Management and Communication Synergism

Current research on reducing turnover of nursing staff, both CNAs and RNs, in the nursing home setting, indicates that employee interactions with management are a crucial element to increase employee retention and effectiveness of other retention  efforts. 

A study done by Karl Pillemer, a doctor of human development at Cornell University found that a system in which an experienced employee was placed as a “facility specialist” whose role was to facilitate communication between nursing staff and management. The appointment of a facility specialist was found to increase retention rates by an average of about 8%, which is a marginal improvement in retention rates, when compared to control settings (Pillemer, K., Meador, R., Henderson, C., et al., 2008). The appointed facility specialists were able to facilitate communication between the CNAs and RNs and the management of the nursing home. This allowed for nursing employees' concerns to be heard and addressed by management more efficiently, as well as increased management desire to show appreciation to nursing staff, which have been shown to increase retention rates. 

A study done by a Duke associate professor of nursing agrees with the conclusions drawn from the study above with findings that indicated that improved and open communication in combination with a reward-based climate at the facility, characterized by merit based rewards, clear goals, concern employee welfare, and good relationships with administration, lead to increased retention of CNAs (Anderson, R. A., Corazzini, K. N., & McDaniel R. R., 2004). The combination of open communication and a reward-based climate improved information flow and improved quality of connections between staff and management which lead to more creative and applicable actions taken by management to support their nursing staff. 

The sources' conclusions agree that by improving the communication and management climate involved in treatment and action taken towards employees and their concerns actually improves relationships between the nursing staff and management of facilities, which in turn improves retention rates of nursing staff.

 

References:

Pillemer, K., Meador, R., Henderson, C., Robison, J., Hegeman, C., Graham, E., & Schultz, L. (2008). A facility specialist model for improving retention of nursing home staff: Results from a randomized, controlled study. The Gerontologist, 48(suppl_1) 80-89, doi: https://doi.org/10.1093/geront/48.Supplement_1.80

Anderson, R. A., Corazzini, K. N., & McDaniel R. R. (2004). Complexity science and the dynamic of climate and communication: Reducing nursing home turnover. The Gerontologist, 44(3), 378-388. https://doi.org/10.1093/geront/44.3.378

 

Employee Empowerment’s Effect on Retention Rates

By implementing empowerment strategies amongst the nursing staff in our client we will see a variety of positive effects, including increased retention. A study by Yeates, a professor of sociology at the University of North Texas, found that by implementing empowerment teams, groups of employees are given the additional role of making recommendations about others and some supervisory responsibility, employees’ “improved performance, higher job satisfaction and reduced turnover” (Yeates, D. & Cready C. M., 2007). 

This support for empowerment strategies for nursing staff is mirrored by another study done by Barry in 2005, wherein the nurses who received empowerment strategies, such as rewards and opportunities for advancement saw an decrease in ulcer rates of residents and employee retention rates (Barry, T., Brannon, D., & Mor, V., 2005). These changes are indicative of not only lessened turnover but an increase of the quality of care that residents received. The utilization of empowerment strategies seems to motivate the nursing staff and help them to feel impressive and important which not only makes their work better but makes their job slightly easier as everyone involved in the strategies gets their work quality increased.

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References:

Barry, T., Brannon, D., & Mor, V. (2005). Nurse aide empowerment strategies and staff stability: Effects on nursing home resident outcomes. The Gerontologist 45(3), 309-317, doi: https://doi.org/10.1093/geront/45.3.309

Yeatts, D. E. & Cready, M. C. (2007). Consequences of empowered CNA teams in nursing home settings: A longitudinal study. The Gerontologist, 47(3), 323-339. https://doi.org/10.1093/geront/47.3.323

 

Positive Work Environment and Nurse Retention

Research has shown that a positive work environment and relationship with coworkers in healthcare facilities promotes nurse retention rates. According to a study conducted by Lee Ann Waltz, a registered nurse and certified nurse educator, “Positive relationships with peers and a sense of teamwork were described as bringing joy to their work and contributing to their retention” (Waltz, 2020). Nurses value communication and positivity to facilitate day-to-day job duties. A positive relationship with the nursing staff motivates nurses to collaborate and contribute similar efforts for the success of the team. 

