Background
Recruiting and retaining qualified staff is a priority issue in healthcare. Maryland hospitals are facing critical staffing shortages, with one in every four nurse positions vacant (Maryland Hospital Association [MHA], 2022). At the same time, the demand for registered nurses (RNs) in Maryland across all settings is expected to increase by 2035 (Global Data, 2022). This is consistent with national predictions that more than one quarter of all nurses plan to leave nursing or retire by 2027 (Smiley et al., 2023). Factors such as heavy workloads, burnout, and insufficient staffing have contributed to high levels of job dissatisfaction and burnout among RNs and other nursing personnel (Lasater, 2024). Workplace violence and lack of administrative support affect staff well-being and lead to higher turnover rates (Nursing Solutions Inc., 2024). Improving RN retention requires a comprehensive and multi-faceted approach that includes improving staffing levels, providing better support systems, and creating healthier work environments (National Advisory Council on Nurse Education and Practice, 2020).
A Partnership for Action
To uncover issues related to nurse retention, and showcase approaches to address them, the Maryland Nursing Workforce Center, Lead Nursing Forward, and the Maryland Action Coalition developed two anonymous, web-based surveys. The first explores hospital nurse leaders’ perspectives on retention strategies and their effectiveness. The second is designed to uncover the perspectives of RNs and nursing support personnel about the effectiveness of their organization’s retention efforts and is currently seeking individuals interested in participating (see recruitment flyer below for more about this opportunity).
The surveys are structured around the six Nurse Staffing Think Tank priority topics (Partners for Nurse Staffing Think Tank, 2022):
- Healthy Work Environment – an organizational culture prioritizing employee physical and psychological safety, that ensures shared governance, meaningful recognition, and zero tolerance for assaults on another’s self-esteem.
- Diversity, Equity, and Inclusion – inclusion and well-being are embedded in organizational values, policies, resource allocation, operations, training, and practices.
- Work Schedule Flexibility – staff scheduling approach that encompasses flexibility in work options, policies, and roles.
- Stress Injury Continuum – risk assessment, available resources, and evaluation of strategies to address burnout, compassion fatigue, moral distress and other consequences of stress exposure
- Innovative Care Delivery Models – using high-tech and high-touch models for quality patient care and outcomes while improving nurse and patient satisfaction.
- Total Compensation – all forms of employee payment including salary, wages, and benefits.
Through an iterative process, 114 distinct retention strategies were identified. For the hospital nurse leaders’ survey, respondents are asked to indicate for each strategy, whether it is “currently in use,” “currently in use and effective,” or “not in use but believe would be effective.” For the RN and nursing support staff survey, the retention strategies were adjusted slightly for relevance to this group. These respondents are asked to indicate if the retention strategies are “currently in use in their organization”, “make them want to stay at their organization”, “if the retention strategies are NOT currently in use but they would like their organization to use” or “not applicable if unsure if the retention strategy is in use in their organization”.
Improving Work Environments and Nurse Retention
Outcomes of these anonymous surveys will be instrumental in identifying similarities and differences in perspectives of nurse leaders and nursing staff. These insights will guide advocacy for meaningful organizational changes that advance healthier work environments. Additionally, they will support creation of standardized metrics to monitor progress, allowing healthcare organizations to benchmark their efforts and ensure continuous improvement. Best practices for RN and nursing staff growth, retention, and promotion will also be highlighted and publicized on www.leadnursingforward.org and the Maryland Nursing Workforce Center website, fostering collaboration and knowledge-sharing across institutions.
Actively listening to staff feedback and implementing actionable changes are critical steps in advancing a culture of empathy, support, and mutual respect. This approach strengthens organizational trust and demonstrates a commitment to addressing workplace challenges (Kilham, 2023). A healthy work environment not only empowers nurses to provide the highest quality of patient care but also enhances their sense of fulfillment and professional satisfaction. Healthcare organizations that prioritize healthier work environments see tangible benefits among nursing staff, including reduced burnout, higher job satisfaction, and decreased intent to leave their organizations (Good, 2024). To achieve this, leaders can implement simple strategies and create sustainable, healthy environments where nurses thrive, and patients receive the best possible care.
Strategies can include the following:
• Ensure open and transparent communication channels where nurses feel safe to voice concerns.
• Offer professional development opportunities to help nurses feel valued and supported in their career growth.
• Implement effective measures to prevent workplace violence, such as zero-tolerance policies, staff training, and rapid response protocols.
• Regularly assess workplace culture through surveys and focus groups to stay aligned with staff needs.
• Recognize and celebrate the contributions of nurses to foster a sense of belonging and appreciation.
Research Study Recruitment Flyer_10_23_2024
References
Good, V. (2024, September). Nurse retention strategies and resources. https://solutions.aacn.org/blog/nursing-retention-strategies
Global Data. (2022, June). Maryland nursing workforce study. https://mhaonline.org/transforming-health-care/workforce
Kilham, E. (2023). State of the healthcare employee experience. https://go.perceptyx.com/research-the-state-of-healthcare-employee-experience-2024
Lasater, K.B. (2024). Addressing the Nurse Retention Crisis—Leveraging Policies Supported by Evidence https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821344
Maryland Hospital Association. (2022, June). Maryland nurse workforce projections 2021-2035. https://www.mhaonline.org/docs/default-source/default-document-library/maryland-nurse- workforce-projections-globaldata.pdf
National Advisory Council on Nurse Education and Practice. (2020). Preparing nurse faculty and addressing the shortage of nurse faculty and clinical preceptors: 17th report to the Secretary of Health and Human Services and the US Congress. https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/nursing/reports/nacnep-17report-2021.pdf
Nursing Solutions Inc. (2024) 2024 NSI national health care retention & RN staffing report. https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdf
Partners for Nurse Staffing Think Tank. (2022). Nurse staffing task force. https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-task-force/
Smiley, R. A., Allgeyer, R. L., Shobo, Y., Lyons, K. C., Letourneau, R., Zhong, E., Kaminski-Ozturk, N., & Alexander, M. (2023). The 2022 National Nursing Workforce Survey. Journal of Nursing Regulation, 14(1, Suppl), S1-S90.
