What do nurses want?

By Jennifer Larson, NurseZone contributor

Do they want better pay? Better hours? Less mandatory overtime? More autonomy? Better benefits?

Absolutely. But as it turns out, most nurses really want to go to work each day at a place where they will be valued, where they feel like they are part of a team that really works together. Working conditions seem to matter even more than financial rewards, and hospitals and other facilities that provide a positive work environment are more likely to have a satisfied nurse workforce.

Researcher K. Lynn Wieck, Ph.D., RN, found that working conditions top the list of what matters most to nurses.

That’s what researcher K. Lynn Wieck, Ph.D., RN, discovered when she surveyed more than 1,500 nurses in 22 hospitals. She had expected all of the nurses to tell her that good health benefits topped their list of incentives to stay in a job, but she was surprised to learn that benefits were further down the list.

“The number one, most important incentive for staying in a hospital (job) was a cohesive work environment,” she said. “Working with people who help you share the work and pull together as a team.”

This kind of environment is something that nurse managers can directly affect, Wieck noted. They can start by recognizing nurses for their accomplishments and by saying, “Thank you, you did a very good job.”

“I think that managers can help to build cohesive environments by recognizing the contributions that nurses make, and by getting rid of factors in the environment that are not conducive to cohesion,” she added.

Wieck’s research will be published later this year in the journal Nursing Economics.

Hospitals can definitely benefit if they can find ways to create the kind of environment that nurses desire. After all, it costs more than $60,000, on average, to replace a registered nurse who leaves a job, according to research conducted by Cheryl Bland Jones, Ph.D., RN. The cost of filling an empty nursing position has escalated in recent years, and as the nursing shortage continues, the costs could continue to rise.

“It’s a huge investment that hospitals lose when a nurse walks out the door,” Wieck noted.

Hospitals are already short of nurses—can they afford not to work on finding ways to improve their retention rates? The national hospital vacancy rate is already over eight percent, according to a July 2007 report from the American Hospital Association. The rate is much higher for newly minted nurses; a Health Research Institute study, also in July 2007, found that the average voluntary turnover among first-year nurses was 27.1 percent. Job dissatisfaction is often cited in studies that examine the reason nurses leave their jobs or their profession altogether.

It is clear that reducing RN turnover would save hospitals a lot of money, and there are other benefits, as well. Jones’ research also notes that investments in retaining nurses can contribute to a stable and satisfied workforce, which may also improve patient satisfaction.

Hospitals interested in finding examples of cohesive work environments that attract and retain nurses may want to check out those hospitals that have achieved Magnet status.

Magnet status is a designation awarded by the American Nurses Credentialing Center for facilities that exhibit excellence in nursing. The Magnet Recognition Program was launched in 1990, and the first hospital to receive Magnet status was the University of Washington Medical Center in Seattle in 1994. Only hospitals that meet the ANCC’s rigorous standards are given the designation.

One of the most recent additions to the Magnet list is Seattle Children’s Hospital, which received notice about their achievement in mid-September. The hospital, which employs more than 1,000 nurses, deliberately emphasizes the importance of a good working environment for its nurses because that also translates into better outcomes for patients, said chief nursing officer Susan Heath, RN, MN, CNAA.

“We are doing extremely well with our relationship with our nurses,” Heath said. “It’s been very intentional.”

The Seattle Children’s Hospital has also imported success strategies from the business world that gets nurses involved in making improvements. For example, the hospital now abides by a Toyota principle called “continuous performance improvement.” The system involves staffers in identifying changes that are needed and then creating the solutions.

Wieck applauds hospitals for communicating with their nurses and asking for feedback and ideas. In that way, they can identify benefits and incentives that really do appeal to nurses. When it comes to creating benefits packages, Wieck suggested that hospitals offer a menu of different types of benefits that nurses can choose from, depending on their needs. A younger nurse may be motivated by a benefit that helps her with child care for her toddler, while an older nurse may be pleased by a good retirement plan.

Effective communication can also identify problems and ways to solve them, Wieck said. For example, her survey found that many nurses dislike being asked to “float” off their unit. If a nurse manager is aware of this, he or she can step in and address the situation before dissatisfaction builds and eventually provokes nurses to leave.

“You can put together a float team and ask nurses if they want to be on a float team, and they’ll make extra money if they do,” Wieck suggested. “You’ll be paying people who don’t mind being floated.”

Having programs in place that involve nurses in problem-solving, as well as a set of consistent behavior standards, doesn’t just make the nurses at Seattle Children’s Hospital happy. It directly contributes to the hospital’s financial success, according to Heath. All of the efforts are worthwhile.

“Everything’s working together,” Heath said.

Wieck agreed that making the investment in nurses now will pay off later—for everyone.

“Our lives will be in their hands,” she said.

© 2008. AMN Healthcare, Inc.