The purpose of this project was to evaluate the impact of a quality improvement strategy to implement an RN clinical learning and development specialist (CLDS) with the intent to reduce high turnover in novice nurses and low nurse engagement. The CLDS served as expert, role-model, coach, and mentor. Benner'€™s model of novice-to-expert was used as the conceptual framework to monitor progression of nurses mentored by the CLDS. The Institute for Healthcare Improvement model for improvement was reviewed to assess the effectiveness of the CLDS on turnover rates and nurse engagement. At the time of program evaluation, the CLDS role had been operational at the project site for 8 months in inpatient and perioperative service lines. An analysis of turnover rate by headcount of 1510 RNs within the practice environment was completed. The change from the preintervention period to the postintervention period was statistically significantly lower. A nonparametric test to compare the monthly rates was used (z = -2.613; p = .005). To evaluate nurse engagement, the practice environment scale was deployed to all RN nurse residents from 9/2018 through 3/2019. A total of 166 surveys were deployed. There were 86 responses; 62 respondents were RNs with an assigned CLDS. There were no statistically significant differences in the scores between these 2 groups. The social impact of this project is important to share with nursing and operational leadership as an intervention to reduce RN turnover across healthcare settings, specifically in acute care practice areas. The issues of RN turnover and satisfaction with the practice environment are relevant across organization types and settings.

This thesis examines issues pertaining to health human resources in the Ontario nursing profession, focusing on registered nurses (RNs) and registered practical nurses (RPNs). It consists of four chapters that explore the following nursing labour market trends: (1) multiple jobholding, part-time and casual employment, and other individual nurse and job-level characteristics (2) nursing job instability as measured by turnover and the number of years a job-worker (job-nurse) match exists, (3) nurse staffing agency employment, and (4) occupational attrition or turnover rates. The first two chapters compare nurses employed in the long-term care home (LTCH) sector, to the following healthcare sectors: hospitals, primary care, home care, supportive housing, public health (Chapter 2 only), and an aggregate “other” category. In Chapters 2 to 4, pre-COVID-19 trends are compared with the first, and where possible, the second year of the pandemic. All chapters in this thesis employ the Health Professions Database (HPDB), a dataset from the Ontario Ministry of Health, which derives from regulatory registration data. Chapter 1 examines the prevalence of multiple jobholding, part-time and casual employment, employment status versus employment preference, and other individual nurse and job level characteristics (e.g., the location of first education, languages spoken in practice). The results indicate the likelihood of multiple jobholding does not significantly differ in the LTCH sector compared to other healthcare sectors, especially among RPNs. Moreover, there is no evidence of excessive part-time and casual employment in LTCHs compared to other sectors. However, LTCH RNs and RPNs are significantly more likely to prefer full-time employment, while being employed in part-time or casual positions, referred to as involuntary part-time or casual status. Nurses are heterogenous across sectors in their individual characteristics and employment preferences. Notably, LTCH nurses are more likely to be internationally educated, and primary care nurses are more likely to prefer part-time employment. Chapter 2 investigates nursing job instability across the healthcare sectors found in Chapter 1, with the addition of public health. Average annual turnover (2014-2019) was 25.7 percent among LTCH RNs and 22.9 percent among LTCH RPNs. These findings demonstrate RN job turnover rates in LTCHs do not substantially deviate from those observed in other sectors and fall in the middle of the distribution. RPN job turnover rates in LTCHs are the second lowest observed, where turnover rates are lower in the hospital sector. Across both nurse categories, hospital jobs are the most durable, where a job-nurse match lasts 0.6 to 0.8 years longer than the average RN LTCH job, and 0.1 to 0.2 years longer than the average RPN LTCH job (over a five-year period). Results from 2020 indicate turnover increased the most in the LTCH and supportive housing sectors (by a maximum of 7.5 percent among LTCH RPNs) – the only two sectors where a single site restriction was implemented in 2020, making it difficult to interpret the cause of these findings. Chapter 3 documents the share of agency employed nurses, and the rate at which previously non-agency employed nurses obtain at least one agency position (the agency transition rate) over the 2011-2021 period. The results show that over the data period, the share of agency RNs was small (ranging from 2.4 to 3.4 percent), and slightly higher among RPNs (ranging from 6.1 to 7.1 percent). The agency transition rate is also low – ranging from 0.7 to 1.1 percent among RNs and 1.9 to 2.5 percent among RPNs from 2011-2021. The share of agency employment and the agency transition rate decreased during the first year of the pandemic (2020), and subsequently increased back to pre-pandemic levels in 2021. However, mean hours of work increased among agency (and non-agency) nurses, which may explain a small part of the increase in public spending on agency fees. Chapter 4 measures occupational turnover, where nurses leave the profession altogether, as opposed to job turnover (Chapter 2), which includes nurses who change jobs within the profession. Occupational turnover, or attrition rates, are lower compared to the job turnover rates found in Chapter 2. Annual attrition rates ranged from 6.1 to 7.2 percent among RNs and 6.6 to 7.5 percent among RPNs pre-pandemic (2014-2019). In the first two years of the pandemic, attrition rates increased modestly to 7.7 (2020) and 8.1 (2021) percent among RNs, and 8.0 (2020) and 8.6 percent (2021) among RPNs. Over the entire period of analysis, a larger share of attrition derives from nurses who register active, but are without Ontario nursing employment, compared to nurses who register inactive or do not register. Nurses who register active without Ontario nursing employment may be viewed as undertaking a more temporary exit, as such nurses are significantly more likely to return to the profession. / Thesis / Candidate in Philosophy / This thesis examines health policy relevant issues in the Ontario nursing labour market. Reports of health human resource deficiencies, especially in the nursing profession and the long-term care home (LTCH) sector, increased throughout the COVID-19 pandemic. I perform empirical analysis to ratify such claims. First, I compare the rate of multiple jobholding, part-time and casual employment, and other individual and job-related characteristics among nurses employed in LTCHs compared to five other healthcare sectors. Next, I measure nursing job turnover in LTCHs compared to six other healthcare sectors. Third, I examine the count and share of nurses employed at private staffing agencies, and the rate at which nurses in traditional jobs transition to agency employment. Finally, in contrast to job turnover, which includes nurses who change jobs within the profession, I measure occupational turnover at the individual level where nurses leave the profession altogether. In most analyses, I compare pre-pandemic and pandemic (2020 and 2021 where possible) trends.

