1. Newton, Kathy G. RN
  2. Stewart, Florence BSN, RN
  3. BSN, Sabra Henry RN

Article Content

With the topic of retention being very high on most nursing leaders' agendas, I feel that Susanna Fraser makes some powerful and insightful points in her article, "Influencing Outlook: The Importance of Nursing Staff Satisfaction," published in the September issue. First, I believe that the quote from Pamela Bilbrey, president of the Baptist Health Care Leadership Institute, "Every leader in our organization is a chief retention officer," should be the mantra of every nursing leader. For retention to truly become a priority, it must be embraced by managers of all levels. Fraser points out that managers should take part in fostering communication and encouraging employee input. Second, Fraser notes the economic impact of replacing just one nurse. Turnover may cost an organization up to two times a nurse's salary. Further, Fraser explains that the same factors influencing job turnover lead to an increase in sick days and extended periods of leave. This is eye-opening as it not only increases costs but may also disrupt patient care.


Another important point that Fraser makes is that managers can have a positive impact by demonstrating both the desire and ability to help nurses perform their jobs effectively. This to me describes a transformational leader. According to Porter-O'Grady and Malloch in their book, Quantum Leadership: A Resource for Health Care Innovation, a transformational leader allows individuals to contribute to their fullest potential to deliver the most effective healthcare possible. I believe that's certainly an indicator of job satisfaction. As Fraser notes, retaining qualified nurses is vital. Managers in healthcare organizations must focus on retaining their current staff.


Transformational leadership a must

As a practicing RN since 1978, I wholeheartedly agree with the article, "Improve RN Retention Through Transformational Leadership Styles" by Ben D. Gardner from the August issue. Nurse retention and satisfaction is directly tied to nurse manager behaviors and the manager's dominant style of leadership. Numerous studies have shown throughout the past decades the success of transformational leadership. In the growing climate of healthcare changes, costly staff turnover, nurse retirement, and an aging population, it's imperative that organizations empower and train managers to not only excel but also mentor the next generation of nurse leaders who will come from the ranks.


A transformational leader focuses on strengths, identifying weaknesses, reexamining of ideas, motivating subordinates, optimistic review of the future, being a positive role model, competence, celebrating achievements, and fostering confidence. These manager behaviors do impact a nurse's decision to stay in a current position and inspire the nurse to seek out leadership positions in his or her place of employment. At the end of the day, when reflecting on the interactions of the day, the nurse who can look back on the support that was fostered by the manager can gain a source of comfort about a challenging day that can be exhaustive because of the workload. The leader who mentors builds confidence in the nurse and promotes self-knowledge among the nursing staff. The nurse who feels supported has confidence in his or her leaders and provides care that supports patient outcomes and the mission of the nursing profession and the institution.


Change in healthcare is one of the hot topics of the past year, and the stress that comes with changes can be bridged by individual nurses who are empowered by a transformational leader. Nurse retention will impact the budget in a positive way and cost containment, which so many institutions have to always be mindful of, will be achieved.


The recent article by Ben D. Gardner, "Improve RN Retention Through Transformational Leadership Styles" in the August issue was outstanding. We've often heard that nurses don't leave organizations; rather, they leave their managers. Objectively determining the leadership behaviors that influence nurse retention is crucial to developing a high-performing nursing team. In today's economy, many nurses may be staying in less than satisfying positions to ensure job security and a steady family income. In my hospital, our human resource executive reports 40% of our employees are dealing with an immediate family member's unemployment. However, as the economy improves, the nursing shortage is expected to be more severe than ever before. Retention of experienced nurses will be of utmost importance to an organization's ability to continue to meet patient's increasingly complex nursing needs. Measuring leadership styles and substyles and correlating behaviors with retention will help in developing leaders who are more likely to retain nurses and create a positive work environment. As nursing leaders, we're expected to have high employee satisfaction scores and low vacancy and turnover rates, but aren't always sure how to consistently achieve these results.


The approach in this article makes perfect sense, as it mimics the nursing process: assess individual leadership styles, understand the behaviors associated with these styles, and develop a plan to maximize the positive or functional behaviors. Looking at the substyles of the transactional style is especially illuminating. Many of the behaviors most closely correlated with decreased nurse retention are exactly what you see so often in underperforming nursing units, addressing issues by constantly putting out fires rather than establishing processes. It's also interesting that the active management by exception style, which is utilized so frequently in hospitals to ensure compliance with regulatory and legal issues, leads to underreporting and hiding of mistakes-a well-researched issue in healthcare. A blend of established processes and monitoring, along with a transformational leadership style, seems to be the most effective style to create a functional and engaging care environment.


Especially useful in the article was the description of how to minimize those leadership behaviors that negatively impact satisfaction and retention. Focusing on minimizing those behaviors that negatively impact retention is a measurable and identifiable goal. Although the author reported no validated educational or training technique to ensure development of transformational characteristics in nurse leaders, I would think awareness of one's style and the characteristics associated with desirable leadership styles can lead to self-awareness and behavior changes.


Another point that rang true was that it's the frontline leader-the charge nurse role-where this awareness and training is most crucial. It isn't surprising that novice leaders would be the most likely to utilize transactional leadership styles. Most charge nurses come from being clinically competent and more task oriented than relationship oriented and are placed in a leadership position with no formalized training. The charge nurse role is the one that most intimately impacts the day-to-day work environment on a unit. How often do staff members purposefully schedule themselves to work, or more tellingly not work, with a particular charge nurse? Developing the charge nurse as a leader will allow the nurse manager to be exponentially more effective and make the most difference in overall nurse satisfaction and retention.


I wholeheartedly agree that the cost of providing frontline leadership development is well worth the outcomes of increased nurse satisfaction and retention. Not only does retention and engagement reduce employment cost and increase productivity, but overall organizational outcomes are also impacted by a satisfied work environment. According to the American Association of Critical-Care Nurses' Healthy Work Environments Initiative, creating a healthy work environment leads to superior patient outcomes and satisfaction. Patients are utilizing public reporting and technological information sources to determine hospitals with better outcomes and patient satisfaction scores. This article lends credence to how important evidence-based leader development is to the overall success of the healthcare organization. Thank you so much for this enlightening and forward-thinking article.?