Journal of Gerontological Nursing

Evidence-Based Practice Guideline Supplemental Data

Evidence-Based Practice Guideline: Nurse Retention for Nurse Managers

Jane H-C. Tang, PhD, RN, NE-BC; Pamela Hudson, DM, RN

Abstract

Nursing retention and turnover impacts health care on many facets; pressures are increasing to provide quality care in a cost-effective manner to a satisfied patient with an engaged staff as defined by the Quadruple Aim. Retention of experienced staff nurses is paramount as the nursing profession enters another shortage era, which leads to impact on patient safety and quality of care. The purpose of this nurse retention evidence-based practice guideline is to provide strategies for first line nurse managers in various health care settings to use in enhancing job satisfaction and decreasing turnover of staff nurses. Interventions are focused on three areas that are beyond compensation issues and are within the purview of nurse managers: (a) autonomy; (b) recognition; and (c) communication. Retaining expert nurses will have a positive effect on quality patient care. [Journal of Gerontological Nursing, 45(11), 11–19.]

Abstract

Nursing retention and turnover impacts health care on many facets; pressures are increasing to provide quality care in a cost-effective manner to a satisfied patient with an engaged staff as defined by the Quadruple Aim. Retention of experienced staff nurses is paramount as the nursing profession enters another shortage era, which leads to impact on patient safety and quality of care. The purpose of this nurse retention evidence-based practice guideline is to provide strategies for first line nurse managers in various health care settings to use in enhancing job satisfaction and decreasing turnover of staff nurses. Interventions are focused on three areas that are beyond compensation issues and are within the purview of nurse managers: (a) autonomy; (b) recognition; and (c) communication. Retaining expert nurses will have a positive effect on quality patient care. [Journal of Gerontological Nursing, 45(11), 11–19.]

Nursing retention and turnover impacts health care on many facets; pressures are increasing to provide quality care in a cost-effective manner to a satisfied patient with an engaged staff as defined by the Quadruple Aim (Bowles, Batcheller, Adams, Zimmerman, & Pappas, 2019). Turnover is costly both financially and emotionally. The monetary costs associated with staff turnover are related to recruiting and orienting nurses (Kovner, Brewer, Fatchi, & Jun, 2014; NSI Nursing Solutions, 2019). Turnover also affects staff's satisfaction and disturbs productivity of nursing, frequently causing the hospital to turn patients away due to inadequate staffing numbers, which decreases revenues (Vardamann, Rogers, & Marler, 2018). Insufficient staffing leaves nurses feeling disenfranchised, increases stress, and impacts job satisfaction, causing many nurses to leave the profession as they cannot care appropriately for their patients (Aiken et al., 2017; Spence Laschinger & Fida, 2015). Buerhaus (2017) has predicted the profession will experience a shortage of nurses in the next 10 years. The supply of nurses over the next decade is uncertain due to changes in age of nursing population, economy, interest in nursing, and availability of nursing faculty (American Association of Colleges of Nursing, 2019).

Because of the shrinking pool of available nurses, it is especially important to retain staff nurses within the organization/unit (Hollis, 2019). Retention is a process that should be started before a staff nurse is hired and needs to be ongoing (Ziebert et al., 2016). Nurse managers are critical to promoting job satisfaction and diminishing turnover of nurses working in their area. Although some factors that contribute to turnover are not in the control of managers, there are many actions that can be taken by them (Boamah, Read, & Spence Laschinger, 2017; Brunges & Foley-Brinza, 2014; Haid et al., 1993). Therefore, the purpose of this evidence-based practice guideline is to provide strategies for first line nurse managers in various health care settings to use in enhancing job satisfaction and decreasing turnover of staff nurses. The goal of this guideline is to present strategies that will retain experienced nurses beyond compensation issues.

Defining Key Terms

Job satisfaction is the extent to which individuals like or enjoy their jobs (McCloskey & McCain, 1987). Voluntary turnover is initiated by individuals who quit or resign an agency. In contrast, involuntary turnover is initiated by the organization, such as dismissals and layoffs (Hinshaw & Atwood, 1983; Price, 1977). Retention is the ability of the organization to retain individuals in their employment once they are hired (Tomey, 2008). A first line nurse manager is also called head nurse, nursing care coordinator, nurse manager, patient care manager, or patient care coordinator, whose major responsibility includes day-to-day operations of the nursing care delivery and organization and personal needs in a given unit(s) (Huston & Marquis, 1989).

Factors Influencing Job Satisfaction

Studies have found that turnover has resulted in many nurses leaving the profession, making it costly for health care agencies. Among the factors studied, job satisfaction has been widely recognized as a critical factor affecting retention and turnover (Bolima, 2015; Cotton & Tuttle, 1986; Dilig-Ruiz et al., 2018; Ellenbecker, Porell, Samia, Byleckie, & Milburn, 2008; Gillet et al., 2018; Gregory, Way, Lefort, Barrett, & Parfrey, 2007; Halter et al., 2017; Hom & Griffeth, 1995; Irvine & Evans, 1995; Kovner et al., 2016; Letvak & Buck, 2008; Leveck & Jones, 1996; Li et al., 2018; Lucas, Atwood, & Hagaman, 1993; Mueller & Price, 1990; Nei, Snyder, & Litwiller, 2015; Portoghese, Galletta, Battistelli, & Leiter, 2015; Price, 2001; Price & Mueller, 1981; Saber, 2014; Sourdif, 2004; Tang, 2005, 2008; Tourangeau & Cranley, 2006; Yang & Kim, 2016). Job satisfaction is a complex phenomenon. Although many factors have been associated with job satisfaction, no one single factor can stand alone as the major explanatory variable (Blegen, 1993; Hinshaw & Atwood, 1983). The following factors, which are grouped into four categories, are directly related to nurses' job satisfaction in multiple settings:

  • Work environment: includes factors such as job stress or burnout, autonomy, group cohesions or peer support, recognition or feedback, routinization of work, and pay.
  • Nurses' characteristics or mobility factors: include race/ethnicity, age, marital status, dispositional affectivity, nurse experience or tenure, educational level, amount of time worked, shift type/length, clinical service and type of unit, availability of alternative jobs in the community, and organizational commitment or loyalty.
  • Organization characteristics: factors such as distributive justice or fairness, promotion or advancement opportunity, professionalization, or career commitment, and value congruence.
  • Nurse manager characteristics: include communication with supervisors and management/leadership support, and management/leadership style.

Assessment Criteria

The first step toward improving nurse retention is to take an initial measurement of retention and turnover. Essential areas for assessment of nurse retention and turnover include: (a) nurse demographic information; (b) turnover rate; (c) job satisfaction; and (d) intent to stay.

Demographic Information

Demographic information provides a quick reference for nurse managers to understand their staff nurses. Demographic data (e.g., age, education, marital status, number of children, clinical experience, employment status, stress levels) may be obtained through survey, interview, or review of nurses' personnel records or human resource electronic database.

Turnover Rate

Accurate measurements of turnover are important for effective turnover management and evaluation (Duxbury & Armstrong, 1982; Hofmann, 1981; Jones, 2008; Mann & Jefferson, 1988). To calculate turnover, raw data of employees' personnel records might be obtained from health care agency personnel or the nursing department. There are several commonly used turnover indicators to measure nursing turnover (Duxbury & Armstrong, 1982; Hofmann, 1981; Palmer, 2014; Price, 1977). The “Nursing Turnover Measurement Form” is designed to help nurse managers in measuring turnover in an easy and consistent manner over time.

Job Satisfaction

There are several possible ways for managers to determine the level of job satisfaction of their staff nurses. For example, personal interviews, group meetings, or questionnaires can be used. In addition, there are numerous existing tools available for measuring job satisfaction (Bolima, 2015; Cicolini, Comparcini, & Simonetti, 2014; Dilig-Ruiz et al., 2018; Li et al., 2018; Saber, 2014). Among them, the Price Job Satisfaction Scale (Table A, available in the online version of this article) is one of the most common tools used to measure staff nurses' attitudes toward their job (Chu, 2001; Price, 2001; Tang, 2005, 2008).

