Chapter 1: Introduction
Problem background
Turnover among the nursing staff is an issue that severely impacts the performance and profitability of medical institutions. Any institution within the pharmaceutical sector usually needs highly trained, fully committed and stable nursing staff to offer adequate medical care to their clients. Despite the greater need for more nurses, the current rate of nursing turnover is still alarming (Barbato, 2013). It is assumed that the problem of nursing turnover will even increase within the next few years, as growth in the healthcare industry continues to outnumber the supply of nurses who are present at the current times. It is roughly approximated that there will be at least one million shortages of nurses within the US by 2020.
Literature indicates that employee retention is a crucial measure for establishing the fiscal and the general health of an institution. Any dynamic within the place of work that drives a higher turnover rate among the employees should always be modified at its earliest time. Employers within the healthcare institution who fail to make assessment of the seriousness of employee turnover are boycotting very essential resources in the institution that have negative impact on the overall financial interests of the institution, the whole process of nursing care, patient care, and positive healthy working environment for both the patients and staff (Barbato, 2013). For example, it is approximated that nursing staff turnover accounts for more than 5% of the total working budget of Kaiser Permanente Hospital and this is always compelled with loss of a very instrumental group of nursing staff. The literature demonstrates that having a better working environment between employees and top organizational leadership can reduce the nurse turnover rate (Choi & Ahn, 2016). The leadership can do this by improving the perception
concerning employees’ engagement, organizational support, team cohesion and lastly, connection to the mission of the medical institution.
Problem statement
Nursing staff retention in the healthcare industry is of great concern. The high turnover rate of these professional workers has posed significant challenges to healthcare institutions and other agencies who are concerned with healthcare. Nursing is an academic discipline and profession whose primary goal is to improve the quality of life and wellbeing of individuals, groups, community and the entire population. They perform this role through direct practice, organizing the communities, policy, research, teaching, and crisis interventions. Their analysis and methods are always concerned with the counseling, social policy, psychotherapy, social program evaluation, and community development (Hoch, Bommer, Dulebohn & Wu, 2016). The practice of professional nursing means undertaking acts which need a functional level of judgment, knowledge, as well as skills in nursing, all based on physical, biological and social sciences. The scope of practice as a licensed nurse is to maintain health, promote wellness, and prevent diseases or illness from members of the community.
Despite the expectation to perform all these crucial roles, there have been high cases of turnover among nursing employees. The retention rate is so low while the percentage of people who are planning to leave the profession continues to increase day by day. Several research articles have shown that more than 43 percent of nurses in community mental health departments and 39 percent of nurses in family services are very likely to leave their jobs within the next two years. The findings also report that there is a 50 percent yearly turnover rate among mental health nursing workers at the community, and over 60 percent turnover rate each year among the general human services nursing workers (Hoch, Bommer, Dulebohn & Wu, 2016).
Retention of nursing staff is a very critical affair that must be given the priority within healthcare institutions, considering the essential roles that such nurses usually play in offering appropriate health care. The literature demonstrates that the present rate of nursing turnover has a severe impact not only to the nurses themselves but also to the organization and the patients. Nurses are not only considered as vital stakeholders, but they play essential functions in the daily running of healthcare institutions. Without having higher retention of nurses, not even a single healthcare organization can be in a position of achieving its intended objectives (Jaramillo, Bande & Varela, 2015). Nursing turnover has a human cost that is strongly linked to poor quality of care received by the patients, poor communication among the individual healthcare providers, poor outcome among the patients, higher level of medical errors and reduced HCAHPS scores, accompanied with increased inpatient mortality and nurse burnout. Most institutions, including Kaiser Permanente Hospital, report that nurses only remain within their organizations for a maximum of two years. It has become seriously challenging for the institution to retain some of her best nurses.
The goal of any healthcare organization is always to reduce staff turnover, as this will subsequently reduce the total fiscal expenses that are paid out to recruit and train the less skilled nurses and consequently save the healthcare institutions millions of avoidable costs. It is essential for healthcare organizations to improve their overall productivity, efficiency and nursing staff retention for them to remain more relevant in the healthcare industry (Laschinger & Fida, 2014).
Nursing staff usually leave as a result of several reasons. Some of these reasons include ambiguous and unchallenging roles, poor supervision, inadequate peer support, not being recognized at the workplace, limited career growth, limited work control, lack of equity in
payments and promotions among the employers as well as existence of favorable opportunities in some other sectors or institutions. It is, however, important to note that such organizations are usually at a complete loss when these employees decide to leave. Laschinger, Read & Zhu (2016) points out the need for health institutions to take into account employees retention strategies so that an individual stays within the organization for the highest period possible. With a high number of opportunities existing elsewhere, it has always been tough for companies like Kaiser Permanente Hospital to hold their nursing employees for a more extended period. Losing such employees means losing capital, skills, knowledge, together with experience.
For the case of Kaiser Permanente Hospital, there had been a constant pressure from the management of the few nurses to perform very complex services within difficult conditions at the hospital. Moreover, the nurses are always required to work under strict instructions from their supervisors. The nurses are never happy with that since supervisors always treat them with minimal respect. The nurses are facing numerous difficulties in managing their frustrations at work, but the management has failed to recognize this. The administration has an attribution error of believing that nurses must work under the orders of the top leadership of the hospital. This has always resulted in nurses developing negative comments, aggressive talks, and sarcasm about the administration. Nurses are ever complaining and would only work when the supervisors are around. When the supervisors/ management are not there, they will engage themselves in talks and discussions. This situation has witnessed several nurses leaving their employment with the hospital as they seek for places with better working conditions elsewhere.
