Journal of Nursing Management, 2013, 21, 603604
Editorial
International perspectives on retention, stress and burnout
Retention and the career trajectory
Retention of a nursing workforce is an international
and a burning issue worldwide. It remains, however,
still unclear what are the reasons that trigger nurses
intentions to leave or how exactly nurses career trajec-
tories may unfold. While we see all the time almost a
predicable evolution happening for some, others seem
to struggle and navigate career progression with great
uncertainty and strife. Several years ago, Shirey (2009)
presented a framework of Career Phases and Stages
that include (1) Promises, (2) Momentum, and (3) Har-
vest. This framework may help to explain why some
stay in a practice setting for their entire career, while
others transition through multiple practice settings or
leave nursing altogether. The increased complexity of
the healthcare environment coupled with the rapid
changes in todays contemporary health care milieu
increasingly support the need for formalized transition
programs for nurses (OGrady & Malloch 2013).
Nurse managers and leaders, but also entire health
care systems and nursing professional organizations
have risen to the challenge to find new ways to support
practicing nurses as they continue to navigate uncer-
tainty in ever-changing practice environments. While
opportunities in nursing remain limitless and new pos-
sibilities are emerging to strengthen and advance the
role of the nurse across multiple pathways and bor-
ders, many continue to experience stress and burnout.
Bumps in the road
The impossible challenges in life are the best teachers
Amy Mindell, Metaskills.
A few years ago Tonges (1997) posited that to
know and be guided by ones own values is an inher-
ent quality needed for professional renewal in chaos
saturated environments. Additionally, nursing work
must be accepted with change. This issue will explore
contemporary international research and scholarship
that probes the burning questions: why nurses leave
and why they continue to experience stress and burn-
out? And what mechanisms can the professional put
into place to protect the practice of nursing from
untoward outcomes associated with these phenomena?
DOI: 10.1111/jonm.12118
2013 Blackwell Publishing Ltd
This issue begins with a systematic review (pp. 605
613) of the nurse shortage which is adversely affected
by nurses who prematurely leave the profession. It pro-
vides compelling evidence for individual and organiza-
tional reasons for burnout and nurses intention to no
longer practice nursing. Some of these factors are modi-
fiable, while others are not.
The second article (pp. 614623) supports the argu-
ment that nurses working abroad are not always in
control of factors affecting their role. Organizational
commitment and subsequent acculturation impact
practice setting longevity. A culturally sensitive and
competent environment and appreciation of cultural
values are an undisputed focus of interest for nurse
leaders managing these workforces. It is important to
keep in mind that meeting the demand of health sys-
tem needs for tomorrows nurses and other profession-
als is predicated on preserving the integrity and value
for existing ones.
Innovation
The Future of Nursing, Leading Change, Advancing
Health recommendations have been instrumental in
fostering a paradigm shift of professional perceptions
internal to nursing and across health professions in
the US (Institute of Medicine 2010). One key message
in this document is that: Nurses should be full part-
ners, with physicians and other health professionals,
in redesigning health care in the United States. Part-
nerships across health professions are now under-
scored by the movement toward inter-professional
education and practice. In 2011, the Interprofessional
Education Collaborative (IPEC 2011) expert panel
developed four competencies that include values and
ethical principles for inter-professional practice, roles
and responsibilities for collaborative practice, inter-
professional communication, and inter-professional
teamwork and team-based care (IPEC 2011). Accord-
ing to Huston (2008) new innovations in the form of
competencies are needed to be integrated into tradi-
tional management solutions to prepare nurse leaders
for 2020. While all competencies are meritorious,
competency six, highly developed collaborative and
team building skills speak to the importance of the
603
Editorial
nurse role in team based care. All this reinforces the
presence of the seeds of innovation and the notion
that nurse leadership across disciplines has been relied
upon and exercised. The third article in this issue (pp.
624632) expands the current perspective and illumi-
nates an interesting, new avenue designed to promote
a collaborative, team-based approach aimed at
improving nurse retention.
Balancing all the challenges
So, how can nurse managers in different countries
worldwide reconcile these contemporary challenges? A
commentary paper from Greece discusses workforce
issues including illegal private duty nurses, a challenge
caused by the current economic climate (pp. 633
637). This journal also includes articles: exploring
commitment and burnout within the profession as a
mechanism for understanding factors associated with
the phenomenon in Australian context (pp. 638647),
reporting researchers efforts of further testing the
Maslach Burnout Inventory in Taiwan (pp. 648656)
and a translation of an instrument measuring self-con-
cept in Chinese (pp. 657667). Additionally, the last
three articles highlight: transforming care at the bed-
side by engaging staff to transform work processes
and quality of care in the US (pp. 668678), develop-
ment of electronic standardized measure of nursing
work (e-SMNW) in Iceland (pp. 679689) and results
from the evidence-based management project Getting
my Work Done demonstrating how principles of
complexity science assisted newly licensed RNs in
mastering dilemmas that inhibited professional
practice (pp. 690-704).
The editors would like to thank all the authors who
have contributed to this issue. We hope that the readers
604
of the Journal of Nursing Management find these arti-
cles interesting and helpful for developing the practice.
Kristiina Hyrkas R N , M N S c , L i c N S c , P h D 1,2,3
1
Director, Center for Nursing Research and Quality
Outcomes, 2Adjunct Associate Professor, University of
Southern Maine, Portland, ME, USA and 3Editor, Journal of
Nursing Management.
E-mail: hyrkak@mmc.org
Jennifer L. Morton D N P , M P H , A P H N
Department of Nursing, University of New England,
Portland, ME, USA
E-mail: jmorton@une.edu
References
Huston C. (2008) Preparing nurse leaders for 2020. Journal of
Nursing Management 16, 905911.
Institute of Medicine (2010) The Future of Nursing: Leading
Change, Advancing Health. The National Academies of Health,
Washington, DC. Available at: http://www.rwjf.org/content/
dam/farm/reports/issue_briefs/2010/rwjf67346/subassets/rwjf6
7346_1, accessed 6 May 2013.
Interprofessional Education Collaborative (2011). Core Compe-
tencies for Interprofessional Collaborative Practice, IPEC
Expert panel, May 2011. Available at: http://www.aacn.nche.
edu/education-resources/ipecreport.pdf, accessed 6 May 2013.
OGrady T.P. & Malloch K. (2013) Leadership in Nursing
Practice. Changing the landscape of health care, Jones and
Bartlett Learning, Burlington, MA.
Shirey M.R. (2009) Building and extraordinary career in nursing:
promise, momentum, and harvest. The Journal of Continuing
Education in Nursing 40 (9), 394400. doi:10.3928/
00220124-20090824-01.
Tonges M. (1997) The whitewater of change. A survivors
guide. Nursing Management 28 (11), 6469.
2013 Blackwell Publishing Ltd
Journal of Nursing Management, 2013, 21, 603604