Price Job Satisfaction ScalePurpose: To assess the overall satisfaction of staff nurses with their current job.Instructions: For each nurse receiving the Nurse Retention guideline, please have s/he complete the Price Job Satisfaction Scale. This scale should be completed at baseline (before the nurse retention guideline is initiated) and on a regular basis, such as every 6 months.Scoring: Each item is scored from 1 to 5, with “strongly disagree” scored as 1 and “strongly agree” as 5. Scores are summed and divided by the number of items to attain a mean. A higher score indicates higher level of satisfaction.Directions: Please circle the number that best reflects your response to the following statements about your overall satisfaction with your current job.

Table A:

Price Job Satisfaction Scale

Purpose: To assess the overall satisfaction of staff nurses with their current job.

Instructions: For each nurse receiving the Nurse Retention guideline, please have s/he complete the Price Job Satisfaction Scale. This scale should be completed at baseline (before the nurse retention guideline is initiated) and on a regular basis, such as every 6 months.

Scoring: Each item is scored from 1 to 5, with “strongly disagree” scored as 1 and “strongly agree” as 5. Scores are summed and divided by the number of items to attain a mean. A higher score indicates higher level of satisfaction.

Directions: Please circle the number that best reflects your response to the following statements about your overall satisfaction with your current job.

Intent to Stay

It is important to detect staff nurses' perceptions of likelihood of staying in their current job. McCain's Intent to Stay Scale (Table B, available in the online version of this article) is one way of understanding staff nurses' perceptions (Al-Hamdan, Nussera, & Masa'deh, 2016; McCloskey, 1990; Tang, 2005, 2008).

McCain's Intent to Stay Scale (A 5-Item Subscale from McCain's Behavioral Commitment Scale)Purpose: To assess the staff nurse's perception of the likelihood to stay in her or his current job.Instructions: For each nurse receiving the nurse retention guideline, please have the nurse complete the McCain's Intent to Stay Scale. This scale should be completed at baseline (before guideline is initiated) and on a 6-month basis.Scoring: Each item is scored from 1 “strongly disagree” to 5 “strongly agree”. Scores are summed and divided by the number of items to attain a mean. A higher score indicated higher intent to stay.Directions: Please circle the number that best reflects your response to each statement.

Table B:

McCain's Intent to Stay Scale (A 5-Item Subscale from McCain's Behavioral Commitment Scale)

Purpose: To assess the staff nurse's perception of the likelihood to stay in her or his current job.

Instructions: For each nurse receiving the nurse retention guideline, please have the nurse complete the McCain's Intent to Stay Scale. This scale should be completed at baseline (before guideline is initiated) and on a 6-month basis.

Scoring: Each item is scored from 1 “strongly disagree” to 5 “strongly agree”. Scores are summed and divided by the number of items to attain a mean. A higher score indicated higher intent to stay.

Directions: Please circle the number that best reflects your response to each statement.

Description of the Practice

After assessing the level of job satisfaction and analyzing the turnover data, the next step is to implement appropriate interventions. Despite a large body of research on the phenomena of retention and turnover, empirically supported interventions in this area are limited (Hom & Griffeth, 1995; Kang, Kim, & Yun, 2017; Tullar et al., 2016; Wilson, 2006). Exhaustive literature reviews have shown that nurse retention and turnover are caused by many interacting factors. These complex relationships have resulted in no best or quickest way to fix turnover problems. Recommendations for interventions to address nurse retention and turnover are based mostly on correlational descriptive studies, expert opinions, and informal observations. Although the supportive evidence is not conclusive, the wealth of information and suggestions found in the literature can be useful. Interventions are focused on three areas: (a) autonomy; (b) recognition; and (c) communication. Reasons for focusing on these areas are two-fold. First, these factors are identified as having significance in influencing job satisfaction. Second, these interventions are more controllable and within the purview of first line nurse managers because they are not financial approaches.

Enhance Nurses' Autonomy

Autonomy is a job characteristic that encourages and promotes staff nurses' sense of control over their job, including the ability to make decisions about daily nursing practices or increases in vertical movement, or the ability of employees to perform their job independently by creating clinical guidelines to enhance decision making (Barto, 2019; Palmer, 2014). Nurses value autonomy as an important job satisfier (Laschinger & Finegan, 2005; McCloskey, 1990; Nei et al., 2015). Nurses favor working in a participative environment as opposed to one that is autocratic (Lucas, 1991; Volk & Lucas, 1991). Participative management/transformational leadership is characterized by a caring, supporting, and encouraging environment with opportunities for staff participation and involvement in decision making related to professional practice. Nurse managers should value their staff and have effective communication skills to promote shared control and participation in decision making of their staff nurses. However, it is important for nurse managers to understand and consider individual differences among their staff members. The following are strategies to enhance nurses' autonomy.

Allow Staff Nurses to Have More Control Over Their Work. Nurses should have more control and make their own decisions related to nursing practice and managing caseload (Aiken & Cheung, 2008; Al-Hamdan, Smadi, Ahmad, Bawadi, & Mitchell, 2019; American Organization of Nurse Executives [AONE], 2000; Breau & Reheaume, 2014; Choi, Goh, Adam, & Tan, 2016; Collins et al., 2000; Déry, Clarke, D'Amour, & Blais, 2018; Dilig-Ruiz et al., 2018; González-Gancedo, Fernádez-Martinez, & Rodríguez-Borrego, 2019; Han, Trinkoff, & Gurses, 2015; Kovner et al., 2016; Kretzschmer et al., 2017; Li et al., 2018; Moneke & Umeh, 2014; Morsaini, Bagnasco, & Sasso, 2017; Nei et al., 2015). For example, nurse mangers can encourage staff nurses to have input regarding nurse–patient ratio via mechanisms, such as admissions processes, staffing-level decisions, decisions to open or close units or beds in the health care setting, and determination of unit size. In addition, nurse mangers can involve staff nurses in decisions related to pulling staff nurses or rotation of nurses to different units or have staff nurses decide on substitution among staff nurses and between nurses and auxiliary personnel (Li et al., 2018; Munnangi, Dupiton, Boutin, & Angus, 2018).

In addition, nurse mangers can delegate responsibility to staff nurses for unit schedules. This delegation of responsibility will result in more flexible scheduling and control over working shifts (American Nurses' Association, 1983; AONE, 2000; Brunges & Foley-Brinza, 2014; González-Gancedo et al., 2019; Hinshaw, Smeltzer, & Atwood, 1987; Vermeir, Downs, et al., 2018; Wilson, Squires, Widger, Cranley, & Tourangeau, 2008). Furthermore, nurse mangers can support staff nurses in balancing family and work lives, such as allowing time to take a class or meet family needs, by permitting flexible scheduling (AONE, 2000; Dawson, Stasa, Roche, Homer, & Duffield, 2014; Dilig-Ruiz et al., 2018). In addition, it is important that nurse managers provide staff nurses with some control over how their work time is spent. For example, build time into their schedule to complete paper work/computer charting or attend patient care conference or council meetings (Noblet et al., 2017).