Practice Change, Quality Improvement, or Innovation
There is a great need for practice change and quality improvement for nursing staff to realize their high retention rate. Unless there is practice change, Kaiser Permanente Hospital will
continue experiencing retention problems as more nurses continue to leave. It is firmly believed that the low retention rate at the hospital is directly associated with poor leadership style. With the change in leadership practices, the retention rate of nursing staff will most likely be enhanced. The goal of Kaiser Permanente Hospital, in this case, should be reducing nursing staff turnover rates. This has to begin with the top leadership of the healthcare institutions. The senior administration must always address the individual concerns and challenges faced by nurses on time so that the professionals can have the ability to effectively serve the patients when they are equally satisfied with their working environment. An in-depth review of the literature on staff turnover offers suggestions that nurse staff retention can quickly be realized through effective leadership that also empowers the individual nurses (Laschinger, Read & Zhu, 2016). The present paper seeks to demonstrate how authentic leadership can greatly improve nursing staff retention. There will be a PowerPoint presentation on the known positive effects of trustworthy administration on nursing staff retention. This project will be implemented at the Kaiser Permanente Hospital. The clear focus will be placed on the characteristics of authentic leadership and how such leadership techniques can be used to ensure higher nursing staff retention.
The rationale for the Practice Change, Quality Improvement, or Innovation
It is clear that the current high employee turnover rate does not imply well with consistency, quality, and stability of services provided to the people who use nursing services. Turnover can have detrimental effects on staff members and clients who have remained to give
and receive quality services when senior positions have been vacated and are filled with new personnel (Parkes & Davis, 2013). Moreover, the high turnover rate is likely to cause mistrust of the clients to the system and at the same time can demoralize other workers from remaining or entering into the field. Kaiser Permanente Hospital has recently been experiencing a high rate of
nursing staff turnover, with the primary causes being associated with poor organizational conditions (organization culture and fairness on matters of compensation), and poor leadership styles leading to low morale among the nurses. The proposed solution for this problem is to take the top leadership of Kaiser Permanente Hospital to one-month training on an aspect of authentic leadership styles. The literature demonstrates that authentic leadership can help improve the level of staff retention within an organization. Genuine kind of leadership in healthcare institutions strongly encourages active participation and full engagement of all the staff within the organization, which subsequently lead to higher retention rate and active involvement of employees in the organization (Regan, Laschinger & Wong, 2016). Presentation and training on the positive impacts of the authentic type of leadership on employee retention will, therefore, be of higher value to the upper command, patients and nurses at Kaiser Permanente Hospital.
Chapter 2: Literature Review
Credible Sources
The general process of developing this capstone did involve a systematic review of relevant literature on the topic of the influence of authentic leadership and empowerment on nursing staff retention level. The article was generated by first entering relevant keywords into the system or the network to search databases that have important journals and reports on the topic of capstone problem.
The researcher searched for different peer-reviewed articles from different databases which included: Google Scholar, EBSCOhost, Medline, PubMed, ERIC and Academic OneFile. Different keywords were used in searching. Words like "authentic" and "Leadership" were separately entered into the databases for retrieving relevant articles. Additional search with all the three words put together "authentic leadership” was later used to produce more relevant results. When the word “authentic" was typed in the databases, it generated numerous irrelevant articles that required adding the words "authentic leadership” where it generated more than 100 results. Most of the results generated from the databases discussed leadership without containing the aspect of authentic leadership in the healthcare industry. Only 38 articles had part or whole of their content discuss authentic leadership and how it is essential in the healthcare industry. Out of the 38 items, eight items were excluded from the study because they contained information that was older than five years from the time of publication. A total of 30 scholarly works of literature were generated and used. A table summary of these credible sources is shown in table 1 below
Table 1 illustrating the summary of credible sources
|
Author(s) (Formatted as an in-text citation) |
Database (CINAHL, EBSCO, Cochrane, Pro Quest) |
Peer Reviewed (Yes/No) |
Applicability (Yes/No) |
Evide nce Grad e (Stren gth/ Hiera rchy) |
Appraisal (Summary of findings; how findings inform your project?) |
Inclusion (Yes/No) |
|
(Burke, Flanagan, Ditomassi & Hickey, 2017). |
EBSCO, |
Yes |
Yes |
4/ Cros s secti onal |
Developing an authentic leadership in healthcare institutions will assist such institutions in experiencing a higher level of staff retention. My project focuses on implementing authentic leadership to improve nurse staff retention. |
Yes |
|
(Fisher, Jabara, Poudrier, Williams & Wallen, 2016) |
Google scholar |
Yes |
Yes |
4/ Cros s secti onal |
Authentic leadership within healthcare institutions involves pro-engagement and active participation, which subsequently results in higher retention and involvement of employees in a productive manner into the activities of the company. My project focuses on implementing authentic leadership to improve nurse staff retention. |
Yes |
|
(Laschinger, Borgogni, Consiglio & Read, 2015). |
EBSCO, |
Yes |
Yes |
5/Me ta Synt hesis |
Improper style of leadership when accompanied by lack of employees’ empowerment usually results in low productivity and a higher rate of |
Yes |
|
|
|
|
|
|
turnover of the employees. My project focuses on how to improve employees’ empowerment to improve nurse staff retention. |
|
|
(Laschinger, Wong & Grau, 2012) |
Cochrane, |
Yes |
Yes |
4/Cr oss secti onal |
Authentic leadership always plays a significant role in championing for the employees’ loyalty at the place of work. My project focuses on implementing authentic leadership to improve nurse staff retention. |
Yes |
|
(Lea & Cruickshank, 2017) |
Cochrane, |
Yes |
Yes |
4/Cr oss secti onal |
Lower turnover rate of nurses can easily be achieved when there are stronger employer employee relationships, and this can only be triggered by the presence of authentic leadership at the institution. My project focuses on implementing authentic leadership to improve nurse staff retention. |
