Essay title - Retention of Nursing Personnel and Job Satisfaction
Abstract
The difficulties confronted by a number of hospitals around the world are high nursing turnover and shortage of nursing personnel. Hospital administration is loosing highly trained and experienced personnel. Although, the recruitment of agency and foreign nurses has solved the problem to an extent, yet it is not the solution to this problem. The paper discusses various strategies to help the hospital administration to retain the nursing staff. Hospital administration should fully focus on the work environment and employment level of the nurses. It should also pay attention to the psychological contract if it needs to retain and motivate the nursing personnel.
Introduction
Today’s world poses a challenge for hospital administrators as the turnover rate for nurses is increasing and there is a shortage of nurses in the hospitals. For example, for the last five years, the figures for graduating nurses have declined by 20 percent in the United States and the vacancy rate for nursing position has increased to 10 percent (Silby, 2003). The 2006 predictions of the Council of Nurses in Australia are that it will have only 60 percent of the registered nurses it needs. Similar situation prevails in Europe, Asia and Africa also.
As a result to this, hospitals in developed countries are obliged to recruit foreign nurses from developing countries. But, there is another set of challenges for hiring the foreign nurses. For example, if hospitals in developed countries fill the vacancies from the developing countries, this will reduce the number of qualified nurses in the developing countries (World Health Organization, 2003). Discrimination faced by foreign nurses and wage exploitation (i.e. less pay to foreign nurses than domestic nurses) are the important ethical complications associated with the movement of nurses (Kline, 2003).
For the societal consolidation of the nurses from foreign countries and for reducing the difficulties in language and communication, the hospitals need to introduce diversity management initiatives. Such nursing initiatives exemplify how nursing turnover and shortage has the attributes of a global crisis. To look after this problem, hospital management is encouraged to support or reassess crisis management plan that looks after labor shortage.
Prevention, preparedness, responsiveness and recovery are the four steps for effective crisis management ( Sapriel 2003, Sheaffer & Mano-Negrin 2003). These 4 stages look at how an organization may cut down or decimate risks, plan for the worst case scenario and respond to the critical situation. The health care department is continuously looking for strategies to cope up with the shortage of nurses and crisis of turnover and similar is the case in the responsiveness stage. The hospital administrators should search some productive initiatives taken in other hospitals that have shown useful results in retaining nurses (e.g., flexible rostering system, including the use of web-based rostering).
The environmental pressures regarding nurse turnover and shortages should be clearly understood before deciding retention strategies for nurses. The government and management led initiatives of providing quality patient service at low cost have deeply affected the nursing work (Bolton 2004). Performance indices and quality inspection are considered as Taylorist form of ‘performance control’ by some commentators. These forms of ‘performance control’ weaken nurses’ occupational autonomy and increase the workloads of nurses. The new public sector management practices are perceived as alien by the nurses, especially when there are not enough resources available to fulfill the promise of a quality service (Armstrong, 2003).
There will be a decreased commitment along with an increased frequency of industrial actions, low morale, increased job dissatisfaction and high frustration among the nurses because of radical changes in the health care environment (Ribelin, 2003) .The psychological declaration between the nursing personnel and the administration is being affected by the change in the expectations of nurses. Promotion of the ways to analyze the arising levels of dissatisfaction among nurses along with their feeling of the work is possible through the concept of psychological contract and perceptual experience, which has been more and more outraged in recent years. The ‘psychological contract’ can be defined as the individual employee’s subjective perceptual experience of the reciprocal responsibilities among employer and employees. As it is subjective, it contemplates the employee’s incomplete, exclusive and potentially deformed perspective of the relationship.
The psychological contract helps in fulfilling the perception gap in the employment relationship and determines the day-to-day employee behavior. Contravention of psychological convention may bring out negative emotional effects such as feelings of disagreement, bitterness and distrust. As a result of these emotions, behavior at work becomes negative, which in turn develops a wide category of these behaviors such as reduced commitment, interruption and higher absenteeism. Inconsistency in the real execution of responsibilities by the organization has resulted in the act of violation by the employees. Change is another factor, which is responsible for the violation, as it enhances the chances of clashes between promise and execution. Changes with regard to the hospital management and its budgeting affect the performance of nurses on the job by reducing the time that is used by them to counsel on the matters required for the caring of patient. Input changes in psychological agreement also lead the feeling of disagreement among the nurses with regard to the intrinsic reward. Changes also add extra responsibility for nurses in decision making with regard to managing agency of nurses who are junior or fresher (Gormley, 2003).
