Organizational Leadership

Is Anyone Still There? Reducing Turnover in New Nurses-

Resonance, Activation, and Cultivation 

Nursing as a profession is facing unprecedented challenges. According to the National Workforce Study, the average age of nurses in this country is 50, and 70% of nurses are over the age of 40. And…an alarming 50% of new graduate nurses are leaving the bedside in less than 2 years of practice (National Nursing Workforce Study | NCSBN, 2022). This is the largest exodus from any profession. We are facing a 1.25 million nursing shortage between 2020 and the year 2025 just in the United States (National Nursing Workforce Study | NCSBN, 2022). If we do not change the way that we have been engaging nurses in healthcare, the predictions that we fear the most in healthcare will become a reality; there will be no nurses to care for the sick and dying. 

The Dynamics of Social Influence 

As nurse leaders, we diligently try to ensure that our team members achieve a work-life balance. Nursing is a special field. Hospitals are not closed on holidays or weekends. There is no down time or after-hours reduction in the number of patients that we see. In fact, it is the opposite. Our census inevitably increases when clinics close, and there is nowhere else to go for care. And it is on holidays and weekends when nurses so desperately would love to be home with their families that this influx of patients arrives. Ruben and Gigliotti stress that leaders actively listen to their team and attempt to understand their perspectives. As leaders, if we can better understand our staff concerns, we are better prepared to address them. Staff nurses must feel appreciated and valued. Just this week a colleague asked me to cover her shift. Her son was invited to a pool party and insisted that she attend it too. Our unit director would not approve her request and was uphauled that she would request such a thing, as my coworker’s son was sixteen years old. As a charge nurse on the floor, and being a friend for over ten years, I personally knew the fear of having her son go without her to a pool party. As you should know, this nurse friend of mine lost a son to a drowning about five years ago. As silly as it sounded to the director, who spent more time in the office than on the floor, it sounded reasonable to me.  

My Take-away:  

Since effective communication and effective leadership are so closely intertwined, it is an essential aspect of the position. As a leader, you must be a skilled communicator at the organizational level. You are required to think with clarity, possess critical thinking skills, express ideas, and share information with various audiences. Leaders must be able to utilize innovative technology and social media mediums within the organization, all partners and/or vendors, stakeholders, and influencers.  

As a nurse leader and nurse educator, I will value the importance of building strong relationships with my staff members and having an open-door policy. Active listening and open communication allow employees to feel valued and respected. Establishing a trusting relationship also reduces stress and turnover in the workplace. Stress for both nurses and nursing students is quite frequently overlooked. Yet, its impact can affect many aspects of their professional and personal life. Stress can affect the physical and mental health of nurses, which unfortunately can overflow into patient outcomes. It also undermines nursing retention and can hurt a healthcare organization’s finances. With this scenario, I covered the shift for my colleague. As a leader, serving the team with honesty and compassion, building trust, and ensuring that staff feel valued is essential to maintain highly skilled staff members on the unit. 

Demand Formal Training 

As a leader it is imperative that we know who we are, what we stand for, our goals, what we are willing to negotiate and when we are not willing to negotiate. Formal training with mentors and preceptorship programs is essential to reduce turnover with graduate nurses, as the rates of turnover are the greatest in the first year of practice” (Blake, 2022). Before the pandemic, this was less of a concern since hospitals were able to hire primarily experienced nurses with a mix of a few new graduate nurses. In today’s world, with the mass exodus of experienced nurses retiring, traveling, or looking toward another profession for employment, hospitals are met with the challenge of hiring new graduates with little to no experienced personnel to train them. Hospitals with critical shortages are challenged to hire, train, and keep nurses. Ruben and Gigliotti caution us to choose wisely our position, and to engage or activate only after making informed decisions. Knowing who we are and what we stand for allows us to make clear decisions. As a leader, I incorporate the policy and procedure manual and/or mission statement as a resource when decision making. Today’s graduates enter practice as licensed RNs (registered nurses) almost immediately. An unintended consequence of the nursing shortage, especially post pandemic, is the rapid deployment into clinical settings with minimal orientation to their role. They are met with responsibilities that are potentially beyond their capabilities. To increase the demands, our patient population has a rising acuity of problematic health concerns, a reduction in the length of hospital stay, staffing shortages, and complex innovative technology. Nurses are also responsible for completing tasks previously assigned to other specialists, like hearing screening, laboratory duties, and/or housekeeping. These concerns, on top of the lack of formal training, all contribute to the revolving door of new graduate nurses. 

My Take-away:  

Leaders should stand up for what they believe in, and never deviate from their values. Make informed decisions. Stay connected with their new graduate nurses so that they do not feel professionally isolated. Ensure that all team members know how to seek assistance when it is needed. Schedule regular meetings with staff and their preceptors to re-evaluate their strengths and weaknesses, coordinating new goals. Offer praise for achievements. Encourage continuing education, skill enhancement, and professional growth. Maintain an open-door policy. Collaborate with staff to make changes and allow for new and innovative ideas. This incorporates staff buy-in and enhances their value on the unit.  