Yes |
|
Nelson, Boudrias, Brunet, Morin, De Civita, Savoie & Alderson, 2014) |
EBSCO, |
Yes |
Yes |
4/Cr oss secti onal |
Proper leadership and employees’ engagement are essential in ensuring higher staff retention rate. My project focuses on implementing proper administration to improve nurse staff retention. |
Yes |
|
(Nikstaitis & Simko, 2014) |
EBSCO, |
Yes |
Yes |
4/Cr oss secti onal |
The duty of ensuring that there is a highly motivated nursing staff that is willing to stay within the organization falls squarely on the |
Yes |
|
|
|
|
|
|
top organizational leadership. My project focuses on motivating nursing staff to improve nurse staff retention. |
|
|
Read & Laschinger, 2015) |
EBSCO, |
Yes |
Yes |
4/Cr oss secti onal |
Authentic leadership, as well as structural empowerment, has an effect on the mental health of staffs as well as job satisfaction for the nurses who had recently graduated. My project focuses on implementing authentic leadership and staff empowerment to improve nurse staff retention. |
Yes |
|
(AbuAlRub & Nasrallah, 2017) |
EBSCO, |
Yes |
Yes |
4/Cr oss secti onal |
Authentic leadership, as well as employees’ empowerment, is very crucial in providing a favorable environment for graduate nurses. My project focuses on implementing authentic leadership and staff empowerment to improve nurse staff retention. |
Yes |
|
(Frederick, 2014) |
EBSCO, |
Yes |
Yes |
4/Cr oss secti onal |
Authentic nurse leaders will always improve team morale and hence retain the nurses. My project focuses on implementing authentic leadership to improve nurse staff retention. |
Yes |
|
(Van den Heede, Florquin, Bruyneel, Aiken, Diya, Lesaffre & Sermeus, 2013) |
Google scholar |
Yes |
Yes |
5/Me ta Synt hesis |
Adequate care of nurses is an essential factor towards ensuring their retention. My project focuses on how to retain nursing professionals. |
Yes |
|
(Lavoie‐ Tremblay, Fernet, Lavigne & Austin, 2016) |
EBSCO, |
Yes |
Yes |
4/Cr oss secti onal |
Transformational leadership styles always have a very positive influence on the functioning of the employees. My project focuses on implementing authentic leadership to nursing staff. |
Yes |
|
(Brewer, Kovner, Djukic, Fatehi, Greene, Chacko & Yang, 2016) |
Cochrane, |
Yes |
Yes |
5/Me ta Synt hesis |
The absence of leadership support is one of the main reasons why nurses would always wish to leave. My project focuses on implementing authentic leadership to improve nurse staff retention. |
Yes |
|
(Laschinger, Wong & Grau, 2013) |
EBSCO, |
Yes |
Yes |
5/Me ta Synt hesis |
Authentic characters senior nursing leaders are very much crucial to the general perception of the nurses of being empowered structurally and are most likely to lead into a very higher retention rate. My project focuses on implementing authentic leadership and staff |
Yes |
|
|
|
|
|
|
empowerment to improve nurse staff retention. |
|
|
(Fallatah, Laschinger & Read, 2017) |
Google scholar |
Yes |
Yes |
4/Cr oss secti onal |
Authentic leadership always has more significant effects on the personal identification of nurses. My project focuses on implementing authentic leadership in the workplace. |
Yes |
|
(Blake, Leach, Robbins, Pike & Needleman, 2013) |
EBSCO, |
Yes |
Yes |
4/Cr oss secti onal |
Personal identification, directly and indirectly, has a positive relationship with the intention of nurses to leave the job. My project focuses on empowering staff to improve their retention rate. |
Yes |
|
(Blake, Leach, Robbins, Pike & Needleman, 2013) |
Cochrane, |
Yes |
Yes |
4/Cr oss secti onal |
Authentic leadership plays a vital role in ensuring a higher retention rate of new graduate nurses. My project focuses on implementing authentic leadership to improve nurse staff retention. |
Yes |
|
(Al‐Hamdan, Nussera & Masa'deh, 2016) |
EBSCO, |
Yes |
Yes |
4/Cr oss secti onal |
Authentic leadership always increases the confidence that new graduate nurses have on their abilities to manage challenges associated to nursing roles, which subsequently impacts the moral view of new graduate nurse and the willingness to stay. My project focuses on implementing authentic leadership to improve nurse staff retention. |
Yes |
|
(Rodwell, |
Google scholar |
Yes |
Yes |
4/Cr |
Nurse leaders who have a |
Yes |
|
McWilliams & Gulyas, 2017) |
|
|
|
oss secti onal |
stronger understanding of social exchange within the place of work are usually most likely to retain very many numbers of staffs who are working under them. My project focuses on implementing authentic leadership to improve nurse staff retention. |
|
|
Laschinger & Smith, 2013) |
EBSCO, |
Yes |
Yes |
4/Cr oss secti onal |
Interprofessional relationships are the best ways for the project participants to benefit from the project and to realize the intended impact or outcome of the project. My project focuses on interpersonal relationships required of authentic leadership to improve nurse staff retention. |
Yes |
|
Bridges, Davidson, Soule Odegard, Maki & Tomkowiak, 2011) |
Cochrane, |
Yes |
Yes |
4/Cr oss secti onal |
Interprofessional learning always increases the general understanding of the learners and in the end, promote the collaborative approach of practice within the institution, leading to the positive outcome of the project. My project focuses on interpersonal relationships required of authentic leadership to improve nurse staff retention. |
Yes |
|
(Waite, McKinney, Smith-Glasgow & Meloy, 2014) |
EBSCO, |
Yes |
Yes |
4/Cr oss secti onal |
An ever-growing shortage of qualified nurses has always led into some sorts of a steady rise in the rate of turnover among the nurses. My project focuses on |
Yes |
|
|
|
|
|
|
how to improve nurse staff retention |
|
|
(Aamir, Hamid, Haider & Akhtar, 2016) |
EBSCO, |
Yes |
Yes |
4/Cr oss secti onal |
Poor leadership results in high nurse turnover. My project focuses on authentic leadership to improve nurse staff retention |
Yes |
|
(Lartey, Cummings & Profetto‐ McGrath, 2014) |
Google scholar |
Yes |
Yes |
5/Me ta Synt hesis |
Employers in health institutions who fail to assess the seriousness of the employee turnover are somehow neglecting significant resources for the organization that negatively impact on the institution’s financial interests. My project focuses on the benefits of authentic leadership in improving nurse staff retention |
Yes |
|
(Nei, Snyder & Litwiller, 2015) |
EBSCO, |
Yes |
Yes |
4/Cr oss secti onal |
Hospital staffing turnover is responsible for more than 6% of the total working budget of the hospital and is always compelled with the loss and needed replacement of equally qualified nurses who might have left the organization. My project focuses on the benefits of authentic leadership in improving nurse staff retention. |
Yes |
|
(Collini, Guidroz & Perez, 2015) |
Cochrane, |
Yes |
Yes |
4/Cr oss secti onal |
Creating a conducive working environment, more also between the top leadership and members of staff will usually generate a stronger deterrent to the already existing nurses who might be having the intention of leaving |
Yes |
|
|
|
|
|
|
the organization. My project focuses on the benefits of authentic leadership in improving nurse staff retention |
|
