1. Introduction and Background
The COVID-19 pandemic has impacted healthcare worldwide differently, especially regarding nurse retention. According to Lavoie‐Tremblay et al. (2022), there were mixed effects of COVID-19 on a nurse’s retention. While the pandemic highlighted the nurse’s crucial role in the healthcare systems worldwide, it also presented different stressors and challenges, directly influencing the nurse’s retention rate. In contrast, there were positive impacts of COVID-19 on nurses’ retention; the pandemic also presented negative implications on their retention, making it an essential topic for research (Falatah, 2021). For instance, the study by Marks et al. (2021) identified that COVID-19 negatively affected nurse retention in the U.S. by contributing to increased nurse burnout. This study demonstrates that COVID-19 forced nurses to witness the suffering of COVID-19 patients, leading to moral distress. That was because the nurses watched thousands of patients suffering and dying helplessly due to COVID-19. The patients suffering from other diseases agonised more since the healthcare system was forced to make resource allocation decisions that favoured people with COVID-19 more than others.
However, proponents argue that COVID-19 led to decreased nurse retention since it led to their recognition and appreciation, making most of them stick to their roles to help the public heal from the pandemic. According to Senek et al. (2020), nurses’ essential and visible role during the pandemic encouraged many to work harder to care for COVID-19 patients properly. That was vital in promoting a reasonable retention rate among nurses since it highlighted their expertise and dedication, making nursing among the most essential careers globally. To that end, the nurses realised the importance of their work in promoting good health and well-being, justifying why the pandemic enhanced the nurse’s retention, as believed by many. The mixed feeling, as witnessed in the current literature, makes it necessary to carry out further research on the topic to identify the necessary practice changes, quality improvement, and innovations to prevent the impacts of COVID-19 on nurse retention in the future. This study examines ways healthcare institutions can enhance nurse retention during future pandemics.
2. Purpose Statement and Literature Review
2.1. Purpose Statement
This study examines how the COVID-19 pandemic affected nurse retention in the U.S. to identify possible solutions for enhancing nurse retention. The study aims to identify the effects of COVID-19 on nurse retention by scrutinising how the pandemic affected the nurse’s job security and demand, sense of purpose, and opportunity for growth to influence practice change. The second objective is to observe how the pandemic influenced the nurse’s physical and emotional exhaustion, safety concerns, and workload to develop quality improvement strategies and innovation to promote nurse retention. The contribution of this study is significant, enabling healthcare institutions to be more prepared for similar pandemics in the future by providing the healthcare industry with several strategies for managing nurses’ retention in the face of worldwide pandemics. Identifying the COVID-19 impacts on retention will also enable healthcare institutions to understand how similar pandemics will likely affect nurses. That is essential in promoting good practice and a reasonable nurse retention rate, underscoring this research’s value to the healthcare industry.
2.2. Practice Change, Quality Improvement, and Innovation
To promote a better nurse retention rate, healthcare institutions should consider implementing strategies and practices, like reasonable compensation and a better work environment, which make them value their roles and organisations. First, healthcare institutions in the U.S. can improve their nurse retention rate by offering them competitive benefits and salaries. According to Maben et al. (2022), providing nurses with competitive benefits and salaries is crucial in attracting and retaining skilled nurses who are likely to stay in their roles even during trying times like COVID-19. That is affirmed by Squires et al. (2022), indicating that reasonable compensation for nursing roles is necessary for demonstrating to nurses that the healthcare institutions they work for are committed to rewarding their hard work and recognising their contribution. That lowers the chances of the nurses seeking better opportunities in companies that may treat them better.
Second, healthcare institutions in the U.S. should consider creating a supportive and safe work environment for their nurses to promote nurse retention. According to Endacott et al. (2022), offering nurses a safe work environment is a strategy that can enable many of them to continue working, especially during the COVID-19 pandemic, when an unsafe and less supportive environment would increase their chances of attracting the virus. Healthcare institutions in the U.S. can achieve this by promoting teamwork, encouraging open communication, and ensuring sufficient staffing levels (Crismon et al., 2021). These would be important in motivating the team of nurses to work hard amidst the pandemic, knowing that their work environment is safe for their health and supportive of their roles.
