Current approaches often address symptoms only.

EQ Leadership is key to the "breakthrough to world-class performance" essential to a thriving organization. Without it, you're faced with low engagement, moderate employee and patient satisfaction, turnover, and "business as usual."

Success in the current healthcare environment requires exceptional leadership skills.

Engagement and Satisfaction

Some 40% of nurses are dissatisfied (Health Affairs, May 2001).
Nurses across the nation are reporting increased stress and dissatisfaction with nursing (Boyle, Bott, Hansen, Woods, & Taunton, 1999; Bratt, Broome, Kelber, & Lostocco, 2000; Bruffey, 1997; Davidson, Folcarelli, Crawford, Duprat, & Clifford, 1997; Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2001; Shader, Broome, Broome, West, & Nash, 2001). Nurse-physician conflicts add to an already stressful work environment (Rosenstein, 2002).

Stress, Burnout, Errors

Healthcare workers report that they are burned-out due to shortages, working longer hours and climates that are not responsive to their issues. out of control in their environment, and a lack of voice in the institution.
The Institute of Medicine reports that nurses working longer hours to fill vacancies are prone to make errors.
Aiken, Clarke, Sloane, Sochalski, and Silber (2002) determined that each additional patient, over a patient-nurse ratio of 4:1, was associated with a 7% increase in the chance of failure to rescue, as well as a 7% increase in the likelihood of the patient dying within 30 days of admission. Furthermore, they reported that a 6:1 ratio increased the chance of death by 2.3 per 1,000, and an 8:1 ratio increased the chance of death by an additional 8.7 per 1,000. Each patient over a 4:1 ratio increased the odds of nurse burnout by 23% and job dissatisfaction by 15%.
Job dissatisfaction is linked to increased burnout. Garret and McDaniel (2001) described environmental uncertainty as being important in all aspects of burnout. Aiken et al. (2002) reported nurses with the highest nurse-to-patient ratio experience burnout and dissatisfaction more than twice as much as those with lower ratios. The researchers noted that 43% of nurses who reported high levels of burnout and dissatisfaction intended to leave their jobs within a year. This was compared to nurses who did not complain of burnout or dissatisfaction. Only 11% of these nurses intended to leave their current jobs.

Turnover and Vacancy

126,000 nurses are needed now to fill vacancies at our nation's hospitals (American Hospital Association). RN vacancy rate is expected to be 15% by 2003 and 20% by the year 2020 (Buerhaus et al., 2000; Heinrich, 2001).
One in five nurses plan to leave the profession within the next 5 years (Letvak, 2002).
The rate of nurse turnover in 2000 was 21.3% (The HSM Group, 2002), with turnover costs up to two times a nurse's salary.
The cost of replacing one nurse are estimated between $30,000 and $145,000. The national average salary of a medical-surgical nurse is $46,832. Therefore the cost of replacing just one nurse would be $92,442. To replace a specialty area nurse, the cost can increase to $145,000. Replacement costs include human resources expenses for advertising and interviewing, increased use of traveling nurses, overtime, temporary replacement costs for per diem nurses, lost productivity, and terminal payouts (Colosi, 2002). If a hospital with 100 nurses experienced turnover at the rate of the national average of 21.3%, expenditures could amount to as much as $1,969,015 yearly, for the turnover of medical-surgical nurses alone (The HSM Group, 2002).
Nursing schools are not graduating enough nurses to meet current demands. Although enrollments in schools of nursing are beginning to increase slightly, there remains a projected shortfall of one million new nurses by the year 2010 (Rosseter, 2001). The number of students who graduated with master's degrees in nursing education, though rising slightly (1.1%) from 2000 to 2001 (Berlin, Stennett, & Bednash, 2002), are not enough to offset earlier declines. From 1997 to 1998 alone, the number of master's students in nursing education fell 27.5%. The average age of nursing educators is 49 years, giving rise to serious concerns about expected mass retirements in the next several years. With inadequate new faculty to replace retirees, the country is facing a nursing educator void (Frase-Blunt, 1999). This will directly affect the ability of schools of nursing to admit additional nursing students.
Using agency nursing staff to fill vacancies is 3 times more costly and affects quality and patient satisfaction.

