1. Holland, Cecil EdD, PhD, MSN, APRN, FNP

Article Content

Today's healthcare landscape is uncertain. Trends of escalating costs, healthcare disparities, and a nursing shortage have ignited the interest of nurse leaders to partner, collaborate, and critically examine opportunities to invest in the nursing workforce. These investments should ensure the future of our healthcare systems and provide sustainability of the most critical mass of healthcare professionals in our nation.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

As the most trusted healthcare providers, nurses are the catalyst for improving healthcare systems and patient outcomes. It's incumbent on nurse leaders, educators, scientists, and healthcare executives to engage in conversations regarding sustaining the nursing workforce through deliberate, planned investment initiatives. Attention has to focus on recruitment and retention, education and training, and leader development and succession planning.


Recruitment and retention

Myriad factors contribute to the need to recruit nurses, including the exodus of nurses leaving the profession through retirement. Consider engaging in creative recruitment activities that will attract the best nurses to your organization.1


One strategy that may yield a great return on investment is the use of social media to recruit qualified nurses. You can build effective recruiting strategies by determining which social networks work best for your organization.2 If your organization has Facebook, Twitter, or any other social media platform, connect with your information technology experts to build an effective social media recruitment plan. Using social media not only strengthens your employment brand, but it also promotes engagement of candidates with your organization. Effective use of social media for recruitment enhances an organization's chances of reaching the most qualified talent.2


After new nurses are recruited, the next challenge is retention. Retaining highly qualified employees is a critical part of any recruitment strategy and important in terms of providing quality and stable patient care environments, and building productive and sustainable teams. Patient safety and quality of care, patient satisfaction, and nurse satisfaction and safety have been identified as benefits of effective retention strategies.3 Be diligent in transforming the work environment by providing strong and effective leadership and support; engaging team members in decisions regarding unit operations and patient care delivery practices; and improving the culture of the work environment through innovative scheduling, job sharing, and other attractive benefits.1,3


We not only want to retain new graduate team members, but also experienced, seasoned, and expert nurses who have been part of the nursing workforce for decades. You can minimize the exit of qualified nurses in a number of ways, such as offering alternatives to full retirement. Designing alternatives, such as flexible work schedules, opportunities to mentor and train new nurses, and partnering with educational institutions as clinical faculty, keeps experienced nurses in the pipeline and provides the expertise to new and emerging talent that's so important to organizational success.1,4,5


Healthcare systems and patient care outcomes are enhanced when organizations invest in their experienced nursing workforce. When nurses are satisfied with their careers, their employers, and themselves, they're more likely to contribute additional years of service, expertise, and experience to the nursing workforce. Providing opportunities for retooling the aging workforce, such as continuing education, tuition reimbursement, career ladders, and sharing of resources with educational institutions, may minimize the exit of qualified nurses and support the development of new talent in the nursing workforce.4


Education and training

The American Nurses Association has affirmed its commitment to the BSN degree since the early 1960s.5,6 The literature recognizes the impact of a well-educated staff on quality patient care outcomes and nurse recruitment and retention efforts.7,8 Nurses who are viewed as professionals with a broad knowledge base demonstrate more job and personal satisfaction, thereby positively influencing retention.6 Nurse leaders who provide opportunities for the professional growth and development of staff members through support and access to high-quality educational and career mobility programs increase the likelihood of a sustainable workforce.


This support can be offered in a number of ways, including, but not limited to, flexible work schedules, career ladders, leadership and mentoring programs, and partnering with educational institutions. Connect with local academic institutions to develop flexible pathways for nurses to engage in education and training programs.9 Through purposeful and intentional collaborations between practice and education, a viable and sustainable nursing workforce can be actualized. In addition, providing continuing-education opportunities that meet state boards of nursing, accreditation, and licensure requirements increases the probability of nurses remaining with their current employers.