Increase Involvement of Staff Nurses in Decision Making That Affects Nursing Practice. One example is to develop task forces or committees to facilitate staff nurses' participation, such as quality improvement committees, research utilization committees, nurse retention and recruitment committees, or financial planning committees (Goode et al., 2005; Hinshaw et al., 1987; Lageson, 2004). Another example is to use and value staff nurses' input and expertise (e.g., ask staff to interview and provide input on hiring a new staff nurse or nursing aide, consult staff nurses about patient care issues, have nurses lead patient care conferences) (AONE, 2000; Breau & Reheaume, 2014; Déry et al., 2017; Hinshaw et al., 1987; Lucas, 1991). A further example is to create a supporting environment allowing staff nurses the opportunity, freedom, and guidance necessary to participate in unit activities. This can be done by giving staff nurses full accountability to plan for nurses' activity during the week or give staff nurses paid time off to conduct a research utilization project (Cummings et al., 2008; Force, 2005). A final example is to encourage staff nurses to make decisions about nursing practices, such as formulating procedures and policies and implementing changes in the unit. If staff nurses perceive their voices are valued, they will become more involved (Boamah et al., 2017; Breau & Reheaume, 2014; Choi et al., 2016).

Promote Shared Governance. Promoting shared governance as it contributes to nurses' autonomy leads to nurses' job satisfaction (AONE, 2000; Brunges & Foley-Brinza, 2014; Force, 2005; Hess, 2004; Jones, Stasiowski, Simons, Boyd, & Lucas, 1993; Kovner et al., 2016; Moneke & Umeh, 2014). Shared governance provides an environment and structure that enhances professional nursing practice and empowers nurses to make decisions in practice. Promotion of shared governance can be done through several mechanisms.

First, provide means for nurses to express points of view and preferences. This can be done by conducting surveys, using group meetings, or having one-on-one interviews with staff members (AONE, 2000; Khowaja, Merchant, & Hirani, 2005). Second, delegate authority to unit councils, such as education, quality improvement, and practice councils, for important unit activities. For example, the issues of patient care standards, nurses' activity during the week, management procedures, protocol development, and implementing and monitoring quality improvement activities can be decided by staff nurses who participate in the unit councils (Hess, 2004; Specht, 1996; Wilson et al., 2008). Third, show a supportive attitude over shared governance to facilitate the implementation of the model. For instance, recognize and praise nurses' achievement on a group decision (Specht, 1996). Fourth, schedule meeting times wisely so they will not interfere too much with nurses' time for patient care activities (AONE, 2000). Ask staff nurses' input for agendas, circulate the agenda and/or send out information prior to the meeting, and ask for responses. Finally, evaluate staff nurses' perception of shared governance on a regular basis (Specht, 1996).

Demonstrate Recognition and Respect to Nurses

Recognition is defined as “head nurse behaviors that acknowledge, with a show of appreciation, staff nurse performance and achievement” (Blegen et al., 1992, p. 58). Staff nurses want their achievements to be recognized. Consistent recognition of efforts by management and feeling valued and appreciated by management will support the effort of nurse retention (Abou Hashish, 2017; AONE, 2000; Blegen et al., 1992; Goode & Blegen, 1993; Kovner et al., 2016; Morsiani et al., 2017; Munnangi et al., 2018; Perlo et al., 2017; Sveinsdóttir, Ragnarsdóttir, & Blöndal, 2015). Recognition can be formal, such as written acknowledgement, or informal, such as conversation during day-to-day activities. The following strategies may be used.

Provide Verbal Acknowledgement and Feedback to Staff Nurses. Nurse managers should take time to visit patient care areas and socialize with staff members with expressions of appreciation, such as “Thank you for working extra hours,” “You are a very valuable member of our team,” or “I'm proud of the work you did” (AONE, 2000; Blegen et al., 1992; Force, 2005; Goode & Blegen, 1993; Wagner, 2006). Managers can give private verbal feedback for staff nurses' achievements, such as obtaining a Bachelor's degree, receiving nursing certification in their specialty, winning an award, publishing an article, or finishing a specialty course (Blegen et al., 1992; Goode & Blegen, 1993). Immediate and private oral feedback can be provided for staff nurses' outstanding job performance, such as handling a critical patient care situation well or solving a conflict between other staff members (Blegen et al., 1992; Goode & Blegen, 1993).

Provide Written Acknowledgement and Feedback to Staff Nurses. Handwrite thank-you notes to staff nurses for appreciation of their hard work or any outstanding performance, for example, taking an extra shift for a coworker or participating in committee meetings (AONE, 2000; Aronson, 2005; Blegen et al., 1992; Force, 2005; Goode & Blegen, 1993; Wagner, 2006). Send a copy of any letters regarding the outstanding performance of the staff nurse to the nurse executive and place a copy in the staff nurse's personnel file (Blegen et al., 1992; Goode & Blegen, 1993). Provide a copy of patient or family complimentary evaluations to staff nurses and nurse executives (Blegen et al., 1992; Goode & Blegen, 1993). Write a card to staff nurses in remembrance of their special days, such as Nurse's Week, birthdays, anniversaries, graduation, or other events. All of these strategies provide great recognition for staff nurses.

Acknowledge the Performance and Achievements of Staff Nurses Publicly. One example is to create a form that allows patients/families, managers, and staff nurses to nominate a nurse for outstanding job performance (AONE, 2000; Brunges & Foley-Brinza, 2014; Haid et al., 1993). In addition, congratulate the outstanding performance and achievements of staff nurses in front of their peers or others (Blegen et al., 1992; Goode & Blegen, 1993). Finally, post complimentary patient evaluations for individual staff nurses on the bulletin board or in the agency newsletter (Blegen, 1993; Blegen et al., 1992).

Provide Opportunity for Staff Nurses' Professional Growth, Development, and Participation. Encourage staff nurse participation in leadership roles, such as in shared governance or to serve as resource nurses for unit peers (Brunges & Foley-Brinza, 2014; Force, 2005). Another strategy is to provide support and assistance toward professional and career goals of staff nurses. For example, help staff develop specialty expertise, such as pain management, or help them find a school or college to pursue a higher nursing degree (Al-Hamdan et al., 2019; Blegen et al., 1992; Goode & Blegen, 1993; Hinshaw et al., 1987; Nowrouzi et al., 2016; Wilson, 2005). Finally, encourage collaborative relationships especially with physicians. The use of interdisciplinary tools for rounding will increase RN/physician communication and collaboration. Creating RN/physician committees increases the opportunity for building collegial relationships. Well-designed training programs help each discipline understand the needs of the other (Adams & Feudale, 2018; Kovner et al., 2016; Ma, Shang, & Bott, 2015; Moneke & Umeh, 2014; Nantsupawat et al., 2017; Nei et al., 2015; Saber, 2014; Van Osch, Scarborough, Crowe, Wolff, & Riemer-Kirkham, 2017).

Provide Awards to Acknowledge Staff Nurses. Nurse mangers can provide release time for staff nurses to shadow managers or other mentors to experience administrator roles and functions or to work on projects for the unit (AONE, 2000; Blegen et al., 1992; Goode & Blegen, 1993). Another way to show appreciation is by celebrating the long years of service of nurses or any achievements, such as holding a potluck lunch or reception at a unit (Blegen et al., 1992). Design a fun day (e.g., once per month) as staff nurse appreciation day. Lastly, managers can provide a reasonable reward, such as lunch or movie passes, and in some cases, a small cash bonus (Brunges & Foley Brinza, 2014; Hashish, 2017; Li et al., 2018).

Improve Communication With Staff Nurses

Staff nurses who have adequate information about the job and know what is expected of them on the job are more satisfied. Goals should be communicated throughout the organization. Consistent and attentive listening, sharing of information, and follow up from managers will support communication and lead to better nurse retention (Gibson & Petrosko, 2014; Van Osch et al., 2017). There are many ways to support communication.

