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Effective Approaches in Leadership and Management
Many studies that have been conducted in the past decade support the idea of a positive relationship between leadership style and retention of nurses in hospitals. According to Ritter (2011), there is a relationship between anticipated staff nurse turnover and the management style in a hospital. American Organization of Nurse Executives averaged the turnover rate for registered nurses in the year 2002 as 21.3% (Currie & Hill, 2012). Obviously, the high rate of staff turnover is costly to hospitals and patients due to several significant reasons such as low quality of patient care, increased waiting time for services, and a reduced number of health care services that can be offered. According to Currie and Hill (2012), a reduction in the nurse turnover ratio by a mere 10% leads to a savings of $800,000 on replacement cost. Transformational leadership is the most appropriate in nursing since it addressed the welfare of nurses by providing them with a means of improving their skills.
The current approach aimed at reducing staff turnover problem has been faced by many systemic flaws. To make nurses retain their jobs, hospitals have being forced to offer very attractive sign-on bonuses and other incentives during recruitment. Ritter (2011) asserts that such economic solutions are ineffective in recruiting more nurses in hospitals because they only redistribute the existing supply of nurses. Nevertheless, sign-on bonuses have become the standard recruitment strategy for managers. Such bonuses have nothing to do with where the nurses will choose to stay or work. Therefore, change needs to be implemented by nurse managers and hospital administrators in the acute care setting to solve the current challenge in recruiting and retaining nurses. According to Currie and Hill (2012), the United States is estimated to have a shortage of more than 150,000 nurses. This shortage is expected to increase to about 800,000 in 2030. Moreover, this gloomy reality is compounded by the fact that few young people are willing to pursue a profession in nursing at a time when most nurses are nearing their retirement age.
Ways of Addressing the Problem
The high turnover rate of nurses can address through the use of a flattened management structure and transformational leadership. There is a positive relationship between leadership and staff nurse retention. A study that was examining the relationship between nurse retention and effective leadership reported that there was a reduction in nurses’ turnover from 36% to 13% in the emergency unit of Southampton University’s hospital in London (Duffield, Roche, Blay, & Stasa, 2011). This study concluded that a change in the recruitment and the use of a flattened structure are appropriate since they allow nurses to exercise leadership and to have a greater sharing of duties and responsibilities. As a result, it leads to the professional development of the nursing staff.  Other ways that can be used to solve this problem are the use of an education plan that provides equitable staff development, a contractual arrangement to promote career development, and protected time to participate in continuing education. In this regard, managers in the institution focus on meeting the desire for professional development that is common among nurses (Duffield, Roche, Blay, & Stasa, 2011). According to Duffield, Roche, Blay, & Stasa (2011), nurses are more satisfied with their jobs and prefer to retain them if managers focus on their professional development. Therefore, within the context of nursing administration in the country, it is important that managers budget and allow room for professional development activities of the nursing staff, rather than only focusing on economic measures recruitment and retention.
In another anecdotal case study that was carried out in Tenet Healthcare System, which is in the United States, a multi-dimensional approach to leadership was recommended as a means of addressing the problem of nurse recruitment and retention. In the study, nursing staff within one regional zone of Tenet Hospital system were required to identify their job likes and dislikes. 78% of the nurses identified, their relationship with the manager as a crucial contributor to job satisfaction (Ritter, 2011). In addition, the nurses expressed that optimized working conditions through a fair and caring manager would encourage them to prolong their stay in the hospital than an increase in payment. As a result, the company resulted into training managers on good interactions between employees, in a program that lasted three years. The leaders training program was part of the company’s Employer Choice Initiative providing leaders with skills for an employee-focused support system in their hospitals to increase employees job satisfaction and reduce nurses’ turnover ratio. In a press statement that was released by Tenet Healthcare Corporation, there was a reported nationwide decline in staff turnover from 21.4% to 21.0% within one year after the training program. This change indicates that there is a positive trend in job satisfaction and retention for nursing staff (Ritter, 2011). Therefore, nursing managers and administrators need to focus more on building an administrative environment that is conducive for all employees. It provides further support to the employee development initiative mentioned previously.
Finally, there are proven results for adopting a transformative approach to the nursing leadership. Currie and Hill (2012) evaluated transactional and transformational leadership approaches to determine the relationship that exists between leadership style, job satisfaction, and turnover rates. Generally, the characteristics of transformational leadership include the ability to articulate a shared vision for the future of an organization and encourage creative problem-solving methods that encourage and support the staff. A research funded by the National Centre for Nursing Research and the National Institute of Health found that there was a correlation between low nursing staff turnover and transformational style of leadership. Previous study results indicate that such style of management is considerate of the staff and at the same time focused on meeting the goals and objectives of the organization. Considerate leadership behavior in transformational style includes fairness, developing of employees’ skills, and supporting and valuing the contributions of employees in decision making. Currently, the dominant style is the transactional of leadership method where the focus is placed on the day-to-day activities of the employees and rewards are dependent on performance alone.
Transformational leadership style is the best fit for my personal and professional philosophy of nursing. To begin with, this style incorporates the two recommendations aforementioned, that is, professional development and conducive employees’ environment. It is one solution to multiple problems. In addition, the style incorporates individual leadership behaviors such as focus, vision, and fairness. Lastly, it has proven results in the past, with most researchers connecting job satisfaction for the nursing staff to transformational leadership style.
In conclusion, the evidence is clear that effective leadership in nursing enhances staff retention and as a result addresses the problem of nurse shortage. Different strategies for health care management have been observed as having a significant impact on nursing staff retention involving the professional development of nurses, an appropriate working environment, and a transformational style of leadership. Transformational style of leadership is best preferred since it accommodates the leadership qualities that I possess.
Currie, E. J., & Hill, R. A. C. (2012). What are the reasons for high turnover in nursing? A discussion of presumed causal factors and remedies. International Journal of Nursing Studies, 49(9), 1180-1189.
Duffield, C. M., Roche, M. A., Blay, N., & Stasa, H. (2011). Nursing unit managers, staff retention, and the work environment. Journal of Clinical Nursing, 20(1‐2), 23-33.
Ritter, D. (2011). The relationship between healthy work environments and retention of nurses in a hospital setting. Journal of Nursing Management, 19(1), 27-32.