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Recruiting and Retaining High-Value Nurses

By Bonnie L. Barndt-Maglio, PhD, RN  
   September 14, 2010

The continuing debate over healthcare reform legislation has focused national attention on complex issues such as high cost, overuse of technology, significant gaps in quality, access to services, and consumer satisfaction. Although the future system of healthcare remains unclear, the solutions to these issues will undoubtedly need to be both innovative and comprehensive in order to address the needs of an aging population and the millions of previously uninsured Americans who will be entering the system. In this new horizon, nurses will continue to play a key role in providing efficiently orchestrated care, reducing length of stay, achieving desired quality outcomes, and managing costs.

These challenges will require what Health Affairs terms a high-value workforce—one with the ability to quickly assess patient needs, develop comprehensive plans of care, and work within the health system to marshal the resources needed to attain necessary outcomes.

Key to maintaining and building a high-valued workforce is the retention of experienced nursing staff with advanced problem-solving skills and an understanding of the healthcare environment developed over years of service. Typically these attributes can be found and cultivated in nurses within the age range of 40 to 60 years, who have, during their career, witnessed an evolution in the healthcare system, including significant changes to the system of care delivery, third party payment, technology, internal and external organizational structures, and focus on public reporting of quality data and care outcomes. The 2004 HRSA National Sample Survey of Registered Nurses indicated that 59% of currently licensed RNs are between the ages of 40 and 59 years of age, indicating a substantial resource.

In an effort to retain a high-value nursing workforce, nurse leaders tend to initially focus on salaries. Although in most studies salaries continue to be an important work satisfier for nurses, this alone will not retain the talented nursing staff necessary to meet current and future demands. One critical factor is for leadership to be committed to creating a culture that values the depth of knowledge and skill that a seasoned nurse brings to the workplace, provides a sense of job satisfaction, and inspires organizational commitment. This is only attained through an atmosphere of mutual trust, collaborative decision-making, and meaningful recognition for clinical excellence.

Strategies to create this culture begin with an understanding of the individual and collective staff values and needs. This type of understanding will develop a workplace where individuals have a sense of organizational fit and belonging which leads to retention. Providing forums for collaborative decision-making on schedule development, policies, and individual responsibilities is key. Encouraging staff to participate in the decision-making process will help unite them as a unit and develop a strong sense of ownership.

Another culture building strategy is to assign seasoned staff to mentor less experienced nurses. Typically, mentoring occurs only during orientation or with new graduates. However, these experienced high-value nurses are repositories for professional knowledge and skills that have yet to develop in other staff members. Designating mentors allows the rest of the staff to seek guidance in a safe environment and properly recognizes seasoned nurses as invaluable experts while creating closer bonds with the staff and organization.

Creating meaningful rewards for the tenured staff has long been overlooked as a strategy to retain high-value nurses. Salary compression has been common with salary dollars focused on competitive wage rates to attract new recruits, especially new graduates. Other ways of recognition and reward for high-valued nurses may be to decrease the holiday commitment for nurses with 20 or more years of tenure, provide a bonus structure based on contribution, and/or assigning unlicensed personnel to work under their direction to lower the physical stress.

Although the solutions to the complex problems related to healthcare reform will not be easy, every bit of talent is needed to fashion successful new systems. A high-value nursing workforce with members who can use their individual and collective knowledge to structure new avenues to meet patient needs is an essential component. Retaining the current resources present now will serve as the key to future success.

Bonnie L. Barndt-Maglio, PhD, RN, is a vice president at the Camden Group, where she specializes in incentive management and other ways organizations can substantially improve current operations while successfully navigating likely healthcare reform initiatives.

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