Recruitment and Retention of Nurses

Introduction

Putting in place mechanisms of retaining nurses is a critical measure for success of any heath institution. In fact, scholars of nursing management view nursing as one of the most stressful professions. For instance, Force (2005) argues that nurses often encounter situations that make them burn out. Handling injured people, sick patients, and almost all dying people exposes nurses to emotional turmoil. Hence, they have to be managed such that their cognitions and physical efforts in their work are not influenced by the constant exposure to these strenuous situations (Force, 2005). This means that nursing managers should deploy appropriate strategies to ensure that they always remain motivated and committed to their work. It is important to note that nurses work in organizations, which are similar to any other organization where concepts and theories of organizational management are important in addressing issues that are related to recruitment and retention. From the basis of this argument, this paper discusses recruitment and retention of nurses within an organization from multidisciplinary paradigms with particular attention being placed on nursing management or administration, human resource management and psychology or counseling, and business management. The paper also analyzes scholarly findings on the roles of nursing recruitment and retention within a health care facility by showing statistics to address the scope and the impact of the issue while not negating the economic implications of issues of nursing recruitment and retention. Lastly, the paper considers the application of one method of human resource management supposition: theory X and Y. It also states the creative strategies and solutions for human resource issues of recruitment and retention from the basis of nursing management.

Literature Review

Recruitment followed by successful retention of registered nurses within any health facility is an incredible challenge especially in an environment that is characterized by a shortage of nurses. Scholarly research in recruitment of nurses identifies several factors that may influence nurses to accept nursing jobs within different health care facilities together with factors that influence their decisions to stay on the job they have accepted. For instance, Jones (2009) claims that recruitment and subsequent retention of nurses are influenced by factors such as salary, reputation of the health facility, nature and status of unions, and more importantly the autonomy of work (p.43). From the paradigms of the factors that may influence the decisions of a given nurse to stay within a given facility, retention of nurses may be influenced by factors such as recognition and inclusion of an individual nurse in the decision making process of the health facility. Nature of workload and the interrelations of a nurse with fellow workers within the departments and/or even the entire organization are also other influential factors (Jones, 2009; Halm, Kandels, & Blalock, et al., 2005).

Although Jones (2009) and Halm, Kandels, Blalock et al. (2005) discuss the above factors in the context of hospital settings, they are also confirmed by other disciplines such as human capital management and human resource management as essential factors, which contribute to enhancement of workers’ motivations. For instance, Erskine (2012) argues that workforce motivation is an essential element in any organization seeking to use employees’ talent potentials to yield organizational success. Indeed, from a human resource perspective, the department of human resource within an organization is established to ensure that an organization recruits the most productive workforce, remunerates them accordingly, and resolves conflicts between employees. It also presents the work concerns raised by employees before the organizational management and administrative teams and ensure that employees remain committed to the business of an organization (Brockbank, 2006, p.338). Coincidentally, within a hospital, nurses’ managers are charged with similar responsibilities. This implies that nurses’ motivation is a significant element for enhancing retention of nurses.

Recruitment, as a function of nursing management and retention often overlap. Sourdif (2008) confirms this assertion by arguing that the concerns of recruited nurses overlap with the decisions to remain employed. Consequently, Sourdif (2008) concludes that factors, which encourage registered nurses to have the drive to join a health facility followed by their subsequent desire to remain in the employment, need to be given central consideration by any organization, which seeks to attract and retain sufficient nursing staff. However, although it is important to conduct a thorough scrutiny of nurses before they are recruited to an organization in the attempt to find whether they would be retained and/or motivated while working under the existing working conditions within an organization, it is important to note that recruitment is an expensive affair. For example, Jones (2009) approximates that it requires about $62,100 to replace an existing registered nurse within a heath facility (p.45). Perhaps this amount is an immense cost especially by noting that a single turnover of a single nurse creates a vacuum in terms of workload, which must be taken up by other nurses. From the perspective of human resource management, increasing the workload implies that nurses who are left are likely to get lowly motivated due to increased workloads, which they consider unfair. In fact, DiMeglio, Padula, and Piatek (2010) find a single turnover as having the capacity to truncate into multiple turnovers. The only most practical way to deal with this self-replicating problem is to seek mechanisms of nurses’ retention.