|
(Barbato, 2013) |
EBSCO, |
Yes |
Yes |
5/Me ta Synt hesis |
Retention of the nursing staff is a very much essential phenomenon within a healthcare organization, taking into consideration the vital roles that are played by nurses in offering healthcare. My project focuses on how to improve nurse staff retention |
Yes |
|
(Fallatah, Laschinger, & Read, 2016) |
Google scholar |
Yes |
Yes |
4/Cr oss secti onal |
The present nurse turnover has a severe impact on the patients and nurses of the institution. My project focuses on how to minimize staff turnover rate. |
Yes |
|
(Fallatah et al., 2016). |
EBSCO, |
Yes |
Yes |
4/Cr oss secti onal |
Turnover of nurses has a human cost that is linked directly to the low quality of care that the patients get, poor outcome among the patients, poor continuity of care, poor communication among health care providers and, medication errors. My project focuses on the benefits of authentic leadership in improving nurse staff retention. |
Yes |
|
(Parkes & Davis, 2013) |
Cochrane |
Yes |
Yes |
4/Cr oss secti onal |
The top organizational leadership must handle all the individual concerns and challenges faced by nurses working under them from time to time so that they can continue to care for the patients while feeling heard efficiently and equally satisfied with their working environment. My project focuses on implementing authentic leadership to improve nurse staff retention. |
Yes |
Chapter 3: Influence of Leadership Style on Staff Nurse Retention
Leadership has been widely researched in various behavioral sciences. The broad research here is because the success of social, economic, and organizational systems usually depends on the general efficiency and effectiveness of the guidance that leaders provide. Organizations are traditionally classified as social frameworks within which human resources are considered as the essential components for effectiveness and proficiency. Great leadership has received considerable attention within the popular press, and renowned authors on organizational management have discussed its benefits on organizational performance and employee satisfaction and retention. Literature conceptualized great leadership as a way of life and not as a management technique. Perhaps this has slowed the overall acceptance of this leadership theory in academia. Organizations always need great leadership together with employees who are highly satisfied for them to accomplish their goals. By registering some individual capabilities, abilities, and authorities, it is expected of leaders to have a higher capacity of developing a more clear leadership style to help the organizations realize their intended objectives.
Using a sample of 520 staff nurses, Lartey, Cummings & Profetto‐McGrath (2014) did
examine if psychological empowerment mediated the effects that transformational leadership has on the general organizational commitment. The study also examined the structural distance between the leaders and the immediate followers moderated the relationship which is there between transformational leadership and overall organizational commitment. The cross-sectional study design was used in this case, with the result from HLM analysis showing that
psychological empowerment to mediate the relationship which is there between transformational leadership and overall commitment of the employee to the organization.
Existing evidence has also shown that transformational leadership is positively correlated with work behaviors and attitudes at both the organizational and individual level. It is important to note, however, that the process and mechanisms through which transformational leaders exert their influence on the performance and motivation of their juniors are yet to be adequately addressed by the existing literature. It is noted that indeed, there is a great need for much attention being put forward to understand the general process and mechanisms through which transformational leadership tends to influence the attitude of employees and their subsequent intention to remain at the place of work. Literature indicates that one organizational and personal factor that affects organizational performance and subsequently the purpose of the employees to continue staying in the organization is a commitment by leadership. Transformational leaders influence the commitment that junior nurses have towards the organization by encouraging the aspect of critical thinking and involving them in essential decision making — a direction that answers to the desire of the junior nurses to experience very minimal cases of nurse turnover. Such views had been supported by the previous study which indicated that organizational commitment is higher among nurses whose leaders encourage the aspect of participation in the whole process of decision making.
In transformational leadership, for instance, “the main motivational forces rely on the desire to treat members of an organization with the greatest dignity they deserve.” Frederick (2014) stated that most health institutions in the US practice transformational leadership at all times. This leadership style is based on “giving supportive support and being involved with the people.” Hence, most managers use transformational leadership to impact the wellbeing of their
employees effectively. Blake, Leach, Robbins, Pike & Needleman (2013) defines leadership culture of an organization as “necessary for the successful development and growth of a modern institution.” They describe the four primary constructs associated with transformational leadership in an organization: (1) persuasive mapping, (2) emotional healing, (3) altruistic calling, and (4) transparency.
Al‐Hamdan, Nussera & Masa'deh (2016) carried out a study to describe the perceptions
on managerial leadership behaviors that are related to the staff nurse turnover and to make a comparison of the nurse manager leadership behaviors as assumed by the nurses as well as nurse managers. The descriptive, correlational study, in this case, was carried out at a 465-bed community hospital in the north of the United States. All the staff nurse managers that had been employed in both the ambulatory and acute care nursing units were called together to take part in the study. It is worth to note that the study sample, in this case, did comprise 79 staff nurses as well as ten nurse managers, who helped in completing demographic forms together with 45-item Multifactor Leadership Questionnaire, which did measure 12 different dimensions of the style of leadership. Data used in this study were all collected from July to September 2015. The study results have shown that having effective leadership styles on the side of nurse managers are strongly associated with the general satisfaction of staff nurses and their subsequent willingness to be retained. Even though both transactional and transformational leadership styles have been broadly described as effective, it is not very clear which nurse manager leadership behaviors have the highest contribution to staff nurse retention. AbuAlRub & Nasrallah (2017) conducted descriptive correlational research at an around 465-bed community hospital in the United States.
