Building a strategy for the recruitment and retention of nurses in healthcare: A contemporary issue

Abstract

The global nursing shortage is a critical issue in healthcare. In this brief contemporary issue, we will present insights originating from a quality improvement project. The project included the planning and execution of a comprehensive strategy designed to recruit and retain nurses. Our aim with this issue is to inspire and guide other healthcare leaders. The quality improvement project sought to reduce vacancies, lower turnover rates, boost job satisfaction, and improve patient care assessments. Addressing the nursing shortage requires healthcare leaders to develop effective strategies for both recruitment and retention. The project, conducted in a Danish Neurological Department between October 2021 and June 2023, supported us to assess the potential impacts of our developed strategy. Although we could observe positive trends, the design limitations of a quality improvement project prevent us from definitively attributing these outcomes to our developed strategy alone. However, by sharing our experiences, we hope to inspire and provide actionable insights for other healthcare leaders facing similar challenges.

Introduction

The healthcare industry is under increasing pressure to address a growing demand for skilled nursing professionals. This demand is driven by multiple factors, including an aging global population, rising healthcare needs, and rapid advancements in medical innovations, which have led to many new treatment possibilities. Despite these escalating demands, the recruitment and retention of qualified nurses have become increasingly challenging. The nursing profession, known for its long shifts, heavy patient loads, and often demanding working conditions, contributes significantly to high levels of burnout and stress. A study conducted by the National Academy of Medicine revealed that over 50% of 3000 surveyed nurses reported experiencing burnout, a primary factor contributing to voluntary resignations. ¹ The consequences of high turnover rates are profound, extending beyond diminished care quality and increased burnout; they also encompass substantial financial costs, estimated to be in the range of $30,000–$60,000 per nurse departure. Considering these challenges, it is imperative for healthcare organizations to engage in strategic planning to effectively manage nurse shortages and reduce turnover. Although there is limited evidence on universally effective practices, strategic planning is widely recognized as crucial for both recruitment and retention efforts. In response to these challenges, we developed and executed a focused strategy designed to reduce vacancy rates, minimize turnover, boost job satisfaction, and ultimately enhance the quality of care delivered to patients and their families. This aim of this paper was to share and highlight our experiences with a quality improvement initiative focused on planning and executing a recruitment and retention strategy. Our objective was to provide insights and future recommendations to improve nurse recruitment and retention, reduce vacancy rates, and enhance job satisfaction and the quality of care delivered to patients and their families. By outlining our journey, we hope we are able offer valuable knowledge and practical advice for other organizations facing similar challenges.

Creating a recruitment and retention strategy

Our nursing expert group comprises a diverse team of five nurse leaders, eight nurses engaged in practice development, one educational nurse, and one senior researcher. This team convenes biannually to discuss and advance nursing practice, dedicating 1.5 days to discussions and educational sessions. The October 2021 session focused on developing retention strategies, while the June 2022 session was dedicated to recruitment strategies. Before the initial meeting, the group established a comprehensive vision for the Neurology Department, emphasizing the need to address the nursing shortage. The primary objectives were to reduce vacancies, minimize turnover, enhance job satisfaction, and improve the quality of patient care. During the October 2021 session, a lecture on evidence-based retention strategies was delivered. Although a formal systematic literature review was not conducted, a senior researcher curated relevant literature to inform the group's efforts. Subsequently, the group conducted a workshop to create a customized retention strategy. Nurses were organized into teams according to their units and utilized planning templates to identify and outline three evidence-based retention interventions for implementation over the next year. Similarly, the June 2022 session concentrated on recruitment, with teams devising three targeted recruitment evidence-based interventions. Actions for both recruitment and retention were thoroughly documented using templates. These actions were informed by a variety of sources, including research studies, organizational reports, webinars, and leadership experiences making the actions suitable for the local hospital unit. The primary strategies identified included supportive work environments, professional development opportunities, flexible scheduling, active engagement in decision-making processes, and competitive salaries.

Implementation and evaluation of the recruitment and retention strategy

The implementation of our recruitment and retention strategy appeared to result in several positive outcomes. Between 2020 and 2023, the turnover rate decreased from 22.6% to 20.0%, indicating a modest but favorable shift in nurse retention. This reduction in turnover can likely be attributed to enhanced job satisfaction, improved working conditions, and increased professional development opportunities. The annual job satisfaction survey reflected an increase in scores from 3.9 in 2020 to 4.1 in 2023, suggesting a notable improvement in employee contentment. In addition, quality of care scores showed an improvement, rising from 82.2 in 2022 to 89.2 in 2023. Although this increase is modest, it signifies improved patient assessments and suggests that the strategic interventions may have positively impacted patient care quality. The results from our project are interpreted to underscore the effectiveness of strategic planning and implementation in addressing the challenges associated with nurse recruitment and retention. The observed decrease in turnover rates correlates with improvements in job satisfaction and quality of care, indicating that the implemented strategies had a beneficial impact.

