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Editor,

The critical need for all health care institutions to focus on and to aggressively intervene in the improvement of nurse retention is reiterated by the authors of the 2011 study by Hinno S., Partanen, P., & Vehviläinen-Julkunen (‘Hospital nurses' work environment, quality of care provided and career plans’, International Nursing Review, 58(2), 255–262). While this study centered on Dutch nurses, the nursing shortage prediction is an issue of international concern. The regression analysis in the Hinno et al. study established that characteristics of the work environment affect nurse-reported quality of care and nurses' career plans. Their results verified that individual factors explain 10% (nursing competence, support for professional development, and supportive management) to 22% (adequate staffing) of the variance in quality of care. It would have been interesting and helpful if the authors had conducted a multiple regression analysis to determine how much of the variance the combined factors explained.

A study by Aiken et al. (2011) used pooled odds ratio logistic regression to analyze data from 98 116 nurses from 1406 hospitals across nine countries. Results indicated that ‘better vs. poor’ and ‘mixed vs. poor’ work environments consistently had increased quality of care and better outcomes in the areas of nurse burnout, job satisfaction, and confidence in discharge participation (Aiken et al. 2011). A systematic review by Ritter (2010) in the USA provided evidence of the link between healthy work environments and nurse retention in a hospital setting. Further Duffield et al., 2011 completed a study involving 2488 nurses in Australia and noted two factors associated with lower intention to leave their current job: praise and recognition for a job well done and an immediate supervisor who is a good manager and leader.

The extent of nurse dissatisfaction with the rising demands of the healthcare environment and their increased consideration of leaving their jobs and even the nursing profession is disheartening. Hinno et al. also revealed that 10% of the nurses often thought about changing their profession while 44% considered it sometimes (Hinno et al. 2011). Their recommendations indicated a significant need for nursing administrators and management to analyze and address their institution's staffing processes.

The U.S. Department of Labor Bureau of Labor Statistics predicts a 22% increased need (581 500) for registered nurse employment from 2008–2018 (Bureau of Labor Statistics, 2010-2011). The nursing shortage issue has continued for more than a decade. According to Sigma Theta Tau International, the nursing shortage is a major threat to the future of the world's healthcare system (Sigma Theta Tau).

Although there is abundant research written on the topics of the healthcare work environment and nurse retention, not much is written about successful interventions. It is time for nursing scholarship to move from a description of factors associated with work environment to interventions that enhance those factors and outcomes. What solutions have been effective and do they continue to dissuade nurses from leaving their jobs and their profession? More effort is needed to investigate specific actions that have a sustained positive effect on the nursing work environment, nurse recruitment and retention issues.

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