All the staff nurses and the nurse managers who had been employed in both acute and ambulatory acute care nursing units were called upon to take part in the study. The overall findings revealed that active management on the side of nurse leadership was seriously associated with the total nurse turnover. The investigation showed that managers with transactional leadership style tend to motivate the nurses working under them and such nurses will consequently be willing to remain working.
Such arguments are supported by Aamir, Hamid, Haider & Akhtar (2016) who suggest that in an era when the nurse manager is both responsible for and critical retention and performance, the style of leadership is essential towards achieving better outcomes. The authors, in this case, argue that transformational leaders tend to move beyond the management to staff motivation. In such, nurse managers who pose the characters of transformational leadership will get more nurse staff retained than those who do not have such leadership characteristics. It has equally been noted that staff nurse who perceive their managers to be transformational usually demonstrate very high organizational commitment (Brewer et al., 2016). As transformational leaders are seen to be highly effective, the performance standards of nurse managers are usually rooted within transactional characteristics. Further literature has recognized the leadership skills and the abilities that nurse managers have as a contributing factor to the staff retention.
For instance, the first-line nurse manager who is positioned at the proximity to the work itself and to the nursing staff who is engaged in care of the patient can have more significant impact on the general work environment and willingness of the nursing staff to continue being retained at their places of work (Bridges, Davidson, Soule Odegard, Maki & Tomkowiak, 2018).
Burke, Flanagan, Ditomassi & Hickey (2017) clarifies that staff retention in the nursing profession is usually impacted on by the inner environment of the organization. The situation in this case mainly has workforce leadership. Leaders who are capable of persuading their employees or appropriately coordinating them are more likely to have highly satisfied nurses who are willing to continue working in the organization. Such leaders will be rewarded with a high level of faithfulness and execution of the jobs assigned. Successful and great leaders usually matter to the general prosperity of the employees they are leading and the whole organization that they are running (Wallis & Kennedy, 2013). Literature has always argued that compelling leadership is a foundation for life, more so also when it makes the organization to progress (Waite, McKinney, Smith-Glasgow & Meloy, 2014). The style of leadership within an organization also performs an essential function in actually determining the level of satisfaction among the members of staff.
Studies have shown that great leaders always take their time to offer good direction to all staff within the organization. Waite, McKinney, Smith-Glasgow & Meloy (2014) has pointed out further that strategic leaders will communicate their individual decisions in respect of what they want the organization to achieve in future. Great leaders come up with strong goals and strategies, having the much-needed competency for the success of their organizations. Such group of leaders usually strives towards serving the interest of the company together with that of the employees. Effective leaders have to be in the very clear position of handling issues raised by their nursing staff (Van den Heede et al., 2013). Scholars assume that it is this type of leadership that always promotes a higher level of satisfaction among the individual nursing employees and a subsequent higher rate of staff retention. It also promotes the loyalty of the employees and their effectiveness at the places of work.
Rodwell, McWilliams & Gulyas (2017) clarifies that job satisfaction and motivation among the employees is usually impacted on by the inner environment of the organization. The environment in this case mainly has workforce leadership. Leaders who are capable of persuading their employees or appropriately coordinating them are more likely to have highly satisfied and motivated staff nurses (Regan, Laschinger & Wong, 2016). Such leaders will be remunerated with a high level of faithfulness and execution of the jobs assigned. Successful and great leaders usually matter to the general prosperity of the employees they are leading and the whole organization that they are running. Literature has always argued that compelling leadership is a foundation for life, more also when it makes the organization to progress (Regan, Laschinger & Wong, 2016). The leadership style within the organization equally plays essential functions in helping to determine the amount of motivation among the individual nursing employees.
Read & Laschinger (2015) carried out a study to examine the effects that leadership styles have on organizational commitment. Samples were taken from Australian and Hong Kong managers. The study reported statistically significant differences between the two samples for measures of innovative leadership and commitment as well as retention of the employees, with Australia sample being recorded as having higher means scores in all the variables. It is worth to note, however, that innovative and consideration leadership styles tend to have positive effects on both employee’ commitment and job satisfaction, with the impact of consideration leadership style on commitment being reported as strong among the Australian sample. The same study said that an initiating structure style of leadership had a sort of adverse effect on the overall job satisfaction of both examples.
Nikstaitis & Simko (2014) examined the impact that employees’ perceptions of their immediate supervisors’ supportive and directive leadership behaviors and the various types of general organizational commitment in health institutions found in Malaysia. The study utilized a survey strategy “self-administered questionnaire” to collect primary data (Nikstaitis & Simko, 2014). The sample of the targeted population comprised 300 supervisors as well as employees who come from different health institutions within Malaysia by using non-random sampling method to take part in the study. The overall statistical results revealed that there was a significant strong association between nurse behavior and leadership behavior. Additionally, the study reported great impacts of the specific leadership behavior on the willingness of the staff nurses to be retained in their places of work.
Chapter 4: Nurse Retention As A Result Of Transformational Leadership
Nurses are not only considered as vital stakeholders but play essential roles in the daily operations of any healthcare institution. Without a higher rate of nurse retention, not even one single health organization can be able to realize its perceived objectives. Several organizations currently report that nurses tend to remain at the organizations only for a limited period, mostly 18 to 24 months 27 (Nelson et al., 2014). It has become a great challenge for different health institutions; even the academic teaching hospitals to retain some of their best’s nurses in the profession without keeping them empowered and engaged in their essential duties. As the shortage of nurses continues to grow with the retirement of baby boomers, organizations are taking severe measures to reduce nursing staff turnover rates. The reduction of turn-over rates among nurses would significantly lessen the known fiscal expense that is paid out to recruit and train the less skilled nurses and subsequently, save the organization millions of unnecessary costs
(Nei, Snyder & Litwiller, 2015). It is essential for the organizations to ensure higher productivity, efficiency, and retention of the nursing staff.
