Kanter and Neuman Theory on Nursing Retention

Nursing retention is essential for healthcare organizations. Nurse retention strategies promote quality care and create a healthy workplace environment for nurses. A positive work environment helps retain experienced nurses and attracts new nurses into the healthcare organization. In this paper, the concepts of nursing retention and turnover are explained in the context of nursing shortage. Theories and concepts that have been proposed about nursing retention are also discussed. In particular, two theories, Kanters theory on employee empowerment and Neumans framework are discussed. The paper also relies on literature to recommend strategies that can promote nurse retention in health care organizations. The concepts and perspectives on nursing retention and related policies and statistics are also provided. The QSEN and ANA competencies as related to nursing retention are also reviewed. The paper concludes that through enhanced job satisfaction, nursing retention can be enhanced in hospitals. This in turn will result in improved patient and nurse outcomes.

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Introduction
The attrition rate in the nursing sector has been on the rise over the past few years. While the high turnover can be attributed to various factors, its impact on is alarming. High nurse turnover has often resulted in poor patient outcomes, reduced access to health care, the decline in profits of an organization and low job satisfaction. High nurse turnover in all nursing specialties is attributed to the nursing shortage currently felt in the healthcare sector (Rosseter, 2012). Given the negative effects of nurse turnover, strategies to reduce turnover and promote nursing retention have been adopted in most provider organizations.

The financial effects of turnover have motivated organizations to begin to explore ways to enhance nursing retention and increase their financial returns. A study by Morgan and Lynn (2009) established that healthcare organizations incur as much as $60,000 for every RN leaving the organization. Thus, the financial implications of turnover are significant. Nurse retention strategies help organizations to improve nurse staffing levels, enhance patient health outcomes and increase financial returns while maintaining a healthy and productive staff.

Explanation of the Key Terms
The key terms used in this report include nurse retention, attrition or turnover and shortage. Nurse retention refers to the strategies adopted by the healthcare organization to prevent turnover and attract a competent workforce (Hayes et al., 2007). On the other hand, attrition or turnover rate describes the rate at which an organizations workforce leaves the organization to other organizations or sectors. High attrition rates are associated with a , low remuneration, and lack of staff development opportunities. The last concept is a nursing shortage; it refers to the unavailability of qualified nursing staff in an organization due to turnover (Morgan & Lynn, 2009). An acute shortage of qualified nurses in all the subspecialties is currently being felt in the healthcare sector.

Background
Nursing retention calls for a multi-modal approach that takes into account issues of quality, assumptions and policy. A recent report by NSI Nursing Solutions revealed that, on average, nurse turnover rates stand at 14%, with some hospitals experiencing an attrition rate as high as 20%. Nursing turnover is most prevalent in nursing homes, with some reporting an attrition rate of 34% (Hunt, 2009). From these statistics, one would expect hospitals and nursing homes to have a retention strategy in place to counter the effects of nursing turnover. However, in some organizations, a nurse retention strategy is lacking.

Hunt (2009) associates the nursing shortage in healthcare organizations with a high turnover rate involving qualified staff. Another study by Brewer et al. (2011) established that about 35% of RNs leave their first job within one year after being employed. This has been attributed to horizontal violence perpetrated by experienced nurses and physicians. In some instances, the attrition rate may be as high as 60% for graduate nurses and newly employed nurses (Brewer et al., 2011). Lack of experience, limited support, and poor working relationships with other staff make new nurses leave their first employment within the first year.

The nursing retention strategies implemented require a change of policy to address the biting nursing shortage. The policies address issues of recruitment, training and skill development and various assumptions related to the nursing shortage and retention. The policies are implemented by the government through its various agencies and organizations. The policies promote staff retention in nursing schools and faculties through increased funding and grants. Also, some federal policies on health reform aim to expand federally-funded health care facilities and institutions. To in these facilities, the government will employ nurses and other healthcare professionals in these facilities.