Start by showing support to staff nurses by encouraging them to express their views and listening to them carefully (AbuAlRub, 2004; AONE, 2000; Farley, 1989; Li et al., 2018; Vermeir, Downs, et al., 2018). Ask staff if they have sufficient accessibility to obtain information and resources necessary to do their job (Boamah et al., 2018; de Almeida, Orgambídez-Ramos, & Batista, 2017; Li et al., 2018; Van Osch et al., 2017; Vermeir, Blot, et al., 2018). Be honest, efficient, and accurate in sharing information and opinions to gain trust and credibility from staff nurses (AONE, 2000; Gibson & Petrosko, 2014; Özer, Santas, Santas, & Sahin, 2017; Van Osch et al., 2017; Vermeir, Blot, et al., 2018). In addition, be visible and available for staff nurses to ask questions and receive support, such as having an open door policy or walking rounds once per shift, day, or week (AONE, 2000; Gregory et al., 2007; Price, Paynter, Hall, & Reichert, 2018; Van Osch et al., 2017). Be willing to ask nurses for input such as, “What do you think is the best way to celebrate Nurses Week?” or “What is your opinion about self-scheduling in our unit?” (AONE, 2000; Brunges & Foley-Brinza, 2014; Li et al., 2018; Perlo et al., 2017; Pincus, 1986).

Use mechanisms such as one-on-one meetings, staff meetings, unit huddles, discussion sessions, focus groups, surveys, suggestion boxes, bulletin boards, and newsletters to enhance communication and feedback (AONE, 2000; Khowaja et al., 2005; Lassiter, 1989; Pincus, 1986; Van Osch et al., 2017). Assess managers' communication on a systematic and regular basis from their staff nurses as a way of improving managers' communication (Boamah et al., 2018; Farley, 1989). It is imperative to recognize and resolve conflict in a supportive manner and proactively (Al-Hamdan et al., 2015; Havens, Gittell, & Vasey, 2018; Kang et al., 2017). Lastly, use communication methods that are familiar to each generation: Baby Boomers prefer personal communication via telephone, Generation X prefer e-mail, and Millennials prefer text (Stutzer, 2019). Managers should ask employees about their preference of messaging (Price et al., 2018).

Evaluation of Process and Outcomes

To evaluate the use of this nurse retention guideline by nurse managers, process indicators and outcome factors should be evaluated. Process indicators are those interpersonal and environmental factors that can facilitate the use of a guideline. Outcome factors are those indicators expected to change or improve from consistent use of the guideline. The major outcome factors that should be monitored over time are: (a) increased job satisfaction; (b) increased intent to stay; and (c) decreased turnover. Nurse managers should regularly assess (e.g., annually, every 6 months) these outcome measures throughout the use of the guideline.

Conclusion

Turnover is costly both financially and emotionally. Retaining experienced nurses will have a positive effect on patient safety and quality care. Not all turnover is controllable; however, there are many actions that can be taken by nurse managers to promote job satisfaction and diminish turnover of nurses. The information in this administration guideline provides strategies for nurse managers who may not have access to a monetary reward system to retain experienced nurses working in various health care settings. Having nurse managers who use the documented strategies and respect the contributions, expertise, and leadership of staff nurses will intensify positive experiences for nurses and patients.

Although the turnover rates may be different among long-term care (LTC), hospitals, and nursing specialties, job satisfaction has been widely recognized as a critical factor affecting retention and turnover. Extensive literature review has shown that factors related to job satisfaction (i.e., work environment, nurses' characteristics or mobility factor, organization characteristics, and nurse manager characteristics) are similar in multiple settings. Therefore, this guideline is developed to provide strategies for nurse managers in various health care settings, including LTC, to use in enhancing staff retention.

