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Plans for Nursing Retention During the COVID-19 Pandemic

Jordynn Towner

Delaware Technical Community College

NUR460 Nursing Capstone

Dr. Jeanmarie Maloney

November 28, 2021

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The COVID-19 pandemic has undoubtedly had some effect on most individuals working

in the healthcare field since it began in 2020. From exposure to a relatively unknown disease

process, to navigating patient care with limited supplies and PPE, to being the only one at the

patient’s bedside when visitors were not permitted, this pandemic has taken a toll, both

mentally and physically, on those who are fighting against it. The mental strain and hardship

placed on healthcare providers, like nurses, by this pandemic is leading many of them to leave

the bedside and seek out other career opportunities. As more nurses leave the bedside, it

creates additional strain on those who choose to stay, and eventually brings them to their

breaking point as well. Retention of nursing staff is crucial, as it plays a role in safe patient care

and patient satisfaction, as well as impacts coworker’s mental health and job satisfaction. There

have been many ideas on how to improve nurse retention mentioned throughout this

pandemic, and they will be discussed further during this paper.

The threat of a nursing shortage began prior to the COVID pandemic due to an aging

workforce, and in some cases COVID provided motivation for an earlier retirement. “To address

the global nursing shortage, 10.6 million more nurses must replace retiring nurses” (Morris,

2021). That number is solely reflective of nurses that are of retirement age, and does not

include those nurses who are leaving the bedside due to the working conditions brought on by

COVID. As more nurses leave the bedside, it can negatively impact those nurses who chose to

stay as they are expected to still care for all the patients in need, while having less help. This

can lead to increased nurse to patient ratios, which can lead to an increased risk for errors,

mortality, decreased patient satisfaction, and amplified stress levels. “An ICN survey found that

nearly 90% of national nurses' associations were concerned that heavy workloads, burnout, and
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stress were factors for the growing nursing shortages” (Morris, 2021). COVID could be

considered an influence in all of those factors, as it has required nurses to work short-staffed

with limited equipment for critically-ill patients whose families are not allowed to be with them,

and many times ultimately not getting good patient outcomes. The mental and physical stress

brought on by this pandemic has lasting effects and is causing individuals to search out other

career options. “A 2020 survey of nearly 6,500 RNs working on medical–surgical units or ICUs in

New York and Illinois found that, on average, 47% reported high burnout and 24% said they

intended to leave their current job (Fauteux, 2021)”. As there is already a deficit due to the

retiring nurse population, the more nurses that leave the profession now the greater the

chance working conditions will not improve, thus allowing this vicious cycle to repeat. Nursing

retention is essential, as it can impact patient safety and satisfaction, along with coworker

satisfaction and stress levels. It is important to focus on nurse retention because adequately

staffed units can have safe nurse to patient ratios, decreased chance for errors, increased

mental health in coworkers and increased patient satisfaction.

Nurses are thoroughly educated about leadership while going through school, and are

taught that there can be both formal and informal leaders. When entering the workforce, you

will know who your formal leaders are due to their title, while the informal leaders will present

themselves through various interactions. Nursing leaders are a great voice for change and for

advocacy, and also a great resource, due to the personality traits that made them leaders in the

first place. Upon speaking with nurse leaders at my job, they had varying ideas for how to

increase nurse retention rates. One of the most common ideas brought up was increased

compensation, either through incentive pay for picking up extra shifts, increase in pay rate, or
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through a retention bonus. Many nurses are leaving to pursue travel nursing due to the

lucrative pay, so this would appeal to those thinking of going down that path. The other big idea

that was brought up was the promotion of mental health, this is a broad topic that could look

different to everyone. Some of the more specific examples included sticking to specific nurse to

patient ratios, honoring time off requests, visits by pet therapy dogs, providing information for

therapists, and providing ideas for promoting mental health at home. The nurse leaders I spoke

with agreed that stress and feeling undervalued were among the main reasons individuals were

leaving the nursing profession, by providing appropriate compensation along with recognizing

