Retention of nurses

Introduction

Retention of nurses is a priority issue because the profession is currently beset by an unprecedented shortage of nurses at every level (Buerhaus, 2008; Buerhaus, Auerbach, & Staiger, 2007; Donley, 2005; Gallagher, 2008). These shortages are even more pronounced in rural areas: it can take up to 60% longer to fill rural nursing positions (MacPhee & Scott, 2002). Nursing professionals widely acknowledge a number of factors contributing to the shortage: aging of the workforce; lack of representation of the younger-aged, male, and minority candidates entering the profession; lack of doctoral degree-prepared faculty to educate those who do; and a multitude of environmental factors in the workplace that discourage the very heart of nursing (Aiken, Clarke, Sloan, Lake, & Cheney, 2008; Aiken, Clarke, Sloan, Sochalski, & Silber, 2002; Hayhurst, Saylor, & Stuenkel, 2005).

The viability of the profession and the healthcare industry depend upon how nurse leaders and researchers confront this ever-worsening shortage of nursing professionals and the inability to retain them. Ironically, these present-day sentiments echo the 1950 statement of the Chief Nurse Officer of the Public Health Service who recommended “generating a research base through new methods . . . [and] analysis of . . . conditions reducing turnover and promoting job satisfaction, use of management theories in the healthcare arena, and therapeutic effectiveness of interpersonal relationships” (Leone in Gortner, 2004, p. 107). Clearly, the problems facing the profession have not changed much, nor has the plea for research to address them. What is different 50 years later is the wealth of available research data on leadership styles, particularly on transformational style of leadership (TFL) and its power to change organizational health. Furthermore, the present-day drive to attain Magnet Recognition (American Nurses Credentialing Center, 2005; McClure, Poulin, Sovie, & Wandelt, 1983) has given focus to this call to “use management theories in the healthcare arena [to improve] therapeutic effectiveness of interpersonal relationships.” The research study described in this paper supported this call by investigating the potential effectiveness of a particular management theory; namely, TFL for nursing leaders.

The purpose of this study was to craft an educational intervention to develop characteristics of TFL in novice nurse managers and administrators (NNM) and to determine if this intervention made a difference in their leadership knowledge and ability. However, it is challenging to engage the population of NNM in an ongoing instructional program or research endeavor. Competing priorities and multiple demands on the time of NNM require the researcher to devise a thoughtful approach that yields valuable information, but also respects the limitations of engaging this population in scholarly inquiry in a patient-centered healthcare setting.

Today's hospitals are increasingly turbulent workplace environments (Havens, Thompson, & Jones, 2008; Tillman, Salyer, Corley, & Mark, 1997), and research with NNM calls for flexibility and adaptability on the part of the researcher. A mixed method research approach was used to design a study seeking to develop characteristics of TFL in NNM through an educational intervention. The intervention was presented in the context of a Journal Club, which is a gathering of professionals to read and discuss research and literature related to their common practice in order to build knowledge and professionalism (Mikkelsen & Laursen, 2007).

Combining quantitative and qualitative research styles is referred to as mixed method research. There are three rationales for selecting mixed method research:
complementarity, incrementality, and enhanced validity (Polit & Beck, 2008). Each of these three rationales as Polit and Beck (2008) define them will be described, and their relevance to this study will be discussed.

Quantitative and qualitative styles complement each other; they represent numbers and words, the two fundamental languages of health communication. Since all methods are fallible, researchers can allow each of the two methods to do what it does best, hopefully averting the limitations inherent in a single approach. This study was limited by a relatively small sample size and contact time due to the researcher's distance from the research setting; complementarity of the two research methods addressed these limitations.

Incrementality refers to the fact that research is an incremental process relying on feedback loops (Polit & Beck, 2008). Each of these two research methods can inform the other, posing questions from which one style can generate more information than the other. In this study, quantitative methods measured participants' knowledge of characteristics of TFL and perceived readiness to lead, while qualitative inquiry added meaning and depth to those measurements and explored the participants' perception of the effectiveness of the intervention.

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