Limin Wang, a registered nurse, agrees with Waltz that nurses need positivity in the work environment, as he says, “a positive environment in which many more colleagues are engaged in work would further motivate nurses’ engagement” (Wang, 2021). According to Wang, nurses are impacted by the level of engagement of coworkers. High engagement indicates willingness to do work and therefore greater job satisfaction. The authors concluded that having a positive relationship with coworkers and contributing to team efforts increased nurse retention rates.

 

References:

Waltz, L. A., et al. (2020). Exploring job satisfaction and workplace engagement in millennial nurses. Journal of Nursing Management, 28(3), 673–681. https://doi.org/10.1111/jonm.12981

 

Wang, L., et al. (2021). Effects of self-rated workload and nurse staffing on work engagement among nurses: A cross-sectional survey. Journal of Nursing Management, 29(5), 1329–1337. https://doi.org/10.1111/jonm.1327

 

Importance of Support Systems: Increase Satisfaction of Workers

Nurse retention rates in long-term healthcare facilities have been associated with job satisfaction. A contributing factor is a well-established support system that is dependent upon the nurse’s experience with coworkers, supervisors, as well as patients. In a study regarding job satisfaction and work engagement, Dr. Lee Ann Waltz, an RN, CNE, and assistant professor at the University of the Incarnate Word states, “support from nurse leaders was closely tied to job satisfaction and retention of millennials” (Waltz, 2020). This was proved by the results of the study involving millennial nurses which concluded that “verbal and written praise for doing a good job was highly rewarding and led to greater job satisfaction” (Waltz, 2020). 

Waltz revealed that receiving positive feedback from patients and supervisors is appreciated and anticipated by nurses. Kimberly Lee, a graduate from the School of Health Administration in Texas State University agrees with Waltz that receiving support from upper management is an important factor in the nurse’s job experience by stating that, “Key facilitators of job satisfaction and engagement in hospitals and healthcare systems have included manager support and style” (Lee, 2020). Lee confirmed that nurse managers or leaders play a crucial role in motivating nurses and showing them that they are valued. The authors concluded that gaining recognition and support is an important factor affecting nurse retention rates.

 

References:

Lee, K., Mileski, M., Fohn, J., Frye, L., & Brooks, L. (2020). Facilitators and barriers surrounding the role of administration in employee job satisfaction in long-term care facilities: A systematic review. Healthcare (Basel), 8(4), 360. https://doi.org/10.3390/healthcare8040360

Waltz, L. A., et al. (2020). Exploring job satisfaction and workplace engagement in millennial nurses. Journal of Nursing Management, 28(3), 673–681. https://doi.org/10.1111/jonm.12981
 

How Educational Benefits Can Increase Retention Rates in Nursing Homes

Experts have suggested that an increase in the provision of educational opportunities has shown an increase in employee retention, specifically in nursing homes. The expert in question, Selina Roberdeau Hunt Mckinney has a Bachelor of Science in Nursing and a Masters of Science in Nursing. In this study, she aimed to find the factors related to the retention of registered nurses on a national level. “Moderate and high retention facilities offered tuition reimbursement, and career promotion/development opportunities more frequently than low retaining facilities” (Hunt, 2010) This quote from the study shows that nursing homes that experienced higher retention rates also offered tuition reimbursement and opportunities for their employees to be promoted and develop new skills, in comparison to facilities with lower retention rates, which did not. 

Another article in agreement with this one was written by Erika Paxman, a registered nurse who graduated from the University of Victoria in 2000. She wrote this study about nurse retention in long-term care facilities. “Knowledge and the ability to act on that knowledge was important in helping nurses feel confident in their practice. They believed that their knowledge helped others trust clinical decisions that were made.” (Paxman, 2002) This quote from her study shows how the nurses she interviewed feel about advanced education opportunities. They feel strongly that knowledge is what keeps nurses confident in their practices, and that learning more about their field will only build on their foundation of knowledge. 