You got to PAY before you PLAY 

As an experienced Registered nurse of 26 years, I have been blessed to mentor and precept many nurses. Throughout this time, there have been several that were eager to obtain the “charge nurse” role without first gaining valuable experience of working at the bedside. I have witnessed administration hire on mastered-prepared nurses to a director or management position straight out of nursing school, without ever working on the floor. Ruben and Gigliotti state that a “person’s natural leadership capabilities are honed through experience and that leadership capabilities can be developed, enhanced, or refined by anyone who is dedicated to the goal” (Ruben & Gigliotti, 2019). Leaders must be able to understand first-hand the challenges a floor faces to be able to properly lead them. Without followers, there are no leaders. To be effective leaders, team members must be engaged and activated. According to Ruben and Gigliotti, without followership, there is no need for leadership. And without the life experience obtained from working on the floor, leaders cannot be successful. What I have learned over the years is that to be a good leader, you must be able to ‘demonstrate the delegation.’ You must be able to role model any expectations, and in nursing, especially, readily intervene and assist. In nursing, when a leader actively manages a crisis, she quickly earns a leadership position in the eyes of her followers.  

My Take-away:  

I will be patient and hone-in on my leadership skills to become a confident, competent, and successful leader in every side of life and work. The best way to do this is to practice being a great follower. I will be open to feedback from team members and cultivate an environment that appreciates and fosters nurse/team member innovation. Leaders must continually role model expectations to staff members and complete any task they would ask of another team member. I will continually train the trainers, educate the educators, and develop, enhance, and/or refine any staff member willing to train as a future leader in health care. 

Promoting Integration and Cultivation- Patience is a Virtue 

Ruben and Gigliotti states that the “expansion of the zone of resonance and activation, and the cultivation of new views, perspectives, and sensitivities, can, and often does, stall at various points in the process” (Ruben & Gigliotti, 2019). Cultivation on the unit takes time. Just as it takes buy-in from a patient to treat a medical condition, such as diabetes and hypertension, cultivation in the workforce needs buy-in from staff members to ensure its success. Positive attitudes and patience are key! Remember to celebrate the small wins!  

My Take-away:  

Malcom Gladwell was quoted stating, “We live in a world that assumes that the quality of a decision is related to the time and effort that went into making it” (Katschnig, 2010). As nursing leaders and educators, we must practice patience and understanding. We must practice what we preach. As leaders, we should be role models and willing to demonstrate skills and behaviors expected from our staff and/or students.  

Create a Culture of Safety: 

A healthy work environment is one in which polices, procedures, and systems are designed so that team members collaborate collectively to meet organizational objectives and achieve personal satisfaction toward a common goal. Leaders must meet with staff regularly to better understand individual strengths and weaknesses and coordinate/update goals. This allows an opportunity to strengthen staff members individually and as a team. In nursing, simulation training quarterly opens educational opportunities as well as a moment of evaluation. Ruben and Gigliotti recommend evaluating each group of followers separately to find what widens their zone of resonance, and how they are best motivated. During this time, nurse leaders and educators can also use any negative feedback or noted resistance to answer any questions or concerns, clarify any confusion, or offer a moment to openly discuss issues that staff members might have. Having a culture of safety, where staff feel that their feedback and recommendations are appreciated, allows for a culture that promotes nurse innovation and evidence-based best practices in the unit, enhancing patient safety. 

My Take-away:  

Remember that I too, learn from each interaction, whether it be a patient interaction, another professor, or even a student. Each shift and each lecture, I am continually learning and perfecting my craft. When working with either a nurse on the unit or a student in the lab or clinical setting, I will create an environment of respect, shared learning, and creativity. Utilizing and incorporating evidence-based best practices in both areas, and open to feedback. I will use my employee and student evaluations to grow professionally and personally. I will support nurses to develop and adopt innovative patient-centered care models and implement programs to expand their competencies. This will improve patient outcomes as they complete specialty certification or advanced degree programs. Fostering a culture of lifelong learning and interprofessional continuing education, improves employee satisfaction, employee retention, and maximizes patient care. 

References: 

Blake, N. (2022). Starting Now: Implementing the Healthy Work  

Environment Standards Is More Important Than Ever. AACN  

Advanced Critical Care, 33(4), 372–375.  

https://doi.org/10.4037/aacnacc2022958

Katschnig, H. (2010). Are psychiatrists an endangered species?  

Observations on internal and external challenges to the profession.  

World Psychiatry, 9(1), 21–28.  

https://doi.org/10.1002/j.2051-5545.2010.tb00257.x

National Nursing Workforce Study | NCSBN. (n.d.-b). 

NCSBN. https://www.ncsbn.org/research/

recent- research/workforce.page 

Ruben, B. D., & Gigliotti, R. A. (2019). Leadership, communication, and 

social influence. A theory of resonance, activation, and cultivation.  

Emerald Publishing.