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Why a nurse leaves can be based on a number of factors, but the most frequent reasons fall into five categories: 6. Workload is a major issue for nurses. At the very least, nurses want to complete their shift knowing they have provided the care encompassed in their patient-care assignment. Health care differs greatly from other employment settings. As acuity rates rise, lengths of stay are compressed and nurses are assigned larger patient loads. Meeting the goals of quality patient care and even patient safety needs may be overwhelming — perhaps impossible.

The perception of unsafe, unbearable or even unfair workloads can put a nurse over the edge. Scheduling flexibility may take precedence, as well. Job seekers have many career options that offer much more flexibility than that of an RN. Look at information technology jobs that even allow you to set your own work times and schedule. Though health care must be available 24 hours a day, to attract employees, employers need to provide flexibility through four-, eight- and hour shifts, as well as a variety of full-time and part-time options.

With the high value placed on family, recreation and time away from work today, health care employers need to provide scheduling options that are both worker and family friendly. Provide competitive compensation and benefit packages. Employers should pay their staff fairly and review compensation levels at least twice a year to make sure they remain competitive. It all makes good sense. Look around you — employers with high retention rates include flexible benefit programs and consistently provide competitive salaries.

The constant advances in medical science and treatment can make keeping up to date a Herculean task. But doing so is the cornerstone of improving patient care and outcomes. Nurses know that staying abreast of new skills, procedures and medications is vital to their practice. Yet in many settings, as budgets are tightened, continuing education is often put on the chopping block. Providing continuing education in a variety of user-friendly formats is a key to retaining nurses.

To retain nurses, employers need to provide opportunities for nurses to explore their potential. For many years, excellent bedside nurses who looked for ways to boost their earning power or develop additional expertise were limited to manager or educator positions. Many, however, found that their passion was to remain at the bedside.

Clinical care models that recognize expanded levels of patient care expertise would recognize and reward professional growth in direct patient care. Nurses can use a variety of strategies to directly influence the workplace even though their employer may determine workload, schedules, compensation, continuing education and career growth.

Looking closely at each of these areas can help build a workplace environment that retains nurses as well as other health care personnel. We nurses are great at providing care to patients, but how good are we at taking care of our own nurse colleagues? The bottom line is we all need to accept responsibility for creating a positive workplace environment. We need to turn some things around.

Consider giving staff nurses an opportunity to interview job candidates to get their take on how well that person might fit into the unit work culture. Once they arrive, welcome them with open arms. Be flexible with start dates and pair new employees with seasoned nurse preceptors who have similar interests. He or she will remember what it felt like to be a novice.

Tell them where the hidden supplies are located, and describe the different nurse preferences on the unit. Help them learn to blend into and shape workplace culture. Approach colleagues already in your workplace in a professional manner to discuss how behaviors affect the work environment. If a colleague consistently arrives late or tasks are not completed, talk with him or her about the impact that has on you. You might even openly discuss some of these issues in staff meetings and determine as a group what is acceptable and what is not. Certainly, discuss workload situations when you feel it influences patient or nurse safety.

Communicate openly and honestly with your nurse manager.

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As actions are taken to address particular issues, clearly communicate these improvements to your colleagues and staff. Suggest developing a retention committee on your unit. Talk about how to create a quality workplace. The committee may wish to survey staff or hold focus groups to determine priority retention issues.

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Members might collect information from other employers about how they distribute nurse workloads. The committee might compare and contrast scheduling models in other health care settings and develop a unique model to meet staff needs.

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It could develop a process for gathering nurse input by piloting the model before implementation. Self-scheduling may even be a part of the model. The retention committee would be an excellent way to develop clinical advancement programs for your unit.

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Tracks for management and education can be implemented for those nurses interested in these areas. Clinical advancement programs that provide higher salaries for expert levels of clinical expertise are an integral part of a professional work environment.

Help administration develop compensation methods that reward productivity. Request that the human resources department provides a written annual update on individual compensation packages. Many nurses are unaware of how much their employers contribute to fringe benefits. Nursing staff can discuss new competencies and skills required on your unit. Inform staff development personnel of the evolving clinical challenges nurses face as acuity levels rise.

Also, include suggestions on education topics that improve the workplace, such as communication, teamwork and quality improvement. And encourage programs that improve both work life and home life, such as stress reduction and financial management. Maintain a personal continuing education file and look at a variety of options from which to obtain offerings, such as professional journals and online courses.


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Nurse-physician communication and work relationships are reported as a retention issue in a number of agencies. Many facilities have developed and implemented nurse-physician policies that outline unacceptable behavior, a process for reporting that behavior, and recourse for correcting it.

Any communication or behavior that demeans another should not be tolerated in workplace interactions. Encourage employers to develop nurse council governance structures that promote nurse autonomy and allow nurses to provide input into workplace decisions. Health care requires diverse ideas to care for our patients and provide a quality work environment.

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Nurses need to embrace diversity in the workplace. While we want to encourage colleagues to conform to mutually agreed-upon work and performance standards, we also should recognize individual preferences and differences. We need to be open-minded and willing to learn from others. And not just the skills and competencies of nursing care — we need to learn and appreciate the individual perspectives that each person brings to the job. We need to be open to exploring and understanding how colleagues perceive health care and the world differently. When diversity is discussed, the immediate thought or focus is usually ethnic background — African American, Asian, Caucasian, Latino, Native American, and so on.

Diversity is broad and includes many differences in our nursing workforce, including age, disability, ethnic or national origin, gender, race, religion, sexual orientation and a number of other attributes.