References

  • Abou Hashish, E. A. (2017). Relationship between ethical work climate and nurses' perception of organizational support, commitment, job satisfaction and turnover intent. Nursing Ethics, 24(2), 151–166 https://doi.org/10.1177/0969733015594667 PMID: doi:10.1177/0969733015594667 [CrossRef]
  • AbuAlRub, R. F. (2004). Job stress, job performance, and social support among hospital nurses. Journal of Nursing Scholarship, 36(1), 73–78 https://doi.org/10.1111/j.1547-5069.2004.04016.x PMID: doi:10.1111/j.1547-5069.2004.04016.x [CrossRef]15098422
  • Adams, H. & Feudale, R. (2018). Implementation of a structured rounding tool for interprofessional care team rounds to improve communication and collaboration in patient care. Pediatric Nursing, 44(5), 229–233.
  • Aiken, L. H. & Cheung, R. (2008). Nurse workforce challenges in the United States: Implications for policy. Retrieved from https://www.who.int/hrh/migration/Case_study_US_nurses_2008.pdf?ua=1
  • Aiken, L. H., Sloane, D., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M. & Sermeus, W. (2017). Nursing skill mix in European hospitals: Cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality & Safety, 26(7), 559–568 https://doi.org/10.1136/bmjqs-2016-005567 PMID: doi:10.1136/bmjqs-2016-005567 [CrossRef]
  • Al-Hamdan, Z., Nussera, H. & Masa'deh, R. (2016). Conflict management style of Jordanian nurse managers and its relationship to staff nurses' intent to stay. Journal of Nursing Management, 24(2), E137–E145 https://doi.org/10.1111/jonm.12314 PMID: doi:10.1111/jonm.12314 [CrossRef]
  • Al-Hamdan, Z., Smadi, E., Ahmad, M., Bawadi, H. & Mitchell, A. M. (2019). Relationship between control over nursing practice and job satisfaction and quality of patient care. Journal of Nursing Care Quality, 34(3), E1–E6 https://doi.org/10.1097/NCQ.0000000000000390 PMID: doi:10.1097/NCQ.0000000000000390 [CrossRef]30817412
  • American Association of Colleges of Nursing. (2019). Nursing shortage fact sheet. Retrieved from https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage
  • American Nurses Association. (1983). Task force on nursing practice in hospitals. Magnet hospitals: Attraction and retention of professional nurses. Kansas City, MO: Author.
  • American Organization of Nurse Executives. (2000). Nurse recruitment and retention study. Scottsdale, Arizona: The HSM Group, Ltd.
  • Aronson, K. R. (2005). Job satisfaction of nurses who work in private psychiatric hospitals. Psychiatric Services (Washington, D.C.), 56(1), 102–104. https://doi.org/10.1176/appi.ps.56.1.102 PMID: doi:10.1176/appi.ps.56.1.102 [CrossRef]
  • Barto, D. (2019). Nurse driven protocols. Nursing 2019. Critical Care (London, England), 14(4), 19–24.
  • Blegen, M. A. (1993). Nurses' job satisfaction: A meta-analysis of related variables. Nursing Research, 42(1), 36–41 https://doi.org/10.1097/00006199-199301000-00007 PMID: doi:10.1097/00006199-199301000-00007 [CrossRef]8424066
  • Blegen, M. A., Goode, C. J., Johnson, M., Maas, M. L., McCloskey, J. C. & Moorhead, S. A. (1992). Recognizing staff nurse job performance and achievements. Research in Nursing & Health, 15(1), 57–66 https://doi.org/10.1002/nur.4770150109 PMID: doi:10.1002/nur.4770150109 [CrossRef]
  • Boamah, S. A., Read, E. A. & Spence Laschinger, H. K. (2017). Factors influencing new graduate nurse burnout development, job satisfaction and patient care quality: A time-lagged study. Journal of Advanced Nursing, 73(5), 1182–1195 https://doi.org/10.1111/jan.13215 PMID: doi:10.1111/jan.13215 [CrossRef]
  • Boamah, S. A., Spence Laschinger, H. K., Wong, C. & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes. Nursing Outlook, 66(2), 180–189 https://doi.org/10.1016/j.outlook.2017.10.004 PMID: doi:10.1016/j.outlook.2017.10.004 [CrossRef]
  • Bolima, D.C. (2015). The relationship between caring leadership, nursing job satisfaction, and turnover intentions [unpublished dissertation]. Grand Canyon University, Phoenix, AZ.
  • Bowles, J. R., Batcheller, J., Adams, J. M., Zimmermann, D. & Pappas, S. (2019). Nursing's leadership role in advancing professional practice/wok environments as part of the quadruple aim. Nursing Administration Quarterly, 43(2), 157–163 https://doi.org/10.1097/NAQ.0000000000000342 PMID: doi:10.1097/NAQ.0000000000000342 [CrossRef]30839452
  • Breau, M. & Reheaume, A. (2014). The relationship between empowerment and work environment on job satisfaction, intent to leave and quality of care among ICU nurses. Dynamics (Pembroke, Ont.), 25(3), 16–24.
  • Brunges, M. & Foley-Brinza, C. (2014). Projects for increasing job satisfaction and creating a healthy work environment. Journal, 100(6), 670–681 https://doi.org/10.1016/j.aorn.2014.01.029 PMID:25453685
  • Buerhaus, P. I. (2017). State of the registered nurse workforce as a new era of health reform emerges. Nursing Economic$, 35(5), 229–237.
  • Choi, S. L., Goh, C. F., Adam, M. B. H. & Tan, O. K. (2016). Transformational leadership, empowerment, and job satisfaction: The mediating role of employee empowerment. Human Resources for Health, 14(1), 73 https://doi.org/10.1186/s12960-016-0171-2 PMID: doi:10.1186/s12960-016-0171-2 [CrossRef]27903294
  • Chu, C.I. (2001). Examining organizational citizenship behavior among nurses using Price and Mueller's turnover model [unpublished doctoral dissertation]. University of Iowa, Iowa City, IA.
  • Cicolini, G., Comparcini, D. & Simonetti, V. (2014). Workplace empowerment and nurses' job satisfaction: A systematic literature review. Journal of Nursing Management, 22(7), 855–871 https://doi.org/10.1111/jonm.12028 PMID: doi:10.1111/jonm.12028 [CrossRef]25298049
  • Collins, K., Jones, M. L., McDonnell, A., Read, S., Jones, R. & Cameron, A. (2000). Do new roles contribute to job satisfaction and retention of staff in nursing and professions allied to medicine?Journal of Nursing Management, 8(1), 3–12 PMID:11013536
  • Cotton, J. L. & Tuttle, J. M. (1986). Employee turnover: A meta-analysis and review with implications for research. Academy of Management Review, 11(1), 55–70 https://doi.org/10.5465/amr.1986.4282625 doi:10.5465/amr.1986.4282625 [CrossRef]
  • Cummings, G. G., Olson, K., Hayduk, L., Bakker, D., Fitch, M., Green, E. & Conlon, M. (2008). The relationship between nursing leadership and nurses' job satisfaction in Canadian oncology work environments. Journal of Nursing Management, 16(5), 508–518 https://doi.org/10.1111/j.1365-2834.2008.00897.x PMID: doi:10.1111/j.1365-2834.2008.00897.x [CrossRef]18558921
  • Dawson, A. J., Stasa, H., Roche, M. A., Homer, C. S. & Duffield, C. (2014). Nursing churn and turnover in Australian hospitals: Nurses perceptions and suggestions for supportive strategies. Biomed Central Nursing, 13(1), 11 https://doi.org/10.1186/1472-6955-13-11 PMID:24708565
  • de Almeida, M., Orgambídez-Ramos, A. & Batista, P. (2017). Workplace empowerment and job satisfaction in Portuguese nursing staff: An exploratory study. Central European Journal of Nursing and Midwifery, 8(4), 749–755 https://doi.org/10.15452/CEJNM.2017.08.0028 doi:10.15452/CEJNM.2017.08.0028 [CrossRef]
  • Déry, J., Clarke, S. P., D'Amour, D. & Blais, R. (2018). Scope of nursing practice in a tertiary pediatric setting: Associations with nurse and job characteristics and job satisfaction. Journal of Nursing Scholarship, 50(1), 56–64 https://doi.org/10.1111/jnu.12352 PMID: doi:10.1111/jnu.12352 [CrossRef]
  • Dilig-Ruiz, A., MacDonald, I., Demery Varin, M., Vandyk, A., Graham, I. D. & Squires, J. E. (2018). Job satisfaction among critical care nurses: A systematic review. International Journal of Nursing Studies, 88, 123–134 https://doi.org/10.1016/j.ijnurstu.2018.08.014 PMID: doi:10.1016/j.ijnurstu.2018.08.014 [CrossRef]30292878
  • Duxbury, M. L. & Armstrong, G. D. (1982). Calculating nurse turnover indices. The Journal of Nursing Administration, 12(3), 18–24 https://doi.org/10.1097/00005110-198203000-00005 PMID: doi:10.1097/00005110-198203000-00005 [CrossRef]7038058
  • Ellenbecker, C. H., Porell, F. W., Samia, L., Byleckie, J. J. & Milburn, M. (2008). Predictors of home healthcare nurse retention. Journal of Nursing Scholarship, 40(2), 151–160 https://doi.org/10.1111/j.1547-5069.2008.00220.x PMID: doi:10.1111/j.1547-5069.2008.00220.x [CrossRef]18507570
  • Farley, M. J. (1989). Assessing communication in organizations. The Journal of Nursing Administration, 19(12), 27–31 PMID:2585113
  • Force, M. V. (2005). The relationship between effective nurse managers and nursing retention. The Journal of Nursing Administration, 35(7–8), 336–341 https://doi.org/10.1097/00005110-200507000-00005 PMID: doi:10.1097/00005110-200507000-00005 [CrossRef]16077275
  • Gibson, D. & Petrosko, J. (2014). Trust in leader and its effect on job satisfaction and intent to leave in a healthcare setting. New Horizons in Adult Education and Human Resource Development, 26(3), 3–19 https://doi.org/10.1002/nha3.20069 doi:10.1002/nha3.20069 [CrossRef]
  • Gillet, N., Fouquereau, E., Coillot, H., Cougot, B., Moret, L., Dupont, S. & Colombat, P. (2018). The effects of work factors on nurses' job satisfaction, quality of care and turnover intentions in oncology. Journal of Advanced Nursing, 74(5), 1208–1219 https://doi.org/10.1111/jan.13524 PMID: doi:10.1111/jan.13524 [CrossRef]29350770
  • González-Gancedo, J., Fernández-Martínez, E. & Rodríguez-Borrego, M. A. (2019). Relationships among general health, job satisfaction, work engagement and job features in nurses working in a public hospital: A cross-sectional study. Journal of Clinical Nursing, 28(7-8), 1273–1288 PMID:30549352
