What healthcare organizations should do to increase nurse retention

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The COVID-19 pandemic has been a major disruptor of nurse retention and contributes to increased burnout and related risks of higher nurse turnover.

Employers must respond to nurse burnout and retention challenges because they
have a duty of care for their workforce, and because it is in their own interests.

Any pre-existing nurse understaffing and resource limitations have been exposed and
amplified by the pandemic, and have added to the stress and workload of the nurses
who are at work. In addition, the pandemic has directly impacted on nurses as people
— they have suffered higher than average incidence of infection, illness, and mortality
rates.
Analysis of the impact of the pandemic on nurse retention is growing, with extremely
worrying findings. There will be reduced nurse retention because of COVID-19 driven
ill health, burnout, reduced working hours and early retirement, which will exacerbate
existing nurse workforce shortages.

Employers and organisations must therefore take responsibility and provide supportive
conditions, and policy interventions should be focused on improved work
environments; ensuring adequate staffing levels; and providing attractive working
conditions, pay and career opportunities.

One vital policy intervention that will improve retention, and will demonstrate that
employing organisations are supporting their staff is to ensure that nurses have
priority access to full vaccinations.

Second, sustained success in improving nurse retention is likely to be related to planned,
sequenced, multi- policy intervention – so called “bundles” of linked policies, rather
than single interventions. Identifying the most effective balance of policies to improve retention of nurses is in part about taking account of the pandemic impact, experiences and motivations of the nurses. This is why a nurse workforce impact assessment approach is an important underpinning of effective nurse workforce retention and sustainability.

An Action Agenda and Plan for 2022, and Beyond: Recommendations for sustaining and retaining the nurse workforce during the COVID-19 pandemic

The nursing workforce has been central to COVID-19 response effectiveness in all countries. This brief highlights that the effects of COVID-19 are increasing the demand for nurses, but are also having a damaging direct and indirect effect on individual nurses, and on overall nurse supply. There was a global nurse shortfall of almost six million as the pandemic hit in early 2020. COVID-19 has exposed the vulnerabilities of nurse supply flows, domestically and internationally. At the time of publishing this brief in January 2022, it is all too evident that the latest Omicron variant is surging around the globe, and having further severe impacts on an already understaffed and overstretched global nursing workforce.

The growing risk is that COVID-19 is driving up significantly the pre-pandemic 5.9 million
global shortfall of nurses, and may also increase the unequal distribution of nurses, and push up international flows of nurses from low/middle-income countries to high-income countries. This will undermine both country-level progress towards rebuilding after the pandemic shock, and could prevent the attainment of universal health coverage in some countries, as well as compromising the overall global response to the Omicron variant and any future pandemic waves.

To mitigate these damaging effects, and to improve longer-term nurse workforce
sustainability, there is an urgent need for effective and co-ordinated policy responses both at national level, and internationally. This response must include both immediate action to meet the urgent challenges set out in this brief, and the development of a shared longer-term vision and plan for the global nursing workforce, to ensure that the world is better placed in the future to meet major health shocks.

At country level:

• Act: Commitment to support for safe staffing levels. Based on consistent application
of staffing methods, necessary resource allocation, and health system good
governance;

• Act: Commitment to support for early access to full vaccinations programmes for all
nurses;

• Act: Nurse workforce impact assessments, conducted regularly in order to generate
evidence and develop a better understanding of pandemic impact on individual nurses
and the overall nursing workforce;

• Plan: Reviewing/ expanding, the capacity of the domestic nurse education system
which should be based on data generated from impact assessments and from a
regular and systematic national nurse labour market analysis;

• Plan: Assessing/ improving retention of nurses and the attractiveness of nursing as
a career, by ensuring that the damaging effect of COVID-19 burnout of nurses is
addressed, and by the provision of fair pay and conditions of employment, structured
career opportunities, and access to continuing education;

• Plan: Implementing policies to enable the nursing workforce contribution to
pandemic response to be optimised through supporting advanced practice and
specialist roles, effective skill mix and working patterns, teamworking, and provision
of appropriate technology and equipment, as well as training in its use;

• Plan: Monitoring and tracking nurse self-sufficiency by using the self-sufficiency
indicator of level of % reliance on foreign-born or foreign-trained nurses.