The American Association of Colleges of Nursing recognizes the debate between the associate and bachelor's degrees in nursing education programs.5,7 Practice partners and educational institutions are challenged with preparing RNs to meet our evolving healthcare needs and transform the healthcare system.10,11 These entities can partner to develop articulation and/or bridge programs that support advancing the education level of professional nurses while meeting the needs and demands of the organization. Collaborations, such as the Regionally Increasing Baccalaureate Nurses Project, bring associate and bachelor's degree programs together to provide ADN graduates a seamless transition to the BSN, increasing the educational preparation and diversity of the nursing workforce.12 It's essential that nurse leaders are at the table to provide a practice perspective in terms of workforce needs as academic enterprises move forward through collaborative partnerships to meet the challenge of increasing the nursing workforce.


Leader development and succession planning

The development of the next cadre of nurse leaders must be at the forefront of our strategic plans. In order to sustain and improve our current healthcare system, new and creative energy has to be infused. This often presents a challenge in terms of leader development and succession planning. Partnering with staff development departments and academic institutions provides an opportunity to collaborate regarding critical skills, characteristics, knowledge, developmental processes, and other essential tools and attributes needed in a leadership development action plan and/or curriculum.


There are a number of tools that you can use to assess and support leader development at the unit level. One instrument is the American Association of Critical-Care Nurses' Nurse Manager Learning Domain Framework.13 The model has three distinct domains: the science (managing the business), the leader within (creating the leader in yourself), and the art (leading the people). These domains can be helpful in determining developmental needs through self-assessments when no formal leadership development plan exists.13 You can use the data generated to create opportunities such as on-the-job training, mentoring, staff development programs, continuing education, and career ladders for leader development and/or succession planning.


Another tool used to identify future nurse leaders is the Growth Factor Inventory (GFI).9,14 You can use the GFI indicators to design leader development and succession planning opportunities for individuals who demonstrate a readiness to lead and/or the propensity to become a leader.9 Through cooperative collaboration between practice and education, leader development plans can be developed that include training, retraining and/or retooling, and mentoring.


Healthcare organization should be intentional with regard to identifying potential leaders, directing necessary resources, and investing in leader development initiatives.9 Ensure that the needed resources and time are available to aspiring leaders. By providing these, along with the aforementioned resources, the nurse leader creates and supports an environment for leader development and succession planning.


In the black

When healthcare organizations focus on recruitment and retention, education and training, and leader development and succession planning, the return on investment is substantial. The strategies identified in this article provide the nurse leader with tools and ideas to facilitate a successful recruitment and retention plan and wise investment choices. Moreover, a well-planned education and training program enhances leadership development and supports succession planning.




1. Mayhew R. Recruiting strategies for nurses. [Context Link]


2. Greenberg A. Innovative recruiting strategies for 2014. [Context Link]


3. Jones CB, Gates M. The costs and benefits of nurse turnover: a business case for nurse retention. [Context Link]


4. Wood D. Top retention strategies for keeping the best nurses in the profession. [Context Link]


5. American Nurses Association. ANA reaffirms commitment to BSN for entry into practice. [Context Link]


6. Rambur B, McIntosh B, Palumbo MV, Reinier K. Education as a determinant of career retention and job satisfaction among registered nurses. J Nurs Scholarsh. 2005;37(2):185-192. [Context Link]


7. American Association of Colleges of Nursing. The impact of education on nursing practice. [Context Link]


8. Porter S. Nursing educational levels and positive patient outcomes. [Context Link]


9. Holland C. Practice and education: partnering to create a pipeline of nurse leaders. Nurs Manage. 2015;46(1):8-10. [Context Link]


10. The future of the associate degree in nursing program. [Context Link]


11. Kelbach J. ADN vs. BSN-the big debate. [Context Link]


12. Foundation for Nursing Excellence. Regionally increasing baccalaureate nurses (RIBN) project. [Context Link]


13. Sherman R, Pross E. Growing future nurse leaders to build and sustain healthy work environments at the unit level. [Context Link]


14. Hay Group. Growth factor inventory (GFI). [Context Link]