Third, healthcare institutions should resort to providing an excellent work-life balance for their nurses. According to Bergman et al. (2021), a balanced work-life is critical to promoting nurse retention. It offers nurses flexible scheduling options that enable them to be more productive, making them feel comfortable with their roles during a pandemic like COVID-19. That is affirmed by Xu et al. (2020), indicating that healthcare institutions in the U.S. can promote good nurse retention by offering them paid time off, especially during COVID-19, when a good number of nurses became COVID-19 patients. Paying them their salaries during such a time will likely encourage them to continue working for their employer, enhancing nurse retention.
2.3. The Chosen Practice Changes
The chosen practice changes necessary to promote nurses’ retention during pandemics like COVID-19 is the adoption of telehealth and remote monitoring technologies. Telehealth and Remote monitoring technologies effectively enhance nurse retention by allowing nurses to offer remote care to their patients and monitor COVID-19 patients from a distance (Rangachari & Woods, 2020). That would be essential in retaining nurses who fear having direct contact with COVID-19 patients. According to Sniderman et al. (2022), over 4% of nurses in the U.S. changed their profession during COVID-19 for fear of contracting the virus. Telehealth and remote monitoring would be necessary to prevent such nurses from resigning, justifying the significance of this technology in promoting better nurse retention in the U.S. That is true since remote monitoring enables nurses to track their patients’ conditions, making it easy for them to feel satisfied with their jobs by enabling them to intervene proactively without risking their health (Powers et al., 2022).
2.4. Quality Improvement
Healthcare institutions should consider adopting quality improvement practices like offering the nurses strict adherence to control protocols and infection prevention, which is essential in enhancing better nurse retention amidst pandemics like COVID-19. According to Powers et al. (2022), over 30% of nurses who resigned from their jobs during COVID-19 believed the virus would infect them if they continued handling COVID-19 patients for a long time. Offering a strict adherence to infection prevention is essential in preventing such nurses from running away from their roles when faced with similar situations. Ongoing education and training on control protocols should ensure that nurses understand disinfection practices, proper use of personal protective equipment, and hand hygiene, which is essential in making them feel more protected from similar viruses in the future (Lyman et al., 2022).
Healthcare institutions can also enhance quality control by ensuring adequate staffing levels. According to Lyman et al. (2022), inadequate staffing among nurses during the COVID-19 pandemic was a major factor that forced many nurses to quit and look for better opportunities in other industries. That is acknowledged by Roberts et al. (2021), stating that the imbalance of the nurse-patient ratios was the second factor that led the nurses to quit their jobs and join other industries during the COVID-19 pandemic as it increased the chances of infection. That is true since overburdened nurses needed more time to implement proper infection control measures as the virus was abrupt and spread fast, increasing the risk of patient-nurse infection (Vogt et al., 2023). Adequate staffing would promote good nurse retention by giving the nurses enough time to offer care services that are safe for them and of high quality to the patients.
2.5. Innovations
Several innovative solutions can promote nurse retention amidst similar pandemics in the future. According to Poon et al. (2022), innovations like Virtual health & Telemedicine, remote work, and mental health support apps are essential in promoting nurse retention. Such innovations are crucial during similar pandemics since they aim to address the stressors and challenges nurses may face during such trying moments in the healthcare industry. That would be important in fostering good retention for the nurse, as discussed below.
First, Virtual Health and Telemedicine can prevent nurses from leaving their jobs for other companies. Their expansion has allowed them to provide services from the comfort of their homes, making them less susceptible to contracting the coronavirus. According to Sheng et al. (2020), leveraging Telemedicine and Virtual Health technologies can enhance nurse retention by enabling nurses to offer their education and support to patients from a safe distance. The technology offers reduced exposure and flexibility to nurses, making them love their jobs more and enhancing their retention rate in their healthcare institutions.
Second, innovations like remote work that promote better scheduling also enhance nurse retention. According to Sheng et al. (2020), the COVID-19 pandemic emphasised the significance of working remotely. All the nurses who worked remotely did not seek other job opportunities during the pandemic, justifying its significance in protecting healthcare institutions from losing highly skilled nurses. Therefore, healthcare institutions in the U.S. must implement this technology to allow nurses to work from their homes, especially for telehealth services, administrative tasks, and other non-patient roles, to prevent overcrowding of nurses in healthcare institutions during deadly pandemics like COVID-19. That is affirmed by Singh et al. (2021), who identified that remote work’s flexibility and flexible schedule could enable nurses to experience better job satisfaction, augmenting their retention in their healthcare organisations.