Why Relationship-Centered Leadership Matters in Healthcare

JCAHO concludes a primary solution is to build "a culture of professional satisfaction" (Healthcare at the Crossroads, 2001). What creates satisfaction? According to decades of research, relationships are key:

In their study of nurse manager job satisfaction, Stengrevics, Kirby, and Ollis (1991) identified that role development, support, compensation systems, communication systems, and educational strategies were needed to promote retention. Littell (1995) found organizational climate to be the most important predictor of job satisfaction of mid-level nurse managers. Specifically, their perception of the organizational climate and affective tone in working relationships were most salient.
Acorn, Ratner, and Crawford (1997) found that "providing nurse managers with autonomy over decisions that affect the work at the unit level," affects nurse managers' organizational commitment. Concomitantly, "the nurse manager has to feel empowered and influential not only in her current role but also as a clinical nurse" in order to empower and influence staff nurses (Aroian et al., 1997). Three processes were described by the managers: building relationships, sharing decision making, and sharing knowledge (Arioan et al., 1997).
A major theme in the literature suggests that the social climate of the workplace is the initiator of a nurse's intent to stay or leave. Social climate is a determinant of work frustration (a negative influence), and work excitement (a positive influence). These factors directly influence job stress, leading to job satisfaction or dissatisfaction (Moos, 1994). Job satisfaction and/or dissatisfaction is the strongest predictor of intent to stay or leave the job (Bratt et al., 2000; Bruffey, 1997; Davidson et al., 1997; Garrett & McDaniel, 2001; Taunton, Boyle, Woods, Hansen, & Bott, 1997).
Researchers from the Wellesley College Stone Center identified that women thrive in "growth fostering relationships" (Baker, 1986; Jordon, Kaplan, Miller, Stiver, & Surrey, 1991; Miller & Stiver, 1997). Their theory of women's psychological development and well-being is known as the Relational Model (Jordon, 1986; Surrey, 1985). Characteristics of growth-fostering connections are mutual engagement, authenticity, empowerment/zest, and the ability to deal with conflict or difference (Miller & Stiver, 1997).
Mycek (1998) proposed that fundamentally health care is about the business of relationships. An institution's customers and employees are the "second bottom line" and therefore, it was suggested that the core business of health care should be the business of relationships. Fletcher et al. (2000) reports that healthcare managers say relationships are key to staying on the job.
Quality of life, specifically life/work balance, is important for nurse manager retention. Separating work from home and having time for self and family are significant. Manion (2000) emphasizes personal and professional renewal as a strategy to retain leaders. Nurse managers with a healthy work/life balance perform their jobs effectively for the long term.
Nurses want to be appreciated and respected by physicians and the administrative team; they want to be recognized for their expertise, and they want to take responsibility and participate in the decisionmaking processes concerning patient care (Aiken, 1984, 1989; Johnson, 2000; Trossman, 2002). Nurses want to be valued.
Nevidjon and Erickson (2001) reported that nurses desire increased autonomy in their work environments. Aiken et al. (2002) determined that increased autonomy is one of the factors decreasing emotional exhaustion of nurses in magnet hospitals (hospitals recognized by the American Nurses Credentialing Center for attracting nurses and providing excellent nursing care).
In another study of magnet hospitals, Laschinger, Shamian, and Thomson (2001) affirmed that autonomy, or control over the practice environment, had a positive influence on nurses' job satisfaction, managerial trust, and their assessment of the quality of care delivered to their patients. Davidson et al. (1997) confirmed the importance of autonomy by demonstrating the converse; decreased job satisfaction is associated with decreased autonomy.
Among critical care nurses, autonomy was indirectly affected by the leadership of their managers (Bruffey, 1997). Bratt et al. (2000) described a correlation between job satisfaction and nursing leadership. Management style, perceived as empowering nurses to perform their jobs effectively, was strongly related to job satisfaction.
Communication is an important factor to increase the perceptions of nurse autonomy -- and thereby improve both retention and performance (Davidson et al. 1997).

For additional perspective on the "emotional intelligence causes" of turnover and how to address the root causes, download "Vital Signs for Nurse Retention: Focus on the Relationship" (downloads are available in the "Case Studies"section)

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