For healthcare organizations to improve the retention rate of their nursing staff, there is an urgent need for changing the existing practice, both at the organizational and unit level. This starts right from the top leadership within the healthcare institution. It is the work of senior leadership to address the individual concerns and challenges that their nurses tend to face on their routine basis so that they can continue caring for the patient as they feel satisfied with their work environment (Nei, Snyder & Litwiller, 2015). A critical literature review on staff turnover suggests that retention of nurse staff can quickly be realized via effective leadership that tends to empower the individual nurses.
Nurses always leave their organizations of work due to some reasons like ambiguous and unchallenging roles, poor leadership, lack of recognition, and lastly, favoritism and limited opportunities for individual growth. However, a loss of a nurse, irrespective of the cause for leaving employment might cause a significant impact on the entire organization. Leroy, Anseel, Gardner & Sels (2015) stress on the fact that leadership in healthcare organizations need to prioritize employee retention strategies to help retain staff within the organization for an as long period as possible.
Nursing functions are very much exhausting, both mentally and physically, resulting in high cases of frequent burnout, low morale, and eventually increased turnover. There is strong evidence that psychological and emotional support from the top leadership can be motivating factors towards easing all sorts of stress acquired when handling the patients (Lea & Cruickshank, 2017). Scholarly evidence demonstrates that support given by top management to
the nursing staff can significantly reduce the turnover rate among such nurses. People who achieve personal satisfaction or comfort from their immediate supervisors are least likely to leave their job and profession while those who lack personal satisfaction are more likely to leave the organization for greater monetary compensation. Study findings have also shown that employees who are usually in the conflict between their professional values and the organizational values will most likely quit their jobs compared to those who do not have such conflicting values Weber, 2010). Those whom the organization’s values align with their values, needs, and desires are more apt to stay despite other co-workers leaving.
Lavoie‐Tremblay, Fernet, Lavigne & Austin (2016) carried out a study with the purpose
of exploring the relationship which is there between multidimensional leadership types and burnout among the nursing staff. The study, in this case, applied non-experimental study design in which data was collected from 601 nurses and the nurse managers who were working in different health care organizations. The authors found out that rewarding transformational leadership looks to be offering protection, especially from depersonalization. They further illustrated that active management tends to increase personal accomplishment on the side of employees. The study also reported that status of employment and the character of work tasks impacted on the connection which is there between organizational leadership and burnout among nurses. The study concluded that the relationship which is there between leadership style and exhaustion is very much complex in its whole nature, impacted by the situational factors of management leadership and the general ambiguous nature associated to fatigue. Nurses of different ages and at various stages of career development require varied types of leadership.
Laschinger, Wong & Grau (2013) on their part explored the relationship which is there between burnout among nursing staff and multidimensional kind of leadership. This study did use non-experimental survey design, involving several nurses. The study was a meta-analysis that was to determine the consistency of reliability estimates, together with evidence of relative construct validity of the existing ATS scores in different studies of RNs in the US. The search strategy did comprise of trying to access computerized databases, consulting relevant experts, emailing the researchers, and lastly trying to access reports which have not been published. The overall mean weighted effect size of reliability from the 12 relevant studies was reported to be 0.89. Again the overall MWES of validity that is correlating to ATS as well as some other four job satisfaction measures for seven different studies was found to be -0.53. The final results showed that leadership within a place of work significantly impact on the overall satisfaction of employees and their willingness to remain working for such organization. Nurses are not exceptional in this case.
Laschinger, Read & Zhu (2016) investigated the impact of transformational leadership on early career nurses’ intent to stay, organizational commitment and staff satisfaction. The author had purported that lack of proper leadership support is among the main reasons why a staff nurse would always wish to leave. By using cross-sectional study of nurses who had actually been licensed for around 7-8 years, with analytic samples of about 1030 national representative, the author reported that transformational leadership never had a significant impact on the intention to leave the job or satisfaction, but was strongly associated with the general organizational commitment on the side of the nursing staff. The researcher, in this case, used a probit model in modeling the relationship which is there between transformational kind of leadership and the overall intention of staying, job satisfaction and total organizational commitment.
The study also revealed that job satisfaction, organizational commitment, promotional opportunities, mentor support, and age were positively related to one’s intention to stay, while at the same time, the non-local job opportunities, as well as age, were positively associated with one’s intent to visit (Laschinger, Read & Zhu, 2016). The study, in this case, concluded that transformational leadership had no direct relationship with one’s intent to stay as well as job satisfaction but had a positive effect on the extent to which an employee is committed to the jobs they are doing (Laschinger, Read & Zhu, 2016). However, the same study noted that any improvement in job satisfaction, as well as organizational commitment, would in a positive manner increase the change in the chances of one’s intent to stay.
On his part, however, Laschinger & Smith (2013) noted that nursing leadership has a very significant impact on nurse retention rate. In their study to present an evidence review of determining the effect of transformational leadership on the overall burnout and satisfaction of the staff, the authors reported that transformational leadership is strongly associated with increased comfort, increased the well-being of the team, reduced amount of burnout, and decreased overall stress among the staff nurses.
Literature has indicated that organizational commitment entails three central attitudes: a sense of being identified with the individual goals of the organization, a feeling of getting involved in the duties of the organization, and lastly, a feeling of loyalty to the organization. Laschinger & Fida (2014) actually characterized commitment as a shared acceptance and belief of the goals and values of the organization and the general eagerness to move above and even beyond the call of duty so as to enhance the values and objectives of the organization, together with having great desire to maintain membership with the whole organization. The positive outcomes of the organizational commitment have been stated correctly in literature related to
management (Laschinger, Wong & Grau, 2012). Employees who are committed to their work are least likely to quit or even accept other jobs being offered to them. Such a group of employees is also less likely to be absent from work. The cost related to higher employees’ turnover and absenteeism is greatly avoided at all cost.
