Nursing is a noble profession. A place where you can touch lives, make a difference, make connections, and keep growing throughout your life in many ways. I know I am not alone when I say that I became a nurse to help people, to care for people, to be a comfort in situations that many others in this world wouldn’t want to even witness. One thing I have seen almost universally among my colleagues throughout my career is that nurses care. We have heart. We want to do what is best, what is right, for those we are responsible for. So why are we struggling as a profession to keep nurses in a stable, long term position where they can have this impact while growing personally and professionally across their career lifespan? We need to reverse the trend of high turnover, burnout, and job instability, and replace it with a move towards stable careers, long-term growth, and increased job satisfaction. Building relationships within our profession can help us all collectively shoulder the emotional workload that nursing involves. But with the demands of staffing shortages, irregular shift times, and work-life balance, we will need to take a creative approach. Luckily, we live in a time and a society that is “virtually” connected, and we should leverage this connectivity to bolster our morale and improve our resilience as a profession.

We have a problem

Nursing retention is not a new problem in our field, but it is definitely a problem. Studies clearly show that not only is there a shortage of nurses, but that turnover rates among nurses are higher than average (Brunetto et al., 2013). One study found that as many as 33.5% of nurses change their job within the first two years of practice (Kovner, Brewer, Fatehi, & Jun, 2014). This seems like a terrible way to start a career- by changing jobs in the critical time for forming habits, building relationships, and establishing oneself professionally. It is also well documented that having a stable nursing workforce leads to improved outcomes for patients (Thomas, Mor, Tyler, & Hyer, 2012).  Yet our workforce is becoming characterized by a series of job-hopping and role-shifting behaviors that doesn’t lend stability to either our career or the care of the patients in our charge. Sadly, we often perpetuate this culture by failing to build relationships with each other that could forge mutually beneficial alliances, and worse yet, occasionally by shutting one another out and alienating ourselves or our colleagues in detrimental ways. You’ve heard it said that we “eat our young,” and how disappointing it is that a profession with a heart for caring could be so blind to the impact of this behavior.
So why do nurses leave? Let’s face it, nursing is not easy. There are long hours, work that taxes us physically and emotionally, high expectations, even higher stakes, and shifts that always fall on the exact day and time of the family gathering that we have missed every year (because we were always working). And that’s a good week. Throw a monkey wrench in like a patient crashing 30 minutes before the end of our shift, a day or two when everyone else in the hospital calls in sick simultaneously, an unexpected computer down-time, and your own kid at home with the flu, and you’re done. It isn’t easy, and it is even harder when you feel like you’re facing the mountain alone with no grappling hooks. But there is light, I promise. I know for me, seeing my B-FAW (best friend at work) when I walk into a shift makes the entire night seem brighter. Suddenly I know I will not be flying solo- I will have my trusty wingman beside me and together we will conquer the bedpans, shift totals, call lights, and narc checks, and we will walk out together at the end smiling (well, something like that). Don’t take my word for it: Brunetto et al. (2013) says that relationships with colleagues are responsible for 50% of a nurse’s intent to stay in her position or leave. They describe the Social Exchange Theory (SET) that says that employee interactions can benefit the employees and the organization because they foster the sharing of resources, support, and knowledge (Brunetto et al., 2013). Another study discusses the emotional burdens in nursing, and how having a strong team can moderate the emotional impact and improve well-being (Cheng, Bartram, Karimi, & Leggat, 2013). Like I said, your B-FAW can completely turn your night around. But beyond having your partner in the trenches for a shift, Veld (2014) found that nurses were more motivated by a positive social climate than an increased financial incentive to join and stay with an organization. Think about that- a strong social network is more attractive than extra dollar bills.

Better, Together

Strong teams make stronger nurses, and it doesn’t stop there. As social climate improves there is a positive group force that emerges. The mutual exchange of support and resources makes the team stronger as a whole, and leads to more efficient and higher quality work output and lower individual stress levels (Avanzi, Schuh, Fraccaroli, & van Dick, 2015). Teams develop a synergy among themselves and with other functioning teams, allowing for new ideas to be shared, creative solutions to be imagined and tested, and exciting possibilities to unfold (Scott-Spaulding, 2013). The individuals are empowered as part of something larger than themselves, and the organization sees these innovative ideas and creative solutions grow into enhanced workflows, improved efficiency, and better patient outcomes. What exciting possibilities exist when positive relationships are fostered. But wait, we’re still stuck at eating our young in between dodging the call bell that is ringing its 15 hundredth peal after scrubbing the vomit off our shoes for the third time tonight. So how do we find this utopia of workplace harmony when we are stuck in this dys-topia of misery? It starts with building relationships, and we have to make that a priority.
So it’s Monday morning at 7 am, but that’s your “Friday night” because you just dragged yourself through your third 12-hour night shift in a row.  Your hair is sticking out in 4 places, your shirt smells like a strange mixture of chlorhexidine and iron, and you’re pretty sure that the spot on your pants is betadine. Yeah, let’s call it betadine, it couldn’t be blood. The last thing you want to do is go to a breakfast social to build relationships. You want to build a relationship with your bed. And fast, because you have to be up in 4 hours to bake a cake for your 3-year-old’s birthday party. I know- life is busy. But I bet you have a phone in your pocket that you can send a text, check your email, and maybe look at the internet on, right? And if you’re like me, you’ve tackled going back to school and probably used an online discussion board at some point in the journey. It’s true, we will find time for the things that matter, and technology has allowed us the ability to fit in way more than we used to. So why don’t we start using technology to improve our work relationships? In academia we call it asynchronous dialogue- or having a discussion over a period of time (Hall, 2016). Online learning has been doing it for years, allowing learners to contribute to discussions at their own convenience. It allows people time to think before speaking, to overcome barriers of introversion or social anxiety, and to all have a level playing field for owning and sharing ideas and discussion (Berkstresser, 2016; Hall, 2016). Contributing to an online community allows flexibility while providing an outlet for reflection, brainstorming, and sharing of support (Bourke, Waite, & Wright, 2014). So let’s give our bedside nurses this same tool. Let’s use technology that is already in place and successful to build the relationships and team cohesion that could change a nurse’s career path by giving her the support, encouragement, and resources she needs to feel validated and empowered.