Yes / This study aimed to determine factors that influence the nursing workforce shortage and their impact on nurses. This study applied a systematic review design. Using Cochrane library guidelines, five electronic databases were systematically searched (Research 4life-PubMed/Medline, Scopus, Embase, CINAHL) from 2010-2021. The remaining articles with pertinent information were presented in a data extraction sheet for further thematic analysis. A Reporting Items for Systematic Reviews and Meta-Analysis Flow Diagram was adopted and used. The studies published from 2010-2021 and in English language were examined and included in the systematic review. Four themes were identified as factors influencing the nursing workforce shortage, including Policy and planning barriers, Barriers to training and enrolment, Factors causing nursing staff turnover and Nurses' stress and burnout. Nursing workforce shortage is a global challenge that roots in multiple causes such as individual, educational, organizational and managerial and policy-making factors.

Many newly graduated registered nurses (NGRNs) leave the nursing profession within the first 2 years of employment in a rural hospital located in the Southwestern region of Oklahoma. A strategy to address this problem was to introduce a mentorship process that would help support the NGRNs as they transition into independent practice in the clinical setting. The goal of this project was to develop a mentorship program for future implementation. The Partners In Nursing (PIN) program sponsored by the Robert Wood Johnson Foundation, and developed by the American Association of Colleges of Nursing and the American Nurses Association, was selected to support the NGRN transition from student nurse to practicing clinician with a goal to improve retention rates by 10 percent. Benner's novice to expert framework and the Psychological Empowerment model were used in the development of activities contained within the mentorship program modules. Barrett's theory of power helped to guide the development of resilience activities for the future participants. An evaluation plan was developed to monitor new nurse progress before and during the program using the Casey and Fink questionnaire to evaluate the needs and job performance of the participants. The target hospital National Database of Nursing Quality Indicators (NDNQI) was analyzed to help justify the project abe used in future evaluations. Facilitating mentorship will result in social change through increased autonomy of the new professionals, along with improved retention which positively impacts patient outcomes. Social change will bridge the gap in retention and the cost of replacing a NGRN. Dissemination of this project is planned to occur both within the facility and at the relevant national organizations supporting nurse educators.

