The 2005 NDNQI Nurse Satisfaction data revealed that on average, 30% of adult medical-surgical registered nurses (RN) had been on their present unit for less than a year and for some, those months reflected their entire nursing career. Tenure (or lack thereof) of RNs has a significant impact on quality of care and patient safety implications. Nationally, little attention has been paid specifically to the plight of medical-surgical nurses with the associated retention issues.
This presentation consists of a case study of one 24-bed medical-surgical unit generating a number of interesting statistics over time. Currently, only 7% of the nurses have been there less than one year, while over half have been there more than five years.  Further, on the 2005 NDNQI Nurse Satisfaction survey, this unique medical-surgical unit scores were in the top quartile or upper confidence level on every single question associated with job satisfaction and quality of care. Marlene Kramer reported in 2006 that this unit has generated the highest autonomy scores in the nation.  On three consecutive annual satisfaction surveys, these medical-surgical staff nurses report high satisfaction with the unit, hospital, leadership, salaries and benefits. What makes them stay and why are they so happy?
Leaders of this medical-surgical unit will present historical and current strategies designed to keep the nurses engaged, challenged and satisfied with their jobs and work environment. Strategies are related to the professional practice model long active in this hospital, and include: a clear selection, de-selection, and incorporation process of all new hires in the unit; implicit and explicit unit norms embracing teamwork, high expectations, and strong work ethic; creation of a sense of community and family within the staff; exciting and innovative performance improvement projects; and an emphasis on professional development, career advancement, and certification.
Most hospital nurse leaders will agree that medical-surgical nursing is one of the toughest jobs in healthcare. High patient acuity, diverse patient populations, a fast-paced environment, and challenging patient assignments create cultures which quickly drive out young nurses within a year or two of starting their career. In addition, medical surgical nurses are expected to possess broad knowledge, skills, and expertise. As everyone rushes to address the issues of work environment, staffing resources, patient workload, and support infrastructure, it is certain that retention of medical-surgical RNs will play a key role as we look toward solutions.
This presentation acknowledges the unique challenges facing medical-surgical RNs today and presents a number of retention solutions utilized by one high performing unit. The objectives of this presentation are: 1) Discuss four factors that cause RNs to leave medical-surgical units; and 2) Identify three unique approaches which keep medical-surgical registered nurses engaged and dedicated to their jobs.