Running head: SERVANT LEADERSHIP PROJECT

Servant Leadership and Nursing Retention

Samantha Hasenzahl
Bon Secours Memorial College of Nursing
I pledge

SERVANT LEADERSHIP PROJECT

Servant Leadership and Nursing Retention

The neuroscience unit at St. Mary's Hospital has a high turnover rate and as a result they
are working on recruiting and retaining nursing staff. Turnover negatively impacts cost, unit
productivity, and patient outcomes (Dawson, Stasa, Roche, Homer, & Duffield, 2014). In order
to solve this problem, or at least decrease the turnover rate, a nurse manager must understand the
root cause. According to Hunt (2009), lack of support for career development, not feeling
respected and valued for contributions/capabilities, feeling overworked, lack of role clarity, and
poor communication with management are common complaints that result in turnover. Research
shows that managers who create and support opportunities for nurses to grow (i.e. develop future
leaders), communicate effectively with their team (i.e. are open to feedback), and who recognize
contributions from their staff (i.e. identify other team leaders) can effectively reduce turnover
(Dawson et al., 2014; Hunt, 2009; Kilanska, Gorzkowicz, Sienkiewicz, Lewandowska,
Dominiak, & Bielecki, 2016; Ritter, 2011; Zhang, You, Liu, Zheng, Fang, Lu, Lv, Ma, Wang,
Wang, wu, Zhu, & Bu, 2014).
Monetary incentives like salary and benefits are the most common areas of job
dissatisfaction, but non-financial incentives like positive work environments increase job
satisfaction (Zhang et al., 2014). Nurse managers may not have the ability or the funds to alter
the salary and/or benefits of the staff, but they do have the capability to elicit a culture shift on
their unit. Hiring staff who's vision and goals align with the manager's and the hospital's (Hunt,
2009), improving the on-boarding process for new hires (Ritter, 2011), providing professional
development opportunities (Dawson et al., 2014), flexible staffing (Kilanska et al., 2016),
recognizing staff achievements (Hunt, 2009), and creating a collaborative culture (Ritter, 2011)
are all ways that a manager can recruit and retain nursing staff.

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This paper will examine how a manager who practices servant leadership could improve
nurse recruiting as well as nurse retention. The four domains of leadership, the head, heart,
hands, and habits, will be reviewed. In addition, the five practices of exemplary leadership
(model the way, inspire a shared vision, challenge the process, enable others to act, and
encourage the heart) will be discussed. Lastly, professional practice implications and outcomes
evaluations will be explored.
The first step in addressing recruitment and retention is to assess the situation; why is the
turnover rate high? The best way to examine this phenomenon is to go to the source, the nurses.
Conducting exit interviews could provide some insight to why nurses are leaving. Using surveys
such as the Healthy Workplace Index (HWI) or Practice Environment Scale of Nursing Work
Index (PES-NWI) could provide an anonymous platform for nurses to convey their opinions
(Ritter, 2011). Holding meetings where staff can share their perspective on potential
improvements could also help the manager better understand the problem. A plan of action
and/or staff led committees could be developed to address the findings of this research.
There are, however, things that nurse managers can do to create a positive work
environment that all staff would appreciate. Placing a staff recognition board in the break room
where staff can be publically acknowledged for the things they are doing and writing personal
thank you cards to staff are all little ways that managers can say thank you and show
appreciation. Nurse managers can provide information about upcoming certifications or
educational opportunities to encourage professional growth and development. These sorts of
gestures can help retain staff.
Another important aspect to nurse turnover, is hiring (Hunt, 2009). It is important for
nurse managers to think about the unit culture they want to develop and hire based on this vision.

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When new hires and managers have similar practice expectations job satisfaction can increase as
the nurse knows what is expected of them (Ritter, 2011). Creating a strong on-boarding process
is imperative for long term success. New employees should feel welcomed and supported as
soon as they start to work on the unit. Pairing new graduates and new employees with more
experienced preceptors can help create a strong working relationship among peers. In addition is
provides older nurses the opportunity to share their knowledge and pass on their skills. Nurse
managers should remain in close contact to new hires throughout the orientation process so that
good communication between staff and management can develop.
Four Leadership Domains & Five Practices of Exemplary Leadership
A servant leader can develop a positive work environment by utilizing the four domains
of leadership: the heart, head, hands, and habits (Blanchard & Hodges, 2005). Modeling the way,
inspiring a shared vision, challenging the process, enabling others to act, and encouraging the
heart, the five practices of exemplary leadership, also foster a positive work environment
(Marquis & Huston, 2015).
Heart
Nurse managers who are self-serving and who are more concerned with their own
agendas, goals, and gratification (Blanchard & Hodges, 2005) are not going to be as successful in
retaining their nursing staff as those managers who are servant leaders. Those with the heart of a
servant leader will be open to feedback from their staff and will develop future leaders
(Blanchard & Hodges, 2005). They encourage their employees to grow and develop in all aspects
of their lives. Supporting staff and open communication are ways to decrease turnover (Dawson
et al., 2014).
Head

