Facilitating the Retention of Experienced: Critical Care Nurses: A Survey Report on What Matters Most

The survey included only 7 items and was available via a link at the Critical Care Nurse Web site (http://ccn.aacnjournals.org) from the date of that issue’s publication in early April until July 15, 2007. A total of 187 readers completed the survey during that period.

Because the survey was designed to elicit the preferences of “experienced critical care nurses,” the age group of primary interest was nurses approaching or already in middle age. Among survey respondents, more than 68% were 45 years of age or older (Figure 1). More than half of respondents had 25 years of experience or more as a registered nurse (RN) and 75% had 15 or more years of RN experience (Figure 2). Ninety percent of survey participants had 5 or more years of critical care or progressive care RN nursing experience, 64% had 15 or more years, and 42% had more than 24 years of such experience (Figure 3). More than 90% of respondents worked in critical care, 7% in progressive care, and 5% in a postanesthesia recovery unit (Figure 4); 56% of respondents were certified (CCRN, CCNS, PCCN, CMC, or CSC).

Survey item 6, “Of all these factors that could potentially affect your decision to continue practicing as a critical care nurse, rank the top 5 factors that are (or will be) the most important to you,” was followed by a list of 26 possible factors derived from the wide array of influences mentioned in the literature review in the editorial.¹ The survey was intentionally constructed to force respondents to select only a single factor as the “most important” among those 26 possible influences and, in kind, only a single factor as the second, third, fourth, and fifth most important factors in their decision to remain in practice.

Among all factors identified in the literature as affecting the retention of experienced nurses, the factor identified as “most important” in this decision by the largest proportion of critical care nurses was related to flexible work scheduling and was stated as follows: “Flexible work scheduling such as being able to plan weekends, holidays, vacations off from work (with reasonable expectations these will not be lost) and to bid on unpopular shifts.”

Of the 26 factors available for selection, survey participants selected only 17 as “most important.” Among those 17 factors, flexible work scheduling was designated as “most important” by 23% of survey respondents (Figure 5). Moreover, among all selections for the top 5 factors bearing on a critical care nurse’s decision to remain in practice, this factor received the largest percentage of selections (61%). If healthcare facilities are genuinely interested in retaining their experienced critical care, acute care, and progressive care nurses, the best place to start demonstrating that intention is in enabling these nurses to not only plan their work and time off, but ensuring that those schedules are implemented on a reliable basis.

In addition to distinction of the single-most important factor in a critical care and progressive care nurse’s decision to remain in practice, the top 3 factors in this consideration also stand apart from other potential influences. This trio of influences includes the following:

• Flexible work scheduling (see above)

• Meaningful monetary retention bonus (“Retention bonuses or service awards that include meaningful monetary compensation”)

• Organizational respect (“An organizational culture that acknowledges, values, and respects a nurse’s work experience and the contributions that nurses make”)

Among the 17 factors rated as “most important” by survey participants, the latter 2 factors each garnered 18% of those ratings. When all selections for the top 5 factors influencing a critical care nurse’s decision to remain in practice are considered, the 3 influences listed above were accorded highest importance by 61%, 60%, and 58% respectively of survey respondents. The factor cited as important next most often was identified by only 35% of respondents, reflecting a substantial gap along the continuum of relevance for this decision.

The top 10 rank order of factors considered as “most important” in an experienced critical care or progressive care nurse’s decision to remain in practice is presented in Table 1. When all factors selected anywhere among the top 5 are rank ordered by frequency of selection, a similar yet not identical top 10 list, shown in Table 2, results. The later, more encompassing set includes 2 influences not previously captured:

• Improve the safety and comfort of the nurse’s work environment

• Physicians who are passionate and compassionate, competent, honest, and ethical

The findings from this brief survey, although limited, unscientific, and drawn from a small, self-selected sample, nonetheless communicate some clear messages—that is, nurses who work in critical care, acute care, and progressive care areas can identify and prioritize what matters most to them in their decision whether to continue practicing nursing. Although the factors identified here share similarities with those pertaining to all nurses and/or all experienced workers mentioned in the literature review in the April 2007 editorial,¹ they should also be recognized as unique because they are the only evidence we have of what matters most to critical care and progressive care nurses in this decision. Healthcare institutions that wish to retain these valuable nursing work-force resources would do well to listen and heed these messages.