Background: Previous studies show that nurse retention is one of the most effective strategies to counteract nursing shortages. Few studies have focused on the crucial resource of registered specialist nurses in operating departments. Aim: The overall aim of this thesis was to gain knowledge on registered specialist nurses’ and assistant nurses’ work in operating departments and on what factors they consider to be important for attractive work. Methods: In Study I, operating room nurses were interviewed regarding their perspective on their work. In Studies II and III, specialist registered nurses and assistant nurses at operating departments in a Swedish county council responded to the Attractive Work Questionnaire. Study IV is a case study with interviews, a review of organisational goal documents and data concerning the number of planned, acute and cancelled operations. Findings: The adaption of the Attractive Work Questionnaire for nurses in operating departments was satisfying. The most important factors for attractive work were: Relationship, Leadership and Status. The factors with the largest discrepancies between their important to work attractiveness and their rating at the nurses’ current work were: Salary, Organisation and Physical Work Environment. It was important for nurses to be able to prepare for and be in control of the different work tasks. However, the daily operating schedule guided the nurses’ work, and changes in the schedule, nurse shortages and the design of the premises constituted obstacles to their work. Conclusion: The Attractive Work Questionnaire provided specific information to management on what to focus on to make work attractive. The majority of the identified attractive factors are already known to be of importance in nurse retention; however, factors requiring more investigation are Equipment, Physical Work Environment and Location (of the workplace). Their work prerequisites did not enable the specialist and assistant nurses to reach what they saw as their daily goals. Regularly occurring activities, such as acute and cancelled operations, were interpreted as obstacles to reaching daily goals.

Researchers have predicted that by 2020 the United States will experience a severe shortage of registered nurses. The purpose of this correlation study, using the National Sample Survey of Registered Nurses 2008, was to investigate the relationship between nurse job satisfaction and its effect on nurse retention nationwide. Secondary data sets from the 2008 National Sample Survey of Registered Nurses and examining relationships between the variable of nurse retention and job satisfaction. Bivariate (correlation coefficient, chi squares, and simple linear regression) and multivariate (logistic regression) analyses identified and connected associations and examined measurement levels between the dependent and independent variables, including correlation coefficient (r), alpha values, and confidence intervals. Significant inverse relationships, although weak, were found between nurses' age and their job satisfaction level and between the numbers of years since nurses graduated from an initial RN education program and their job satisfaction. In addition, there was a statistically significant relationship between the nurses' highest education level and their job satisfaction. The ordinal regression results showed nurses' age, education, and years practicing since earning the RN were significant predictors of job satisfaction, although other factors might explain changes in satisfaction levels. This study will help bring social change to the health care industry by increasing understanding of what many nurses believe to be important within the nursing field, which could help health care facilities retain qualified nurses. Specifically, the results could help community hospital leaders find innovative ways to support nurses and increase nurse retention in small rural hospitals.

This mixed-methods research examined student nurse retention methods perceived as best practice by directors and coordinators in selected Associate Degree Nursing (AND) programs within the Florida Community College System (FCCS). A critical nursing shortage is expected to worsen over the next twenty years due to the aging workforce and the inadequate supply of qualified nurse graduates. The Associate degree nursing programs supply the majority of nursing graduates to the workforce. Thus, the associate degree nursing programs and student retention measures were studied. The research was conducted using a Delphi survey of directors of nursing in ADN programs within the FCCS. This survey served as the template for faculty surveys, which were distributed to faculty members under the selected ADN program directors. Students were surveyed with a similar Likert type scale with focus groups to allow for open-ended interviewing. Following analysis of the data, directors of nursing, faculty, and students in the ADN programs identified eleven best practices. Extensiveness strengthened the research. Resulting information will be helpful for nursing program curriculum and program planning. Future research can examine best practices quantitatively. This study can also be replicated at other venues.

