Nursing Shortage and Nurse Turnover: Leadership Strategies

Introduction: The Nursing Shortage Challenge

Several research scholars have stressed the significance of effective healthcare leadership, and leadership by nurses is critical to this endeavor, since nurses constitute the largest group of healthcare workers. For more effective nurse recruitment, hospital leadership should actively support the nursing profession. It is vital for them to identify their most capable nurse managers and nurses, and place them within communities to attract individuals possessing similar traits into the profession. Furthermore, hospital leaders must partner with colleges, universities, and secondary schools to identify students who possess the traits needed to thrive despite the challenges accompanying slow improvements to the healthcare sector. World-class hospitals and healthcare facilities do not simply wait for potential nurse candidates to find their recruiting organizations (Curtis, de Vries & Sheerin, 2011).

Recruitment Partnerships and Nurse Residency Programs

One way of addressing this issue is for a healthcare employer to offer a school or college clinical faculty resources, with the school teaching nursing staff how they can become members of a clinical faculty. Such educational practice partnerships have been gaining popularity in the field of nursing education, serving as a vehicle to bridge educational preparation and nursing practice. These partnerships address multifaceted healthcare problems such as nurse educator and nurse shortages, promote shared accountability and mutually advantageous goals, and foster workforce competencies by building on partners' assets and values. The U.S. healthcare and educational sectors have implemented several different types of partnerships across the country to take advantage of the benefits gained through collaboration between multiple institutions and schools (NACNEP, 2010).

It has been observed that the student-to-nurse transition is not easy. Fresh nursing graduates must begin at top speed — that is, seize opportunities immediately — often without adequate support, and the stress linked to this transition can bring about high turnover of new recruits in their first couple of years in practice. While healthcare organizations allocate considerable resources and time to nurse training, recruitment, and orientation, fresh graduates account for over 50% of turnover in some hospitals. One means of coping with this challenge is implementing nurse internship or nurse residency programs, which train nursing students to work in real-world practice settings before graduating from their nursing courses. These programs aid fresh graduates in transitioning to become professional registered nurses (RNs), support them in delivering safe and competent care, and increase overall nurse retention (NACNEP, 2010).

Leadership Versus Management in Nursing

Though one may claim that nurse leaders currently encounter numerous challenges — including new technology, new roles, increased focus on participation, continuing education, financial limitations, and cultural diversity — it is important to emphasize that leadership should not be perceived as an optional nursing function or role. Leadership is required at all healthcare facilities in which implementing change and attaining high patient care standards are reflected in job titles such as Nurse Consultant, Modern Matron, or Director of Nursing (Sullivan & Garland, 2010). However, assuming a leadership position does not in itself ensure effectiveness. Leaders must possess knowledge of leadership theory and be capable of applying their leadership abilities across every area of their work.

Marquis and Huston (2009) note that some confusion still exists regarding the relationship between management and leadership. Some consider leadership to be one of many management functions, while others claim that leadership skills are more complex than management skills. Although the two terms are sometimes used interchangeably, "management" and "leadership" represent rather different aspects of professional practice. Hughes and colleagues (2006) differentiate between leaders and managers as follows:

• Leaders innovate; managers administer.
• Leaders develop; managers maintain.
• Leaders inspire; managers control.
• Leaders take a long-term view; managers take a short-term view.
• Leaders originate; managers initiate.
• Leaders ask why and what; managers ask when and how.
• Leaders challenge the status quo; managers accept it.

These differences in the roles of leaders and managers align with distinctions documented in nursing literature. What requires emphasis, however, is that leaders do not become leaders by virtue of their job title alone — their behavior defines them. Leaders inspire, innovate, challenge, and guide (Curtis, de Vries & Sheerin, 2011).

From nurse executives' perspective, nursing leadership differs from leadership in general because of its focus on nurses taking charge of shaping and improving their practice environment. The knowledge nurses develop through practice plays a key role in influencing leadership. When describing nursing leadership, terms such as empowering others, working through and with others to attain success, facilitating learning, and developing the nursing profession's knowledge base are commonly used. An individual is considered a leader when he or she becomes a recognized authority with followers who rely on that person's expertise to accomplish their objectives (Curtis, de Vries & Sheerin, 2011).

Conclusion: Institutional Strategies for Sustainable Nursing

Hospitals should recognize that their nursing personnel are professionals, and adopt a collective approach to decision-making that empowers nurses to make work-related decisions. Several hospitals have nurse teams — typically called Shared Governance Committees — that afford nurses a meaningful role in decision-making across areas such as patient care, equipment selection, human resources policies, and workspace design. This greatly impacts nurses' engagement as well as their loyalty to their healthcare facility.

The best healthcare organizations are not waiting for recruiting agencies, the government, or nursing schools to resolve the issue of nursing shortage, nor are they waiting for artificially intelligent solutions. Rather, they are personally working to overcome shortages by concentrating on identifying the most promising candidates well in advance. They are driving engagement among these recruits through partnerships with effective managers, and they are formulating innovative policies tailored to their respective diverse nursing staffs (Paller, 2004).

References

Bowles, A., & Bowles, N. B. (2000). A comparative study of transformational leadership in nursing development units and conventional clinical settings. Journal of Nursing Management, 8(2), 69–76.

Curtis, E. A., de Vries, J., & Sheerin, F. K. (2011). Developing leadership in nursing: Exploring core factors. British Journal of Nursing, 20(5), 306.

Hughes, R. L., Ginnett, R. C., & Curphy, G. J. (2006). Leadership: Enhancing the lessons of experience (5th ed.). McGraw-Hill.

Marquis, B. L., & Huston, C. J. (2009). Leadership roles and management functions in nursing: Theory and application (6th ed.). Wolters Kluwer/Lippincott Williams and Wilkins.

National Advisory Council on Nurse Education and Practice (NACNEP). (2010). Addressing new challenges facing nursing education: Solutions for a transforming healthcare environment.

Paller, D. A. (2004). Rx for the nursing shortage. Gallup Management Journal.

Sullivan, E. J., & Garland, G. (2010). Practical leadership and management in nursing. Pearson Education Limited.