High-Performance Work Practices in Nursing and Healthcare

Introduction

How do high-performance work practices benefit the nursing profession — and, moreover, how are they beneficial to the patients receiving care from nurses? This paper delves into the concept of high-performance efforts in the nursing workplace, exploring what these practices look like in practice and why they matter for both workers and healthcare organizations.

The Challenge of Nursing Shortages and Frontline Workers

Severe nursing shortages and urgent concerns about the quality of care resulting from those shortages have led to the increased implementation of high-performance work practices (HPWPs), according to assistant sociology professor Janette Dill and colleagues, writing in the peer-reviewed journal Health Care Management Review. It should be noted that the study Dill and colleagues conducted relates not to licensed nurses per se, but to the career development that HPWPs offer for "unlicensed frontline healthcare workers" — a large and often overlooked segment of the healthcare labor force (Dill, 319).

Who Are Unlicensed Frontline Healthcare Workers?

These workers include nursing assistants, mental health counselors, patient care technicians, and respiratory therapy technicians (Dill, 319). Although they are not licensed as registered nurses, they make up approximately 50% of the healthcare workforce — roughly six million workers in the United States today — and are therefore critical to the delivery of quality services. Indeed, they are described as being "among the fastest growing occupations in the United States" (Dill, 319).

Traditionally, because of the low entry-level qualifications required, these unlicensed workers have been considered easily replaceable and have consequently received little training or opportunity for advancement. The central question posed by Dill and colleagues is whether a new policy approach — one that recruits, trains, and invests in these workers — would benefit both the workers themselves and the healthcare organizations that employ them.

HPWPs and Career Mobility: The Research Framework

Specifically, the researchers asked: if healthcare employers offer career ladders and tuition remission to workers who previously had little or no chance of upward mobility, will those workers come to believe that advancement is genuinely available to them — and, as a result, become longer-serving employees?

To investigate this, the authors analyzed a sample of 947 frontline healthcare workers in 22 healthcare organizations, examining whether a relationship exists between HPWPs and unlicensed workers' sense of future career mobility. The research framework expected that three continuous measures of employer support would signal to workers that their employers genuinely "support their career development and advancement" (Dill, 322–23):

a) Financial rewards — whether workers feel their pay is fair for the work they provide; b) Autonomy — captured by the statement "It is basically my own responsibility to decide how my job gets done"; and c) Workload — assessed through the statement "There is not enough time to get the required work done." These three dimensions formed the core of the human resource management framework used in the study (Dill, 322–23).

Conclusion

Employees who stay on the job because of perceived job satisfaction — when they believe their employer genuinely cares about their careers — represent significant cost savings for healthcare organizations, since recruiting, hiring, and training replacements is both costly and time-intensive. The findings from Dill and colleagues demonstrate that HPWPs such as tuition remission, educational release time, and on-the-job training are not merely employee perks; they are strategic investments that benefit workers, organizations, and ultimately the patients who depend on a stable, well-supported healthcare workforce.

Works Cited

Dill, J.S., Morgan, J.C., and Weiner, B. (2014). Frontline health care workers and perceived career mobility: Do high-performance work practices make a difference? Health Care Management Review, 39(4), 318–328.