The realization of the need to retain employees within an organization prompts management scholars to explore various theories that can provide a guide on how to do it. Some of the ways that are developed by organizational theory include fostering motivation, mentoring, and even choosing a balance between X and Y theory. Motivational theory is essentially ingrained in the perspectives of human capital management (Pfeiffer & Gellar, 2003). Its focus is looking for mechanisms for maintaining work morale of both new and existing workforce within an organization.

People are important assets for an organization. Recognition of the value of people for an organization prompts organizations to invest in human capital management with the chief objective of “responsibly attracting, developing, and managing a firm’s biggest asset: people” (Bowles & Gintis, 2007, p.75). In fact, the value of service delivery within any organization depends on the extent of motivation of employees who deliver services to clients. In a health facility setting, nurses are the persons who are always in close contact with the service seekers: the patients (Sourdif, 2008). Hence, it is crucial for the nursing management to ensure that nurses remain motivated by handling various situations that may make them have low self-esteem and low altitude towards their work, among them being burnout. This makes the concepts of human capital management relevant in the health facility settings.

Investment in human capital is particularly significant in an organization whose success is driven by the capacity to change various operational approaches to meet new changes in the business environments (Sveiby, 2007). Upon considering the importance of people who are also driven by multiple motivators and various diversity factors that influence their performance, the concept of capital management attracts different scholarly views in the manner in which people need to be managed to realize optimal outputs from them.

Amid valid theoretical approaches to the concepts of human capital management and its applicability in health care facility settings, Alan Erskine, a management consultant, argues that an organization cannot implement human capital management without collaboration between IT, human resource, and operations management arms of an organization (Erskine, 2012, p.12). According to him, human capital management entails the mechanisms for ensuring that organizational workforce remains motivated and/or productive in the effort to realize organizational goals (Erskine, 2012, p.12). According to Erskine (2012), human capital management can simply be defined as the “holistic approach to contracting and optimizing the time of employees” (Erskine, 2012, p.12). From the basis of this definition, human capital management can be argued as entailing an essential component of achieving goals and objectives of an organization through people. To realize organizational goals through people, it is important to make efforts to ensure that recruited nurses are retained within the facility for long-term basis.

According to Rhay, Wen, and Li-Yu et al. (2010), turnover and intents of turnover among nurses are normally common amongst new recruits. Beecroft, Dorey, and Wenten (2008) support this line of argument by claiming that the turnover rate among first-year nurses is in the range of 35 to 60 percent in the US (p.50). Cognition of these outstanding rates calls for the deployment of imperative and effective nurses’ retention strategies. Beecroft, Dorey, and Wenten (2008) explain these causes of high turnover intents among the new recruits as being instigated by delegations of responsibilities to new recruits within a hospital yet the nurses do not have any experience. Consequently, it sounds imperative to reckon that, even though delegation is an incredible strategy for enhancing the work morale of people as developed by studies in human resource, it fails to work well in situations involving new workforce due to work pressures while operating in an unfamiliar environment. In fact, scholarly evidence such as Lu, While, and Barriball (2005) and Chu, Hsu, and Price (2007) show that altitudes together with work pressures incredibly influence nurses from the basis of job satisfaction and their commitment to the health facility for which they work. Global research on the impacts of organizational commitment and job satisfaction of the nurses, absenteeism, and turn over indicate a correlation (Lee, Tzeng, Lin, & Yeh, 2009; Salt, Cummings, Profetto-McGrath, 2008). This evidence is a wakeup call for nurses’ managers to look for means of addressing issues of job satisfaction and organizational commitment in the effort to enhance their retention within healthcare facilities.