2.6. The Rationale for Practice Change, Quality Improvement, and Innovation
Telehealth and remote monitoring technologies are good practice changes and effective in enhancing nurse retention since they allow nurses to offer remote care to their patients (Simonovich et al., 2022). Offering a strict adherence to infection prevention is vital in preventing nurses from running from their roles when faced with similar situations in the future. Adequate staffing promotes good nurse retention by giving the nurses enough time to offer care services that are safe for them and of high quality to the patients (Roberts et al., 2021). Virtual Health and Telemedicine can prevent nurses from leaving their jobs for other companies. Its expansion has allowed them to provide their services from the comfort of their homes, making them less susceptible to the coronavirus (Poon et al., 2022). As previously identified, remote work can enable nurses to experience better job satisfaction, augmenting nurse retention.
2.7. Literature Review
The current literature demonstrates evidence of how COVID-19 impacted nurse retention. First, 6% of the registered nurses approaching retirement age retired earlier than expected since they were more susceptible to COVID-19 (Martin et al., 2023). The early nurses’ retirement increase had only been experienced after COVID-19, proving that the COVID-19 pandemic fostered it (Vozzella & Hehman, 2023). That is affirmed by Simonovich et al. (2022), indicating that the increase in the number of nurses seeking retirement proves that COVID-19 negatively impacted the retention of nurses in the healthcare industry. 4% of nurses nearing retirement age decided to retire early due to the high risk and demand of COVID-19 (Kung et al., 2023). In collaboration with the government, the healthcare industry should prepare nurses for similar pandemics to prevent them from retiring early, which is essential in promoting good nurse retention in the U.S.
The second evidence of the COVID-19 impact on nurse retention is the number of nurses seeking career change during and after the COVID-19 pandemic. According to Kabir et al. (2023), there was a 7% increase in the number of nurses seeking career change within the last two years alone, a number that is considered the highest within the last 15 years. According to Xing et al. (2023), the COVID-19 pandemic forced 15% of registered nurses to seek jobs in other career paths that are less demanding and with less risk of contracting the virus. Therefore, healthcare institutions should improve their recruitment process and the requirement to attract nurses who are less self-centred and more caring of their patients. That would prevent the rise of the number of nurses abandoning their patients to seek their safety elsewhere.
The third evidence of COVID-19’s impact on nurse retention in the U.S. is the increased workforce shortage and demand during and after the pandemic. According to Martin et al. (2023), the U.S. nurse shortage has increased by over 15.1% since the inception of COVID-19, encouraging the healthcare industry to seek nurses from other countries and states worldwide. That is affirmed by Kung et al. (2023), indicating that one of the current careers that are easy to secure jobs in the U.S. is nursing. Besides, the nurses’ wage rates have improved by 5% within the last two years (Kabir et al., 2023). The rise in wage rate is intended to attract more nurses in the industry, proving that COVID-19 forced many nurses to seek other roles, negatively affecting nurse retention in the country.
Recent studies demonstrate that COVID-19 increased the nurse turnover rate in the U.S. According to Jefferson, Heathcote, and Bloor (2023), in April 2023, Dr Auerbach David and colleagues published a nursing workforce analysis which identified that the total supply of registered nurses decreased by over 100,000 between 2021 and 2023. The drop in the number of registered nurses in the U.S. was the largest ever observed within the last five decades. That proves the heavy impact COVID-19 had on nurse retention. The evidence is affirmed in the study by Cegolon et al. (2023), which shows that most registered nurses who shifted their profession during COVID-19 were younger nurses aged between 25 and 34.
In a recent national survey of licensed nurses in the U.S., 40% of the 1200 surveyed nurses demonstrated that many of their colleagues shifted their profession from nursing because of fatigue and burnout (Mohammadinia et al., 2023). Half of the surveyed nurses indicated they were emotionally drained due to the increased workload and long working hours since their colleagues left, fearing the virus would infect them. The registered nurses indicated that they thought of living too but decided to stay since their family members were infected; hence, they did not want to be viewed as having abandoned COVID-19 patients when they needed the nurses the most (Jefferson et al., 2023). This analysis offers critical and contextual evidence to understand the COVID-19 implications on the U.S. nursing workforce. It shows that nurses’ retention rate increased by 15.53% between April 2020 and May 2023 (Norris, 2023).
Potential Long-Term Influence of COVID-19 on the Nurse’s Decision to Stay or Leave.