  • Goode, C. J. & Blegen, M. A. (1993). Development and evaluation of a research-based management intervention. A recognition protocol. The Journal of Nursing Administration, 23(4), 61–66 https://doi.org/10.1097/00005110-199304000-00015 PMID: doi:10.1097/00005110-199304000-00015 [CrossRef]8473946
  • Goode, C. J., Krugman, M. E., Smith, K., Diaz, J., Edmonds, S. & Mulder, J. (2005). The pull of magnetism: A look at the standards and the experience of a western academic medical center hospital in achieving and sustaining magnet status. Nursing Administration Quarterly, 29(3), 202–213 https://doi.org/10.1097/00006216-200507000-00004 PMID: doi:10.1097/00006216-200507000-00004 [CrossRef]16056154
  • Gregory, D. M., Way, C. Y., LeFort, S., Barrett, B. J. & Parfrey, P. S. (2007). Predictors of registered nurses' organizational commitment and intent to stay. Health Care Management Review, 32(2), 119–127 https://doi.org/10.1097/01.HMR.0000267788.79190.f4 PMID: doi:10.1097/01.HMR.0000267788.79190.f4 [CrossRef]17438395
  • Haid, S. D., House, K. A., Kea, S. M., Hott, B. R., Wagner, A. H. & Whisennand, S. R. (1993). Effect of quality of work life plan on employee recruitment and retention at Organ Recovery Systems, Inc. Journal of Transplant Coordination, 3(1), 18–22.
  • Halter, M., Boiko, O., Pelone, F., Beighton, C., Harris, R., Gale, J. & Drennan, V. (2017). The determinants and consequences of adult nursing staff turnover: A systematic review of systematic reviews. BMC Health Services Research, 17(1), 824 https://doi.org/10.1186/s12913-017-2707-0 PMID: doi:10.1186/s12913-017-2707-0 [CrossRef]29246221
  • Han, K., Trinkoff, A. M. & Gurses, A. P. (2015). Work-related factors, job satisfaction and intent to leave the current job among United States nurses. Journal of Clinical Nursing, 24(21-22), 3224–3232 https://doi.org/10.1111/jocn.12987 PMID: doi:10.1111/jocn.12987 [CrossRef]26417730
  • Havens, D. S., Gittell, J. H. & Vasey, J. (2018). Impact of relational coordination on nurse job satisfaction, work engagement and burnout: Achieving the quadruple aim. The Journal of Nursing Administration, 48(3), 132–140 https://doi.org/10.1097/NNA.0000000000000587 PMID: doi:10.1097/NNA.0000000000000587 [CrossRef]29389801
  • Hess, R. G. Jr. . (2004). From bedside to board-room: Nursing shared governance. Online Journal of Issues in Nursing, 9(1), 2.
  • Hinshaw, A. S. & Atwood, J. R. (1983). Nursing staff turnover, stress, and satisfaction: Models, measures, and management. Annual Review of Nursing Research, 1(1), 133–153 https://doi.org/10.1891/0739-6686.1.1.133 PMID: doi:10.1891/0739-6686.1.1.133 [CrossRef]6365122
  • Hinshaw, A. S., Smeltzer, C. H. & Atwood, J. R. (1987). Innovative retention strategies for nursing staff. The Journal of Nursing Administration, 17(6), 8–16 https://doi.org/10.1097/00005110-198706000-00003 PMID: doi:10.1097/00005110-198706000-00003 [CrossRef]3647116
  • Hofmann, P. B. (1981). Accurate measurement of nursing turnover: The first step in its reduction. The Journal of Nursing Administration, 11(11-12), 37–39 https://doi.org/10.1097/00005110-198111000-00008 PMID: doi:10.1097/00005110-198111000-00008 [CrossRef]6915082
  • Hollis, K. (2019). Improving retention strategies for experienced nurses [unpublished doctoral dissertation]. Walden University, Minneapolis, MN.
  • Hom, P. W. & Griffeth, R. W. (1995). Employee turnover. Cincinnati, OH: South-Western College Publishing.
  • Huston, C. J. & Marquis, B. L. (1989). Retention and productivity strategies for nurse managers. Philadelphia, PA: J.B. Lippincott.
  • Irvine, D. M. & Evans, M. G. (1995). Job satisfaction and turnover among nurses: Integrating research findings across studies. Nursing Research, 44(4), 246–253 https://doi.org/10.1097/00006199-199507000-00010 PMID: doi:10.1097/00006199-199507000-00010 [CrossRef]7624236
  • Jones, C. B. (2008). Revisiting nurse turnover costs: Adjusting for inflation. The Journal of Nursing Administration, 38(1), 11–18 https://doi.org/10.1097/01.NNA.0000295636.03216.6f PMID: doi:10.1097/01.NNA.0000295636.03216.6f [CrossRef]
  • Jones, C. B., Stasiowski, S., Simons, B. J., Boyd, N. J. & Lucas, M. D. (1993). Shared governance and the nursing practice environment. Nursing Economics, 11(4), 208–214 PMID:8232638
  • Kang, J., Kim, J. I. & Yun, S. (2017). Effects of a cognitive rehearsal program on interpersonal relationships, workplace bullying, symptom experience, and turnover intention among nurses: A randomized controlled trial. Journal of Korean Academy of Nursing, 47(5), 689–699 https://doi.org/10.4040/jkan.2017.47.5.689 PMID: doi:10.4040/jkan.2017.47.5.689 [CrossRef]29151565
  • Khowaja, K., Merchant, R. J. & Hirani, D. (2005). Registered nurses perception of work satisfaction at a tertiary care university hospital. Journal of Nursing Management, 13(1), 32–39 https://doi.org/10.1111/j.1365-2834.2004.00507.x PMID: doi:10.1111/j.1365-2834.2004.00507.x [CrossRef]
  • Kovner, C. T., Brewer, C. S., Fatehi, F. & Jun, J. (2014). What does nurse turnover rate mean and what is the rate?Policy, Politics & Nursing Practice, 15(3–4), 64–71 https://doi.org/10.1177/1527154414547953 PMID: doi:10.1177/1527154414547953 [CrossRef]
  • Kovner, C. T., Djukic, M., Fatehi, F. K., Fletcher, J., Jun, J., Brewer, C. & Chacko, T. (2016). Estimating and preventing hospital internal turnover of newly licensed nurses: A panel survey. International Journal of Nursing Studies, 60, 251–262 https://doi.org/10.1016/j.ijnurstu.2016.05.003 PMID: doi:10.1016/j.ijnurstu.2016.05.003 [CrossRef]27297385
  • Kretzschmer, S., Walker, M., Myers, J., Vogt, K., Massouda, J., Gottbrath, D. & Logsdon, M. C. (2017). Nursing empowerment, workplace environment, and job satisfaction in nurses employed in an academic health science center. Journal for Nurses in Professional Development, 33(4), 196–202 https://doi.org/10.1097/NND.0000000000000363 PMID: doi:10.1097/NND.0000000000000363 [CrossRef]28683033
  • Lageson, C. (2004). Quality focus of the first line nurse manager and relationship to unit outcomes. Journal of Nursing Care Quality, 19(4), 336–342 https://doi.org/10.1097/00001786-200410000-00009 PMID: doi:10.1097/00001786-200410000-00009 [CrossRef]15535539
  • Laschinger, H. K. & Finegan, J. (2005). Empowering nurses for work engagement and health in hospital settings. The Journal of Nursing Administration, 35(10), 439–449 https://doi.org/10.1097/00005110-200510000-00005 PMID: doi:10.1097/00005110-200510000-00005 [CrossRef]16220057
  • Lassiter, S. S. (1989). Staff nurse retention: Strategies for success. The Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses, 21(2), 104–107. doi:10.1097/01376517-198904000-00007 [CrossRef]
  • Letvak, S. & Buck, R. (2008). Factors influencing work productivity and intent to stay in nursing. Nursing Economic$, 26(3), 159–165 PMID:18616053
  • Leveck, M. L. & Jones, C. B. (1996). The nursing practice environment, staff retention, and quality of care. Research in Nursing & Health, 19(4), 331–343 https://doi.org/10.1002/(SICI)1098-240X(199608)19:4<331::AIDNUR7>3.0.CO;2-J PMID: doi:10.1002/(SICI)1098-240X(199608)19:4<331::AID-NUR7>3.0.CO;2-J [CrossRef]
  • Li, H., Shi, Y., Li, Y., Xing, Z., Wang, S., Ying, J. & Sun, J. (2018). Relationship between nurse psychological empowerment and job satisfaction: A systematic review and meta-analysis. Journal of Advanced Nursing, 74(6), 1264–1277 https://doi.org/10.1111/jan.13549 PMID: doi:10.1111/jan.13549 [CrossRef]29473198
  • Lucas, M. D. (1991). Management style and staff nurse job satisfaction. Journal of Professional Nursing, 7(2), 119–125 https://doi.org/10.1016/8755-7223(91)90096-4 PMID: doi:10.1016/8755-7223(91)90096-4 [CrossRef]2030230
  • Lucas, M. D., Atwood, J. R. & Hagaman, R. (1993). Replication and validation of anticipated turnover model for urban registered nurses. Nursing Research, 42(1), 29–35 https://doi.org/10.1097/00006199-199301000-00006 PMID: doi:10.1097/00006199-199301000-00006 [CrossRef]8424064
  • Ma, C., Shang, J. & Bott, M. J. (2015). Linking unit collaboration and nursing leadership to nurse outcomes and quality of care. The Journal of Nursing Administration, 45(9), 435–442 https://doi.org/10.1097/NNA.0000000000000229 PMID: doi:10.1097/NNA.0000000000000229 [CrossRef]26301550
  • Mann, E. E. & Jefferson, K. J. (1988). Retaining staff: Using turnover indices and surveys. The Journal of Nursing Administration, 18(7–8), 17–23 PMID:3404268
  • McCloskey, J. C. (1990). Two requirements for job contentment: Autonomy and social integration. Image—the Journal of Nursing Scholarship, 22(3), 140–143 https://doi.org/10.1111/j.1547-5069.1990.tb00196.x PMID: doi:10.1111/j.1547-5069.1990.tb00196.x [CrossRef]
  • McCloskey, J. C. & McCain, B. E. (1987). Satisfaction, commitment and professionalism of newly employed nurses. Image—the Journal of Nursing Scholarship, 19(1), 20–24 https://doi.org/10.1111/j.1547-5069.1987.tb00581.x PMID: doi:10.1111/j.1547-5069.1987.tb00581.x [CrossRef]
  • Moneke, N. & Umeh, O. (2014). Leadership practices influence job satisfaction. Nursing 2014 Critical Care, 9(2), 33–36.
  • Morsiani, G., Bagnasco, A. & Sasso, L. (2017). How staff nurses perceive the impact of nurse managers' leadership style in terms of job satisfaction: A mixed method study. Journal of Nursing Management, 25(2), 119–128 https://doi.org/10.1111/jonm.12448 PMID: doi:10.1111/jonm.12448 [CrossRef]
  • Mueller, C. W. & Price, J. L. (1990). Economic, psychological, and sociological determinants of voluntary turnover. The Journal of Behavioral Economics, 19(3), 321–335 https://doi.org/10.1016/0090-5720(90)90034-5 doi:10.1016/0090-5720(90)90034-5 [CrossRef]
