1. Vaughn, Rebecca M. Gunnar RN, MSN

Article Content

The Two-Factor Theory of Motivation reveals that job satisfiers relate to job content (achievement, educational enhancement, professional status, and the work itself) and that job dissatisfiers relate to job context (work conditions, salary, company policies, interpersonal relations).1 In this theory, the satisfiers are labeled "motivators" and the dissatisfiers "hygiene factors".2 The hygiene factors prevent job dissatisfaction, while the motivators lead to overall job satisfaction. Although the hygiene factors don't directly motivate, they're a necessary base to prevent dissatisfaction, while serving as a starting point for motivation.3 When creating a retention strategy for your unit, consider some of these creative motivators to keep your staff productive and satisfied.


Enhanced education

Offer classes on a regular basis and utilize your staff in developing and presenting the specific information. It's important that these classes are offered to each shift and department, and that RNs receive reimbursement for their time.


Nurses often experience frustration due to a lack of education related to various procedures or diagnostic tests that patients undergo off the unit. On a quarterly basis, hospitals such as Research Medical Center, Kansas City, Mo., incorporate RN visits to other departments or divisions such as nuclear medicine, x-ray, cardiac catheterization labs, and intravenous therapy for a day of education, observation, and practice. These visits count as a scheduled day of work for the RN.4


Breakfast group meetings provide another interesting strategy for delivering education while promoting a level of comfort for collaboration between RNs and specialized physicians, such as cardiologists. One morning per week, staff RNs from the cardiac telemetry unit at North Kansas City Hospital, Kansas City, Mo., congregate in a classroom and receive a content-specific presentation by one of the hospital's cardiologists, followed by breakfast for the participants.5


Room to grow

Professional status includes autonomy, workplace involvement, and collaboration, as demonstrated by the nursing profession.6 Nursing administrators and managers at Ben Taub Hospital, Houston, Tex., encourage retention by granting authority to RNs in critical decision-making. This practice is referred to as the "Universal Application of Standards without Favoritism."7 In the event that an RN fails to follow a policy, the organization provides verbal and written support if the decision was made in the best interest of the patient. Also, administrators place a commendation letter in the RN's permanent file when he or she makes a sound, critical decision and colleagues recognize it.


Charleston Area Medical Center, Charleston, W.Va., reports a widespread increase in RN autonomy through its Career Ladder program, a type of differentiated nursing practice model.8 RNs hold positions consistent with their individual experience and education levels (Level I-new graduate to 6 months with BSN degree and RN license; Level II-6 months to 2 years with BSN degree; Level III--2 or more years with BSN degree; Level IV--2 or more years with MSN degree). As a result of appropriate placement, the administration encourages RNs to achieve autonomy and a sense of comfort at each level of the ladder before advancing to the next. Annual RN surveys demonstrate a significant increase in job satisfaction from this program. In addition, a management survey indicated that units with RNs advancing on the career ladder demonstrated improved patient outcomes and decreased rates of staff turnover.


Motivated and dedicated

Among the numerous retention factors suggested by the Two-Factor Theory of Motivation, nurses most desire a sense of recognition and achievement. With or without a plentiful budget, managers can creatively develop motivators to give nurses the recognition they seek.




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