Running head: NURSING SHORTAGE AND RETENTION

Nursing Education Key Issue: Nursing Shortage and Retention

Amy J. Herrington
Ferris State University

NURSING SHORTAGE AND RETENTION

Abstract
Nurse leaders are facing myriad challenges in healthcare today. A specific challenge for a nurse
leader in education involves the nursing shortage. The nursing shortage is aggravated by many
issues including a faculty shortage, increasing need for nurses and nurse retention. A noteworthy
number of nurses are leaving the profession and contributing to the nursing shortage. There are
various reasons for leaving the profession including feeling under-supported, overwhelmed, poor
work environments and physical demands to note a few. The nurse leader in education is in a
pivotal position to make a change. The role of Spradleys Change Theory and the concept of
servant leadership in nurse retention will be explored.
Keywords: nurse shortage, nurse retention, Spradleys Change Theory, servant leadership

NURSING SHORTAGE AND RETENTION

Nursing Education Key Issue: Nursing Shortage and Retention

The United States healthcare system is currently facing serious challenges. Though these
challenges affect the population as a whole, healthcare leaders will need to advocate for change
and guide the nation through these challenges. As an emerging healthcare leader in nursing
education, the author will take on a number of issues including but not limited to health literacy,
patient safety and the nursing shortage (Marshall, 2011). The author will examine the current
challenge of the nursing shortage, focusing on nurse retention. The author chose this issue
because the shortage affects other healthcare challenges such as patient safety and quality of care
(Billings & Halstead, 2012).
Nursing Shortage
The challenge of the nursing shortage comes at a time when the industry is experiencing
increasing demands including patient safety initiatives, high quality care and patient satisfaction
(Marshall, 2011). Various factors contribute to the nursing shortage, including faculty shortage
and nursing retention. The nursing shortage and the faculty shortage affect the other. Due to the
faculty shortage, qualified applicants are denied acceptance into nursing programs further
intensifying the nursing shortage. This highlights the obvious problem that nursing programs are
unable to accommodate qualified individuals because there are not enough qualified nurses who
teach or want to teach. Another significant issue involves individuals who are accepted into
schools of nursing and graduate only to leave the profession a short time later. The challenge of
nursing retention will need to be dealt with head on by nurse leaders.
Nursing Retention
Hillman & Foster (2011) report that over 30% of new graduate nurses leave their position
voluntarily within the first year and up to 50% in the second year. The need for change is
heightened when faced with the fact that a significant portion of our population, the Baby
Boomer generation, are aging and people are living longer and healthcare needs are becoming

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more demanding (Rosseter, 2012). Rosseter (2012) also noted that registered nurses will have
the most job growth through the year 2020, as projected by the U.S. Bureau of Labor Statistics.
A large number of nurses are also aging with the average age of practicing nurses being 45 years
old; this too will affect the nursing shortage (Marshall, 2012). It is evident that the nursing
profession has many factors contributing to the nursing shortage, as well as concerns that will
continue to exacerbate the shortage. These factors and concerns illustrate why it is so important
to retain each and every nurse and keep nurses in practice.
Factors Influencing Retention
In a recent study, many reasons for leaving the profession were noted, including burnout
or stressful work environments, physical demands, inadequate staffing and inconvenient
scheduling (Wood, 2009). Cottingham, DiBartolo, Battistoni, & Brown (2011) reports most new
nurses report leaving the profession due to inadequate support. This inadequate support can be
linked to the old saying that nurses eat their young, insufficient orientation and educational
support or leaders not truly understanding the needs of a staff nurse. New nurses enter the
professional world and have difficulties integrating the information learned in school into the
reality of nursing (Nelson, Arjes, Bushman, Carlson, Czaplewski, Derby, Godman, Horton,
Stansfield & Tan, 2012). The challenge of assimilating into the real world of nursing can lead to
feelings of fear, apprehension and insecurity (Nelson et al., 2012). The feelings experienced
through this challenge can lead to increased stress and anxiety for new nurses (Welding, 2011).
In addition to the anxiety and stress of trying to apply learned knowledge into practice, new
nurses must also deal with challenges related to staffing, workload and coworker relationships.
The first few years of a new nurses career are very delicate and can make or break a nurses
choice to stay in the profession.
The Role of the Educator

