To identify top opportunities for driving nursing engagement, researchers from The Advisory Board Company analyzed responses from a 2014 engagement survey database including more than 343 000 employees at 575 healthcare organizations.1 Further details on the authors' research background and methodology can be found in Perspectives on Engagement in the April 2015 issue of JONA.2

A Top Opportunity for Nurse Engagement

A top opportunity for improving nurse engagement is to broaden access to desirable professional development and promotion opportunities. This is confirmed by survey data from the Advisory Board's 2014 Employee Engagement Survey database: less than two-thirds of nurses agree or strongly agree with the statements "Training and development opportunities offered by my organization have helped me to improve" and "I am interested in promotion opportunities in my unit or department."1 To understand why staff nurses do not agree with these statements, Nursing Executive Center (NEC) researchers conducted more than 100 telephone interviews with nurse leaders (including chief nursing officers, nurse directors, and nurse managers).

Based on qualitative responses, 3 primary reasons surfaced: the opportunities available are not appealing, the opportunities are limited, and many nurses do not feel they have a clear career path. An important underlying root cause is that clinical ladders have not evolved over time and often do not reflect current development needs of nurses. For example, many clinical ladders still reward tenure and task completion, rather than achievement and meaningful growth. They often focus disproportionately on technical skills and rarely provide structured opportunities for reflection. In addition, most clinical ladders require nurses to advance in a single track, such as education, research, or management (reflecting traditional career paths for nurses choosing to leave bedside or direct patient care). But many nurses want to cross-pollinate their training opportunities across a mix of traditional tracks while remaining in a direct-caregiver role.

To drive nurse engagement in complex environments, leaders must redesign professional development structures to broaden access to nontraditional development opportunities for nurses. With this in mind, NEC researchers identified 2 core strategies for increasing nurse satisfaction with development and promotion opportunities offered by their organizations: enable staff to choose from a menu of options to customize their development and internally source high performers for new or hard-to-fill specialty positions.

Enable Staff to Choose From a Menu of Options to Customize Their Development

To foster meaningful professional growth, top-performing healthcare systems enable staff to select development opportunities from a menu of options and build their own customized development portfolios. For example, at a health system in the Midwest, staff select development opportunities from a menu of options based on preference and are encouraged to mix and match education, research, and clinical opportunities to build an individualized complement of experiences. In contrast to traditional clinical ladders, this nonhierarchical model allows nurses to grow "in place," by pursuing their individual interests. All nurses are required to maintain a professional portfolio in which they track all professional achievements and newly acquired education and skills at least every 6 months. The portfolio is used in 2 ways. The 1st is during each nurse's annual performance review. At this time, managers and nurses review the portfolio to discuss career development opportunities and set long-term goals for development. The 2nd way the portfolio is used is for earning pay incentives. Staff receive incentives for achieving individual and unit-based milestones, such as serving as a preceptor and receiving specialty certifications.

Internally Source High Performers for Specialty Positions

In addition to enabling staff to customize their professional development, high-performing organizations engage staff with opportunities to progress in their career while remaining in a direct-caregiver role. For example, at a healthcare system on the West coast, nursing leaders partner with human resources leaders to determine staffing needs for newly created cross-continuum or hard-to-fill acute care roles. Managers then nominate high-performing nurses for appropriate roles. Nominated staff must complete an online application and are vetted by a panel of specialty unit managers based on clinical, bedside, and leadership skills, as well as behavioral-based interviews. A secondary benefit to this strategy is reducing recruitment costs and time to fill for newly created roles. For example, specialty training for the cohort of staff transitioning to new roles can be synchronized with the completion of new graduate orientation. This allows unit managers to backfill nurses' previous roles as needed.

Conclusions

An organization's ability to operationalize its care transformation efforts is dependent on an engaged nursing workforce committed to the organization. To drive nurse engagement, leaders must redesign professional development opportunities and structures to expand access to nontraditional development opportunities for nurses. Examples of these opportunities include the following: leading a unit-level quality project, obtaining specialty certification, and training for a navigator role. Highly engaged nurses feel their organization provides them with a variety of appealing professional development opportunities that will help them advance in today's complex care environment. These nurses are also more likely to remain with the organization. NEC researchers found organizations that foster personalized, meaningful professional growth for staff have implemented 2 core strategies: enabling staff to choose from a menu of options to customize their own professional development and internally sourcing high performers for new or hard-to-fill specialty positions.

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