The nurse’s experience during COVID-19 will likely encourage many nurses to leave in the future. COVID-19 caused nurses to experience increased stress and burnout (Lane et al., 2023). The immense strain on the nurse’s emotional and physical well-being due to the long working hours and increased workloads is likely to have a long-term influence on the nurse’s decision to leave. A significant number of nurses will potentially shift to less straining professions to avoid similar stress and burnout in the future.
The impact of the pandemic on work-life balance could have a long-term effect on nurse retention. The pandemic forced the nurses to re-evaluate the working hours that most suit them (Cardiff et al., 2023). While others felt like the working hours in nursing are too long, others thought it would be better if the employers allowed them to choose the time of the day that may encourage them to work harder. The nurses who found managing professional and personal responsibilities challenging during the pandemic will likely pursue careers with better work-life balance. The pandemic also affected many nurses’ career advancement and trajectory, which may influence their decision to leave. COVID-19 altered and delayed the nurse’s career advancement plans, making them feel like the profession will likely present less opportunity for growth and advancement if a similar crisis occurs (Dos Santos, 2023). That will likely encourage some nurses to explore other careers with more promising career advancement and trajectories.
However, the nurse’s experience with COVID-19 may also influence their decision to stay. COVID-19 enabled some nurses to develop a sense of adaptability and resilience (Lohiniva et al., 2023). The improved resilience and adaptability likely make such nurses view the experience gained as an opportunity for professional growth. That will likely motivate them to enhance their career growth, creating an opportunity to be more valued and better rewarded by their employers. The nurses’ experiences with the pandemic also enabled them to receive more appreciation and support from the public and their employers (Lohiniva et al., 2023). That will likely make the nurses feel fulfilled and purpose, encouraging them to stay, especially when the employers reward the recognition with better working conditions and increased compensation. The experience is also Lilley to make the nurses feel a sense of job security and stability, knowing that their employers will need them more in case of similar pandemics in the future.
2.8. Cause and Effects of Nurse Retention Changes During
COVID-19
There was a disruption in career development and advancement for nurses, forcing some of them to join other opportunities. According to Li et al. (2021), COVID-19 disrupted the nurses’ opportunities for career advancement as training for nurses was stopped, and every healthcare worker was encouraged to cater to the needs of the COVID-19 patients. For instance, all the professional development opportunities, including conferences and training programs, were postponed indefinitely. Such disruptions harmed the nurse’s job satisfaction, affecting their willingness to continue with their profession. The effect of the career development disruption was that many nurses, especially the younger ones fresh from college, were scared and sought other jobs in other industries.
The cause of the decrease in nurse retention in the U.S. healthcare industry was financial considerations. According to Hughes et al. (2022), the pandemic impacted nurses economically, with many finding it hard to care for their families. The study by Li et al. (2021) indicates that nurses’ salaries were slashed by almost half to enable their employers to pay more nurses and healthcare workers hired during the pandemic to help care for COVID-19 patients. The reduction in nurses’ salaries was because of a decline in the profitability of healthcare businesses in the U.S., as was the case in the rest of the world, making it hard to continue paying the nurses’ average salaries. The effect of financial hardships brought by COVID-19 was that some nurses sought other jobs to provide food and shelter for their families. It impacted the nurse’s decision to continue working in the industry, justifying the decline in nurse retention in the country.
Finally, the third cause of nurse retention decline was the increase in mental health challenges faced by nurses, leading to a decline in their emotional well-being. According to Boamah et al. (2022), 7% of nurses in the U.S. faced emotional distress caused by the pandemic, forcing them to seek therapies during the pandemic. Nurses who are emotionally unstable are not fit to take care of patients, forcing them to abandon their roles for other nurses, further causing burnout among the other nurses. The effect of mental health challenges was that more and more nurses resorted to seeking other jobs that are less distressing (Boamah et al., 2022).
3. Plan for Improvement
To effectively improve nurse retention, healthcare institutions in the U.S. should consider adopting two models: the psychological contract model and the employee engagement model. According to Bell and Sheridan (2020), the employee engagement model enables healthcare institutions to create a more engaging workplace environment. Workplace engagement enables employees to feel a sense of commitment, involvement, and purpose, lowering their chances of seeking employment opportunities in other companies. Beckett et al. (2021) emphasise that the model promotes recognition and rewards, growth and development, meaningful work, and job satisfaction, significant factors that led to low nurse retention during the COVID-19 pandemic. In that light, healthcare institutions in the country should consider creating an environment that meets the nurses’ needs and enhances nurse retention.