NURSING SHORTAGE AND RETENTION

The retention of new nurses is linked very closely to the nursing leader in education. A
nurse leader who is an academic educator carries the burden of preparing students to be ready for
the daunting task of entering the nursing world. This can be a momentous challenge because
academic instructors are burdened with content saturation, as well as budget cuts that can limit
the ability to provide sufficient clinical experience and high fidelity simulation.
The nurse educator within a facility has the potential to have a huge impact on a new
nurses retention. A nurse educator has the ability to provide the support and guidance many new
nurses say they are missing. The nurse educator will also have the ability to observe and
interject if a nurse seems to be struggling in a new position. A nurse educator has the ability to
examine what impacts nurse retention in their particular facility and make strides to improve that
retention.
A Need for Change
Nursing retention has a clear effect on the nursing shortage and a change needs to be
made to improve nursing retention. If more nurses stay in their position longer, less time and
money will be spent training nurses in a new position. In addition, if nurse leaders can improve
the retention of nurses in the profession, this will directly improve the nursing shortage. This is
evidenced by a recent study that revealed there are more than 120,000 nurses that are working
outside the nursing profession (Wood, 2009). Nurse leaders need to identify a plan for change.

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Spradleys Change Theory

The nurse leader can make an impact on nurse retention by employing Spradleys Change
Theory. Spradleys theory is based on the well-known theory of Lewin and involves eight steps.
The eight steps include recognizing the symptoms, diagnosing the problem, analyzing alternative
solutions, select the change solution, plan, implement, evaluate and stabilize (Swansburg, 2002).
The theory involves constant monitoring of the planned change so that a successful relationship
can be developed between the change agent and the change system (Swansburg, 2002).
This theory is ideal for this change because it involves the nurse leader as the change
agent and focuses on a fruitful relationship. Also, this theory is ideal because the nurse leader
could include nurses and other members of the healthcare team to identify solutions during the
planning process which will help the employees feel like a part of the process. The nurse leader
will recognize that a problem exists from the symptoms present and then will identify and name
the problem. The next step is where the nurse leader will employ the help of others to develop
multiple resolutions for the problem, followed by identifying the best solution to utilize. Next
the nurse leader will plan the change and implement the change. During implementation, the
nurse leader will need to utilize a leadership theory, such as the transformational leadership
theory concept of servant leadership. The implementation will be followed by evaluation to
decide if stabilization is needed for permanent change.
Servant Leadership
Transformational theories are ideal to practice for this change. Avolio, Gardner,
Walumbwa, Luthans & May note that many approaches of transformational theories focus on
positive constructs such as hope, resiliency, efficacy, optimism, happiness, and well-being as
they apply to organizations (as cited in Marshall, 2011). To improve nursing retention,

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organizations will need to improve the environment for their employees. Specifically, the nurse
leader could utilize the concept of servant leadership. This concept is ideal for taking on the
challenge of nurse retention because it involves the nurse leader being similar to a mentor.
Rather than directing followers, the nurse leader will engage employees through empowerment,
inspiration, motivation and influence (Marshall, 2011). Robert Greenleaf developed ten
characteristics of servant leadership which includes being a listener first, empathy through
framing questions, heal to make whole, awareness, user of persuasion, conceptualization,
foresight, stewardship, commitment and cobuilder of learning/working communities (Marshall,
2011). If the nurse leader leads with these characteristics, she will be in an ideal position to
make a positive impact on the nurses who are struggling in the nursing profession. If the nurses
who are struggling can be identified by employing this concept, an overall impact on the nursing
shortage could be made.
Conclusion
The nursing shortage and the impending challenges are issues almost all nurses are aware
of; however there seems to be little focus on how retention can improve the shortage. This
challenge effects nursing education directly and nurse leaders in education are in a perfect
position to meet this challenge head on and advocate for change. There are many different
methods the nurse leader could employ to handle this challenge, though Spradleys Change
Theory and the use of the servant leadership concept could be particularly effective. With the
many healthcare issues our nation is facing, it is important that nurse leaders identify a need for
change and advocate for those changes.

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