Retention requires diagnosis, treatment of job dissatisfaction

[NRSKarenRN, BSN, RN]

By Bodil Hansen, MBA, RN

November 12, 2001

Nurse Week

http://www.nurseweek.com/industrypulse/retention.html

A scan of the want ads in journals and newspapers tells us that the demand for registered nurses far exceeds the supply. If we don't believe the ads, we can talk to almost any nurse manager or administrator. Better yet, talk to the nurses who work double shifts and take on more patients than they ever have-they'll convince us. Administrators now are budgeting additional recruitment and training costs while trying to slow down the high turnover of staff and prevent nurses from leaving the profession.

But how do you help nurses rekindle passion for their profession and inspire them to stay? When something meaningful and fulfilling has gone out of your life, it leaves a void similar to the pain of a physical ailment. In most cases, pain can be managed and the cause treated.

For example, when a patient reports generalized pain and malaise, the physician cannot treat the pain or the cause of the malady before he or she takes a history by listening to the patient and running diagnostic tests. Based on the results, a physician uses his or her experience and education to treat the cause and manage the patient's pain.

The principles of listening, diagnosing and treating physical pain might be applied to diagnosing and treating the dissatisfaction and frustration of nurses. Without specifics, we are powerless to help nurses. To identify the cause of the dissatisfaction, we must listen beyond the general complaints to gain a better understanding of the specific problems that frustrate nurses.

We can begin by asking nurses to "distill" the problems, to drill down and identify five areas that drive their dissatisfaction. The administration can invite nurses to complete a brief questionnaire to measure and rank the importance of each of the five "dissatisfiers" and apply the Lichert scale to grade the results.

An example of an indicator that staff might choose to measure for degree of dissatisfaction is: "I feel that I count at work by the way my superiors respond to my opinions." The five possible responses to this statement are: strongly agree (100 percent), agree (75 percent), neutral (50 percent), disagree (25 percent) and strongly disagree (no responses).

An effective goal for an organization is to achieve scores of 80 percent and higher.

When the scores are calculated and the "dissatisfier" that has the lowest score has been identified, leaders of the organization then have specifics to which a treatment can be applied.

The most critical ingredient in the process of listening, diagnosing and treating the frustration is the treatment. The most demoralizing action that management can take is no action at all in response to employee information. Studying a problem is important-but not as important as solving it.

A "healing" response by leaders is to develop and implement a brief, crisp action plan that has "teeth" and is solution-oriented and specific to the problem. Management and staff as a team develop the most effective action plans. Management must commit to provide the presence, communication, emotional and clinical support that nurses seek.

Many solutions that come from staff are in the shape of a commitment to changed behavior, a positive attitude, teamwork and improved communication.

A corrective action plan might include:

*The supervisor/manager contacts individual staff members on a scheduled rotation for staff to express their feelings about how well they are being heard.

*Employees who present solutions that are implemented and have proved effective are given exceptional recognition. For example, a weekend at a resort, paid time off, tickets to sports or theatrical events of their choice.

*Staff members are surveyed once a month to measure their level of satisfaction with the five indicators and to evaluate the effectiveness of the implemented action plan.

*Staff members are asked to hold leaders accountable in follow-through of their commitments.

Like physicians who question patients about their pain, nurse leaders must ask nurses to define their dissatisfaction before they can effectively help them. Nurse leaders and senior management in hospitals can apply their leadership skills to diagnose and prescribe treatment to ease their nurses' frustrations and treat the underlying causes of their dissatisfaction.

Leaders who invest the time and effort to identify specifics are guaranteed to gain significant financial and emotional rewards.

[oramar]

This is a far cry from "nurses are a dime a dozen" and "if you don't like it there is the door". I have doubts that it is being implemented in many places but the fact that the dissatifaction is even acknowledged is great. The sneers of past managers still haunt me. Trying to point out a problem that was causing turn over in the past was to invite trouble.

[Mijourney]

Hi. There has to be a method to the madness. It's time that management use "evidence" from the staff's side of the story to help get staffing problems under control. Hopefully, the information from staff drafted in scientific format, if that's what it takes, will give more confidence to those in lower to mid management when standing up to those above them.

[live4today, RN]

Just saw this post for the first time today, and I couldn't help but post the following statement:

If the nursing shortage is as bad as management says it is, and they wonder why they can't retain or recruit nurses, perhaps it is the way management is going about it. You have a large pool of seasoned nurses desiring to re-enter the field of nursing, yet you do nothing to welcome them back. The hospitals aren't offering nurse refresher courses, at the hospital's expense--not the nurse's expense--in order to show them how much they are truly needed and welcomed. Instead of looking for nurses who will kiss butt for you (management), start doing a little butt kissing yourselves and bring on the nurses who apply at your hospital for a job, but you won't give them the time of day unless they are "green" out of school. Nursing shortage my butt! There's a nursing shortage alright, but not for the reasons management wants the media to believe. Try getting real for a change!