Employers can rely on an employee engagement plan to reduce the nurse turnover rate in three steps. They should consider providing the nurses with a professional development opportunity, offering them autonomy, and recognizing their achievements (Lohiniva et al., 2023). The success of these steps can be achieved using the following strategies. Employers can:
1) Provide professional development opportunities by offering nurses free training programs, continuing education, and certificates as proof of career growth.
2) Employers can foster nurses’ autonomy by empowering them to control their decision-making, patient assignments, and work schedules. This would enhance their motivation and job satisfaction and lower their chances of changing career paths.
3) Recognise the nurses’ contributions and achievements by celebrating by reinforcing their values and celebrating their milestones regularly.
Healthcare institutions should adopt the second model, the psychological contract model (PCM). According to Beckett et al. (2021), PCM fosters mutual expectations and obligations between nurses and their employers, lowering their chances of seeking job opportunities in other companies. Michel et al. (2021) identify that the model enables nurses to meet their psychological needs, like development opportunities, fair treatment, and job security. Nurses will likely seek better opportunities in other organisations without meeting such needs. This plan will enable employers to build loyalty and trust with their nurses, fostering improved nurse retention.
The psychological contract model would enable the employers to engage the nurses to stay in three steps. They can consider offering them competitive compensation, flexible schedules, and a supportive work environment (Norris, 2023). These steps can be achieved using the following strategies: First, the employers should conduct regular salary reviews, which are essential in aligning their salaries with the industry standards. Second, employers should address nurses’ workplace concerns to maintain a healthy work environment. They can achieve that by creating a supportive culture that promotes collaboration, teamwork, and open communication. Finally, employers can achieve the nurse’s flexible scheduling by allowing them self-scheduling, job-sharing arrangements, and part-time positions (Jefferson et al., 2023).
3.1. Literature Gaps
The current literature demonstrates mixed reactions to the effects of the COVID-19 pandemic on nurse retention in the U.S. While past studies show that the pandemic made many nurses seek employment opportunities in other companies, it is also interesting to note that most nurses who left work have registered with healthcare colleges to improve their skills. That makes it hard to validate if the pandemic had a net positive or negative impact on nurse retention. Similarly, proponents believe there was a rise in overall nurse retention and a decrease in the nurse retention rate (Michel et al., 2021). This study will, therefore, be necessary for settling the dispute or filling the gap by identifying the direction of the overall COVID-19 pandemic impact on nurse retention in the U.S.
3.2. Implementation
3.2.1. Description of the Steps
As a nurse leader, the researcher identified that many nurses felt overwhelmed with their roles during COVID-19. The nurses realized that the pandemic brought an unprecedented burden on the healthcare sector. Since nurses were at the forefront of patient care, they felt the initial surge, the heat of staff shortage, and increased workload, making it hard for them to operate effectively. These factors made them experience mental and emotional distress, making some of them step out from their roles to enhance their well-being, demonstrating the causes of the decrease in nurse retention. The increased pressure on nurses discouraged them from seeking other sources of livelihood, especially when employers cut their salaries to enable them to pay all the nurses amidst the economic hardship faced in the healthcare industry, as in other industries.
The adverse effects of COVID-19 on the nurses had to stop, making it necessary to involve the nurses. The researcher identified that involving the nurses in solving their challenges would bear more fruit than excluding them. The nurses worked together to make suggestions to make them feel more comfortable performing their roles without feeling overwhelmed by the increased workload and staff shortage. The pandemic was new, and many nurses had little training in dealing with the situation, justifying why there was a need to offer fast training to prevent them from feeling overwhelmed. The training sessions were vital as they assisted the nurses in improving their skills to handle COVID-19 patients. The training also enabled them to lower their physical and emotional distress, demonstrating why nurse retention improved after the short training offered.
Even after the training, the researcher-maintained contact with the nurses, encouraging them to improve in areas where they may face deficiency. Keeping the nurses in contact enabled them to be more authentic with the researcher, allowing them to share the problems they faced during the pandemic, including how they impacted their work and personal lives. The nurses suggested possible solutions to their problems with COVID-19, including the need for their employers to promote good work-life balance to help them attend to their families back at home. They also suggested that they should be allowed to choose the working hours that best suit them if they remain motivated to hold the assigned tasks. As a result, they could have breaks to rejuvenate their strength since the number of COVID-19 patients admitted increased daily.
