The continuing debate over healthcare reform legislation has focused national attention on complex issues such as high cost, overuse of technology, significant gaps in quality, access to services, and consumer satisfaction. Although the future system of healthcare remains unclear, the solutions to these issues will undoubtedly need to be both innovative and comprehensive in order to address the needs of an aging population and the millions of previously uninsured Americans who will be entering the system. In this new horizon, nurses will continue to play a key role in providing efficiently orchestrated care, reducing length of stay, achieving desired quality outcomes, and managing costs.
These challenges will require what Health Affairs terms a high-value workforce—one with the ability to quickly assess patient needs, develop comprehensive plans of care, and work within the health system to marshal the resources needed to attain necessary outcomes.
Key to maintaining and building a high-valued workforce is the retention of experienced nursing staff with advanced problem-solving skills and an understanding of the healthcare environment developed over years of service. Typically these attributes can be found and cultivated in nurses within the age range of 40 to 60 years, who have, during their career, witnessed an evolution in the healthcare system, including significant changes to the system of care delivery, third party payment, technology, internal and external organizational structures, and focus on public reporting of quality data and care outcomes. The 2004 HRSA National Sample Survey of Registered Nurses indicated that 59% of currently licensed RNs are between the ages of 40 and 59 years of age, indicating a substantial resource.
In an effort to retain a high-value nursing workforce, nurse leaders tend to initially focus on salaries. Although in most studies salaries continue to be an important work satisfier for nurses, this alone will not retain the talented nursing staff necessary to meet current and future demands. One critical factor is for leadership to be committed to creating a culture that values the depth of knowledge and skill that a seasoned nurse brings to the workplace, provides a sense of job satisfaction, and inspires organizational commitment. This is only attained through an atmosphere of mutual trust, collaborative decision-making, and meaningful recognition for clinical excellence.