Renewal and Retention: Strategies for Addressing the Nursing Shortage

    • July 11, 2007

In September 2006, Cynda H. Rushton, R.N., Ph.D., F.A.A.N., associate professor at the Johns Hopkins University School of Nursing, joined a cohort of 19 Robert Wood Johnson Executive Nurse Fellows (ENF). This program, which began in 1998, seeks to provide advanced leadership opportunities for nurses in senior executive roles who have great potential to lead and shape the U.S. health care system of the future.

Rushton and her 2006 ENF colleagues are immersed in three years of comprehensive leadership development, which focuses on five core leadership competencies (self-knowledge, inspiring and leading change, strategic vision, risk taking and creativity, and interpersonal and communication effectiveness). Over the course of the program, each Fellow must develop an individual learning plan, complete self-directed learning activities, and develop a relationship with a mentor. Often a Fellow is working in a professional capacity, while committing to the fellowship.

A nationally recognized expert in bioethics and palliative care, Rushton believes that nursing requires a moral commitment to the welfare of others—a belief shared by the American Nurses Association, whose Code of Ethics highlights this moral commitment. Yet, to care well for others, nurses must also care for themselves.

Rushton knows when nurses reconnect with themselves and to the reason they entered the profession, they are more satisfied, and managers and hospital administrators are better able to retain them at the bedside. She explains, “Nursing and health care delivery in general have changed dramatically. In addition to becoming increasingly driven by data and technology, the global nursing shortage means nurses are stretched thin between more patients. This causes disconnected relationships with patients and families, other practitioners and with the meaning of delivering care. The current environment does not support the strengthening of these relationships.”

For several years, Rushton has seen nurses who operate in unhealthy environments become so disconnected with the meaning of their work that they leave their jobs or the field altogether. Rushton recognizes a need for tools to help providers rekindle their relationship to the profession. During her three-year fellowship, she will create, test and disseminate curriculum and facilitation guides that can be used by hospitals to help nurses cultivate self-awareness and the skills to work more effectively in an increasingly complex and hectic hospital work environment.

The underlying goals for Rushton's R³ program—Renewal, Resilience and Retention for Nurses—are similar to another prominent RWJF initiative to improve nurse retention. Transforming Care at the Bedside®, or TCAB, led by RWJF and the Institute of Healthcare Improvement (IHI), has demonstrated that nurses encouraged to develop, test and spread frontline-generated quality improvement solutions, are more satisfied with their work and more likely to stay in bedside nursing longer.

RWJF Senior Program Officer Sue Hassmiller, Ph.D., R.N., F.A.A.N., describes the alignment, “It is a real asset when the Foundation is able to partner with accomplished and dedicated nurse leaders like Cynda who seek to improve the quality of health care by inspiring nurses to rejuvenate their commitment to bedside care. When nurses leave the profession, patients and families, hospitals and the entire health care system suffer.”

Rushton's program is a continuation of two year's worth of cultivating connections among a group of Johns Hopkins pediatric oncology nurses to improve retention and cultivate an environment of respectful and trustworthy connection, support and mentoring. Having the challenging job of caring for very sick children and the families that love them, the nurses worked together to learn about renewing themselves and participate in activities to help them cultivate their own resilience.

As a result, the nurses are working with Rushton to identify content areas that require additional curriculum and facilitation guide development. This includes exploring the legacy of Florence Nightingale and the foundations of nursing, building personal coping skills, addressing moral distress, and examining concepts of trust and trust worthiness.

“Nurses must extend the compassion they give to others to their own well-being,” Rushton adds. “A lot of times, nurses are used to giving and not receiving. When nurses become burned out, feel underappreciated or are too busy to provide the level of care they know is necessary, the quality of health care is at stake. That is why this investment of renewal and self-care for nurses is imperative for nurse satisfaction, retention, and the delivery of safe, coordinated and compassionate health care.”

While pleased to have the support from the ENF program to further her work in nurse renewal, Rushton is equally enthusiastic about having the time and space to expand her leadership abilities. “The fellowship has allowed me an opportunity to reflect on what leadership means personally and receive feedback from colleagues about how they perceive me as a leader. There is both an inner and an outer process to becoming a good leader. Exploring all of your gifts requires the space to delve into both aspects of these processes.”

Rushton has found the mentorship component of the program key to her development. She describes her gratitude for such guidance, “My mentor, health care futurist Dr. Leland Kaiser, is completely aligned with my individual learning plan and my project. Having access to such an accomplished health care leader who is committed to my leadership journey is truly an honor.”

As a nurse leader, Rushton modestly acknowledges her work will impact health care. She offers the following words of wisdom to new nurses entering the field:

  • Pause to find space and be still every day.
  • Experiment with ways to tap into imagination, creativity, and activities that nurture the mind, body, and spirit. Commit to practice these regularly.
  • Create rituals to remind yourself of why you are serving in this way.
  • Find joy in every day.

No matter what your line of work, these are solid words of advice by which to live.