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Effective Retention Strategies for Midcareer Critical Care Nurses: A Q-Method Study

Lobo, Vanessa M.; Fisher, Anita; Baumann, Andrea; Akhtar-Danesh, Noori

doi: 10.1097/NNR.0b013e31825b69b1

Background: Midcareer nurses continue to be overlooked in the current nursing shortage that is amplified in intensive care units (ICUs) requiring greater numbers of specialized nurses.

Objectives: The aim of this study was to discover what midcareer critical care nurses perceive would be effective retention strategies.

Methods: As a combination of both qualitative and quantitative approaches, Q methodology was used to allow for the development of innovative strategies as well as to provide an understanding of a population of viewpoints and preferences that can guide retention efforts. Forty ICU nurses between the ages of 25 and 44 years from within a Canadian academic health science corporation completed a 45-item Q sort representing their ideas for increasing staff retention. Data were analyzed using centroid factor extraction and varimax rotation in PQMethod version 2.11.

Results: Four viewpoints emerged: The Healthy Workplace and Respect Seeker, The Flexibility and Reward Seeker, The Professional Development and Teamwork Seeker, and The Lifestyle Seeker. Correlations between the factors were appropriately weak, with seemingly distinct demographics characterizing each.

Discussion: These findings suggest a possible association between perceptions and both years of nursing experience as well as age. Implications from the study include the need to involve frontline nurses in developing strategies that will retain them. Following further investigation of the nurses’ preferred strategies, it may be necessary for organizations to develop an array of retention strategies rather than implementing a single solution. In future research, generational preferences and the possible dissonance between nurse managers and frontline nurses’ perceptions should be explored.

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Vanessa M. Lobo, MSc, RN, is PhD Student, McMaster University, Hamilton, Ontario, Canada.

Anita Fisher, PhD, RN, is Associate Professor, School of Nursing, and Senior Research Associate at Nursing Health Services Research Unit, McMaster University, Hamilton, Ontario, Canada.

Andrea Baumann, PhD, RN, is Associate Vice-President, Faculty of Health Sciences (International Health), and Scientific Director, at Nursing Health Services Research Unit, McMaster University, Hamilton, Ontario, Canada.

Noori Akhtar-Danesh, PhD, is Associate Professor of Biostatistics, School of Nursing, McMaster University, Hamilton, Ontario, Canada.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Accepted for publication February 14, 2012.

The authors thank the staff of the Nursing Health Services Research Unit at McMaster University for their support and administrative assistance. Our gratitude also goes out to all of the ICU managers and nurses who generously gave their time and thoughts to this project. Funding for this study was provided by a graduate scholarship to the first author from the Social Sciences and Humanities Research Council of Canada.

The authors have no conflicts of interest to disclose.

Corresponding author: Vanessa M. Lobo, MSc, RN, McMaster University, 3102 Jenn Ave., Burlington, Ontario L7M 0K7, Canada (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.