After adequately interacting with the nurses, the researcher contacted the management of the healthcare institution through a letter and later in person. The researcher requested that they incorporate the nurses’ suggestions in developing better strategies to handle the patients without causing physical and emotional distress to the nurses. The researcher presented the evidence of the nurse’s distress to the management to enhance the chances of the suggestions being approved. The nurse felt that as one of the nurse leaders, it was necessary to stand up for the nurses to prevent them from suffering from the increased workload, emotional distress, and economic challenges they faced because of the COVID-19 pandemic. The researcher also presented how the nurses felt that the pandemic affected their quality of services, encouraging the hospital’s management to develop quick but well-thought strategies that would come to the nurses’ rescue. The management agreed to work together with the researcher and incorporate the nurses’ suggestions, enabling them to develop possible solutions to the challenges faced by the nurses. The solution formation included an extensive literature review of past studies on similar topics.
The hospital invited stakeholders and policymakers to a meeting where the researcher attended. The meeting enabled the stakeholders, managers, and the researcher to develop solutions that made the nurses feel valued and appreciated, improving the hospital’s ability to retain its nurses despite the challenges brought by COVID-19. During the meeting, the team concluded that further training was the best solution. At the same time, the team suggested that the other healthcare professionals be assigned the nurses’ roles to prevent the nurses from feeling overwhelmed with work. That created a supportive environment that encouraged the nurses to work together to ensure patient safety throughout the pandemic. The researcher worked with the hospital to coordinate an additional two months of training for the staff, demonstrating why they managed to work together effectively until the pandemic ended.
3.2.2. Barriers
The researcher faced several barriers to the implementation of the project. The first barrier was resistance to disrupting practices that most nurses were accustomed to. The nurses were accustomed to traditional practices such as attending to a specific number of patients daily. Introducing an extra workload with no promise of extra pay could have sat better with most nurses, forming a barrier that wasted significant time in implementing the project. The nurses ingrained traditional habits and the preference to maintain the status quo greatly hindered the implementation as the proposed changes required a significant shift in workload and clinical protocols.
The second barrier to the project implementation was limited time brought about by workload pressures. During the pandemic, the nurses worked in a highly demanding environment with heavy workloads, leading to time constraints to ensure project implementation success (Li et al., 2021). It was also challenging to keep the nurses attentive and dedicated enough to promote the change implementation as they witnessed their colleagues lose their lives from the virus, demonstrating why they needed to follow up with the nurses to ensure they understood what was expected of them from the training. Many nurses also felt that the changes would increase their workload further and worsen their situation by compromising their patient care abilities.
3.2.3. Overcoming the Barriers
To overcome the nurse’s resistance to the disruptions of the existing practices, the researcher encouraged supporting the nurses and addressing their concerns. For instance, it included active listening to the nurse’s concerns to address them with empathy, making them realise that the patients’ lives solely depended on their cooperation. The researcher showed the nurses that the team understood their fears, uncertainty, and resistance by providing support to alleviate their anxieties. The team also made them understand that the nurses from the other hospitals were undergoing the same and that their career as nurses was a calling to humanity as the patients needed them more than ever before. The researcher offered the nurses an open forum where they would have open dialogue, enabling them to share and express their worries and receive clarifications on the challenges they were experiencing.
The researcher overcame the barrier of limited time created by workload pressure by constantly highlighting best practices and success stories. The researcher shared the success stories from other healthcare institutions, making the nurses and their management understand that they can work together to create time for the project implementation. By highlighting the other institution’s success stories, the team could see the potential positive outcomes and enhanced work environment, allowing them to work harder to control the impacts caused by the pandemic on nurse retention. Besides, the researcher worked with the institution to develop a culture of continuous learning where the nurses could seek clarification for new challenges they faced or could face in the future. Fostering a culture of constant learning enabled the nurses who felt like changing their careers to understand that the situation gave them an opportunity for further professional development.
3.2.4. Identification of the Professional Relationships
The researcher involved ten professionals, including hospital managers and representatives of the U.S. Health Ministry, and nurse leaders. The professionals played different roles in ensuring the success of the project. As a nurse leader, the researcher understood that the project’s success required different levels of commitment, which would come from more than one level of professionals. Involving ten hospital management ensured that the strategies implemented were universal and could help the nurses from different parts of the country. Involving the Ministry of Health representative meant that the government accepted the policies implemented. Similarly, the presence of a nurse representative ensured that the needs and concerns of the nurses were addressed, as discussed in their relationships below.
