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Improving the Work Environment, Step by Step

Kennedy, Maureen Shawn, MA, RN, FAAN

AJN The American Journal of Nursing: April 2019 - Volume 119 - Issue 4 - p 7
doi: 10.1097/01.NAJ.0000554527.47868.3f
Editorial
Free

Greater awareness of the issues will hopefully lead to more change.

AJN Editor-in-Chief E-mail: shawn.kennedy@wolterskluwer.com

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The name of the game for any employer in any industry is retention. Recruitment is fine, but if an organization can't hold onto its staff, recruiters fight a losing battle. The health care industry is no exception. As more health care services (and nursing opportunities) become community based, and baby boomers retire over the next few years, hospitals will have a particularly difficult time recruiting and retaining RNs. Writing in the Journal of Nursing Regulation, workforce researcher Peter I. Buerhaus and colleagues predict that 70,000 baby boomer nurses will retire annually by 2020, taking with them an aggregate of 2 million years of experience.

Hospitals have long depended on newly graduating nurses to replace retiring nurses, and hospitals still seem to be new nurses’ main choice for a first job. A 2017 National Student Nurses’ Association survey of 4,000 new RN graduates showed that 84% were working in acute care hospitals. But the survey also found that 26% of new nurses planned to stay in their first job for a year or less. Results of the American Association of Critical-Care Nurses (AACN) 2018 national work environment survey show that 32% of respondents reported intent to leave their current job in the next 12 months, up from 21% in the 2013 survey and the highest rate to date.

When presenting this data at Sigma Theta Tau's Creating Healthy Work Environments conference in February, lead author of the AACN study Beth Ulrich emphasized that the data didn't show that these nurses were leaving nursing. In fact, most nurses (62.2%) were very satisfied with nursing as a career choice, but only 28.6% were satisfied with their current jobs. The nurses intending to leave were doing so to take other positions in nursing, to return to school, or to retire. These nurses also noted that they might reconsider leaving if there were improvements in staffing and leadership, and “respect from administration.”

These findings can be added to other data supporting what we know: hospital work environments need to change. We have a wealth of data from research on Magnet facilities that support positive outcomes—for nurses and for patients—when workplace issues are addressed. Data from the AACN show that hospitals that have implemented its healthy work environment standards fare better on measures of job satisfaction and critical care nurses’ intent to stay. And while facilities that follow guidelines from these groups seem to fare better than those that don't, they still have issues with retention.

One approach launched by the Institute of Healthcare Improvement (IHI), which has traditionally focused on improving access to care, the quality of patient experiences, and the cost of health care, involves going beyond addressing staff stress and burnout. In 2017, the IHI released a white paper calling for a restoration of joy in the workplace. This is important, especially considering that we spend most of our waking life at work.

Think about your own workplace: do you take pride in what you do, feel that you and your work are valued, and enjoy the team you work with? Do the good days outweigh the bad days? I'm pleased that Rose O. Sherman, a new contributing editor, and Cynthia Blum address this issue in their article, “Finding Joy in the Workplace,” in this month's Perspectives on Leadership column.

We're also excited to debut a follow-up to our award-winning series, Evidence-Based Practice, Step by Step, which takes readers on a step-by-step journey through the process of implementing evidence-based practice at their workplace. The articles in this series are still among AJN’s most viewed online. (You can read them at http://links.lww.com/AJN/A133.) Starting this month, EBP 2.0: Implementing and Sustaining Change will address the issues and challenges surrounding implementation of EBP, which, according to series coordinators Sharon J. Tucker and Lynn Gallagher-Ford, is “a complex and resource-intensive step, and the time and effort needed are often underestimated and underresourced.” The new series will provide case examples from organizations that have implemented practice changes and the adjustments they made as they strove to make these changes stick. We hope this series will aid you in your work.

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