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Evaluating Caregiver Perceptions and Illuminating Nurse Retention Strategies

Researchers reveal factors associated with attrition


Authors of a recent report by the International Council of Nurses predict a global shortage of 13 million nurses by 2030 unless action is taken to reduce attrition and accelerate the rate at which new caregivers are entering the healthcare workforce. The COVID-19 pandemic only compounded the pressures encountered by nurses in medical, surgical and ICU settings, who continue to leave clinical practice in record numbers.


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To better understand this troubling trend at a local level, nurses at Cleveland Clinic Euclid Hospital conducted a study aimed at identifying strategies for retaining nurses at the bedside. Nurse investigators distributed a questionnaire designed to explore caregiver satisfaction and help identify effective strategies for reducing turnover.

“The time from hire to turnover among hospital-based clinical nurses is much shorter than in previous years,” says Kathy Tripepi-Bova, DNP, APRN, CCNS, CCRN, a clinical nurse specialist at Euclid Hospital. “Nurses are now looking for jobs that impose fewer demands than a typical acute medicalsurgical setting. During the pandemic, employment opportunities expanded in scope, which exacerbated existing problems with traditional staffing patterns. We initiated this project after recognizing that a critical step in improving nurse retention involves examining factors that influence turnover.”

Nurse Manager Tracy Ball, MSN, RN, NEBC, who led the study with Tripepi-Bova, explains, “The shrinking nurse workforce has serious ramifications for patient care, particularly in community hospitals like ours. By taking a deep dive into the attitudes and perceptions of our nurses, we hope to create policies and procedures that better support their well being.”

Collecting data

Approximately 60 RNs working on medical-surgical units and ICUs at Euclid Hospital were invited via email to participate in the project. Participants were asked to complete an abbreviated version of the Casey-Fink Nurse Retention Survey, which was modified to address factors unique to Cleveland Clinic. Presented in three sections, the anonymous survey used a five-point Likert scale to capture how nurses perceive their value and role in the work setting and rate their satisfaction with specific components of their job. Six open-ended questions were also used to identify factors that contribute to attrition and generate potential strategies for retaining bedside nurses.

Survey questions included:

  • If there was one thing I could fix about my job it would be…
  • Has COVID-19 changed your perspective on nursing? If so, what has changed?
  • What do you think Euclid Hospital can do to improve registered nurse retention?

Respondents were also asked to indicate how strongly they agreed or disagreed with statements like:

  • I feel my peers provide encouragement and feedback about my work.
  • I feel that my contributions to this organization are acknowledged.
  • I am satisfied with my chosen nursing specialty.
  • I felt isolated at work during the COVID-19 surge.

Nurses’ voices

In analyzing the results, investigators learned elements that fostered retention, including camaraderie with fellow nurses and managers, a sense of “making a difference,” good benefits, convenient work location, and flexible scheduling. Ball adds that many respondents indicated a desire to be recognized and rewarded for their years of nursing experience.


Several factors that contribute to job dissatisfaction were highlighted in the analysis, including staffing shortages, time-consuming nonnursing responsibilities and unbalanced caregiver-patient ratios.

“Prior to the survey, we knew that workload perception and burnout positively correlated with attrition, but we were interested in learning more about specific factors that underlie those problems,” says Ball. “Our ability to identify those factors will be critical to the success of any future retention initiatives.”

The research team, which is currently preparing a manuscript for peer-reviewed publication, hopes to translate its study results into real-world initiatives that encourage retention.

“Nurses aim to cover staffing shortfalls while providing excellent patient care. As leaders, we have a responsibility to apply interventions designed to mitigate current perceptions,” adds Tripepi-Bova. “We hope this survey will be the start of an ongoing dialogue that enables us to meet nurses’ professional needs.”


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