A (not so) New Together

Tepper (2016) describes a process that evolved where leaders in rehabilitation for three health systems collaborated virtually to provide mutual support and idea sharing. These colleagues set aside time for regular conference calls to share ideas across organizations, but they propose the idea of incorporating virtual hangouts, screen sharing, and other technological resources to enhance their collaboration. In Australia and New Zealand, a virtual community has been created called Palliverse, where colleagues in Palliative Care across large geographic areas come together in a virtual practice community to share ideas and resources, provide a peer network that fosters a sense of belonging and collegiality, and supports sharing of information about research and best practice (Collins et al., 2016). These are just two examples of how technology can bring nurses together in a positive way. I envision relationships forming between nurses on the same unit from different shifts, between nurses from different units in the same hospital, and between nurses on similar units at different hospitals in the area or the larger health system. These varied relationships would each share a set of challenges or issues to explore, and could only serve to improve empowerment, increase social support, and help ensure the best care from an engaged workforce. So we should build discussion boards and virtual communities for bedside nurses to grow collectively, making use of the tools our virtually connected society has given us to become stronger, together. We can partner with our peers in online academia to learn the technology. Of course we will have to invest in moderators, establish privacy and professionalism guidelines, and stimulate interest and even excitement among the masses. But the technology exists, the infrastructure of online interaction is already there. We can use the tools that our academic partners have already developed and translate them into something nurses can use to feel less alone, more empowered, and stronger as a workforce. Let’s stop eating our young. Instead, let’s let them show us how to tweet while we show them how to aim the face before pushing the Narcan, and at the end of the day we can all feel like our load is a little bit lighter.

 

References

Avanzi, L., Schuh, S. C., Fraccaroli, F., & van Dick, R. (2015). Why does organizational identification relate to reduced employee burnout? The mediating influence of social support and collective efficacy. Work & Stress, 29(1), 1-10. doi:10.1080/02678373.2015.1004225
Berkstresser, K. (2016). The use of online discussions for post-clinical conference. Nurse Education in Practice, 16(1), 27-32. doi:10.1016/j.nepr.2015.06.007
Bourke, L., Waite, C., & Wright, J. (2014). Mentoring as a retention strategy to sustain the rural and remote health workforce. Australian Journal of Rural Health, 22(1), 2-7. doi:10.1111/ajr.12078
Brunetto, Y., Shriberg, A., Farr-Wharton, R., Shacklock, K., Newman, S., & Dienger, J. (2013). The importance of supervisor-nurse relationships, teamwork, wellbeing, affective commitment and retention of North American nurses. Journal of Nursing Management, 21(6), 827-837. doi:10.1111/jonm.12111
Cheng, C., Bartram, T., Karimi, L., & Leggat, S. G. (2013). The role of team climate in the management of emotional labour: implications for nurse retention. Journal of Advanced Nursing, 69(12), 2812-2825. doi:10.1111/jan.12202
Collins, A., Mills, J., Sinclair, C., Chi, L., Campbell, E., Chapman, M., & ... Jap, J. (2016). Virtual communities of practice such as Palliverse can increase palliative care engagement. European Journal of Palliative Care, 23(2), 80-83.
Hall, S. W. (2016). education extra. Online learning: Discussion board tips. Nursing Made Incredibly Easy, 14(1), 8-9. doi:10.1097/01.NME.0000475170.85231.Of
Kovner, C. T., Brewer, C. S., Fatehi, F., & Jun, J. (2014). What does nurse turnover rate mean and what is the rate?. Policy, Politics & Nursing Practice, 15(3/4), 64-71. doi:10.1177/1527154414547953
Scott-Spaulding, M. (2013). Partnering for success. Advice on building collaborative work relationships. Health Facilities Management, 26(5), 42-44.
Tepper, D. E. (2016). Virtual networking produces tangible results. PT in Motion, 8(2), 26-31.
Thomas, K. S., Mor, V., Tyler, D. A., & Hyer, K. (2013). The relationships among licensed nurse turnover, retention, and rehospitalization of nursing home residents. Gerontologist, 53(2), 211-221. doi:geront/gns082
Veld, M. (2014). The right kind of relationship. Nursing Standard, 28(47), 64-65. doi:10.7748/ns.28.47.64.s51