Serving the home health, home care and hospice industry since 1999.

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by Darcey Trescone

The COVID-19 pandemic has only emphasized the need to focus on recruitment and retention of nurses. We know the US is experiencing a shortage of registered nurses, and that it is expected to worsen as the population ages. Insufficient staffing raises nurses' stress levels, impacts job satisfaction, and drives many nurses to leave the profession. Watch any recent, tear-filled TV interview with a hospital nurse in a COVID ward.

In the March 2005 issue of Nursing Economics, Dr. Peter Buerhaus and colleagues found that more than 75 percent of RNs believe the nursing shortage presents a significant problem for the quality of their work-life, patient care quality, and the amount of time nurses can spend with patients. Looking forward, almost all surveyed nurses see the shortage in the future as a catalyst for increasing stress on nurses (98%), lowering patient care quality (93%), and nurses leaving the profession (93%).1

In September 2007, Dr. Christine T. Kovner and colleagues found that 13 percent of newly licensed RNs had changed principal jobs after one year, and 37 percent reported that they "felt ready" to change jobs.

According to a 2015 study, "the number of nurses leaving the workforce each year has been growing steadily from around 40,000 in 2010 to nearly 80,000 by 2020."1 To change this trajectory for the future, the healthcare industry must figure out why nurses leave and what interventions work, the study recommended.

Reasons for Leaving Nursing

A graduate nurse will have different reasons for leaving than a seasoned nurse, so retention interventions should not be one size fits all. Common reasons reported for leaving are insufficient staffing and increased stress levels. Another primary reason reported was a hostile work environment or a setting of low autonomy or empowerment. For newly graduate nurses in particular, false job expectations or an inability to adjust to the job's pace are stated causes.

As this is being written, the strike by Chicago SNF nurses is entering its second week. Their primary complaint? Inadequate staffing causes burnout and harms patient care.

Evidence has consistently shown that the work environment plays a large role in retention. According to The Future of Nursing: Leading Change, Advancing Health, "improving the workplace environment reduces nurse turnover, lowers costs, and improves the health outcomes of patients."2

In a study conducted in 2014, researchers explored nurses' reasons for leaving the profession. Qualitative content analysis of data showed "Lack of support" as a work value. Comments described lack of support from managers, unsupportive relationships within their workgroup, and a healthcare system putting business principles before care, resulting in job dissatisfaction and nurse turnover. These findings are examples of a complex problem and, as such, will resist simple solutions to the presenting issues.3

Retention Strategies and Interventions

The challenge of retaining nurses in the workforce is an ongoing obstacle. Interventions and strategies are most effective when implemented from several levels: organizational, leadership, and individual.

The organization needs to be committed to nursing retention. From a leadership perspective, nurse managers should be aware of retention trends within their geographical area and work closely with human resource departments.

On the individual level, look to internships and residencies and the availability of a support system, such as a nurse educator. Individual levels of retention focus on the nurse graduate demographic. According to a 2017 analysis, "the highest retention rates were associated with retention strategies that used a preceptor program model that focused on the new graduate nurse."2

Nursing Engagement and Growth with "Professional Practice Models"

Well implemented PPM's have shown to be successful in boosting retention and job satisfaction. A professional practice model provides the foundation for quality nursing practice. It is also a model that depicts nursing values and defines the structure and processes that support nurses in controlling their practice and delivering quality care.4

Key Components of a Successful PPM

1. Leadership: Develop Nurses to be Authentic Leaders

a. View nurses as leaders, both within the organization and of clinical patient care.

b. Allow nurses to have an equal voice in interdisciplinary forums and the operational power to define the nursing practice in place.

c. Provide shared governance and committee structures through which nurses of all levels can participate in system decision-making.

d. Provide education and processes to develop and grow nurse leaders internally.

e. Empower direct care nurses to lead clinical care efforts within interdisciplinary teams.

f.  As authentic leaders, all nurses should be coordinators of care, champion collaborative solutions, and invest in lifelong learning and self-renewal.

2. Nurses' independent and collaborative practice contains three components:

a. Autonomy is related to the nurse's right to manage one's own decision-making within collaborative teams.

b. Accountability provides the framework for a nurse's autonomous decision-making and responsibility to deliver best practice.

c. Collaboration and communication are essential to a nurse's role as coordinator of care.

Integration of practice standards, such as those developed by the American Nurses Association, provide defined criteria for safe and quality care. The responsibility then shifts to the individual nurse to demonstrate competence in the specialized skills required to meet such standards.

3. Enhance the Nursing Environment

a. Support from management and the team, along with the necessary tools and knowledge to perform the role in accordance with the practice standards in place.

b. A respectful work environment was also seen to facilitate interdisciplinary collaboration as the basis for quality care.

4. Research/Innovation

a. Nurses' clinical advancement depended on their knowledge discovery and translation, and their use of the evidence-based practice.

5. Nurse Development/Rewards

a. Provide a framework to support the professional development of nurses. Nurses require critical thinking and technical expertise to inform independent and collaborative practice. The advancement and recognition of nurses have been positively linked to nursing retention.

b. Nursing job descriptions should be revised to reflect desired competencies and performance appraisal systems that drive nurses' development.

c. Compensation closely linked with the professional growth achieved was shown to promote retention.

6. Patient Outcomes

a. Provide structures and processes that empower nurses to achieve quality outcomes.

b. Research shows that having a PPM Model, with bullets one through five, empowers nurses to improve patient and family experiences and satisfaction.

Implementation of a Successful PPM Requires:

  • Good communication between leadership and nursing teams (face to face discussions, newsletters, and posters)
  • Planned education regarding best practices in place and collaboration with nursing teams regarding new practices that should be adopted.
  • The use of nurse champions to work with leadership and the nursing team.
  • Creation of committee structures to facilitate nurse participation in decision-making.
  • Formalized reward and recognition programs.


Next Steps

In conclusion, attention to the environment in which nurses are working and how it enhances or impedes their job satisfaction is vital. 12-hour shifts, or expectations of 6 visits per day, followed by a full evening of paperwork, is not a work environment conducive to job satisfaction. According to Michael McGowan, President of OperaCare, a technology company that offers a system it claims allows Home Health nurses to complete paperwork during regular work hours, "The elimination of after-hours charting requirements and contentious quality assurance requirements significantly reduces nursing burnout, aiding in recruitment and retention of nurses. Give nurses back their lives. They will love you for it! And they will tell their friends." Adopting processes and technology that can decrease after-hours charting requirements would fulfill the PPM requirement to transform the nurse's working environment.


1. Information N, Sheets F, Shortage N. AACN Fact Sheet - Nursing Shortage. Published 2020. Accessed November 24, 2020.

2. Susan K. Sinclair R. Understanding Why Nurses Leave. Published 2020. Accessed November 26, 2020.

3. Tuckett A, Winters-Chang P, Bogossian F, Wood M. ‘Why nurses are leaving the profession … lack of support from managers’: What nurses from an e-cohort study said. Int J Nurs Pract. 2014;21(4):359-366. doi:10.1111/ijn.12245

4. Slatyer S, Coventry L, Twigg D, Davis S. Professional practice models for nursing: a review of the literature and synthesis of key components. J Nurs Manag. 2015;24(2):139-150. doi:10.1111/jonm.12309


Darcey Trescone

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

©2020 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. One copy may be printed for personal use; further reproduction by permission only.