By Susan K. Sinclair, MSN, RN-BC 

What progress have we made in increasing nurse retention within the nation? This topic has been widely researched for many years globally. "Nurses" can be adult nurses who have been in the profession for many years or new graduate nurses. According to a 2015 study, "the number of nurses leaving the workforce each year has been growing steadily from around 40,000 in 2010 to nearly 80,000 by 2020."

To tackle this problem, there are several points to consider. We must figure out why nurses leave, what interventions work, and what has changed in the past 10 years in retention efforts.

Why Do Nurses Leave?

First, let's realize and take seriously why nurses leave. It really depends on the nurse demographic. A graduate nurse will have different reasons for leaving than a seasoned nurse, which is why retention interventions should not be one size fits all. Common reasons for leaving are insufficient staffing and increased stress levels. Another major one is work environment -- a hostile work environment or a milieu of low autonomy or empowerment. For graduate nurses, in particular, inaccurate job expectations or an inability to adjust to the pace of the job are possible causes.

The Impact on the Workforce

A 2019 study found that "shortages of RNs will worsen in the next two decades."

It's similar to the chicken-or-the-egg scenario. Did low nurse retention rates cause shortages in staffing or did poor staffing ratios fuel low retention? Rates of retention and shortages seem to go hand in hand. It would make sense that poor retention rates would exacerbate shortages.

Low retention also puts big costs onto hospitals and facilities. In order for the nursing workforce to stabilize, we must initiate successful interventions.

What Interventions Work?

Interventions need to occur on multiple levels: from individual, leadership, and organizational. In other words, the organization as a whole needs to be committed to keeping nurses. Nurse practice models used in magnet hospitals have had some success in boosting retention. Various practice models help empower nurses and result in high job satisfaction.

From a leadership level, nurse managers should be cognizant of retention trends within the country and should work closely with the organization's human resources. Leadership training also can provide support to the nurse manager but more research is needed to understand leadership's role in retention efforts.

Individual levels look to internships and residencies and the availability of a support system, such as a nurse educator. Individual levels of retention focus on the nurse graduate demographic. According to a 2017 analysis, "the highest retention rates were associated with retention strategies that used a preceptor program model that focused on [the] new graduate nurse."

Where Are We Now?

Evidence has consistently shown that work environment plays a large role in retention. According to The Future of Nursing: Leading Change, Advancing Health, "much of the data showing the impact of reducing turnover by focusing on workplace environment comes from the acute care setting. Nonetheless, these data are instructive in their demonstration of a triple win: improving the workplace environment reduces nurse turnover, lowers costs, and improves health outcomes of patients."

The challenge of retaining nurses in the workforce is still an obstacle to higher quality healthcare and higher nurse satisfaction. Some interventions work, and strategies are most effective when implemented from several levels: organizational, leadership, and individual. Not only is our nation's healthcare on the line, our nursing profession is as well.