If managers want to increase the retention of nurses in hospitals they need to adopt generation-specific strategies, writes Kate Shacklock.
Skilled nurse shortages are well known and commonly experienced within the Australian nursing community. These shortages are also experienced across developed countries with only a few countries having a surplus of nurses.
Perhaps surprisingly then, recent statistics for employment in Australia show that less than three quarters (73 per cent) of qualified nurses were working in the profession. Moreover, the negative consequences of shortages are far reaching, with nurses, patients and healthcare providers all negatively affected.
A significant body of research across a number of countries has been conducted to examine the staff shortages and a variety of approaches developed to resolve the situation.
To begin to understand these shortages in more detail, extensive research has been conducted to understand the factors that influence employee turnover generally. However, most research has been conducted to examine the factors that influence employees’ intentions to leave, with only a small amount of research addressing the question of why employees might stay.
Also, only a limited amount of research has investigated whether there is a difference between the factors that influence Generation Y (1980-2000), Generation X (1965-1979) and baby boomers’ (1946-1964) intentions to continue nursing. This question was examined in a recent study that my colleagues and I conducted.
This study involved 900 nurses (96 per cent female, 4 per cent male) from seven private hospitals around Australia. The respondents included nurse unit managers, registered nurses, enrolled nurses and endorsed enrolled nurses. The anonymous survey inquired into the factors that influenced these nurses’ intentions to stay and resulted in a 36 per cent response rate.
A summary of the sample identifies them as mostly married, working part-time, aged over 42 years, working as RNs, for between five and eight shifts a week, in a specialty area of nursing, and having worked at their hospital for more than 15 years. The sample was therefore representative of the nursing population in Australia, where 91 per cent are women, 40 per cent aged 45 years or older and nearly 90 per cent qualified nursing professionals.
In particular, this study was interested in the effect that seven factors, previously found to influence either intentions to quit or to stay, might have on retention. These factors were: work-family conflict, perceptions of autonomy (or self-determination) in nursing, attachment to work, the importance of working to the individual, supervisor-subordinate relationships, flexible working arrangements, and interpersonal relationships at work. In addition, the study was interested in examining any generational differences in the influences that these factors had on nurses’ intentions to continue nursing.
The results of this study found that six of the seven variables examined had important influences on the combined sample of nurses’ intentions to continue nursing: the supervisor-subordinate relationship, work family conflict, personal autonomy at work, attachment to work, interpersonal relations at work, and the importance of working.
When examining the differences that each variable had on each generation’s intentions to continue working, it was found that across all generations there was one factor reported as important to all nurses’ intentions to continue working: the attachment to their work (a passion for the job; related to the content of the job itself). This factor was the most important to Gen Y nurses, who reported it as the only factor out of the seven tested factors that significantly influenced their intentions to continue working. Further, this factor influenced this generation more than the other generations.
In contrast, Gen X nurses felt that both attachment to their work, as well as satisfaction with the relationships with their supervisors, were significant to their intentions to continue nursing. In further contrast to the two younger generations, baby boomer nurses reported five factors to be important to their intentions to continue working. These were: attachment to their work, positive interpersonal relationships at work, minimal work-family conflicts, perceptions of autonomy, and perceiving work as important to them as individuals.
Unexpectedly, no nurses reported that having flexible working arrangements was important to their intention to continue working. Previous research had identified this as a key factor for retention. One explanation is that flexible working arrangements are accessible enough in those hospitals (and the majority of respondents were already working part-time) that they are not perceived as an important issue any more.
The results from the study suggest that the factors that influence nurses’ intentions to continue working in nursing were different between the generations and therefore different, targeted, approaches are required by human resource management departments within the healthcare sectors in order to retain valued nurses. For example, to assist in their retention, management needs to consider strategies that allow all generations of nurses the maximum attachment to their work, especially access to the caring and healing nature of the profession.
This study confirms the need to use strategies such as exit interviews to determine the reasons why employees leave and to ensure that, for example, supervisor-subordinate relationships are not a contributing factor in those decisions, especially for Gen X. Additionally, this study reinforces the need to invest in training to ensure supervisors are able to effectively manage the supervisor-subordinate relationship, especially for Gen X nurses who have reported this factor as a key reason for continuing to work.
For baby boomers, a more complicated set of retention strategies are needed in order to entice them to stay. Specifically, these retention strategies need to address boomers’ needs for autonomy, reduced work-family commitment challenges, positive interpersonal relationships, reinforcement of the importance of work to them, and their attachment to work itself. Finally, if management is serious about trying to increase the retention of nurses in hospitals and to reduce shortages worldwide, then they need to capitalise on nurses’ inherent attachment to work, irrespective of generation.
Nurses find meaning and importance in their work, and management and policymakers must ensure maximum exposure to nursing work and provide sufficient support to undertake the work properly. There are important policy and management implications from these findings: repercussions for healthcare management, nurse managers, nurse educators, human resource managers and workforce planners, plus policy makers.
Thus, as the milieu of nursing workforce shortages changes, the need for more innovative workforce retention strategies increases significantly. Research such as this study continues to reinforce the need for a multi-pronged approach to the retention strategies that are needed within healthcare organisations. However, more research is needed to continue understanding why employees stay and leave the nursing workforce so that effective retention strategies can be implemented.
Dr Kate Shacklock is a senior lecturer with the department of employment relations and human resources at Griffith University.Do you have an idea for a story?
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