by Darcey Trescone
The nursing workforce is critical for providing safe, high-quality patient care. Considering the nationwide nursing shortage, healthcare facilities need to focus on recruitment, retention, and work satisfaction of their nursing workforce. Clinical experience and the literature show that the most common factors affecting nursing retention have remained relatively unchanged for more than 30 years.3. In this survey of that literature, we see that nurses have always been fundamental to ensuring quality care delivery, and the path to rectifying dissatisfaction in this workforce goes beyond mere higher compensation.
Nursing leadership and staff nurses met at a retreat day to begin defining the framework of their PPM. Outcomes of this day included developing specific workgroups, an operating philosophy of nursing, and an educational packet covering responsibility and accountability, nursing models, committee work, and case management. There was a consensus among the nurses of the importance of developing designated functions for several committees the clinicians participated in and governed.1. A PPM takes time, but it is time well-spent. It indicates a commitment to initiatives that will improve the professional practice environment of your clinicians longer term.
A PPM describes how nurses practice, collaborate, communicate, and develop professionally. It defines what is essential to nursing and drives current and future nursing practice. A PPM supports contributions to practice from the nursing profession. It includes systems consisting of structures, processes, and values that support a nurse's control over care delivery and the environment within which they practice.2.
Five Subsystems are recommended in a PPM:
A PPM commonly includes nursing mission, vision, values, and components specific to high-quality professional practice. It enables the team to develop philosophy statements regarding patient care, education, research, quality contributions, and standards. A well-defined framework for practice improves a nurse's relationships with patients, personal practice, other healthcare providers, other nurses, and the organization.2. The integration of a PPM takes time and requires participation from nurses at all levels within an organization.
Factors contributing to work satisfaction and intent to stay include optimal orientation, support for continuing education, and mentor and preceptor programs. In addition, fair workload, supportive nursing administrators, positive professional values, flexible scheduling, task variety, and workgroup cohesion and teamwork promote nurses' work satisfaction and intent to stay. Shared governance and professional practice models were found to enhance RN's decision-making authority within an organizational structure by specifying areas of accountability.3.
In a qualitative study titled, Graduating Nursing Student and Practicing Nurse Perceptions on Promoting Recruitment, Work Satisfaction, and Intent to Stay, researchers compared different perceptions among these nursing populations.
Studies have described numerous factors impacting newly licensed RNs' decisions to stay or leave their job positions. Newly licensed RN work behavior is influenced by personal characteristics, attitudes toward their work, job opportunities, and workplace attributes. For example, specific factors that supported new RNs' intent to stay at a healthcare facility included competitive pay and benefits, fewer local job opportunities, autonomy, promotional opportunities, full-time employment, 8-hour shifts, voluntary overtime, mentor support, and workgroup cohesion.3. Factors that caused new RNs to consider leaving their position included mandatory overtime, higher patient workloads, children at home, and work-family conflicts.3.
For experienced and specialty nurses, a few positive factors such as effective leadership, interprofessional teamwork, autonomy, and mentorship might offset the negative features of a practice environment and, in turn, support nurses' intent to stay.3. Feeling valued, respected, and acknowledged by their colleagues, leaders, physicians, and other interprofessional team members seemed to contribute to nurses' intent to stay. In addition, clinical leaders who communicate clearly, build teams, and engage while empowering their experienced nurses through shared decision-making influence their intent to stay.3.
Experienced nurses reported greater work satisfaction and intent to stay when discussing positive work factors, organizational commitment, and voluntary overtime.3. In addition, when nurses experience a lack of family-work conflict and receive competitive pay, benefits, and compensation, they report greater job satisfaction and intent to stay.
Theme 1: Competitive Pay and Benefits
Both graduating nursing students and practicing nurses discussed the importance of competitive pay and benefits in encouraging them to practice at a specific healthcare facility, rural facility, or stay working at a healthcare facility. All groups consistently mentioned benefits such as tuition reimbursement, health insurance, flexible scheduling, shift differentials, sign-on bonuses, availability of onsite daycare, nurse residency programs, relocation expense support, retention bonuses for years of service, and organizational support with professional development and specialty certification costs.3.
All focus groups perceived similar facility characteristics necessary for a positive work environment:
Theme 3: Career Goals
Both graduating student nurses and practicing nurses emphasized various career goals as necessary in promoting their intent to stay, recruitment, and work satisfaction at their facilities. Career goals included participating on committees, working in a specific clinical practice, and pursuing education, professional development, and certifications that advance skill and knowledge development.3. Practicing nurses and graduating nursing students valued working at facilities that supported education and professional development opportunities.3.
Theme 4: Personal Goals and Reasons
Participants' personal goals and reasons greatly influenced their decisions on working in a rural or urban healthcare facility. Most discussed a desire to work at a healthcare facility in the rural area where they already lived or close to immediate family.3. In addition, most who desired to work at a rural healthcare facility were born and raised in a rural community, preferred the rural lifestyle, and had current employment at a rural facility.3.
The utilization of shared governance and a professional practice model with clinical staff can help to provide nurses with personal control over their work. A well-executed PPM would allow for innovation, positive relationships, and shared governance between nursing and leadership on how nursing practice will evolve to ensure recruitment and retention improves in the healthcare industry.
1. PIERCE L, HAZEL C, MION L. Effect of a Professional Practice Model on Autonomy, Job Satisfaction and Turnover.
2. https://www.wolterskluwer.com/en/expert-insights/best-practices-for-developing-a-professional-practice-model. Published 2018. Accessed January 31, 2022.
3. Owens R, Burwell P, Deese S, Petros T. Graduating Nursing Student and Practicing Nurse Perceptions on Promoting Recruitment, Work Satisfaction, and Intent to Stay: A Qualitative Study.
Darcey Trescone is a Healthcare IS and Business Development Consultant in the Post-Acute Healthcare Market with a strong background working with both providers and vendors specific to Home Care and Hospice. She has worked as a home health nurse and held senior operational, product management and business development positions with various post-acute software firms, where her responsibilities included new and existing market penetration, customer retention and oversight of teams across the U.S., Canada and Australia. She can be reached at email@example.com.
©2022 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org