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When becoming a nurse manager, it is important to examine the motivation behind why
one wants to take on this role/responsibility. Does the nurse managers beliefs and values
correlate with those of the hospital they work for? Does the nurse managers vision parallel with
the organizations? According to Blanchard and Hodges (2005), an effective leader must have a
clear and compelling vision. Communicating this vision is also important in actually
implementing the necessary changes to meet that goal. In order to get people on board, a
manager must know the purpose of their vision, what the future looks like, and what they value
(Blanchard & Hodges, 2005). Potential new hires must be aware of what is expected of them so
that they can decide if their job expectations align with the unit's; this can prevent future turnover
that results from poor fit (Hunt, 2009).
Hands
The internal aspects of servant leadership, head and heart, are carried out by the hands.
The hands represent the actual doing. According to Blanchard and Hodges (2005), an effective
servant leader must be a performance coach (p. 121). In other words, a servant leader must
help people achieve their goals, praise their accomplishments, and redirect as needed. A nurse
manager who is trying to recruit and retain nurses need to create an environment where the
nurses can grow and develop. Providing resources to help pay for certifications or continuing
education can help nurses feel supported (Dawson et al., 2014; Kilanska et al., 2016) and
improve satisfaction.
Habits
Self-care is important in any level of nursing, including nurse management. In order for a
nurse manager to be effective at her job, she must have healthily habits that promote her own
health and well-being. A nurse manager who is trying to keep staff must also take care of herself.

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She cannot get so wrapped up in the unit that she does not take time to refresh and recharge. This
also demonstrates to staff their need to take care of themselves; this is leading by example.
Five Practices for Exemplary Leadership
Kouzes and Posner's five practices for exemplary leadership (as cited in Marquis &
Huston, 2015) consist of model the way, inspiring a shared vision, challenging the process,
enabling others to act, and encouraging the heart. Leaders who employ these strategies can create
a strong, collaborative, and successful work environment. Modeling the way is similar to the
servant leader's "head," in that the leader must be aware of their values and behave in ways that
are congruent with those values. Inspiring a shared vision is about creating an environment
where management and staff work towards a common goal; they desire similar outcomes. For
example, they both want positive work environments and improved patient care. Nurse managers
who challenge the process evaluate their units to see what changes need to be made and they take
action to make those changes. They do not idly standby, but seek out opportunities to improve.
These leaders must enable others to act; this can be done by collaborating and sharing power.
Leaders empower their followers and give them a voice in the change process. Lastly, strong
leaders will encourage the heart of their subordinates. In other words, they will recognize and
celebrate their achievements.
Professional Practice Implications
Creating a positive work environment has many positive implications such as increasing
unit productivity, reducing turnover, improving patient care/safety, and decreasing costs (Dawson
et al., 2014; Hunt, 2009; Ritter, 2011; & Zhang et al., 2014). The nursing profession as a whole
benefits when units have low turnover rates as staying on a unit breeds clinical experts in that
area of nursing. The more experienced nurses on a unit can then precept/educate new graduates

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and staff teaching them about the caveats of that field. Overall, nurse managers are in a role that
allows them to create environments that develop the future generations of nurses. When nurses
are good at their job, they will provide better care. Better care will lead to better patient
outcomes and strengthen the trust patients have in nurses.
Outcomes Evaluation
Evaluating recruitment and retention takes time and will not be changed overnight. In
order for the nurse manager to evaluate success, a baseline needs to be established. Utilizing
surveys can be a way to establish a baseline as well as evaluate changes over time. Exit
interviews can be used to assess reasons for leaving. Those interviews can provide insight as to
whether it is the units culture that is turning nurses away or if it is due to personal situations (i.e.
moving, going back to school, having a child, etc.). Another way to evaluate success is to notice
the amount of staff involvement. Is the staff more involved in committees? Are they expressing
more satisfaction? There are many different ways to evaluate the success of various
interventions, but the nurse manager must remember that it will take time to truly see a change.
Conclusion
The plan that was presented earlier in the paper incorporated different aspects of servant
leadership and transformational leadership. The goal of the manager should be to include the
staff throughout the entire process from assessment to evaluation. "Involving staff in changing
the practice environment can lead to favorable results. The nurses are the ones working in the
systems and can provide insight as to where the deficiencies are, that if addressed, would lead to
a more favorable practice environment" (Ritter, 2011 p. 30). Including staff creates a
collaborative environment between the leaders and the staff which improves overall satisfaction

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(Dawson et al, 2014). Ultimately, job satisfaction will result in improved patient outcomes;
improved patient outcomes is vision that all nurses and nurse managers can get behind.

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9
References

Blanchard, K. & Hodges, P. (2005). Lead like jesus. Nashville: Thomas Nelson.
Dawson, A.J., Stasa, H., Roche, M.A., Homer, C.S., & Duffield, C. (2014). Nursing churn and
turnover in australian hospitals: Nurses perceptions and suggestions for supportive
strategies. BioMed Central Nursin,g 13(11). doi: 10.1186/1472-6955-13-11
Hunt, S.T. (2009). Nursing turnover: Costs, causes, & solutions. Retrieved from
https://www.nmlegis.gov/lcs/handouts/LHHS%20081312%20NursingTurnover.pdf
Kilanska, D., Gorzkkowicz, B., Sienkiewicz, Z., Lewandowaska, M., Dominiak, I., & Bielecki,
W. (2016). Evaluation of chosen determinants of the positive practice environments
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Ritter, D. (2011). The relationship between healthy work environments and retention of nurses in
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Zhang, L., You, L., Liu, K., Zheng, J., Fang, J., Lu, M., Ma, W., Wang, J., Wang, S., Wu, X., &
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