Nursing shortage-two words that bring fear to most nurse leaders. We've heard these words for years, but the experts believe that due to a multitude of factors, including the age of the nursing workforce and the general population, nursing faculty shortages, and healthcare reform, we're on the cusp of a critical shortage.1 Many states, especially in more rural areas, are experiencing this shortage now. Although the American Association of Colleges of Nursing (AACN) reported a 3.6% increase in entry-level nursing programs, it isn't large enough to meet future demands.2 Nursing schools turned away over 60,000 qualified applicants from baccalaureate and graduate nursing programs in 2016 due to lack of faculty, clinical sites, and classroom space, as well as budget constraints.2 According to healthcare economist David Auerbach, 40% of RNs are older than age 50. He anticipates that the number of nurses leaving the workforce each year will grow to nearly 80,000 by 2020.3

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We haven't buried our heads in the sand, and nurse leaders are working diligently with their human resource partners to increase and enhance our recruitment efforts. The AACN offers several strategies to address the nursing shortage in its Nursing Shortage Fact Sheet.2 These strategies center on global approaches to increase faculty and expand student capacity, and campaigns to recruit more people into nursing.2 Besides being involved in these national initiatives, nurse leaders need to focus locally on retaining our current workforce by ensuring that our staff members are actively engaged and happy in their work. We need to do all that we can to keep the nurses we have for as long as possible.

Addressing turnover

Controlling nursing turnover has been and continues to be one of the highest priorities for nurse leaders. It certainly isn't a new concept. In 2001, the Advisory Board Company published Becoming a Chief Retention Officer: An Implementation Handbook for Nurse Managers, which identified the manager as chief retention officer as a best practice for retaining staff.4 Research has demonstrated that nurses consider leaving their hospital 84% of the time when they're dissatisfied with their direct manager, as compared with 43% of the time when they're very satisfied with their manager.4 Building relationships and developing people are two core competencies of nurse managers.

Ask nurses to define their best boss and the majority will tell you that they were fair and consistent, and they cared about their staff. Nurse satisfaction and tenure are linked to manager effectiveness. Nurse managers need to be able to identify and address staff needs and concerns. One of the best pieces of advice that I received as a new nurse leader many years ago was to understand and embrace the difference between sympathy and empathy when leading staff. A nurse leader who's able to build strong relationships with his or her staff models a strong sense of empathy, or understanding others' feelings even when you don't necessarily agree with their situation ("putting yourself in their shoes"); sympathy is best used sparingly.

Asking questions

One tool that's very helpful in engaging staff is the practice of a stay interview. Most nurses won't tell you that they're thinking about leaving. Rather than waiting until a nurse turns in his or her resignation to realize there are issues, a stay interview is a proactive approach that's been shown to be very successful in retaining staff across multiple disciplines.5 These interviews are performed at least annually with your high-performing staff. A stay interview is a one-on-one meeting with members of the team in which several key and well-defined factors are discussed.6 Stay interviews are different than the informal meetings we have with our staff to discuss something that's come up or as a follow-up to a previous conversation. These are formal meetings with a purpose and not just a casual conversation on the go.

The stay interview includes discussions about what's going well and why the staff member is choosing to stay. Other topics include what would the staff member like to do more of and what would he or she miss most if leaving the current position.6 You also want to take this time to assess the staff member's risk of leaving the organization by asking him or her about days when things aren't going as well as expected.

Here's how to perform a stay interview:

* Schedule the interview at a time convenient for the staff member.

* Explain to the staff member what a stay interview entails.

-Your goal is to find out what motivates and frustrates your employee.

-You want to discuss how best to support, develop, and retain him or her.

-You want to talk about what your employee values about the organization.

* Avoid yes/no questions; remember, you want to gather specific information about what keeps the staff member at your organization and what may drive him or her away.

* Practice active listening; empathize instead of sympathize.

* Be honest. If there are areas you can't address or change isn't possible, be truthful with the staff member.

* Work with the staff member to come up with creative solutions for any issues that are discussed.

* Follow up with the staff member in a timely fashion after the interview to address any open items.

Avoiding the pitfalls

For a stay interview to be successful, there are several suggestions to keep the conversation focused on the goal. One of the biggest pitfalls is when you allow the conversation to veer away from the scripted questions because this can lead to the interview turning into a complaint session or just a casual chat without gaining valuable information about what motivates your staff member. (See Table 1.) To avoid the common pitfalls, it's recommended that you follow these guidelines:

Table 1: Sample stay interview questions

* Keep the interview short, no longer than 15 to 20 minutes.

* Stay focused on the purpose of the interview and don't allow whining to take over the conversation.

* Don't get argumentative or defensive.

* Only discuss practical and realistic solutions.

* End on a positive note.

The key to engaged staff

We all want to feel included and valued. Staff input into decisions that affect their lives, such as their schedules, their workflow, and nursing practice on their unit, is paramount. Stay interviews are only one tool; they aren't intended to be used with the staff members who are actively disengaged or who have significant performance issues. An attempt to use this strategy with these employees is likely to backfire. Stay interviews don't take away from the need for you to spend significant time performing leadership rounds and being a visible and communicative leader. The time spent with your staff in these interviews is well worth the return and goes a long way in retaining your top performers. Interviewing new nurses will take significantly more time than the 15 or 20 minutes you spend with your current staff members who want to hear that you value their input and you want them to stay.

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