Changes in work practices such as more shifts, working load and pressure also contribute to the feeling of disagreement among nurses and they might think that they are not receiving full attention and respect along with less opportunities for career advancement, which further results in to reduced job satisfaction.
This paper provides the base for understanding the nature of present scenario of nursing turnover and shortages. This paper presents a detailed survey of the nursing staff with a particular sample size describing the type of questionnaire used for the survey. It also describes the methodology used in the survey along with the important conclusions derived from this survey.
The paper also describes the job satisfaction among the nurses regarding the prevailing scenario. Job satisfaction is a significant part of nurses' lives that can affect patient security, productivity, functioning, turnover, quality of care, retention and commitment to the organization and the profession. This paper looks into how the elements of job satisfaction change during early career in newly qualified UK nurses.
This paper gives a detailed analysis of the present situation of nurses and their level of satisfaction from their job. It mentions the rate of turnover among nurses and the expected costs of that turnover. It also explains the way in which job satisfaction is related to retention. It identifies the trends in the nursing employment and the possible reasons behind those trends.
Study population
The population for this study is having the qualification and experience of 6 months, 18 months and 36 months, which reflects fresh experience, fresh experience with first promotion and stability respectively. This sample was taken from the population of nurses, who qualified their nursing diploma in England in 2005. It was a mixed sampling approach and the samples were taken from each branch of nursing.
The estimates of nurses’ population from children and learning disability branch were quite low (425 & 150). Adult and mental health branch’s estimation was much larger (4550 & 940) than the children and learning disability branch. The nurses, who were assigned to children and learning disability branch, were qualified from England. The nurses from many colleges, eight regional health authorities and intakes were assigned to adult and mental health branch. For adult and mental health, half and two third of the colleges of each region (three to eight colleges in each region) were sampled respectively.
The division of samples was based on the information gathered from own queries to nursing colleges and from England National Board. The number of colleges of children’s nurse, learning disability, adult and mental health branch was 36, 39, 46 and 24 and the eligible recruitments were 2000, 760, 200 and 705 respectively (total 3665). The percentage of every part is as follows: qualification (75%, 2748), 6 months (64%, 2345), 18 months (53%, 1942) and 36 months (45 %, 1650). There were some cases of non-response due to change in address of nurses.
Study Branches |
No. of Nurses |
Children |
2000 |
Learning Disability |
760 |
Adult |
200 |
Mental Health |
705 |
Instruments for data collection
There are various methods of data collection for the research based on literature review to find out the relationship between job satisfaction and retention. Survey mainly consists of two methods, i.e. interview and questionnaire. For the purpose of literature review, we have chosen questionnaire method of data collection. Mail survey and group administered questionnaire were the important types of questionnaire, which we used in the questionnaire.
Mail survey: Questionnaire was mailed to the nurses who were expected to read and interpret the questions and write down the reply in the space, which was meant for the purpose in the questionnaire itself (Kothari, 2005).
Group administered questionnaire: In this method of data collection, a group of nurses was brought together and asked to respond to a structured pattern of questions.
Characteristics of Questionnaire used in the survey for literature review
Questionnaire is considered to be the heart of survey report. Hence, this should be constructed in a well defined manner. Questionnaires have different forms such as structured and unstructured, with close and open ended questions.
Structured questionnaire: In this form of questionnaire, questions are set in a definite pattern. They are either open ended or close ended. In close ended questions, response can be of yes or no type but in open ended questions, free response is invited. The questions should be stated in advance and in a well defined way.
Unstructured questionnaire: In this form of questionnaire, there is no definite set of questions as all the questions are unorganized and not formulated in the exact way as in the case of structured questionnaire.
We have chosen the structured form of questionnaire as it could easily be interpreted by the nurses. The method of data collection with the help of questionnaire was relatively cheap and there was no personal contact of respondent involved in this method. It included wider and more representative distribution of samples. It was free from any personal bias of the interviewer and the nurses as they had enough time to give well thought out answers. All the questions related to the job satisfaction and retention were asked in a structured form. These questions were asked with regard to the control and independent variables. Control variables were stress, support at work & position and independent variables were workload, resources & external work environment. On the basis of these variables, the layout of questions (close or open) that were used in questionnaire was formed (Kothari, 2005).
Data Collection Method or Research Methodology
The methodology used in this case is questionnaire survey method because this is very popular and helpful in case of big enquiries. Questionnaire is often considered as the heart of a survey. In this method, a questionnaire is mailed to the respondents who are expected to answer these questions. The method of collecting data by the questionnaires is most extensively employed in various economic and business surveys. The rationale behind using this methodology is as follows:
- Its cost is low even when the population is large and is widely spread geographically.