As previously argued, the nature of work environment and work pressures that nurses are often susceptible to influence their retention within organizations. This evidence is rooted in the theory of human resource management. Working condition, which poses threats to the safety or occupational health of employees, comprises one of the issues that may influence the performance of people across all industries including nursing. Many organizations seeking to ensure they are successful in the long-term through the strategic initiative of focusing on the employees as their most important resource for gaining competitive advantage endeavor to ensure that occupational hazards are reduced together with ensuring that manpower loss is minimized. Pfeiffer and Gellar (2003) support this line of argument b further noting, “today, because of the recognition of the crucial importance of people, HRM in an increasing number of organizations has become a major player in developing strategic plans and facilitating changes within the organization” (p.8). One of such plans is looking for mechanisms of enhancing motivation of employees such as enhancing safety in working environments. In contrast, meeting the needs of nurses with respect to the improvement they desire on their working environments involves establishing a compromise between the funding of activities that generate wealth for the healthcare facilities and improvement of working environments. Hence, human resource may fail to establish a match between the strategic initiatives and its mandates within an organization including retention of the nurses in healthcare settings.

In search of mechanisms of making people oriented to their work demands to realize organizational objectives, McGregor developed theory X and Y. Theory X proposes that people are normally lazy and often avoid doing work (Lorsch & Morse, 2006). Consequently, managers must supervise their employees closely to ensure that they are able to control every activity executed by them. The theory advocates for a hierarchical structure of management of staff, which is meant to ensure direct control while leaving very little room for delegation of responsibilities. Indeed, according to Lorsch and Morse (2006), realizing organizational goals from the basis of this theory calls for managers to deploy coercive and threatening management techniques. However, it is arguable that applying this theory in nursing settings leads to mistrust between nurses and nurses’ managers, hence acting as a magnificent catalyst for turnover of nurses especially the senior ones.

Opposed to theory X, theory Y presumes that employees are essentially self-motivated, exercise personal control, and highly ambitious to get things done within the organization for which they work (Lorsch & Morse, 2006). The theory holds that employees enjoy their work particularly if it is physically and mentally satisfying. Such employees are great problem solvers. Managers inclined to this school of thought believe that people are always ready to accept responsibilities. They deploy self-control together with self-direction to ensure that they are able to achieve their organizations’ duties. Given the opportunities, from the context of theory Y, people have an eagerness to do well (Lorsch & Morse, 2006). Hence, satisfaction accompanied by doing well in a given job act as an enormous source of motivation, which also helps to foster employees’ retention within an organization. Considering the roles of theory Y in enhancing motivation of employees, managers have embraced the theory while theory X has been incredibly challenged since it continues to support management theoretical paradigms, which have been proved to have little impacts in enhancing competitive advantage of an organization in the modern globalised and sophisticated organizations (Lorsch & Morse, 2006). In this regard, theory X is inappropriate in recruitment and retention of nurses.

Analysis and Findings

Based on the arguments presented in the above literature review, it is possible to hold that management of nurses to enhance their successful recruitment together with their retention requires possession of skills in human resource management and capital management. This underlines the significance of nursing administration, which involves the provision of services, which make it possible for nurses to conduct their work in an effective manner to clients. DiMeglio, Padula and Piatek (2010) provide evidence that 13 percent of newly recruited nurses alter their principal jobs within a period of one year. For a sample of 1000 nurses who were studied, 37 percent of the nurses held that they could change their jobs if given an opportunity. Directly congruent with the arguments raised in the literature review, it means that retention is a major issue in the management of nurses. Many of the sampled nurses, DiMeglio, Padula, and Piatek (2010) argued that they could easily switch their careers due to poor job satisfaction. This implies that leaders for nurses have to deal with two main important issues to be effective in their works. These are recruitment and maintaining or retaining the newly recruited employees. The purpose of retentions is particularly significant since high rates of nurse turnover, as established in the literature review, results in increased costs for a health facility since work overload occurs when one nurse fails to be retained. This results in poor job satisfaction and low work morale. Hence, high probabilities exist that an organization would continue to lose more employees. A bigger loss of employees implies a higher cost that is experienced by an organization since frequent recruitments are expensive affairs.