These quotes from two separate experts both showcase the importance of educational opportunities among nurses. They both specifically are based around nursing in long-term care facilities like nursing homes; which is directly related to the scope of our project. 

 

References

Hunt McKinney, S. R. (2010). Factors related to registered nurse retention in nursing homes: A national perspective (Order No. 3413216). Available from ProQuest Dissertations & Theses Global; ProQuest One Academic. (746124000). Retrieved from http://ulib.iupui.edu/cgi-bin/proxy.pl?url=http://search.proquest.com/dissertations-theses/factors-related-registered-nurse-retention/docview/746124000/se-2?accountid=7398

Paxman, E. K. (2002). Come, go, 0RW1S34RfeSDcfkexd09rT2stay1RW1S34RfeSDcfkexd09rT2: Nurse retention in long-term care (Order No. MQ74857). Available from ABI/INFORM Collection; ProQuest Dissertations & Theses Global; ProQuest One Academic. (305482522). Retrieved from http://ulib.iupui.edu/cgi-bin/proxy.pl?url=http://search.proquest.com/dissertations-theses/come-go-i-stay-nurse-retention-long-term-care/docview/305482522/se-2?accountid=7398

 

How Employee Relationships Can Positively Impact the Workplace

The literature suggested that peer relationships among employees can boost merit, create a positive work environment, and increase employee retention rates. According to Erika Paxman, “They [the nurses] adamantly stated that the single most important thing to them was the support they received from their peers.” (Paxman, 2002) This quote from the article written by an experienced RN supports the idea that having relationships with your coworkers, specifically in a long-term care facility, is detrimental to a positive work environment. An article with a broader scope on employee engagement suggests a “peer-to-peer recognition program to celebrate daily wins.” (Abbamonte) Since your direct coworkers are the ones who get to see into everyday activities, it allows them to see more of the smaller successes one might accomplish throughout the day. A program like this would encourage employees to work to their full ability while recognizing and being recognized by their peers. 

These methods have of employee engagement have been mentioned in positivepsychology.com where it states, “positive interactions in the workplace have been shown to improve job satisfaction and positively influence staff turnover,” (Moynihan & Pandley, 2008) This is because employees who feel supported by their peers are more likely to stay within that organization for longer periods of time. Overall, positive employee relationships can lead to higher job satisfaction, build a positive work environment, while also increasing employee retention rates. 

 

References

Abbamonte, K. (n.d.). 17 Most Effective Employee Engagement Strategies for 2022. 17 most effective employee engagement strategies for 2022. Retrieved March 2, 2022, from https://nectarhr.com/blog/employee-engagement-strategies 

Moynihan, D. P., & Pandey, S. K. (2008). The ties that bind: Social networks, person-organization value fit, and turnover intention. Journal of Public Administration Research and Theory, 18, 205–227. Retrieved from https://positivepsychology.com/positive-relationships-workplace/

 

Implementing an Effective Preceptor/Mentorship Program: Capability, Opportunity, and Motivation

There are many factors that can affect the efficacy of a mentorship program, so to ensure the most efficacious program certain aspects must be considered in the implementation and maintenance of the program. A literature review and meta-synthesis of qualitative study data conducted for the China Medical Board found that 3 common themes across the qualitative data analyzed were:

• Capability of the mentor

• Opportunity in the mentorship program

• Motivation of mentorship program

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The review and meta-synthesis concluded that these themes “can help us identify what influences effective mentorship programmes” (Liao, L., Xiao, L. D., Chen, H., et al. 2019). Each of these themes is representative of an area of the program that must be considered to ensure an effective mentorship program. 

These findings are backed up by another more real world analysis of a hospital’s successful nursing mentorship program conducted by Hurst and Koplin-Baucum, two clinical nurse specialists and educators. Hurst and Koplin-Baucum’s analysis revealed key aspects of the program that they attribute its success to, which line up surprisingly well with the findings of the study above. These attributes included: the mentorship program being introduced to the new hires and reintroduced to units and floors every year so people have the opportunity to participate, mentors being selected from senior nursing staff as well as attending a 6-hour class to prepare mentor for the position, and a mentor and mentee incentive program in which when the mentee begins to reach goals set both participants of the program receive a monetary reward. 

