Recruitment and Retention of ED Registered Nurses at Level III Hospitals in the United States

Article Outline

• Purpose
• Design
• Setting/Sample
• Methodology
• Results
• Conclusions
• Copyright

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Purpose 

The emergency department (ED) of a hospital never closes; it is considered a 24/7 operation. Due to health care reform in the 1990's, there has been a reduction of registered nurses within hospitals. In addition, an aging nursing population has been advancing toward retirement age, and dissatisfied nurses have been leaving the profession. The decision was made to benchmark this northern New Jersey hospital emergency department with similar Level III hospitals in the United States. The intent of this research project was to explore the successful measures that hospitals implement to improve recruitment and retention of ED nurses.

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Design 

A descriptive, non-experimental study design was used.

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Setting/Sample 

The study population consisted of 101 emergency departments in the United States that were in hospitals designated as Level III trauma centers by the American College of Surgeons. This study was exempt from IRB approval.

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Methodology 

The survey for this study was a researcher-developed instrument designed to gather data pertaining to administration concerns, which included scheduling and staffing issues, nurse-to-patient ratios, and whether the nurse manager utilized the ENA Guidelines for Emergency Department Nurse Staffing. Included in this instrument was an open-ended item that asked emergency departments to identify one innovative practice that had been successfully implemented to increase staff satisfaction and/or retention during the year 2003. The instrument was pilot-tested with a small sample of emergency departments that were not within Level III trauma centers. Suggestions from administrators and educators were then incorporated into revisions of the instrument in an effort to increase construct validity. The concepts for the design of the survey were adapted from a literature review on staff satisfaction. The manager of each emergency department was sent a letter of introduction, a survey instrument, and an enclosed return-stamped self-addressed envelope. The initial mailing comprised 101 hospitals in January 2004, which delivered a 25% return. In February, a second mailing provided a total return of 46% (N=44) with five exclusions.

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Results 

The majority of responding emergency departments that had indicated a nurse retention rate of 90% or greater for the year 2003 had identified three features of their departments that they attributed to increasing staff satisfaction and retention: Flexible scheduling (such as self-scheduling); Staff input into decision-making; and Financial incentives (such as bonuses for overtime hours worked (over full time), premium pay, and improved benefits).

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Conclusions 

The findings of this survey point to improvements that can be implemented in hospitals to alleviate nursing shortages and increase nurse satisfaction. In response to the results of this study, the ED manager is completing a staff-satisfaction survey; instituting measures to improve communication among the administration, patients, physicians and the staff; and piloting computerized self-scheduling.