the effects working in the pandemic is having on mental health, employees may feel more seen

and appreciated by their employer. Another idea that was mentioned was a mentorship

program for new nurses to help them cope with the pressure of becoming a new nurse, along

with the stress of working during the pandemic. As a new nurse, knowing that you have

someone looking out for you that you can talk to at any time, could be very helpful during this

stressful time and could be the reason you choose to stay in a job. Throughout my

conversations with my nurse leaders, the underlying themes reflected that nurses wish to be

seen by their employers as individual human beings instead of as replaceable pawns, and that

nurses wish to be adequately compensated for the work they are doing. With those ideas in

mind, research was done regarding nationwide retention strategies so that a formal retention

plan could be established.

Hospitals across the country are all experiencing the same problems related to the

COVID pandemic, nursing burnout and nursing shortages. Therefore, it is no surprise that the

retention strategies mentioned across the board reflect those that my nursing leaders brought
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up. The main theme established throughout my research of retention strategies was that it was

important to view nurses as individuals and recognize the stress they have gone through as a

result of this pandemic. “The above framework application suggests that in order to preserve

organizational resilience during the COVID-19 pandemic, HCO leaders need to adopt a holistic

consideration of worker psychological safety—one that recognizes the complex impact of

emotional distress experienced by healthcare workers during the pandemic” (Rangachari &

Woods, 2020). It is important to validate their feelings, and to understand that the vast majority

are leaving the profession due to the effects on their mental health. “Therefore, while it may be

reasonable to view worker psychological safety primarily from the perspective of job security

during normal times, it is essential to adopt a more holistic consideration of psychological

safety during unprecedented times like COVID-19, to provide for the broader impact of

emotional distress and worker burnout” (Rangachari & Woods, 2020). Thus, in order to keep

nurses at the bedside it is crucial take steps to ensure improvement in the area of mental

health.

In order to facilitate change in the area of nursing retention, it is important to gather

information regarding the root reason nurses are leaving and devise a plan that addresses the

main concerns. Through my research, I have gathered that strain on their mental health is one

of the main reasons nurses are leaving the bedside, so any retention plans need to speak to

that. A recent study was done, via open-ended questions of over one hundred nurses, to gauge

healthcare worker’s reactions to the pandemic, stressors from working in the pandemic, and

their coping mechanism. “The nurse respondents in our study listed sharing jokes and humor

with coworkers, sufficient rest and time off, community recognition and support, taking
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protective measures, recreational activities such as shopping, streaming movies, outdoor

exercising and social media as effective self-care techniques and measures to cope and reduce

stress” (Gray et al., 2021). With those results in mind, my idea for nursing retention would be a

multi-layer plan that included having employees reflect on their own mental health, provide

education regarding how to improve mental health at home, and incorporate departmental

changes to promote mental health, some of which would come from employee suggestions.

This could all be done by the use of my artifact, which would be a mental health promotion

questionnaire, aimed at highlighting the importance of mental health and at ways to improve it.

The desired outcome of the retention plan and the artifact is to improve mental health, thus

increasing job satisfaction, happiness, and willingness to stay in their current position. The first

part of my mental health questionnaire will include questions regarding how one views their

mental health, this is for the nurse to keep so there is no fear of being judged and they can be

completely honest with their answers. The objective is just for them to get a baseline of where

they stand with their mental health. The next part of the questionnaire will include some

information regarding ways to improve mental health at home, along with names and phone

numbers of therapists, support groups, etc. This part is also for the individual to take home, this

allows them to have resources if they would like to reach out and talk with someone, and

allows it to be done privately. The third part of the questionnaire would include some ways the

department/organization is trying to improve mental health, along with a space to fill in some

suggestions. This artifact can help to facilitate change by allowing the organization to see what

their employees need, and by providing them with resources. A sample mental health

promotion questionnaire, Figure 1.1, is included below.