Hurst and Koplin-Baucum go on to state that they feel that “a nursing mentor program [can] increase retention [and] promote a culture of excellence in nursing…” (Hurst & Koplin-Baucum, 2003). The theoretical component presented by Liao’s review and meta-synthesis of past studies and it’s real world equivalents shown in Hurst and Koplin-Baucum’s analysis of a successful nursing mentorship program show that if the factors are considered and managed, the mentorship program has the ability to improve retention rates amongst many other improvements to both quality and climate of nursing.

 

References:

Liao, L., Xiao, L. D., Chen, H., Wu, X. Y., Zhao, Y., Hu, M., Hu, H., Li, H., Yang, X., & Feng, H. (2019) Nursing home staff experiences of implementing mentorship programs: A systematic review and qualitative meta-synthesis. Journal of Nursing Management 28(2), 188-198. https://doi.org/10.1111/jonm.12876

Hurst, S. & Koplin-Baucum, S. (2003). Role acquisition, socialization, and retention: Unique aspects of a mentoring program. Journal for Nurses in Staff Development 19(4), 176-180. Retrieved from https://journals.lww.com/jnsdonline/fulltext/2003/07000/role_acquisition,_socialization,_and_retention_.3.aspx?casa_token=_TSVNi_9zvcAAAAA:CZnrB1_9_0W-7E3nEr8SC0ehLJ2akfoZgAjd6tJvstsC7tFlAKJoxNEcFu5IzbKL96aozlZ25huSyzZEO9-yl_h5kNU 

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Implementing a Combined Preceptors/Mentors and Retention Facility Specialist: Employee Embeddedness and Communication

By implementing a program that combines aspects of mentorship, preceptorship, and  a facility retention specialist, a new unique position can be formed that can increase their job embeddedness. A study by Pillemer a researcher from Cornell University found that a unique position called a facility retention specialist lead to decrease in employee turnover of “10.54%, whereas the rate in control facilities decreased by 2.64%” (Pillemer, K., Meador, R., Henderson, C., et al. 2008). This position was given to a senior staff member to use their facility specific knowledge and expertise to select and adapt evidence-based retention programs for practical clinical usage in their facility. 

 

The retention specialists were trained in retention practices including:

• Providing respect and recognition to the nursing staff

• Employing structured career development and providing opportunity for growth

• Putting mentorship programs in place

• Improving climate by introducing programs to improve interpersonal skills

 

These implementations are similar to what mentors provide to their mentees at a smaller scale and mentorship is even listed as a tactic these retention specialists are taught to use. A review of mentorship programs by Greene, a clinical nurse educator, found that mentorship programs also benefit  employee turnover by significantly reducing “the number of novice staff terminations” as well as creating a “supportive environment” (Greene, M. T. & Puetzer, M. 2002). Additional benefits seen with mentoring programs are an increase in employee embedment, which can be described as employees ties to others at their job as well as the strengths of those relationships (Holtom, B. C. & O’Niell, B. S. 2004).  This is due to the extended training and support provided by mentors to their mentees as they initially begin their work as well as the social benefit that having an assigned mentor has in the ease of transition into the social dynamic of the workplace. 

By combining these two roles into one we would see an ease of communication between the management and the mentors involved in the program, and because the mentors work so closely with other staff we would also see an increase in communication between nursing staff and management. Moreover we will also see a increase in employee embeddedness of the nursing staff as the combination of mentors and retention specialists will streamline the process of getting new employees involved socially in their workforce while also increasing the sociability and relationships between the employees with programs put in place by the mentors based on what they see the mentees and other employees needing first hand. Overall these factors should lead to an increase in employee retention.

