Definitions

Nurse engagement

• Nurses’ commitment to and satisfaction with their jobs (Dempsey & Reilly, 2016)
• Must also consider the nurses’ commitment to the organization and to the profession

Nurse retention

• Focus on prevention of turnover and keep nurses within their organization (Jones & Gates, 2007)
• Beneficial to quality patient care and safety, higher patient satisfaction scores, and nurse safety

Risk Factors (Bugajski et. al, 2017; Tyndall et. al, 2019; Phillips & Harris, 2017; Schroyer et. al, 2020)

Factors that can contribute to a lack of nurse engagement and reduced nurse retention include:

• Lack of educational training, skills and knowledge
• ​Absence of leadership support
• High acuity and stressful patient workloads
• Limited staffing availability/overtime
• Restricted job growth
• Diminished job satisfaction
• Disputes with management
• Unsupportive coworkers
• Low salary
• Aging workforce
• Toxic work environment or incivility

 
These negative factors can lead to:

• Staff turnover
• Overtime hours
• Prolonged unit vacancies
• Poor quality of patient care
• Low patient satisfaction
• Higher patient ratios
• Nurse burnout/distress
• High costs for new nurse orientation

 
Millennial nurses are particularly at risk for turnover. Although they tend to be engaged, they are more likely to move onto a new role due to available opportunities. Personal attention and feedback on their work can help improve or maintain engagement and retention of this generation of nurses.
 

Steps and Strategies for Nursing Administrators (Koppel et. al, 2017; Tyndall et. al, 2019; Scruth et. al 2018; Phillips & Harris, 2017)

Nurses who are engaged, especially new graduates, are more likely to stay with an organization longer than two years. Nurse engagement and retention should always be on the minds of those in leadership.  Blegen et. al (2017) found that Magnet hospitals had a 92% retention rate compared to the 77% rate of non-Magnet hospitals for new nurse graduates.  
 
The following strategies should be considered to improve nurse engagement and retention: 

• Flexible work hours (i.e. 12-hour shifts)
• Develop workplace culture
• Develop a healthy working environment
  • Utilize skillful communication
  • Encourage collaborative relationships
  • Institute staff recognition
  • Prioritize effective decision making for the unit/department
  • Value leadership
  • Ensure appropriate staffing levels
  • Foster emotional intelligence
• Increase leadership engagement and provide support to staff
• Make leadership visible and available to staff on the unit
• Discuss opportunities for growth within the organization
  • Career ladder program
  • Role transitioning
  • Tuition assistance program for advancing education  
• Provide educational opportunities for leadership to learn more on these topics
• Conduct unit staff meetings to discuss any unit issues or concerns
• Provide mentorship programs and strong preceptors for new graduate nurses to the organization
  • Reduces orientation costs
  • Increases leadership and problem-solving skills
  • Increases morale and retention

Note: the orientation program is critical to developing positive employee attitudes and job satisfaction. Successful programs included approximately 13 weeks of orientation with an additional 2- to 3-week transition component (Kiel, 2020).
 

Education

Collaborating with other leaders and educating one another on ways to connect with staff, be present and supportive, and ensure that staff find meaning and purpose in their role can enhance engagement and retention. It is important to display engaging behaviors, effective communication, and promote a healthy work environment for the staff. Provide guidance, support, and resources to help staff thrive, be engaged, and successful.