3.2.5. Discussion of the Relationships
The researcher understood that the hospital management, nurse leaders, and health ministry representatives would play important roles in enhancing the project’s success. The management of the hospitals played a role in ensuring adequate resource allocation for the project. They also provided supportive policies necessary for prioritising the nurse’s well-being, like the work hours, the best time for breaks, and support for the nurse’s professional development, preventing the nurses who felt neglected during the pandemic from feeling valued again. Similarly, the hospital management was necessarily professional in the project since they provided effective communication and feedback channels, ensuring the strategies implemented were working for the management and the nurses alike.
The health ministry representatives played three crucial roles in ensuring the project’s success and implementing the strategies. The first role was policy development; they developed policies that ensured the nurse’s work environment was positive. For instance, they regulated the safety standards, occupational health, and staffing ratios, ensuring the nurses were comfortable completing their roles. They also played the role of advocacy and support by advocating for the nurse’s support and needs. They, therefore, supported initiatives that supported promoted nursing excellence. The third role played by the health ministry was ensuring stakeholder collaboration. The health ministry representatives ensured the team developed policies that promoted collaboration between the health ministry and the hospital management to enhance the nurse’s work environment, making it possible for the nurses to remain motivated in providing health care services during the pandemic.
The nurse leaders also played critical roles in the project. They provided mentorship and guidance to create a positive work environment for the nurses. They also accomplished this by supporting the nurse’s professional development and advocating for their needs and concerns during the strategy formulation stages. Nurse leaders played a role in promoting workload management, which was the nurses’ primary concern. They also played this role by advocating for sufficient staffing levels. They understood that by balancing the nurses’ workloads, the nurses would eventually experience a healthier work-life balance and avoid seeking alternative career opportunities. Finally, the nurse leaders played the critical role of ensuring the implemented strategies supported the nurse’s flexible scheduling options, allowing the nurses to choose the working hours that best suited them.
3.3. Discussion of the Project’s Success
The success of this project is demonstrated using three factors. The first factor is the achievement of the goal of the project. The main goal of this project was to enhance nurse retention during the pandemic, which was effectively achieved as the retention did not worsen after the implementation of the suggested strategies. That is affirmed by Marks et al. (2021), indicating that the success of a project can be determined by accomplishing the specific goals and objectives outlined at the beginning of a project. Besides, the researcher achieved the targets within the established timeframe, making the project successful.
This project was also successful because it was completed on budget. The researcher allocated $3000 for the project and spent $2950 within the budget. That is supported by Senek et al. (2020), who identified that adhering to a project’s planned schedule and budget is a sign of effective resource allocation and project management success. Even though the barriers to implementation required additional resources, the researcher ensured the project remained within the budget, further proving its success.
The final success factor is stakeholder satisfaction and adherence to quality standards. The stakeholders, like the nurses, were satisfied with the project as they expressed satisfaction despite initially resisting change. Their satisfaction was demonstrated through feedback and testimonials, which reflected a positive perception of the project’s results. The project also adhered to the quality standard since the patient’s demonstrated satisfaction with the quality of the nurses’ services, indicating that the health ministry representatives did their work effectively during the policy development stage of the project.
3.3.1. How the Success Is Likely to Inform Future Projects
The success of this project will offer valuable lessons and insights for future projects in three different ways. First, it will enable future projects to have a reference for the best practices as it will allow the researchers to identify the best approaches and strategies that can contribute to the success of similar projects. The lessons learned from this project will be shared with the stakeholders and teams who will be part of the future project, making it an important reference point to enhance its success. For instance, they will be able to identify what is likely to work better for them as far as execution and project planning are concerned.
The success of this project will also inform future projects by guiding their risk mitigation and avoidance. According to Maben et al. (2022), the success of a project enables future project teams to examine past successful projects to identify potential risks and how they can be mitigated and avoided. The knowledge gained from this project will enhance future projects’ success by enabling better risk mitigation. It will also enable future projects to improve their processes by revealing those areas where processes are practical and efficient to yield positive outcomes. It will thus enable future projects to replicate the success, lowering the chances of future projects flopping.