- It is free from the bias of the interviewers and answers are in respondents’ own words.
- Respondents have adequate time to give their thoughts and answers (Kothari, 2005).
- Respondents, who are not easily approachable, can also be reached conveniently.
- Large samples can be made in such a way so that the results can be made more dependable and reliable.
The questionnaire research methodology and the data collection plan used by the researcher also have some limitation, which are as follows:
- Low rate of return of the duly filled in questionnaires and bias due to no-response is often determined.
- It can be used only when respondents are educated and cooperating.
- The control over questionnaire may be lost once it is sent.
- There is an inbuilt inflexibility because of the difficulty in amending the approach once questionnaires have been dispatched.
- There is also a possibility of ambiguous replies or omission of replies altogether to certain questions and interpretation of omissions is difficult.
- It is difficult to know whether willing respondents are truly representatives.
- This method is likely to be the slowest of all the methods.
Results
It is customary to point out that turnover is not always taken as negative in terms of its impact. Turnover may be useful or wasteful depending upon the situation. It is undesirable when its purpose is to search for entire removal labor consumption. Turnover is definitely positive and useful for the employee as well as for the organization if it happens early in the service relationship when it has become clear that there is no matching between the individual’s properties such as skills, abilities & other characteristics and the job requirements of the organization. These suggestions will assist the organization to focus on different approaches in order to reduce the wasteful turnover attitude among the nurses.
In spite of standard significant costs related to nurse turnover, the cost of substituting a nurse is expected to range from $US10000 TO $US 145000 or up to 150 percent of the nurses’ annual consumption. This cost depends upon the type of job, clinical competency and experience. Only 10 percent out of 20 percent of the US health care setting is supposed to be effective in their nurse retention program. A program of health care settings and hospitals that is common in nature having retention activity is called culture research and is used to test the views of nurses in context of their work culture. Apart from this, there is another approach, which emphasizes on the effective communication between manager and nurses.
Results of study, which was performed to find out the causes of leaving the organization by nurses interpret that the reasons told to third party are different than those told to the employer on the time of exit. This is concluded that there is a lack of trust and effective communication within the organization. As a result of this, the feeling of reduced job satisfaction has developed (Cline, Reilly & Moore, 2003).
It is necessary for the management of hospital to understand that nurses who are experienced and trained should be given enough authority and chances to offer their suggestions in order to improve the work environment (Lacey & Ribelin 2003). Some interviews should be conducted outside the organization with those nurses who left the hospital through the third party in order to find out the causes behind their exit or turnover. It is not possible for the management to develop effective strategies in order to decrease the rate of turnover without knowing the original costs and results linked with losing their staff of nursing.
There should be a proper attention of seniors towards the nurses as they need support from their seniors in context of relationship with the physician and it is found that this constitutes the main reason behind the stay of nurses in the health care setting. Only few of the organizations include this factor in their retention program. According to the survey, it was concluded that most of the nurses like to stay in those hospitals where the relationship with the supervisors are positive. In the increasing competition in hospital business, it is necessary for the management to focus on the behavior of physician, which is not healthy or respectful for the nurses and take some effective measures in order to retain them in the organization for a long time period.
Disagreement of physicians on the matter of viewing nurses as the important and key member of the organization automatically develops an environment, which facilitates nurses to leave the organization (Kimura, 2003). Feelings such as depression, anger and resentment are resulted from this environment among the nurses. It is responsible for the decreased performance level, higher rate of absenteeism and job dissatisfaction that further results in to higher turnover rate. Physicians, who harass the nurses and exhibit the aforesaid behavior, must be tackled and directed to replace their behavior with written warnings.
Ways of nurses for leaving the organization are the same like they are in other groups and organizations (Lacey 2003). These results interpret that in the selection procedure; there should be some improvements in order to hire the suitable candidates as well as to conduct some induction programs for the newly selected employees. Strategies of retention with regard to part time job of nurses should include the implementation of flexibility so that their job can be matched with the pattern of their livings.
The most effective way for the managers to retain the nurses or to reduce the rate of turnover is to perform greatest efforts in hiring nurses in order to achieve the most suitable fit between the nurses and the requirements of their job. The implementation of actual job sample in the selection procedure of nurses assists the manager to reduce the chances of unrealistic expectations with regard to the job, which further reduces the chances of job dissatisfaction and subsequently the rate of turnover. Orientation programs should be conducted in such a fashion, which provides full information to the new employees in order to reduce the depression and to achieve a grip on the job environment effectively (Waters 2003).