The slight decrease in turnover from 22.6% in 2020 to 20.0% in 2023 reflects a reduction in the number of nurses leaving their positions. This improvement is promising, as lower turnover rates contribute to greater stability and continuity within healthcare settings. Reduced turnover also results in lower recruitment and training costs, which can substantially benefit healthcare organizations.^2,3 This stability not only enhances the working environment for remaining staff but also positively influences patient outcomes, as continuity of care is often linked to improved patient satisfaction and better overall health outcomes. The increase in job satisfaction scores from 3.9 to 4.0 reflects improved employee satisfaction. The high response rate of approximately 90% to the annual job satisfaction survey ensured that the data are both representative and reliable. This enhancement in job satisfaction may be attributed to the strategies implemented to improve working conditions and support professional development. Higher job satisfaction is crucial for retaining nurses and reducing turnover rates.^4,5 Improved job satisfaction often leads to increased engagement and productivity, which can further contribute to better patient care and reduced burnout among staff. The improvement in quality of care, as measured by patient assessments, from 82.2 to 89.2 is indicative of a positive trend. Although this improvement is not statistically significant, it reflects a favorable trend in patient care quality. This stability suggests that the strategic efforts to enhance nurse recruitment and retention are also positively influencing patient outcomes. The correlation between nurse satisfaction and patient satisfaction underscores the importance of addressing both employee and patient needs to maintain high-quality care. ⁶ Enhanced nurse satisfaction is known to lead to more attentive and compassionate care, which in turn can improve patient satisfaction and health outcomes. This small quality improvement project highlights the critical importance of addressing nursing vacancies, which have significant implications for labor costs, training opportunities, and patient care. Factors such as staffing levels, burnout, and staff composition play a pivotal role in improving outcomes and reducing stress among nurses. Strategic planning, while not the sole factor influencing outcomes, is essential for stabilizing nurse recruitment and retention amid shortages.

In a recent meta-analysis of 31 empirical studies on strategic planning, the authors reveal its effectiveness, and the importance, of enhancing organizational performance. ⁷ Their analysis demonstrates that strategic planning can be a powerful tool across various sectors, including healthcare. For healthcare organizations, strategic planning enhances the likelihood of achieving desired outcomes, such as reduced turnover and improved care quality. Effective strategic planning helps organizations anticipate and address challenges proactively, leading to more sustainable and resilient operations.

Although this quality improvement project provides valuable insights into the dynamics of nurse recruitment and retention, it also highlights areas for further exploration. We suggest that future research need to explore additional strategic outcomes, such as vacancies, sickness absence, stress and burnout, and staff composition. Addressing these factors is essential for ensuring patient care quality and safety. The importance of the latter is highlighted in a Norwegian study including 1297 nurses. Here the authors found that 27% of recent sick leave cases were related to work-related factors, including high physical workload and understaffing. ⁸ Monitoring these factors over time can offer further insights into the effectiveness of recruitment and retention strategies. Future studies could also investigate the long-term sustainability of the implemented strategies and their impact on various dimensions of nurse well-being and patient care. The implementation of a recruitment and retention strategy appears effective in addressing the challenges faced by healthcare organizations. Although our quality improvement project limits causal conclusions, it provides valuable insights into the impact of strategic planning on nurse recruitment and retention. By prioritizing actionable steps, healthcare leaders can potentially reduce turnover, lower vacancies, improve job satisfaction, and enhance care quality. Our strategic framework provides a practical and accessible model for other organizations encountering similar challenges. The comprehensive approach to managing nurse shortages provides a valuable reference for improving overall outcomes in healthcare settings.

In conclusion, addressing nurse recruitment and retention challenges through strategic planning is vital for maintaining a stable and effective healthcare workforce. By focusing on evidence-based strategies and continuously evaluating their impact, healthcare organizations can better navigate the complexities of workforce management and ultimately provide higher-quality care to patients. We are putting forward that our developed strategic framework can serve as a practical and accessible model for other organizations facing similar challenges. This comprehensive approach to managing nurse shortages provides a valuable reference for improving overall outcomes in healthcare settings. We hope this issue can inspire other healthcare leaders to prioritize actionable steps that reduce turnover, lower vacancies, improve job satisfaction, and enhance care quality.