It seems fair to say this is a difficult time for the nursing profession. There are challenges in recruiting and retaining sufficient quantities of nurses – and this problem is not restricted to the UK. Staffing levels have implications for patient safety and the wellbeing of staff. With reductions in the numbers of places for students in nurse education, there is a restriction on the replenishment of the workforce. Therefore, it is crucial that efforts are made to reduce turnover and keep nurses in work for longer.
Employee turnover is a complex issue – at certain levels it is a good thing – bringing in new employees with the correct skills mix to replace those who retire, move on and indeed, those who were a poor fit for the job. When turnover becomes too high then it may become difficult to maintain appropriate staffing levels and institutional knowledge can be lost. This can be a particular problem when those who are most experienced, and the best performers choose to leave. The reasons that people leave are also varied. Nurses may quit due to sickness, family responsibilities, because they are moving to a distant location, stress, they no longer feel satisfied by their work, to pursue career opportunities, and so on. The complexity of the reasons for turnover means that there is no panacea that will solve the problem of nurse retention.
Work commitment is a psychological concept that has an important bearing on turnover and retention, it can be thought of as the bond or relationship people have with their work. In the commitment literature a distinction is often made between three aspects of commitment. These may be thought of in terms of our desire to be involved in our work, our sense that we ought to be involved in our work, and our sense that we have to be involved in our work. The desire form of commitment arises from positive experiences of work – such as a sense of doing work that matters and the perception of support from colleagues and managers. These positive experiences also lead to a sense of obligation – for example, a wish to return the investment made by educators and employers. Both these forms of commitment tend to be associated not only with retention but also with greater performance and a greater inclination to put more into our work than that which is merely necessary. When we want to be involved in our work, we tend to be happier, and we cope better with the stress that comes with our work. The ‘have to’ style of commitment – which might be thought of as being trapped in the job – arises from an awareness of what we may sacrifice by leaving our jobs. While this form of commitment does improve retention, it does not lead to additional performance benefits.
What this means for nursing retention is that now more than ever it is time to treat the staff experience as seriously as the patient experience. Greater efforts in making staff feel valued, listened to, and supported, will promote the forms of commitment associated with coping during trying times. Conversely, ignoring the staff experience means overlooking a powerful technique for addressing retention. Those individuals who are feeling unappreciated are more likely to withdraw their efforts from their work, and may be more likely to seek alternative forms of employment. Therefore it is crucial that the work of nurses in general is recognised, and that nurses feel that their individual contribution is valued. It is also important that we pay attention to how nurses think of their relationship with their profession, as this is likely to have implications for how they perform, and whether they are likely to stay in the job. For nurses to be committed, they must have a work environment that inspires commitment.
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