HPWPs and Career Mobility for Frontline Healthcare Workers

Introduction

How do high-performance work practices benefit the nursing profession — and moreover, how are such practices beneficial to the patients receiving care from nurses? This paper delves into the concept of high-performance efforts in the nursing workplace, drawing on peer-reviewed research to examine how these practices affect career development and retention among frontline healthcare workers.

The Role of Unlicensed Frontline Workers in Healthcare

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." 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, these workers make up 50 percent of the healthcare workforce — six million of them are employed in healthcare today — and are therefore critical to the delivery of quality services. They are also "among the fastest growing occupations in the United States" (Dill, 319). Because the entry qualifications for these roles have traditionally been low, these workers have historically been considered easily replaceable and have received little investment in training or advancement.

High-Performance Work Practices and Career Development

The central question posed by Dill and colleagues is whether a new policy that recruits, trains, and develops unlicensed frontline workers will benefit both those workers and the healthcare organizations that employ them (Dill, 319). Specifically, if healthcare employers offer career ladders and tuition remission to workers who previously had little or no chance of upward mobility, will those workers develop a stronger sense of future opportunity and, as a result, remain with their employers longer?

To investigate this, the authors analyzed a sample of 947 frontline healthcare workers across 22 healthcare organizations, examining whether HPWPs were associated with greater perceived career mobility. The research identified three continuous measures of employer support expected to signal investment in worker development: (a) financial rewards — the sense that pay is fair for the work performed; (b) autonomy — captured by the statement, "It is basically my own responsibility to decide how my job gets done"; and (c) workload — reflected in the statement, "There is not enough time to get the required work done" (Dill, 322–23). These three dimensions formed the foundation for assessing whether healthcare employers were genuinely supporting career growth among their frontline staff.

Conclusion

This finding has direct implications for healthcare organizations. Employee turnover is costly: recruiting, hiring, and training new workers requires both time and financial resources. When workers perceive that their employer genuinely invests in their careers — through fair pay, professional autonomy, and educational support — their job satisfaction increases and their likelihood of leaving decreases. Retaining experienced frontline workers thus represents a significant cost-saving opportunity for healthcare employers.

Employees who remain in their positions because of perceived job satisfaction — and who believe their employer genuinely cares about their professional growth — help healthcare organizations avoid the substantial costs associated with high turnover. The findings of Dill and colleagues suggest that nursing workforce challenges may be partially addressed not only by recruiting new workers, but by investing meaningfully in those already on the frontlines of care. High-performance work practices, when implemented thoughtfully, have the potential to transform expendable entry-level positions into stable, motivated careers that benefit workers, organizations, and ultimately, patients.

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.