  • Munnangi, S., Dupiton, L., Boutin, A. & Angus, L. D. G. (2018). Burnout, perceived stress, and job satisfaction among trauma nurses at a level I safety–net trauma center. Journal of Trauma Nursing, 25(1), 4–13 https://doi.org/10.1097/JTN.0000000000000335 PMID: doi:10.1097/JTN.0000000000000335 [CrossRef]29319643
  • Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O. A., Thienthong, H. & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International Nursing Review, 64(1), 91–98 https://doi.org/10.1111/inr.12342 PMID: doi:10.1111/inr.12342 [CrossRef]
  • Nei, D., Snyder, L. A. & Litwiller, B. J. (2015). Promoting retention of nurses: A meta-analytic examination of causes of nurse turnover. Health Care Management Review, 40(3), 237–253 https://doi.org/10.1097/HMR.0000000000000025 PMID: doi:10.1097/HMR.0000000000000025 [CrossRef]
  • Noblet, A. J., Allisey, A. F., Nielsen, I. L., Cotton, S., LaMontagne, A. D. & Page, K. M. (2017). The work-based predictors of job engagement and job satisfaction experienced by community health professionals. Health Care Management Review, 42(3), 237–246 https://doi.org/10.1097/HMR.0000000000000104 PMID: doi:10.1097/HMR.0000000000000104 [CrossRef]
  • Nowrouzi, B., Rukholm, E., Lariviere, M., Carter, L., Koren, I., Mian, O. & Giddens, E. (2016). An examination of retention factors among registered nurses in Northeastern Ontario, Canada: Nurses intent to stay in their current position. Work (Reading, Mass.), 54(1), 51–58 https://doi.org/10.3233/WOR-162267 PMID:26967032
  • NSI Nursing Solutions. (2019). 2019 national health care retention & RN staffing report. Retrieved from http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/2019%20National%20Health%20Care%20Retention%20Report.pdf
  • Özer, Ö., Santas, F., Santas, G. & Sahin, D. S. (2017). Impact of nurses' perceptions of work environment and communication satisfaction on their intention to quit. International Journal of Nursing Practice, 23(6), 1–8 https://doi.org/10.1111/ijn.12596 PMID: doi:10.1111/ijn.12596 [CrossRef]
  • Palmer, S. P. (2014). Nurse retention and satisfaction in Ecuador: Implications for nursing administration. Journal of Nursing Management, 22(1), 89–96 https://doi.org/10.1111/jonm.12043 PMID: doi:10.1111/jonm.12043 [CrossRef]
  • Perlo, J., Balik, B., Swensen, S., Kabcenell, A., Landsman, J. & Feeley, D. (2017). IHI Framework for improving joy in work. Retrieved from http://www.ihi.org/resources/Pages/IHIWhitePapers/Framework-Improving-Joy-in-Work.aspx
  • Pincus, J. D. (1986). Communication: Key contributor to effectiveness—The research. The Journal of Nursing Administration, 16(9), 19–25 https://doi.org/10.1097/00005110-198609000-00005 PMID: doi:10.1097/00005110-198609000-00005 [CrossRef]3638336
  • Portoghese, I., Galletta, M., Battistelli, A. & Leiter, M. P. (2015). A multilevel investigation on nursing turnover intention: The cross-level role of leader-member exchange. Journal of Nursing Management, 23(6), 754–764 https://doi.org/10.1111/jonm.12205 PMID: doi:10.1111/jonm.12205 [CrossRef]
  • Price, J. L. (1977). The study of turnover. Ames, IA: Iowa State University Press.
  • Price, J. L. (2001). Reflections on the determinants of voluntary turnover. International Journal of Manpower, 22(7), 600–624 https://doi.org/10.1108/EUM0000000006233 doi:10.1108/EUM0000000006233 [CrossRef]
  • Price, J. L. & Mueller, C. W. (1981). A causal model for turnover for nurses. Academy of Management Journal, 24(3), 543–565 PMID:10252608
  • Price, S. L., Paynter, M., Hall, L. M. & Reichert, C. (2018). The intergenerational impact of management relations on nurse career satisfaction and patient care. The Journal of Nursing Administration, 48(12), 636–641 https://doi.org/10.1097/NNA.0000000000000695 PMID: doi:10.1097/NNA.0000000000000695 [CrossRef]30431517
  • Saber, D. A. (2014). Frontline registered nurse job satisfaction and predictors over three decades: A meta-analysis from 1980 to 2009. Nursing Outlook, 62(6), 402–414 https://doi.org/10.1016/j.outlook.2014.05.004 PMID: doi:10.1016/j.outlook.2014.05.004 [CrossRef]25015408
  • Sourdif, J. (2004). Predictors of nurses' intent to stay at work in a university health center. Nursing & Health Sciences, 6(1), 59–68 https://doi.org/10.1111/j.1442-2018.2003.00174.x PMID: doi:10.1111/j.1442-2018.2003.00174.x [CrossRef]
  • Specht, J. K. P. (1996). The effects of perceived nurse shared governance on nurse job satisfaction and patient satisfaction [unpublished dissertation]. University of Iowa, Iowa City, IA.
  • Spence Laschinger, H. K. & Fida, R. (2015). Linking nurses' perceptions of patient care quality to job satisfaction: The role of authentic leadership and empowering professional practice environments. The Journal of Nursing Administration, 45(5), 276–283 https://doi.org/10.1097/NNA.0000000000000198 PMID: doi:10.1097/NNA.0000000000000198 [CrossRef]25906136
  • Stutzer, K. (2019). Ask the experts: Generational differences and multigenerational teamwork. Critical Care Nurse, 39(1), 78–81 https://doi.org/10.4037/ccn2019163 doi:10.4037/ccn2019163 [CrossRef]30710039
  • Sveinsdóttir, H., Ragnarsdóttir, E. D. & Blöndal, K. (2016). Praise matters: The influence of nurse unit managers' praise on nurses' practice, work environment and job satisfaction: A questionnaire study. Journal of Advanced Nursing, 72(3), 558–568 https://doi.org/10.1111/jan.12849 PMID: doi:10.1111/jan.12849 [CrossRef]
  • Tang, J. H.-C. (2005). Hospital nurses' perceptions of family responsive workplace policies: Relationship to job satisfaction and intent to stay [unpublished dissertation]. University of Iowa, Iowa City, IA.
  • Tang, J. H.-C. (2008). Impact of work-family policies on job satisfaction and intent to stay: A model testing. Proceedings from the Midwest Nursing Research Society 2008 Annual Research Conference. , 114–115.
  • Tomey, A. M. (2008). Guide to nursing management and leadership (8th ed.). St. Louis, MO: Mosby.
  • Tourangeau, A. E. & Cranley, L. A. (2006). Nurse intention to remain employed: Understanding and strengthening determinants. Journal of Advanced Nursing, 55(4), 497–509 https://doi.org/10.1111/j.1365-2648.2006.03934.x PMID: doi:10.1111/j.1365-2648.2006.03934.x [CrossRef]16866845
  • Tullar, J. M., Amick, B. C. III. , Brewer, S., Diamond, P. M., Kelder, S. H. & Mikhail, O. (2016). Improve employee engagement to retain your workforce. Health Care Management Review, 41(4), 316–324 https://doi.org/10.1097/HMR.0000000000000079 PMID: doi:10.1097/HMR.0000000000000079 [CrossRef]
  • Van Osch, M., Scarborough, K., Crowe, S., Wolff, A. & Riemer-Kirkham, S. (2017). Understanding the factors which promote registered nurses' intent to stay in emergency and critical care areas. Journal of Clinical Nursing, 27(5–6), 1209–1215. doi:10.1111/jocn.14167 [CrossRef]29148125
  • Vardaman, J. M., Rogers, B. L. & Marler, L. E. (2018). Retaining nurses in a changing health care environment: The role of job embeddedness and self-efficacy. Health Care Management Review, 1. https://doi.org/10.1097/HMR.0000000000000202 PMID:29642088
  • Vermeir, P., Blot, S., Degroote, S., Vandijck, D., Mariman, A., Vanacker, T. & Vogelaers, D. (2018). Communication satisfaction and job satisfaction among critical care nurses and their impact on burnout and intention to leave: A questionnaire study. Intensive & Critical Care Nursing, 48, 21–27 https://doi.org/10.1016/j.iccn.2018.07.001 PMID: doi:10.1016/j.iccn.2018.07.001 [CrossRef]
  • Vermeir, P., Downs, C., Degroote, S., Vandijck, D., Tobback, E., Delesie, L. & Vogelaers, D. (2018). Intraorganizational communication and job satisfaction among Flemish hospital nurses: An exploratory multicenter study. Workplace Health & Safety, 66(1), 16–23 https://doi.org/10.1177/2165079917703411 PMID: doi:10.1177/2165079917703411 [CrossRef]
  • Volk, M. C. & Lucas, M. D. (1991). Relationship of management style and anticipated turnover. Dimensions of Critical Care Nursing, 10(1), 35–40 https://doi.org/10.1097/00003465-199101000-00008 PMID: doi:10.1097/00003465-199101000-00008 [CrossRef]1989841
  • Wagner, S. E. (2006). Staff retention: From “satisfied” to “engaged.”Nursing Management, 37(3), 24–29 https://doi.org/10.1097/00006247-200603000-00007 PMID: doi:10.1097/00006247-200603000-00007 [CrossRef]
  • Wilson, A. A. (2005). Impact of management development on nurse retention. Nursing Administration, 29(2), 137–145 https://doi.org/10.1097/00006216-200504000-00008 PMID: doi:10.1097/00006216-200504000-00008 [CrossRef]
  • Wilson, B., Squires, M., Widger, K., Cranley, L. & Tourangeau, A. (2008). Job satisfaction among a multigenerational nursing workforce. Journal of Nursing Management, 16(6), 716–723 https://doi.org/10.1111/j.1365-2834.2008.00874.x PMID: doi:10.1111/j.1365-2834.2008.00874.x [CrossRef]18808466
  • Wilson, C. (2006). Why stay in nursing?Nursing Management, 12(9), 24–32 https://doi.org/10.7748/nm2006.02.12.9.24.c2043 PMID: doi:10.7748/nm2006.02.12.9.24.c2043 [CrossRef]16475536
  • Yang, Y. H. & Kim, J. K. (2016). Factors influencing turnover intention in clinical nurses: Compassion fatigue, copying, social support, and job satisfaction. Journal of the Korean Academy of Nursing Administration, 22(5), 562–569 https://doi.org/10.11111/jkana.2016.22.5.562 doi:10.11111/jkana.2016.22.5.562 [CrossRef]
  • Ziebert, C., Klingbeil, C., Schmitt, C. A., Stonek, A. V., Totka, J. P., Stelter, A. & Schiffman, R. F. (2016). Lessons learned: Newly hired nurses' perspectives on transition into practice. Journal for Nurses in Professional Development, 32(5), E1–E8 https://doi.org/10.1097/NND.0000000000000278 PMID: doi:10.1097/NND.0000000000000278 [CrossRef]27648910

