NURSES: THE CASE FOR THE NEED TO LEAD- Ohio State College of Nursing

 INTRODUCTION

“Nurses should be full partners, with physicians and other health professionals, in redesigning healthcare in the United States. Strong leadership is critical if the vision of a transformed healthcare system is to be realized. Yet not all nurses begin their career with thoughts of becoming a leader. The nursing profession must produce leaders throughout the healthcare system, from the bedside to the boardroom, who can serve as full partners with other health professionals and be accountable for their own contributions to delivering high-quality care while working collaboratively with leaders from other health professions” (IOM, 2010).

    In addition to changes in nursing practice and education, strong leadership will be required to realize the vision of a transformed healthcare system. Although not all nurses begin their career with thoughts of becoming a leader, all nurses must be leaders and advocates in the design, implementation, and evaluation of the reformed healthcare system. Nurses will need leadership skills and competencies to act as full partners with physicians and other members of the healthcare team in reforming and redesigning the healthcare system. Nursing research and practice must develop, implement and sustain evidence-based improvements to healthcare and health systems. Nursing leaders must be adept at translating research and evidence into the practice and policy arenas.

Being a full partner in the future of healthcare transcends all levels of the nursing profession and requires leadership skills and competencies that must be applied both within the profession and in collaboration with other healthcare colleagues.  In healthcare environments, being a full partner involves devising and implementing plans for improvement, tracking and sustaining improvements over time, and demonstrating measurable returns on resource investments.  It also means taking responsibility for identifying problems and areas of waste. 

NEEDS

“Nurse retention is both an expectation and major responsibility of the Nurse Manager (NM) role that has both organizational and professional implications.  Organizationally, a stable workforce reduces direct and indirect costs that are associated with turnover that may result in an organizations’ ability to provide services.  From the professional perspective, the benefits of nurse retention are related to the quality and continuity of (patient) care.” (Anthony, M., et al., 2005). “Any action a Nurse Manager takes to increase leadership skills can have tremendous influence on employee, colleague, and patient satisfaction, and on organizational outcomes.” (Henrikson, M., 2006). 

Weberg (2010) states that “transformational leaders are inspiring and facilitate their employees to solve problems by helping them identify the issues and develop the resources needed to overcome their problems.  With inspiration and engagement of employees, a transformational leader should have followers who report better staff satisfaction and lower burnout rates.”  Fennimore and Wolf (2011) note that Nurse Managers are “chief culture builders” who lead professionals rather than just manage workers.  The attainment of a myriad of quality outcomes requires sophisticated leadership skills to engage staff that embrace change and systematically evaluate care practices.  Zori, Noek and Musil (2010) have called the Nurse Manager the “Chief Retention Officer “. 

COSTS of RETENTION

The Pricewaterhouse Coopers’ Health Research Institute estimates that “every one percent increase in turnover costs an average hospital an additional $300,000 annually (Fennimore & Wolf, 2011).  Nurse turnover costs (per nurse) are estimated to be between $82,000 and $88,000, depending on the experience of the newly hired nurse” (Ulrich et.al, 2010).

In the USA, 35 percent of newly graduated nurses left their place of employment within one year, while 57 percent left within two years (Duffield, et al., 2011).  “Nurses working in units with high turnover tend to report higher levels of stress as they may be called on to cover vacant shifts and to participate in the frequent training and induction of new staff” (Duffield, et al., 2011). 

 Recruiting and retention is an ongoing challenge faced by leaders in every healthcare organization. The overall financial and human resources spent on this problem are enormous and it is clear that leaders must be effectively engaged in reducing the outflow of nurses through their organization’s exit doors. Preventing nursing attrition would deliver significant cost savings to healthcare organizations and, in some cases, could be the key to an organization’s future – perhaps even vital to survival.

RESOURCES CITED

1. Institute of Medicine of the National Academies (2010). The Future of Nursing: Leading Change, Advancing Health, from www.iom.edu/reports found on September 2, 2011.

2. Anthony, M., Standing, T., Glick, J., Duffy, M., Paschall, F., Sauer, M., Sweeney, D., Kosty, N., Modic, M., & Dumpe, M. (2005).  Journal of Nursing Administration, 35(3), 103-155.

3. Henrikson, M. (2006). Great leaders are made, not born. AWHONN Lifelines, 9(6), 473-477.

4. Weberg, D. (2010). Transformational leadership and staff retention. Nursing Administration Quarterly, 34(3), 246-258.

5. Fennimore, L. & Wolf, G. (2011). Nurse manager leadership development. The Journal of Nursing Administration, 41(5), 204-210.

6. Zori, S.,  Nosek, L., & Musil, C. (2010). Critical thinking of nurse managers related to staff NRs’ perceptions of the practice environment, Journal of Nursing Scholarship, 42(3), 305-313.

7. Fennimore, L. & Wolf, G. (2011).  Ibid.

8. Ulrich, B., Krozek, C., Early, S., Aslock, C. Africa, L., & Carman, M. (2010). Improving retention, confidence, and competence of new graduate nurses: Results from a 10-year longitudinal data base. Nursing Economic$, 28(6), 368-375.

9. Duffield, C., Roche, M, Blay, N., & Stasa, H.  (2011). Nursing unit managers, staff retention, and the work environment. Journal of Clinical Nursing, 20(1-2), 23-33.

This article was written to Nurses Round  by : T. Scott Graham, Ph.D.; Lt Col, USAF (ret), Director, The Leadership Academy for Peak Performance, The Ohio State University