The intention of nurses to remain in their jobs is akin to their level of job satisfaction. Sourdif (2008) confirms this assertion by claiming that job satisfaction is a major indicator of the capacity of nurses to remain in employment. Consequently, it is possible that nurses are people who have the desire and passion to work without being pressurized or being subjected to intensive control as proposed by theory X. Hence, theory X emerges as inappropriate in explaining the mechanisms of retention of nurses. On the other hand, theory Y suggests that people have the desire to work. They must be managed in an effective manner to ensure that their work morale is maintained in the effort to enhance their retention in an organization. Based on the arguments raised in the literature review on the roles of motivation in enhancing retention of nurses, it is plausible to reckon that applying theory X in management of nurses in complex healthcare settings translates to low motivation in comparison to theory Y. Since motivation is directly correlated to retention of employees, applying theory Y in the management of employees has high probabilities of fostering retention of nurses.

Conclusion

Literature on human resource and human capital management provides a proof that people are one of the most important resources available to an organization, which can help to yield organizational success upon their proper management. However, getting the right people requires leaders and managers to recruit the right people. As argued in the paper, recruitment is not a sufficient measure for ensuring that the recruited people would facilitate the achievement of organizational goals and objectives in healthcare settings. Rather, a measure is necessary to guarantee that nurses are retained by ensuring they are motivated through job satisfaction.

References

Beecroft, C., Dorey, F., & Wenten, M. (2008). Turnover intention in new graduate nurses: A multivariate analysis. Journal of Advanced Nursing, 62 (5), 41-52.

Bowles, S., & Gintis, H. (2007). The Problem with Human Capital Theory–A Marxian Critique. American Economic Review, 65 (2), 74–82.

Brockbank, W. (2006). If HR Were Really Strategically Proactive: Present and Future Directions in HR’s Contribution to Competitive Advantage. Human resource management, 38 (4), 337-352.

Chu, I., Hsu, M., & Price, L. (2007). Job satisfaction of hospital nurses: An empirical test of a causal model in Taiwan. International Nursing Review, 50 (11), 176-182.

DiMeglio, K., Padula, C., & Piatek, C. (2010). Group cohesion and nurse satisfaction: Examination of a team building approach. Journal of Nursing Administration, 35(3), 110-120.

Erskine, A. (2012). Human Capital Management. Management Services, 1(1), 12-13.

Force, M. (2005). The relationship between effective nurse managers and nursing retention. Journal of Nursing Administration, 35 (7/8), 336-341.

Halm, M., Kandels, M., & Blalock, M., et al. (2005). Hospital Nurse Staffing and Patient Mortality, Emotional Exhaustion, and Job Satisfaction. Clinical Nurse Specialist, 19(5), 241-251.

Jones, B. (2009). The Costs of Nurse Turnover. Journal of Nursing Administration, 35(1), 41-49.

Lee, Y., Tzeng, C, Lin, H., Yeh, M. (2009). Effects of a Preceptorship program on turnover rate, cost, quality and professional development. Journal of Clinical Nursing 18 (9), 1217-1225.

Lorsch, N., & Morse, J. (2006). Beyond theory Y. Harvard Business Review, 3 (2), 91-107.

Lu, H., While, E., & Barriball, L. (2005). Job satisfaction among nurses: A literature review. International Journal of Nursing Studies, 42 (3), 211-227.

Pfeiffer, E., & Gellar, S. (2003). Scared safe: How to use fear to motivate safety involvement. Occupational Health and Safety, 6(1), 6-10.

Rhay, W., Wen, T., &, Li-Yu, N., et al. (2010). Exploring the Impact of Mentoring Functions on Job Satisfaction and Organizational Commitment of New Staff Nurses. BMC Health Services Research, 10 (240), 1-9.

Salt, J., Cummings, G., & Profetto-McGrath, J. (2008). Increasing retention of new graduate nurses: A systematic review of interventions by healthcare organizations. Journal of Nursing Administration, 38 (21), 287-296.

Sourdif, J. (2008). Predictors of nurses’ intent to stay at work in a university health center. Nursing and Health Sciences, 6 (12), 59-68.

Sveiby, K. (2007). The Intangible Asset Monitor. Journal of Human Resource Casting and Accounting, 2 (1), 67-71.

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