Chapter 5: Best Practices to Improve Nursing Staff Retention
Nursing staff low retention rate is one issue of great concern within the healthcare organization. The main reasons associated with a low retention rate of nurses are unavailable or poor leadership, lesser peer support, and lower level of satisfaction due to the absence of employee empowerment. The most appropriate practice hence is for the top leadership to gain some understanding and initiate some authentic skills of leadership that move a long way with the empowerment of individual staff members. Developing a style of leadership which is authentic in the organization assists in moving such organization towards a higher rate of employee’s retention (Burke, Flanagan, Ditomassi & Hickey, 2017). Literature affirms that authentic leadership within healthcare institutions is more of being pro engagements and taking an active role of members of staff within the organization, which led into higher retention rate and active involvement of the employees into the activities of the company. Evidence from the literature review has shown that improper style of leadership when accompanied with lack of employees’ empowerment usually results into low productivity and a higher rate of turnover of the employees (Laschinger, Borgogni, Consiglio & Read, 2015). Employees who are not empowered usually have the minimal commitment and will be ready to quit from the institution any time opportunity present itself.
Laschinger, Borgogni, Consiglio & Read (2015) has demonstrated that there is a strong relationship between authentic leadership training and staff retention (P. 81). Laschinger, Wong & Grau (2012) agrees with this statement by affirming further that authentic leadership usually plays essential functions in championing for the loyalty of employees within the place of work (P. 66). Employee’s loyalty usually boosts their morale, resulting in higher retention rate. Lea & Cruickshank (2017) on his side argues that higher rate of retention of individual nurses can only be achieved when there is a robust employer-employee relationship and such can just get triggered by the availability of authentic leadership within the institution (P. 176).
Moreover, employees’ empowerment can contribute very greatly to the nurses’ retention rate. Studied have shown that empowered nursing staffs will be more willing to remain working at the institution or in the unit where they have been deployed, unlike the staffs who feel not empowered. All these arguments confirm that proper leadership and employees’ engagement are essential in ensuring higher staff retention rate (Nelson, Boudrias, Brunet, Morin, De Civita, Savoie & Alderson, 2014, P. 90). The general aspect of authentic leadership training and empowerment should be implemented within all the institutions of healthcare to make sure that there is a higher level of retention among the employees. The overall responsibility of having a nursing staff who is highly motivated and willing to stay in the company falls squarely on the upper leadership of the organization (Nikstaitis & Simko, 2014, P. 293). The upper administration has to empower, motivate and develop all their nursing staff members to enhance their retention rate.
As had been mentioned, the proposed solution for a low retention rate of nursing staff at the Advanced Heart Failure Unit is for the unit’s top leadership to develop authentic leadership
characteristics, which will go a long way in empowering, motivation and improving the morale of nurses and hence, increasing the rate of their retention.
Chapter 6: Evidence Summary of The Literature
Read & Laschinger (2015) had examined the theoretical model that tested the effects that authentic leadership and structural empowerment had on staff’s mental health and job satisfaction for the new graduate nurses (P. 1611). The researcher, in this case, revealed that authentic leadership, as well as employees’ empowerment, is very crucial in providing a favorable environment for graduate nurses (AbuAlRub & Nasrallah, 2017). Authentic leaders create a structural empowerment work environment that fosters positive retention outcomes among the nurses. Frederick (2014) argues that authentic nurse leaders will always improve team morale and hence retain the nurses. Frederick (2014) points out that bullying on the side of leaders is the leading cause of instability in staff retention.
Mentoring of nurses will always allow the team to respond positively to any bullying scenario that they might have encountered. A mentoring culture, in this case, will always start with having an authentic leader who genuinely cares for and respects the employees. Evidence suggests that adequate care of nurses is an essential factor towards ensuring their retention (Van den Heede, Florquin, Bruyneel, Aiken, Diya, Lesaffre & Sermeus, 2013). Most studies have reported that transformational leadership styles always have a very positive influence on the
functioning of the employees (Lavoie‐Tremblay, Fernet, Lavigne & Austin, 2016).
As argued by Brewer, Kovner, Djukic, Fatehi, Greene, Chacko & Yang (2016), the absence of leadership support is one of the main reasons why nurses would always wish to leave. Therefore, transformational style of leadership is essential for ensuring employees’ commitment and the intention to stay. Laschinger, Wong & Grau (2013) argues further that the authentic behavior of the senior nursing leaders is essential to the nurses’ perception of being structurally empowered and will subsequently result into their higher retention rate.
According to this scholarly research, leadership training of the upper leadership might help in developing an empowering work environment that is needed of the current health-care organization to retain or even attract more nurses. This has equally been confirmed by Fallatah, Laschinger & Read (2017) who pointed out that authentic leadership always have more significant effects on the personal identification of the nurses. It is assumed that personal identification, directly and indirectly, has a positive relationship with the intention of nurses to leave the job. This argument illustrates the critical role that authentic leadership plays in ensuring a higher retention rate of new graduate nurses (Blake, Leach, Robbins, Pike & Needleman, 2013).
As indicated in the literature, authentic leadership always increase the confidence that new graduate nurses have on their abilities to manage challenges associated to nursing roles, which results subsequently into positive impact in the moral of new graduate nurse and the
willingness to stay (Al‐Hamdan, Nussera & Masa'deh, 2016). This argument had been supported
by Rodwell, McWilliams & Gulyas (2017) who claimed that nurse leaders with a strong understanding of social exchange at the place of work are always likely to retain more staff working under them. In particular, the willingness of the top leadership to empower the nurse staff will continually improve the retention rate of nurses. Based on the literature that has been reviewed, it is very much clear that nursing staff retention is an excellent problem within institutions of healthcare. Institutions like Kaiser Permanente Hospital is presently facing a higher turnover rate of her nurses, which is mostly caused by a weak type of leadership at the hospital. The studies argue that the poor leadership demonstrated by the top management in such institutions is mainly due to lack of proper training about the aspect of authentic leadership and the importance of such leadership traits in ensuring higher employee retention (Brewer, Kovner, Djukic, Fatehi, Greene, Chacko & Yang, 2016). Nursing staff retention rate can easily be enhanced through effective leadership as well as staff empowerment
According to the arguments of researcher Collini, Guidroz & Perez (2015), authentic leadership styles in healthcare institutions is very much crucial in helping the organization achieve a higher staff retention rate. Collini, Guidroz & Perez (2015) further illustrates that
creating a conducive working environment, more also between the top leadership and members of staff, will usually generate a stronger deterrent to the already existing nurses who might be having the intention of leaving the organization. Their project focuses on the benefits of authentic leadership in improving nurse staff retention. Barbato (2013) on the other hand argues that preservation of the nursing staff is a very much essential phenomenon within a healthcare organization, taking into consideration the vital roles that are played by nurses in offering healthcare. Parkes & Davis (2013) affirms that the top organizational leadership must handle all the individual concerns and challenges faced by nurses working under them from time to time so that they can continue to care for the patients while feeling heard efficiently and equally satisfied with their working environment.