 

References:

Pillemer, K., Meador, R., Henderson, C., Robison, J., Hegeman, C., Graham, E., & Schultz, L. (2008). A facility specialist model for improving retention of nursing home staff: Results from a randomized, controlled study. The Gerontologist, 48(suppl_1) 80-89, doi: https://doi.org/10.1093/geront/48.Supplement_1.80

Greene, M. T. & Puetzer, M. (2002). The value of mentoring: A strategic approach to retention and recruitment. Journal of Nursing Care Quality 17(1), 63-70. Retrieved from https://journals.lww.com/jncqjournal/fulltext/2002/10000/the_value_of_mentoring__a_strategic_approach_to.8.aspx?casa_token=E4tOFUdO-QsAAAAA:TQTxVQBtvIRaA2JTqNI-xSiNDmc-mF8BOU609N1eOfTPLiAaqoCcd71T7hSj_SBJC790k6ynFypuUhrB7v9Kwr7v_60 

Holtom, B. C. & O’Neill B. S. (2004). Job embeddedness: A theoretical foundation for developing a comprehensive nurse retention plan. Journal of Nursing Administration 34(5), 216-227.  Retrieved from https://journals.lww.com/jonajournal/fulltext/2004/05000/nurses__job_satisfaction,_organizational.5.aspx?casa_token=dE7l-y5ZpLMAAAAA:tmU58SDV4OEe19SRTe7iAFGpW7KczNbIBiPE5WH0-mE3EzyPJUAgkl8wnPa4ySE8UL-rUO-8CS3mc7zPjm3F5ky68oo 

 

Improving Work Conditions and Environment

Nurse retention has been affected by multiple factors, such as poor working conditions, and mental and physical burnout. Brian Colosi mentioned factors in his survey he states, “Since conducting this survey, this is the first time that retirement was in the top three. whether this is due to Covid was not a topic of the survey. Finishing the list of top ten reasons include; personal reasons (caring for a child/ parent, marriage, disability, etc. ), unknown, education, workload/staffing ratios, waking conditions, scheduling and salary.”(Colosi B., 2021). In this survey it shows the top ten reasons for nurses to turnover. Another expert Zach Smith, a BSN, Registered Nurse stated that “Fostering healthy, engaged community nurses and nursing stag creates a bond that leads to better teamwork,healthier patients and happier nurses.”(Smith W., 2020). Zach being a nurse having the experience and getting a person from the inside suggests that by improving this and having a good community and help improve the turnover rates in healthcare. Both experts showed how things can impact nursing retention and how it can be improved.

 

References: 

2021 NSI National Health Care Retention & RN Staffing Report. (n.d.). Retrieved March 3, 2022, from https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf  

Smith, W. (2020, December 16). Take One to know one: Nurse retention from a personal perspective. NurseGrid. Retrieved March 3, 2022, from https://nursegrid.com/blog/takes-one-to-know-one-nurse-retention-from-a-personal-perspective/ 

 

Working on Using Strategies to Improve Employee Retention

Research has shown that facilities who provide health plans to their employees have seen better retention rates. Stephen Miller, a certified employee benefits specialist, conducted a survey that showed “ 71 percent of employees are satisfied with their current employer-provided coverage but that high costs worry many (Miller, 2018)”. This facility is using the strategy of giving better benefits such as a good health plan for their employees, which improves their retention rates. Stephen also mentions, “46 percent said health insurance was either the deciding factor or a positive influence in choosing their current job” (Miller, 2018). The results of the survey have shown that employee needs must be addressed when approaching retention strategies. Antique Nguyen, market manager at PreCheck, says that “Understanding specific retention challenges, and creating a specific plan to address them, will help guide your healthcare organization toward lower turnover rates, lower costs, increased engagement, and stronger competitiveness among employers.” Having a steady plan creates an organized organization and will keep the rest of the team on track. Both sources indicate that the organization must address what the employees are missing from their jobs to increase retention.

 

References:

Nguyen, Antique. (2020, June). 5 keys to an effective retention strategy for healthcare HR. PreCheck. Retrieved March 3, 2022, from https://www.precheck.com/blog/5-keys-effective-retention-strategy-healthcare-hr 

Miller, Stephen (2018, February). Employees are more likely to stay if they like their health plan. SHRM. Retrieved March 3, 2022, from https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/health-benefits-foster-retention.aspx