www.nursingmanagement.com Nursing Management • October 2019 7 PATHWAY TO EXCELLENCE ® The effects of positive practice environments: Leadership must-knows By Maricon Dans, MSN, RN, and Vicki Lundmark, PhD “R etention is now a critical issue...as we risk losing nurses faster than we can train them.” This startling state- ment was made by Howard Catton, CEO of the International Council of Nurses (ICN), at the ICN International Workforce Forum in March 2019. 1 Discussion at the ICN Forum recognized that the nursing shortage spans conti- nents, necessitating an urgent global response. In the US, the nursing shortage continues to worsen, with a 17.2% turnover rate for RNs in 2018, tying with the 2015 rate as the highest in the last decade. 2 Increasing RN job satisfaction and improving reten- tion have become high-ranking strategic priorities for healthcare organizations everywhere. Intent to stay and burnout Based on survey responses from nearly 250,000 RNs, the 2018 Press Ganey Nursing Special Re- port identified that nurses plan- ning to leave their jobs soon typi- cally cite dissatisfaction with the work environment as the reason; nurses on units with lower intent to leave more often perceive turn- over as a threat to the delivery of quality care. 3 Regarding the driv- ers of intent to stay, the report showed differences between expe- rienced and newly licensed nurses, emphasizing that a one- size-fits-all approach won’t work. For experienced nurses, job satis- faction, joy in work, quality of care, and career development op- portunities were identified as strong drivers of intent to stay. For new nurses, nurse manager support, joy in work, and praise and recognition were more im- portant factors. When considering how to ad- dress the nursing shortage, it’s important to delve into burn- out—one of the main contribut- ing factors of nursing turnover. 4 Far too common among nurses, burnout is manifested by emo- tional exhaustion, cynicism, and a sense of inefficacy. 5,6 Unresolved professional stress, such as in- creased workload demands and limited resources, poses a risk of burnout. 7,8 However, lower job dissatisfaction and burnout rates are associated with better work environments. 5 Healthcare agencies are ac- knowledging the crucial need for action. To address the staggering reports of burnout among health- care providers, the Institute for Healthcare Improvement issued a framework for improving joy at work that aligns with the tenets of a positive practice environ- ment. 9 Factors that precipitate burnout also impact joy in the workplace. 9 Because providing care for others requires a holistic and often deeply personal invest- ment of one’s self, organizations have the responsibility to safe- guard nurses’ well-being to foster joy. As the World Health Organi- zation’s Director General Tedros Adhanom Ghebreyesus stated in his address to the ICN 2019 Con- gress, “Health facilities must not only be places of healing for pa- tients. They must be places that foster well-being for health work- ers, especially those working in vulnerable and fragile settings.” 10 The reality is that when orga- nizations support and engage their nurses, they’re more likely to retain the professional staff they need to deliver on the promise of safe, high-quality pa- tient care. 11-13 To support nurses to the fullest, many organizations need to drive the cultural change necessary to create a positive practice environment. Strengthening the practice environment To achieve an effective culture, elements such as shared gover- Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.