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Patients come to the emergency department (ED) every day seeking care that requires nursing knowledge and expertise. Data predicts a nursing shortage by 2020 of 1,000,000 nurses.1 This shortage begins with nursing programs unable to produce as many novice nurses to meet the growing demands of the profession. The shortage is enhanced as novice and experienced nurses “burn out” and leave the profession or choose to work outside of the hospital. Additionally, the population of expert nurses is aging and choosing retirement. When expert nurses choose to leave the ED or retire, not only are patients deprived of a nurse, but one with considerable skill and judgment. Further, novice nurses are deprived of a mentor to further their skill development.

ED nurse leaders are challenged to hire the best nurses and to maintain high retention rates. Retention in complex nursing environments is difficult due to high expectations of staff, complexity of patient care, recurrence of stressful situations, and lack of support.2 Creating and maintaining a work environment that fosters professional development, continuous improvement, and retention requires transformational nursing leadership. It is essential for ED nurse leaders to create successful programs that will develop and retain novice and expert ED nurses.

Job “Embeddedness”

Retention rates and turnover historically revolve around reasons why nurses leave. The nurses become dissatisfied with their jobs, seek new opportunities, weigh the risks and benefits of leaving the old job, and finally, leave if the new employer is perceived to be “better.” “Better” is defined as an increase in job satisfaction and commitment and ease of moving from job to job.3 To aid in the retention of nurses, understanding the reasons why nurses stay in ED nursing is important.

“Fit” and Links and Sacrifice

Job embeddedness (JE) focuses on retention and investigates forces that keep employees in their current jobs. These attributes include “fit” and links/sacrifice between the employee and the organization and community.4 The more embedded nurses are in the organization and the community, the more likely they are to remain employed at their current job (Table 103-1).

  1. Fit can be defined as the employee's perceived comfort level of their place in the organization. Staff relate positively to feelings of fit with the team when they are a good match or fit with the organization. Important components of fit include the

      1. Employee's future plans for growth within the organization

      1. Demands of the job including training, skill development, and a manageable workload

        • Organizational support for nurses includes funding for internal and external education and work environments that promote health and wellness. Individuals with negative feelings toward the fit with the organization are more likely to leave an organization. Employees who find job compatibility will remain employed.4

  2. Links refer to connections. These connections may be formal or informal, both of which are important. These connections can be to ...

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