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  1. Kuhar, Peggy A. MSN, RN, CCRN
  2. Miller, Donna MSN, MEd, RN
  3. Spear, Brenda T. MSN, RN
  4. Ulreich, Shawn M. MSN, RN
  5. Mion, Lorraine C. PhD, RN


The present and projected shortage of registered nurses mandates that administrators implement workplace incentives to retain current staff. Although several articles and studies exist on job satisfaction among nurses, few have examined retention strategies. The authors developed, tested, and implemented a tool, the Meaningful Retention Strategy Inventory, in a multihospital system. Results from the Meaningful Retention Strategy Inventory were used to guide decisions in the implementation of site-specific retention strategies.


The United States is experiencing a nursing shortage that, unlike previous shortages, is multifactorial. 1-3 Increased demand for nurses resulting from patient needs, declining school enrollments, opportunities for nurses away from the bedside, and an aging workforce all contribute to the current shortage. 1-5 Unlike earlier nursing shortages, today's healthcare institutions are struggling with such issues as facilitating managed care contracts, restructuring care delivery models, and undergoing mergers of hospitals, nursing homes, and home care agencies into large healthcare systems.


In the early to mid-90s, many healthcare facilities restructured their care delivery and created new roles, for example, replacing registered nurses (RN) with unlicensed assistive personnel. 1,6,7 These changes have resulted in bedside RNs delegating more to lesser trained personnel and assuming more case management and technology-driven responsibilities. 6-8 Consequently, pressures associated with new roles, role conflict, lack of job security, and "tight" resources have emerged. 7,9


Healthcare providers perceive that the rapid and constant changes in the healthcare environment not only result in an increased workload but contribute to a lower standard of care. 7,10-12. Unfortunately, the conditions created in the previous decade may be aggravating the current RN shortage. 13 Finally, the acute care nursing shortage is also affected by the numerous opportunities for nurses to practice away from the bedside. For instance, the number of nurses in outpatient settings increased 25% between 1992 and 1996. 14


Focusing on staff retention has always been important from a leadership perspective; a single nurse replacement can cost the organization up to $44,000, and customer satisfaction is directly related to RN retention. 15-18 Retaining nurses at the bedside is even more critical today as the availability of nurses lessens. Although numerous factors have been linked to nurse turnover, low job satisfaction is the most frequently cited. 7,19-22 In an era of decreasing resources, increasing patient need, and continual cost constraints in healthcare, nursing administrators must use effective retention strategies.


Studies have surveyed staff nurses to determine aspects of the work environment that contribute to their job satisfaction and/or retention. Studies differed in conceptual frameworks, settings, samples, variables, and definitions, yielding conflicting results on several attributes that contribute to job satisfaction or retention. Nevertheless, the literature review yielded several common attributes associated with nurses' job satisfaction: autonomy, communication and interpersonal relationships, administrative aspects (eg, the structure of nursing or leadership style), recognition (both internal and external to the employment site), working conditions, professional practice, pay/benefits, and staffing/ scheduling issues. 16,19,22-36


Recently, authors have postulated that generational differences may affect the individuals' perceptions of important work environment components. 37,38 The Silent Generation, born between 1926 and 1945, has been characterized as a group greatly influenced by patriotism and self-sacrifice, known to be hardworking, dedicated to its purpose, and that rarely makes career changes. 38,39 The Baby Boomer generation, at 76 million strong, comprises the largest percentage of the nursing workforce. 39 Attributes of this generation include thriving for instant gratification, believe in buy-now pay-later, find mixed religious traditions for themselves, and are eager to learn a new skill for higher pay. 37 As compared to the Silent Generation, Baby Boomers are more likely to aspire to retire in their 50s rather than in their 60s. 40 Generation X individuals are estimated at 41 million. 39 This generation believes that they have received less than the Baby Boomers, for example, healthcare benefits. Generation X individuals focus on a form of fundamentalism: believing in themselves; many will have several career tracks throughout their life and believe in having a diverse skill set. 39