Over the next 20 years, it's estimated that the United States will have 400,000 fewer RNs than will be needed.1 And the shortage of qualified RNs is only expected to worsen in the foreseeable future. In this nursing job market, it's a challenge for nursing leaders to retain RNs, especially those who possess specific skill sets, as healthcare facilities compete for the limited supply of experienced nurses. The inability to retain qualified RNs can have consequences for the patient and the organization, such as an increase in financial costs, a decrease in quality of care, and an increase in malpractice claims.2 This article will explore causal factors related to high turnover within the nursing profession and discuss strategies that the unit-level nurse leader can implement to improve the retention of RNs in acute care units.

Causal factors

There have been numerous studies conducted in regards to factors that contribute to RN turnover, retention, and intent to leave. In 2003, one study found that the major predictor of a nurse's intent to leave was job dissatisfaction.3 In 2004, another study found that low job satisfaction was the most frequently cited factor linked to nurse turnover.4 Burnout has been identified as another causal factor that affects retention.5 Other factors cited in the literature as predictors of RN turnover include salaries, lack of time with patients, and demographic characteristics (such as being male, having no children at home, and being unmarried).3

Job satisfaction is a major predictor of intent to leave. There are several strategies that the nurse leader can implement to improve job satisfaction for the RNs assigned to her acute care unit. These strategies can help improve retention rates. Let's take a closer look.

Practicing shared governance/participative decision making

Nurse leaders can promote an environment in which RNs actively participate in the decision-making processes that occur at the unit level. Nurses who work in a participative decision-making environment experience greater autonomy. Autonomy is identified by RNs as an important job satisfier.6 They also favor working in a participative environment as opposed to one that's autocratic.6 Nurse leaders at the unit level can implement a management style that promotes a shared governance model. In shared governance, unit staff members have significant influence on the professional issues, practice, and working conditions in their units.7 Strategies to improve RN autonomy through participative decision making may include self-scheduling, using practice councils to address practice issues, utilizing unit performance improvement teams, and facilitating staff input into policy matters such as RN-to-patient ratios or other workload and acuity issues. Nurses should also be encouraged to represent the unit in organizational decision making by taking part in strategic planning committees.

Improving perception of respect

A nurse's perception of respect is predictive of job satisfaction, as well as intent to leave the organization within the next year.8 Nurse leaders in acute care units can implement strategies aimed at increasing RNs' perception of respect within their organization, which may facilitate increased retention rates among those assigned to their units. Respect involves valuing another individual's dignity and worth. Paying attention to another individual and taking her seriously reflects respect in a social setting.6 Nurse leaders can increase the perception of respect among RNs within the organization by recognizing them for their efforts, as well as making them feel valued and appreciated. Nurse leaders can demonstrate respect for RNs by recognizing their achievements and increasing the amount of individualized attention they receive. Strategies to recognize nurses for their achievements include public and private acknowledgements of their accomplishments in the unit or in their overall professional growth. This can be accomplished by sending e-mails to all nurses and nurse-executives hospital-wide, publishing accomplishments in organizational newsletters, sending a personal thank-you card, or more formally by conducting an awards ceremony. The nurse leader can also provide support and assistance to help staff nurses achieve professional goals. Coaching activities that assist RNs in improving in various clinical and leadership competencies areas, such as assertiveness, public speaking, and research, may also result in increased perception of respect.

Addressing access to communication

Access to communication between RNs and the organizational leadership, as well as other clinical services across the organization, has been cited as an important retention factor.6 Nurse leaders at all levels can improve retention rates by valuing the importance of communication with nurses at the unit level. Strategies that can facilitate RN access to communication within the organization include implementing department and organizational committees that utilize unit-level nurses, emphasizing the use of interdisciplinary team meetings, mandating the participation of a unit-level nurse in all hospital rounds, and scheduling meetings between nurses at the unit level and the chief nursing officer.6

Addressing generational diversity

Nurse leaders must increase their awareness of the generational diversity that has become more and more pronounced in healthcare organizations. Never in history have four generations of nurses worked together.9 The members of these different generations are influenced by a variety of factors, such as changes in social, economic, and public policy and shifts in society-wide attitudes.10 Nurse leaders need to be aware that different generations may have differing value systems and perceptions regarding work and, therefore, different needs. Unit-level nurse leaders should work to promote an increased awareness in themselves and their staff members of the generational differences that exist between nurses in the workplace. A lack of understanding of each other's generational differences may lead to a decrease in productivity and job satisfaction.10 The nurse leader can implement strategies such as lectures or seminars geared toward increasing staff member awareness of different generational characteristics, such as values toward work, leisure, and authority, that exist between the generations.10 When staff members are educated about each other's generational perspective, it can increase mutual understanding and appreciation of the unique contributions that each staff member brings to the nursing team.

The four generations currently in the workplace are known as traditionalist (born before 1940), baby boomer (born between 1940 and 1960), generation X (born between 1960 and 1980), and generation Y (born after 1980). Traditionalist employees view work as inherently valuable and are loyal to organizations and managers. They view leisure as being earned through work and tend to spend leisure time in the home. Traditionalists view authority as accomplished through command and control management and they prefer leadership by hierarchy.9 Baby-boomer employees view work as a challenge and an opportunity for advancement that's meaningful and purposeful. They view leisure as a means to self- fulfillment and work as a shortcut to leisure. Baby boomers view authority as untrustworthy and they prefer leadership by consensus and participation.9 Generation X employees view work as a job, a learning opportunity, and a way to enhance marketability, involving fun and a balance between work and leisure. They view work as a means to obtain money for leisure activities. Generation Xers have disdain for a hierarchy of authority and they demand managers who are competent.9 Generation Y employees are just entering the nursing workforce. They're described as optimistic, inclusive, globally aware, realistic, critical thinkers who see work as having meaning. This generation values volunteerism and is technologically literate.9

Nurse leaders can improve the retention of RNs assigned to their units by implementing strategies that anticipate the individual needs of their staff members. Strategies to meet the needs of traditionalist employees may include assessing the work environment for safety concerns for the older employee, as well as developing modified schedules to provide shorter shifts at times during which staff coverage may be beneficial, such as over mealtimes or over changes of shift.10 For baby-boomer employees, consider adjusting their schedules to decrease workload because members of this generation are agreeable to working overtime. Offer these employees time off to help create a sense of balance between work and leisure time. Strategies to meet the needs of generation X employees may include scheduling practices that facilitate achieving the balance between work and leisure. For generation Y employees, consider providing opportunities to participate in the development and implementation of new technologies. Actively provide career planning guidance and performance feedback to this group and challenge them with new responsibilities.10

Rise to the challenge

Decreasing RN turnover is an ongoing challenge for nurse leaders who manage acute care units. Retaining experienced nurses with specialized skills as organizations compete more aggressively for scarce resources requires a proactive response. By implementing the strategies discussed in this article, you'll be on your way.

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