3.3.2. What Did Not Go Well?
There were increased external factor dependencies, and the project team faced challenges beyond its control. For instance, changes in market conditions and regulations during the project slowed the project’s completion and implementation. Besides, unforeseen events like natural disasters could have arisen due to COVID-19, making those participating in the project feel it was risky to out-complete it. It took longer to adapt to the external factors, disrupting the project’s progress.
3.3.3. Understanding What Did Not Go Well
The factors that could have gone better were mainly enhanced by the fact that there was resource constraint since the pandemic brought with it economic challenges, making it hard to access adequate resources for the project. There were unlimited resources ranging from technological, human, and financial, hindering the project’s success. Besides, based on the urgent need to find solutions to the nurse retention problem, there was inadequate planning, making the external factors identified above have more influence on the project’s progress and success. The rush to develop strategies to enhance nurse retention led to the formation of poor risk management and assessment, showing why the external factors hindered the smooth progress of the project.
3.3.4. How the Gap Was Bridged
Enhancing collaboration and team dynamics bridged the gap created by external factors. The researcher understood that improving the team dynamic and collaboration provided the best shot at augmenting the project’s success. The collaboration promoted the team’s cohesion, commitment, and shared vision, enhancing the project’s success despite the external challenges that threatened the project’s progress.
3.3.5. Support for the Plan
To effectively support the plan, there is a need to take proactive steps to improve the implementation process, which is essential in increasing the plan’s likelihood of success. These can be achieved in three steps. First, the researcher must ensure a clear and realistic plan for enhancing the plan’s implementation. It should begin with considering the constraints, timelines, and resource availability to ensure the plan implementation continues after the project is completed (Endacott et al., 2022). There should also be effective stakeholder engagement and communication to ensure the challenges met during the plan implementation are adequately communicated and solutions developed by all the stakeholders (Squires et al., 2022). There should also be adequate resource allocation and strong project leadership by appointing capable project leaders to provide proper guidance in implementing the plan.
3.3.6. Post-Implementation Resources
Post-implementation resources in this project will include technical support, maintenance and upgrades, and effective communication channels. According to Crismon et al. (2021), the post-implementation resources in a project are support systems, materials, and tools availed to stakeholders after the implementation of a project. The tools, materials, and support systems help ensure the implemented plans’ successful transition and sustainability. For instance, technical support will assist the other stakeholders in offering guidance on the project’s outcomes, addressing questions, and troubleshooting issues. The technical support will come in the form of a dedicated support staff member and a help desk to help report and resolve technical problems that may arise after the project’s initial implementation.
3.4. Reflection: Developing Strategies to Improve Nurse Retention during the COVID-19 Pandemic
This study examined how healthcare institutions can enhance nurse retention during a pandemic like COVID-19. The researcher identified that healthcare institutions should consider adopting the psychological contract and employee engagement models to improve nurse retention. The models can enable healthcare institutions to create a more engaging workplace environment (Bergman et al., 2021). An engaging workplace allows employees to feel a sense of commitment, involvement, and purpose, lowering their chances of seeking employment opportunities in other companies (Xu et al., 2020).
4. Conclusion: The Practical Implication for Healthcare
Institutions and Policymakers
Healthcare institutions and policymakers in the U.S. must understand that improving nurse retention in future pandemics requires a strategic and proactive approach. The first practical implication to consider is the support and resources. They should provide the nurses with adequate support to improve their well-being. Healthcare institutions can achieve these through support groups, counselling, and mental health services. The second practical implication regards safety measures for nurses. They should ensure that the nurses have adequate access to personal protective equipment, which is essential in making them feel protected. Therefore, healthcare institutions and policymakers should acknowledge that considering the above practical implications can improve nurse retention by fostering reasonable job satisfaction and enhancing their protection.
Employers can rely on the employee engagement model to reduce the nurse turnover rate in three steps. They should consider providing nurses with professional development opportunities through free training programs, continuing education, and certificates as proof of career growth. They can offer them autonomy by empowering them to have control of their decision-making, patient assignments, and work schedules. Also, they can recognise their achievements by celebrating by reinforcing their values and celebrating their milestones regularly.
The psychological contract model would enable employers to encourage nurses to stay in three steps. They can consider offering them competitive compensation by conducting regular salary reviews to align nurses’ salaries with the industry standards. They can promote flexible scheduling by allowing them to have self-scheduling, job-sharing arrangements, and part-time positions. Healthcare institutions can develop a supportive work environment by creating a supportive culture that promotes collaboration, teamwork, and open communication.