This makes retention essential, as new nurses must stay with the hospital and become nurse specialists for CMC to continue to maintain its reputation. Nursing education is also essential. Unfortunately, a stressed and pressured environment that is understaffed can create tension rather than foster cooperation between nurses, particularly old and young nurses. Older nurses may believe that their younger colleagues must 'pay their dues' before they are fully accepted as part of the staff. Younger nurses may find themselves given more onerous tasks and denied learning opportunities, as they assume the 'grunt work' of the nursing staff.

Leadership

Sadly, no one benefits from such an adversarial culture. Younger nurses leave in greater numbers, out of frustration, further compounding the nursing shortage at CMC. Little hands-on instruction and education means that new graduates lack confidence and autonomy in their decision-making and are more prone to error and relying upon more skilled nurses.

A new formula of leadership must be introduced: a leadership program of mentoring younger nurses that is educational and more participatory in its approach.

Culture

Nurses must labor under stressful conditions, even under the best of circumstances, which is always a shock for new nurses. "I knew I would have to work hard but this is beyond anything I imagined. I have to work harder, be more adaptable, the parameters change constantly. The expectations are huge" said one recent graduate (Without support, 2008, the Lamp). But while a lack of time and stress may be endemic to the medical profession and the careers of both recent graduates and seasoned nurses, a concern reported by many new nurses is "the lack of available support and backup from experienced nurses" even when the new nurses show a readiness to learn from their older colleagues (Without support, 2008, the Lamp).

"I think, is it worth it?" this type of inner dialogue propels many new nurses to leave the profession (Without support, 2008, the Lamp). Younger nurses feel frustrated with a lack of support and few opportunities to advance their knowledge in a pressured environment, where they are often 'filling in' rather than learning how to do something properly. But pressures to perform themselves can make older nurses brusque with younger nurses.

Finance

Economic strategies have often been used to address the nursing shortage. However, using financial solutions, in an era of cutbacks can prove a challenge. Furthermore, "fewer RNs in 2006 than in 2004 (roughly 10-20 percentage points lower) perceived that hospital recruitment strategies were effective, particularly those that 'provided tuition benefit,' 'offered signing bonuses,' 'provided flexible work schedules,' and 'increased salaries'" (Buerhaus, 2010, p.3). A sharply gradated pay scale favoring more experienced staff or tuition reimbursements that favor younger...

This would foster greater staff cohesion and create a common culture between old and young.
Possible solution

Assigning new nurses a mentor, experienced nurse would show that CMC makes a commitment to educating new nurses. It would also improve retention, given that the personal relationship would make the newer nurse less apt to leave the organization and let her mentor nurse 'down' in her duties. Older nurses would benefit from increased retention of new nurses and reduced mandatory overtime as the ranks of nurses increased at the hospital through improved retention.

Recommended solution and implementation

The CMC cannot solve all of the problems of recruitment and retention of new nurses, such as inadequate funding for nursing educators and less money available for nursing scholarships. However, a mentorship program would attract new recruits in greater numbers to the institution, and help fill an important gap in the education of new nursing staff.