequate time to successfully implement guidelines. In addition, effective communication and cooperative teamwork should be encouraged and practiced by everyone within an organization. The study’s researchers conclude that nurses should ideally be involved in all stages of guideline development, implementation, and use.
How do your nurses respond to clinical practice guidelines? What are some ways you have found to ensure guideline use among your nurses? Share your thoughts in the comments section!