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A place where the spirit can grow: an answer to recruitment and retention? (President's Message).

In my August President's Message article (see August 2002 issue, Volume 29, No. 4, p. 327), I talked about "creating a place where the spirit can grow" in reference to the American Nephrology Nurses' Association (ANNA), your professional organization. The more I contemplate the nursing shortage and strategies to attract and retain exemplary nurses, the more I come back to this idea as one component of a solution. The idea of creating this culture was also supported in a recent document authored by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) entitled, "Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis" (JCAHO, 2002).

Why? Because this phrase simply embraces so much of the research findings found in the news today (American Hospital Association [AHA], 2002; Aiken et al., 2001; JCAHO, 2002; NurseWeek/AONE, 2002). Many, if not all, of the professional, personal, and work environment needs and issues so often discussed regarding the nursing shortage are captured in this one phrase.

Growth of the Professional Spirit

The growth of the professional spirit can indeed be positive for nursing! Just contemplate the impact of a professional environment, quality services, and collegial support, including physician presence, on professional job satisfaction. These components are in contrast to employer spirit that includes such key aspects as realistic staffing ratios and mixes, respect, and fair and equitable compensation and benefits.

My files on factors affecting the shortage expand monthly as surveys, studies, and opinions are published. In fact, key results and information regarding these factors have recently been presented by Nurseweek (NurseWeek/AONE, 2002), Linda Aiken and colleagues (Aiken et al., 2001), and ANNA (2003) to name only a few. While nurses appear satisfied with physician work relationships, many report that they perform functions that don't call upon their professional training and that they lack time to perform the markers of good nursing care (Aiken et al., 2001).

In addition to performing the markers of good nursing care, nurses want the opportunity to influence decisions about the workplace organization, opportunities for professional development and advancement, as well as recognition for work well done (NurseWeek/AONE, 2002). Aiken and colleagues found that magnet hospitals had higher retention rates than nonmagnet hospitals along with lower nurse burnout rates (Aiken, Havens, & Sloane, 2002). While it is beyond the scope of this article to elaborate on the specifics of the study, many of the characteristics of magnet hospitals fall into the professional category--professional autonomy, control over practice settings, adequate support services, and having a powerful chief nurse executive.

Growth of the Personal Spirit

The personal spirit perspective embraces generational as well as personal fulfillment. The importance of personal spirit growth becomes glaringly clear as one scans the literature on generational synergy, personal fulfillment needs, aging, and differences between male and female worker needs and predispositions to accomplishing work demands. No longer can leaders believe, much less act on, the misconception that "a nurse is a nurse is a nurse."

Ulrich (2001) refers to the necessity of recognizing and understanding the uniqueness of races, cultures, and genders. Generational differences not only include value differences, but physical and emotional differences and needs that occur throughout the aging process. Going forward, innovative leaders and companies who excel at recruitment and retention will use demographic data and the literature to structure roles that (a) are satisfying and appealing to individuals; (b) promote the needs of the whole; and (c) achieve corporate goals, objectives, and strategies.

Questions that need to be answered include: "Why should everyone perform all tasks on an equal basis? Can tasks be distributed based on individual strengths and likes? Why can't staff with special interests focus on tasks related to those interests as long as all the needs of the facility and its patients are met? Is job sharing a possibility in our environment? Why not self-schedule and/or bid for shifts? Can time be found during a typical day in a busy unit for rest and relaxation? If the answer is "no," then why not?

Growth of the Work Environment Spirit

Work environment spirit includes the activities in which an employer engages to create a particular type of work environment. While a separate spirit, it includes some of the characteristics of the other two. Examples of work environment spirit include such key considerations as realistic staffing ratios and mixes, consideration of emotional and physical needs of teammates, two-way communication, employee empowerment, and fair and equitable compensation and benefits to mention a few.

There is no argument that with the current reimbursement situation, the nature of chronic treatments, and the current nursing shortage, the ratios of RNs to patients in outpatient settings will always be higher than in hospitals. However, the nagging questions of just what is a reasonable and safe ratio, and what staff mixes enhance safe and effective treatments remain unanswered. In the meantime, professional nurses in these environments report dissatisfaction with nurse-to-patient ratios and express concern about patient safety as a result.

Two-way communication and employee empowerment are highly desired and possible work environment elements regardless of reimbursement, the nature of the disease requiring treatment, and any personnel shortages. All that is required is knowledgable, committed, and empowered managers and leaders.

Implications for the Future

The surveys and studies reported to date provide excellent data and food for thought. However, we must analyze this data further and rank those elements most desirable in professional, personal, and work environments. These elements must be developed and prioritized in consideration of today's financial and human resource limitations found in health care and the nephrology nursing specialty. For example:

1. What four or five criteria are most important in a professional work environment?

2. What criteria rank in the "make or break" category when professional nurses decide to accept or remain in jobs?

3. Which four or five elements are beneficial to all team members in a professional work environment?

So now, our mission is clear: We need to address these questions and implement appropriate programs so that we develop the foundation for creating an environment where the spirit can grow. Won't you join us in helping to fulfill this mission?

ANNA's Mission

ANNA will advance nephrology nursing practice and positively influence outcomes for patients with kidney or other disease processes requiring replacement therapies through advocacy, scholarship, and excellence.


Aiken, L.H., et. al. (2001, May/June). Nurses' reports on hospital care in five countries. Health Affairs, 20(3), 43-53.

Aiken, L.H., Havens, D.S., & Sloane, D.M. (2002). The Magnet Nursing Services Recognition Program. American Journal of Nursing, 100(3), 26-35.

American Hospital Association (AHA). (2002). In our hands: How hospital leaders can build a thriving workforce. Chicago: AHA Commission on Workforce for Hospitals and Health Systems.

American Nephrology Nurses' Association (ANNA). (2003). Work environment survey data analysis report (ANNA unpublished survey). Pitman, NJ: Author.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO). (2002). Health care at the crossroads: Strategies for addressing the evolving nursing crisis. Chicago: Author.

NurseWeek/AONE (2002). National Survey of Registered Nurses, 2002. Sunnyvale, CA: NurseWeek Publishing.

Ulrich, B.T. (2001). Successfully managing multigenerational work forces. Seminars for Nurse Managers, 3(3), 147-153.
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Article Details
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Author:Wick, Gail
Publication:Nephrology Nursing Journal
Article Type:President's Page
Geographic Code:1USA
Date:Feb 1, 2003
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