Various programs such as leadership programs should combine the junior nurses with the senior nurses in order to provide the new one full counseling with regard to the job and its obligations (Lacey 2003). Many health care settings achieve their goal to reduce the turnover rate of nurses by the implementation of this program. Selection procedures such as team membership, work teams and work tours are also effective procedures in order to reduce the turnover rate of nurses within the hospitals and health care settings.
These are the strategies, which should be implemented effectively for the retention of nurses for long time period and to reduce the turnover rate of them in the organization in an efficient way.
Conclusion
From the above discussion and findings, it is concluded that job satisfaction differs largely from one job to another and it even differs within the same profession. The vocation of nurse also falls in this category. Nurses have to deal with all types of patients whether he is a small child, an adult, an old person or a mental patient. They have to work in different contexts and settings and with entirely different organizational cultures, which give a varied experience to them in the profession.
Not only the settings, work environment and organizational culture differ but the individuals choosing this career path also differ in characteristics and aspirations and this might influence their level of satisfaction. According to the present situation and ongoing trends, no such single answer can be quoted to describe the level of job satisfaction.
The research focuses on understanding the particular job characteristics and the level of satisfaction derived from them. The increasing shortage of nurses is resulting in recruitment of nurses from foreign countries, which in turn results in dearth of nurses in foreign countries. Nurses constitute to the success of hospitals rendering their services for the all types of patients. So the hospital management should take great care for the satisfaction among the nurses (Moody, 2003).
The conditions should not be such that frustrate the nurses, lower their morale and decrease their interest and motivation towards their job. The foreign nurses are even exploited with regard to wages, which shows that they are treated with discrimination. The hospital management should try to maintain the present number of nurses and retain the lost ones. For the shortage of nurses, the hospital management should take appropriate steps and try to provide maximum job satisfaction to the nurses (Robinson, Clements, & Land, 2003).
Teamwork should be encouraged and the quality of work life should be improved to retain the nurses in the employment. The administration should take the necessary steps to enhance and increase the talent supply among nurses. Regular training sessions should be conducted to keep them updated (Sapriel, 2003).
It is very important for the hospital management to implement proper human resource practices, which will help in retaining the high performing nursing personnel presently employed in the organization and attracting new nursing talent.
Other relevant point
Monetary consideration can be taken as an important point because there are people who are satisfied by their job, but due to monetary dissatisfaction they might not prefer to continue with the same job. Hospital management should pay attention towards increasing the pay of the nursing personnel. As it is already mentioned in the research that the foreign nurses suffer from wage exploitation and discrimination, the hospital management should avoid such injustice and monetary satisfaction should be considered important to retain the nursing personnel.
References
Armstrong, F. (2003). Migration of nurses: Finding a sustainable solution. Australian Nursing Journal, 11(3), 24-26.
Bolton, S.C. (2004). A simple matter of control? NHS hospital nurses and new management. Journal of Management Studies, 41(2), 317-333.
Cline, D., Reilly, C., & Moore, J. (2003). What’s behind RN turnover? Nursing Management, 34(10), 50.
Gormley, D.K. (2003). Factors affecting job satisfaction in nurse faculty: A meta-analysis. Journal of Nursing Education, 42(4), 174-178.
Lacey, L.M. (2003). Called into question: What nurses want. Nursing Management, 34(2), 25-26.
Kimura, H. (2003). Overcome toxic management. Nursing Management, 34(1), 26-30.
Kline, D.S. (2003). Push and pull factors in international nursing migration. Journal of Nursing Scholarship, 35(2), 107-111.
Kothari, C.R. (2005) Research Methodology (3rd Edition). Delhi: New Age International (P) Ltd., Publishers.
Moody, R.J. (2003). Agency nurses fill void, but can face hostility. The Business Journal, 20(26), 7.
Ribelin, P. (2003). Retention reflects leadership style. Nursing Management, 34(8), 18-19.
Robinson, J.R., Clements, K., & Land, C. (2003). Workplace stress among psychiatric nurses. Journal of Psychosocial Nursing & Mental Health Services, 41(4), 32-43.
Sapriel, C. (2003). Effective crisis management: Tools and best practice for the new millennium. Journal of Communication Management, 7(4), 348-355.
Sliby, J. (2002, July 12). Nurse shortage plagues leads to health care industry crisis. Boston Business Journal. Retrieved July 14, 2008, from http://boston.bizjournals.com/boston/stories/2002/07/15/focus8.html
Waters, L. (2003). Overcome hidden expenses, migrating staff. Nursing Management, 34(5), 20.
World Health Organization (WHO) (2003). International nurse mobility: Trends and policy implications. Geneva: International Council of Nurses and Royal College of Nursing.