Laschinger & Fida (2014) indicates that authentic leadership within healthcare institutions is behind full engagement and active participation of the staff within the organization, which eventually lead into a higher retention rate and active involvement of such group of employees in the activities of the institution. The literature, in this case, asserts further that authentic leadership and empowerment of the employees usually lead into a high level of performance within the institution as the staff members are very much motivated in doing their best to meet the institution’s objectives and goals (Laschinger, Borgogni, Consiglio & Read, 2015). Employees who are not empowered always have less commitment and are likely to move out of the institution whenever an opportunity presents itself.
Lartey, Cummings & Profetto‐McGrath (2014) clarifies that employers in health institutions who fail to assess the seriousness of the employee turnover are somehow neglecting
significant resources for the organization that negatively impact on the institution’s financial interests. Rodwell, McWilliams & Gulyas (2017) argues that nurse leaders who have a stronger understanding of social exchange within the place of work are usually most likely to retain very
many numbers of staffs who are working under them. According to Al‐Hamdan, Nussera &
Masa'deh (2016), authentic leadership always increase the confidence that new graduate nurses have on their abilities to manage challenges associated to nursing roles, which results subsequently into positive impact in the moral of new graduate nurse and the willingness to stay.
All the arguments presented by different scholars confirms the strong connection which seems to be there between authentic leadership style and staff retention. Choi & Ahn (2016) concur by these arguments and offers an explanation that authentic leadership training usually plays a very crucial function in creating change within the organization which ultimately leads into a higher level of loyalty at the place of work. The literature points out further in this case that employees’ loyalty usually boosts their morale, resulting in a very high retention rate. Choi & Ahn (2016) also argues that the retention rate of individual nurses can only be realized when there exists a stronger employer-employee relationship and this is only caused by the presence of an authentic type of leadership within the organizations.
Additionally, Brewer et al. (2016) had focused their study on the need for empowering the organizational leadership so that they can get the best authentic leadership skills among themselves. The overall results of the study, in this case, showed that leaders who are adequately
trained on aspects of authentic leadership are ever willing to practice the same in their organizations and hence will motivate the individual nurses to remain in such organizations. The researchers, in this case, contended that authentic leadership and empowerment need therefore to be implemented in all the healthcare institutions to ensure that there is a higher rate of retention of individual employees (Laschinger, Borgogni, Consiglio & Read, 2015). For any given healthcare organization to have a more focused workforce, the leadership must be trained on how to motive, empower and develop such workers so that they can have higher morale and be ready to be retained at the organization.
Towards the process of attaining a high level of employees’ retention more effectively, leaders must interact with the employees who originate from different backgrounds and give them the direction and resources required for policy implementation. Even though a new leadership style is usually defined to get the best performing, leadership styles can be generally divided into humanistic or mechanistic (Blake, Leach, Robbins, Pike & Needleman, 2013). The dynamic changes that takes place within inside and outside of the organization have acted as encouragement to the leaders for them to shift their standards of leadership from the known traditional approach to the current humanistic leadership approach so as to assist the organizations to achieve their policy objectives and goals (Blake, Leach, Robbins, Pike & Needleman, 2013).
Personnel improvement also referred to as capacity enhancement has one general purpose, to leave better accomplished and performance oriented persons, active and receptive healthcare institution and better setting and policies for future organization development needs (Brewer, Kovner, Djukic, Fatehi, Greene, Chacko & Yang, 2016). With the above regard, the only proper way to ensure that healthcare institution effectively develops their personnel is
through the interaction between the leadership of the organization and the nursing employees and the inclusion of nurses in the development of the personal development plans (Laschinger, Borgogni, Consiglio & Read, 2015). To be effective, the leadership of the organization needs to champion for the usage of these plans which can only be done through interaction with the personnel at both individual and workgroup levels (Blake, Leach, Robbins, Pike & Needleman, 2013). Finally, it is essential that healthcare organizations involve nursing employees in the development of overall organizational development plans. This is due to the need to ensure that nursing employees, the primary target for development, are involved in the development of their development plans. In such a case, very few numbers of nurses will be willing to quit the organization.
Proper leadership within the organization can improve the general performance of employees through encouragement. However, such leadership traits can only be achieved if leaders are trained about the need for them to develop such behaviors within the health institutions that they are leading. Aamir, Hamid, Haider & Akhtar (2016) informs that a good organizational leader should seek the personnel’s opinion on various regulatory issues. The opinions sort should be detailed and would generally comprise of factors that could potentially affect performance metrics. This inclusion and concern from the leadership of the organization help make the employees feel included and relevant in the organization which consequently positively reflects in their dedicated and improved performance.
Further studies were done on the same topic highlights that authentic leadership is key to the retention of nurses. It highlights that training in authentic leadership is the key to ensuring higher employee retention. Research educates that at the workgroup level, the healthcare institution benefits from consistent input from the nursing personnel (Laschinger, Borgogni,
Consiglio & Read, 2015). However, without proper managerial connection and interaction of the organization leadership with the different departmental workgroups, it is impossible for the workgroups to continually perform positively (Laschinger, Borgogni, Consiglio & Read, 2015). Therefore, having an authentic type of leadership is key not only to the retention of nurses and other members of hospital staff but also to the overall growth and success of the hospital. Developing authentic leadership in healthcare institutions will assist institutions in experiencing a higher level of staff retention.
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