Price Job Satisfaction Scale

Purpose: To assess the overall satisfaction of staff nurses with their current job.

Instructions: For each nurse receiving the Nurse Retention guideline, please have s/he complete the Price Job Satisfaction Scale. This scale should be completed at baseline (before the nurse retention guideline is initiated) and on a regular basis, such as every 6 months.

Scoring: Each item is scored from 1 to 5, with “strongly disagree” scored as 1 and “strongly agree” as 5. Scores are summed and divided by the number of items to attain a mean. A higher score indicates higher level of satisfaction.

Directions: Please circle the number that best reflects your response to the following statements about your overall satisfaction with your current job.

ITEMSStrongly AgreeAgreeNeither Agree Nor DisagreeDisagreeStrongly Disagree
1I am fairly well satisfied with my job.54321
2.Most days, I am enthusiastic about my job.54321
3.I like working here better than most other people I know who work for this hospital.54321
4.I do not find enjoyment in my job.54321
5.I am often bored with my job.54321
6.I would consider taking another kind of job.54321

McCain's Intent to Stay Scale (A 5-Item Subscale from McCain's Behavioral Commitment Scale)

Purpose: To assess the staff nurse's perception of the likelihood to stay in her or his current job.

Instructions: For each nurse receiving the nurse retention guideline, please have the nurse complete the McCain's Intent to Stay Scale. This scale should be completed at baseline (before guideline is initiated) and on a 6-month basis.

Scoring: Each item is scored from 1 “strongly disagree” to 5 “strongly agree”. Scores are summed and divided by the number of items to attain a mean. A higher score indicated higher intent to stay.

Directions: Please circle the number that best reflects your response to each statement.

ITEMSStrongly AgreeAgreeNeutralDisagreeStrongly Disagree
1. I plan to work at my present job for as long as possible.54321
2. I will probably spend the rest of my career in this job or the jobs that it leads to in this hospital.54321
3. Even if this job does not meet all my expectations, I will not quit.54321
4. Under no circumstances would I leave my present job.54321
5. I plan to keep this job for at least two or three years.54321
Authors

Dr. Tang is Chair and Professor, and Dr. Hudson is Assistant Professor and Director of MSN Program, Division of Nursing, Immaculata University, Immaculata, Pennsylvania.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Jane H-C. Tang, PhD, RN, NE-BC, Chair and Professor, Division of Nursing, Immaculata University, 1145 King Road, Immaculata, PA 19345; e-mail: jtang@immaculata.edu.

10.3928/00989134-20191011-03

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