The United States has been experiencing a nursing shortage since the mid-1990s. The shortage is expected to deepen as the provisions of the 2010 Patient Protection and Affordable Care Act are enacted. Horizontal violence is a negative phenomenon in the nursing workplace that contributes to difficulty in recruiting and retaining nurses in hospitals. Horizontal violence has been described as a form of mistreatment, spoken or unspoken, that is threatening, humiliating, disrespectful or accusatory towards a peer. The effects of this nurse on nurse aggression can be devastating for the nurse involved and also for the patients under the nurse's care. Nursing and social science literature have advanced oppressed‐group behaviors as a motivating factor driving this phenomenon in nursing. Workplace stress has also been implicated in these negative behaviors. This study used a grounded theory approach to examine how nurses explain, through semi‐structured and open ended interviews, the phenomenon of horizontal violence in the nursing workplace. The primary outcome of this study was a small scale theory focused specifically on horizontal violence in the nursing work environment. The theory that emerged from this analysis was that horizontal violence can be influenced by other environmental factors beyond oppression theory. The results from the data indicated that these behaviors, described as horizontal violence, may be employed as a method of manipulating the care environment in an effort to enhance patient outcomes while maintaining group or individual perception of security through a sense of environmental control.

Retention of registered nurses (RNs) is essential to the sustainability of quality health care services. More than 55% of hospitals in the United States have not translated retention initiatives into a formal retention strategy. The purpose of this study was to examine the relationship between training programs, new hire onboarding processes, frozen positions, and nurse retention. The self-determination theory was the theoretical framework for this study. Secondary data were collected from the 2016 Texas Hospital Nurse Staffing Survey. Data were analyzed using multiple linear regression. The results of the multiple linear regression were statistically significant, with F(3, 251) = .602, p > .001, R2 = .007. Although the model is significant, length of residency/internship/fellowship, length of new employee training, and total number of direct resident care RN positions frozen does not add significant predictive value to turnover. The results of the multiple linear regression produced correlation of the independent variables with the dependent variable of nurse turnover. Length of residency/internship/fellowship was positively correlated with RN turnover rate at .025, length of new employee training was negatively correlated at .072, and total number of direct resident care RN positions frozen was negatively correlated at .012. The findings of this study might influence positive social change by providing insights into length and content of programs and the effect of understaffing on retention of RNs. An increase in retention of RNs might contribute to improved hospital reputation, financial capability, and organizational balance leading to a positive effect on the economy, sustainability, and quality of life of the surrounding community.

The nursing shortage and high turnover rates are a problem in Canada and the world over. The purpose of this single case study was to explore leadership strategies that nurse leaders in specialty care clinics in Canada use to reduce nurse turnover. The participants were 7 nurse leaders from a single organization with specialty care clinics across Canada who all had above average nurse retention rates when compared to the case organization's average nurse retention rate. The authentic leadership theory was the conceptual framework. Data sources for this study were company documents, participants' semistructured interview responses, member checking of the interviews, and reflexive journal notes. Methodological triangulation was used to enhance validity. Data were analyzed using Yin's 5-step approach to qualitative data analysis. Data analysis yielded 4 categories of strategy themes for reducing nurse turnover: moral perspective, self-awareness, relational transparency, and balanced processing. The results of this study have the potential for positive social change in specialty care by providing senior leadership and nurse leaders of specialty care clinics with strategies that can contribute to nurse-retention initiatives. The availability of more nurses might improve the outcomes of patients who depend on these clinics for their regular infusion of specialty medicines to treat their critical illnesses, such as cancer or rare genetic diseases, where delay in treatment due to the unavailability of nurses can result in adverse consequences for patient care.