JOY – The Importance of the Intrinsic Side of Nursing in Retention

I love this image. And the message is as real as it gets.

This is a review of nurse retention strategies. A topic that is trickier than you may think. Here are the numbers and retention strategies, … with an emphasis on going deeper into what matters. 

There are some distinctions and realities about nurse retention:

• RN Numbers  ….. from the Bureau of Labor
  • There are now well over three million working RNs in the United States
  • We need another 712,000 RNs to care for the new patients related to demographic changes and healthcare growth
  • We need another 500,000 RNs to replace the surge of RNs retiring by 2020
  • We need 67,000 additional nurse managers by 2020 associated with the IOM Future of Nursing initiatives.
• RN Turnover rates and Attrition Rates
  • Overall, rates are going up. Up from 12% ten years ago to 20% now.  Rates vary according position and region. And data definitions and collection have not been standardized. So comparisons are rarely reliable.
  • We do know the 2 most vulnerable groups:
    • New RN grads – . An estimated 30 – 40 % of new grads leave or are thinking about leaving nursing within their first three years of practice
    • Nurse Managers – 50 – 72 % of nurse managers turnover. Yikes!
• Reasons for RNs Leaving Jobs and /or Nursing
  • The IOM Future of Nursing in 2010 reported that 40% of nurses leave jobs and /or nursing because of workplace conditions and the remaining reasons were for personal career and family needs.
• Traditional RN Retention Strategies – Extrinsic retention strategies are the most used in nursing organizations and research
  • These focus on structural empowerment, work environment, professional practice improvements, leadership development.
  • Programs that commonly use these strategies – shared governance, Magnet^®recognition, Transforming Care at the Bedside, and the Center for Nursing Excellence and others
  • These programs have had a profound impact in raising nursing’s professional standards and generating over two decades of research on the triple wins of reducing nurse turnover, improving patient outcomes and lowering costs.
• Needed – New RN Retention Strategies – Intrinsic strategies – the natural, the essential, the whole –  are needed to reverse our current tsunami 
  •  And we need to deepen our efforts.
    • The 21^st-century individual wants more, (actually we all do).  Daniel Pink, in his book Drive describes a vast disconnect between motivation science and what businesses do. The 21^st-century RNs want to be a part of something bigger than themselves and achieve a sense of purpose and meaning in their work.
    • The Institute of Healthcare Improvement (IHI) in 2014, expanded their retention efforts when they saw the high burnout and attrition rates of RNs and physicians,  resulting in the Quadruple AIM. They added the goal of  JOY into work. This is right in line with Pink’s intrinsic motivation science, “for the joy of it”, in search of meaning and purpose
  • Healthcare organizations have not kept up.  More resources are assigned to patient satisfaction and less to staff satisfaction, even though their outcomes are interdependent.
• Examples of Intrinsic Retention Strategies in 2018 studies.  There are approximately 14 studies focusing on nurses’ inner / intrinsic resources published in nursing leadership publications over the last 6 years. (That ain’t many).
  • Here are 4 in 2018, which indicates a rising interest among nurse leaders given the attention on the intrinsic motivation of JOY by the IHI.

1.  Health Promoting Behaviors Model –  This is basically a model of self-care practices that have been used to measure the impact of self-care on nurses wellbeing.  There are 3 studies on HPBs. A 2018  study shows the high impact of 1) spiritual exercises (focuses on seeking purpose and meaning),  and 2) interpersonal connections on nurses stress levels.

Williams HL, Costley T, Bellury LM, Moobed J. June 2018.  Do Health Promotion Behaviors Affect Levels of Job Satisfaction and Job Stress for Nurses in an Acute Care Hospital? JONA. pp 342-348.

2. A summary of 9 evidenced-based studies on resilience that nurse leaders can use to help nurses. Strategies: 1) education, 2) support, 3) meaningful recognitions, 4) self-care, 5) relationships, 6) how to set boundaries, 7) Master Resilience Training, 8) debriefs.

Kester K, Wei H. June 2018. Building Nurse Resilience. Nursing Management. pp42-45.  

3. This was a qualitative study using ‘Story Corp’ electronic application to record nurses’ narratives on JOY in their nursing and its impact on their lives.

 Galuska L, Hahn J, Polifroni EC, Crow G. 2018. A Narrative Analysis of Nurses’ Experiences With Meaning and Joy in Nursing Practice. Nurs Admin Q. Vol 42, #2. pp154-163. 

4. Hospital sponsored WellBeing Program on their employee engagement. This study involved the correlation of of 2 surveys, employee well-being and employing engagement.

Jacobs B, McGovern J, Heinmiller J, Drenkard K. 2018. Engaging Employees in Well-Being- Moving From the Triple Aim to the Quadruple Aim. Nurs Admin Q. #3. 

Nurses find science interesting and challenging, but it’s the human connections and caring that bring the sense of purpose and meaning (Galuska,2018)

We have to get smart about retention given the RN shortage tsunami on the horizon.