Why are health organisations focusing on retention as a measure?

In the last couple of weeks, I have been listening to experiences of nurses, through the various programmes I facilitate. I have noticed that these experiences are ‘polar opposites’ in terms of impact on individuals, because of leadership styles and consequently workplace culture.

For example, one nurse described a new strategic leader. They described the leader as appearing very anxious, constantly checking up on everyone via email, questioning and undermining their decisions and constantly asking for update reports. The nurse I spoke to expressed feeling demoralised, doubting their own abilities and consequently she was looking for a new role.

In contrast, I have also recently spoken to an Inspire Improvement Fellow Inspire Improvement – About the Inspire Improvement Fellowship. She, along with the other Fellows, has spent a lot of time thinking about how she works with her team and how she could work with them differently. She described getting together a team of nurses that she co-leads and asking them to check in with each other about how they were feeling. Typically people expressed negative feelings of tiredness and being fed up. She then facilitated a two-hour session helping them focus on finding solutions for an identified practice issue. At the end of their time together, they repeated the exercise asking how people were feeling and this time they used positive words such as energised, inspired and valued.

So, what is important about sharing these experiences? Well, I can’t remember a time in my nursing career when the number of people leaving nursing was so large, and politically, nurses are raising their voices by going on strike. We are in the midst of a nursing workforce crisis. Yet is seems that health organisations are primarily focusing on measuring retention and recruitment. Some of you may argue quite rightly. My question is… What are we paying attention to with this measure? Nurses coming, going and staying? What are we missing?

The first experience I described above, demonstrates how destructive micromanagement or a command and control type of leadership can be for an individual or team, as outlined by Schrag (2023) in his blog John Schrag – trainer, coach & facilitator – Micromanagement and Psychological Safety:

‘Micromanagement is a team cancer. It reduces capacity, learning, growth, psychological safety, and tears teams apart through lack of retention. And yet too often it sits undiagnosed until the damage is done. Teams need regular health and psychological safety check-ups so you can catch problems before they get bad. Focussing on team health will help you be the place where everyone wants to work’

Should organisations be paying attention to why nurses are unhappy and don’t want to stay? Or could organisations focus on supporting the development of enabling leadership styles, as reflected in the second experience. This would promote healthful workplace cultures (McCance and McCormack, 2021) at team level, where relationships and connections are strong, where there is a strong sense of community, and where nurses express feeling valued and respected.

I wonder as you are reading this blog whether you are reflecting on the type of leader that you are? To what extent do you:

• enable your team to collaborate and participate together to create ‘the way we do things round here’? (https://www.fons.org/learning-zone/culture-change-resources/whatisculture)
• fix things for people rather than encouraging others to find their own solutions (Don’t fix – facilitate: the role of reflection in successful change processes (fons.org))
• support and create ‘head space’ to enable the team to freely and openly talk about the patterns of practice, as outlined in the second example at the beginning of the blog

But why should we work in this way? Perhaps because there is an increasing body of knowledge that suggests highly functioning teams are not only happier in their work, they are safer, have better patient safety outcomes and experience, and are less expensive to run, if you factor in the costs of patient safety errors, staff sickness and recruitment costs (West, 2018). See for example: Professor Michael West: How teams improve staff engagement and why it matters – YouTube

For further resources to help you get started visit the FoNS website:Learning Zone – Culture Change Resources (fons.org)

References

Dewing, J., McCormack, B. and Titchen, A. (2014) Practice Development Workbook for Nursing, Health and Social Care Teams. Wiley Blackwell, Chichester

McCance, T. and McCormack, B. (2021) The person-centred practice framework. Chp 3 in McCormack, B. et al. (eds). Fundamentals of Person-centred Healthcare Practice . Chichester, UK: Wiley-Blackwell.