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Figure 1.1

Mental Health Promotion Questionnaire

Part 1: Personal Mental Health Questions – These questions are for personal use only and are
to help you reflect on your current mental health (0=never, 3=sometimes, 5=frequently)
 How often do you feel like things are “out of control” in your life?
 How often do you snap at others for things out of their control?
 How often are happy to be at work?
 How often do you get to partake in activities you enjoy?
 How often are you experiencing sleep disturbances?
 How often are you experiencing not having enough energy to perform ADL’s?
 How often are you having what you consider “breakdowns”?

Part 2: Ways to Help Your Mental Health at Home

 Eat a healthy diet
 Drink an adequate amount of water
 Get a full night’s sleep
 Partake in a form of exercise you enjoy: running, weight-lifting, yoga, biking, hiking,
swimming
 Plan outings with friends and family
 Engage in activities/hobbies you enjoy: reading, shopping, crafting, writing, volunteering
 Participate in self-care, whatever that means for you: spa day, massage, getting yourself
a “treat”, watching Netflix and napping
 Speak with someone
o Dr. Local Therapist, 302-123-1234
o Happy App 833-327-0262
o Therapy Aid Coalition, https://therapyaid.org
o American Nurses Association, https://www.nursingworld.org/practice-
policy/nurse-suicide-prevention/
o Well Being Initiative,
https://www.nursingworld.org/~49d911/globalassets/covid19/nurses-guide-pdf-
003.pdf

Part 3: Mental Health Promotion at Work

 Visits by therapy dogs for staff
 Free PTO day for all employees to use as a mental health day
 Managers honoring all PTO requests (to the best of their ability)
 Adhering to determined nurse-to-patient ratios
 Massage chair in breakroom
 Creation of nursing retention committee made up by peers: easily able to share ideas
with the committee, the committee has scheduled meetings with administration
What other ideas do you have for mental health promotion at work?
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Ideally, this questionnaire could be distributed to nursing leaders, such as clinical

coordinators or department managers, from all units throughout the organization to hand out

to their staff. A spokesperson could then be appointed to report back with the suggestions

made by employees. All the nursing leaders acting as spokespeople could collaborate to discuss

the suggestions and determine which are plausible and which require involvement of higher-

ups in administration. If further approval or planning is necessary, a detailed plan should be

developed prior to presenting the idea to administration. The desired outcome is working

collectively as a team to improve the mental health of the healthcare providers doing their best

during the pandemic.

Nurses leave the bedside, and the profession, for a variety of reasons, but the mental

and emotional strain of working through a global pandemic is at the top of the list right now. As

nurses leave, additional stress is placed on the remaining nurses as they are still expected to

work at the same level, but with less help. Nursing retention is crucial as it helps to eliminate

the additional stressors that arise from working in an understaffed environment. In order to

have a successful nursing retention plan, it is imperative to uncover the reason employees are

leaving and address it. In the midst of COVID, the negative effect on mental health is a key

player and my plan includes speaking to gaps in mental promotion, and working to close them.
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References

American Nurses Association. (n.d). COVID-19 Resource Center.

https://www.nursingworld.org/practice-policy/work-environment/health-
safety/disaster-preparedness/coronavirus/

Fauteux, N. (2021). COVID-19: Impact on nurses and nursing. American Journal of Nursing,
121(5), 19-21. doi: 10.1097/01.NAJ.0000751076.87046.19

Gray, K., Dorney, P., Hoffman, L., & Crawford, A. (2021). Nurses pandemic lives: A mixed-
methods study of experiences during COVID-19. Applied Nursing Research, 60.
https://doi.org/10.1016/j.apnr.2021.151437

Morris, G. (2021). Post-pandemic nursing shortage: What it means for aspiring nurses. Nurse
Journal. https://nursejournal.org/articles/post-pandemic-nursing-shortage/

Rangachar, P. & Woods, J.L. (2020). Preserving organizational resilience, patient safety, and
staff retention during COVID-19 requires a holistic consideration of the psychological
safety of healthcare workers. International Journal of Environmental Research and
Public Health, 17(12), 4267. https://doi.org/10.3390/ijerph17124267