Job crafting as retention strategy: An ethnographic account of the challenges faced in crafting new nursing roles in care practice

Abstract

Nursing shortages in the global north are soaring. Of particular concern is the high turnover among bachelor‐trained nurses. Nurses tend to leave the profession shortly after graduating, often citing a lack of appreciation and voice in clinical and organisational decision‐making. Healthcare organisations seek to increase the sustainability of the nursing workforce by enhancing nursing roles and nurses' organisational positions. In the Netherlands, hospitals have introduced pilots in which nurses craft new roles. We followed two pilots ethnographically and examined how nurses and managers shaped new nursing roles and made sense of their (expected) impact on workforce resilience. Informed by the literature on professional ecologies and job crafting, we show how managers and nurses defined new roles by differentiating between training levels and the uptake of care‐related organisational responsibilities beyond the traditional nursing role. We also show how, when embedding such new roles, nurses needed to negotiate specific challenges associated with everyday nursing practice, manifested in distinct modes of organising, work rhythms, embodied expertise, socio‐material arrangements, interprofessional relationships, and conventions about what is considered important in nursing. We argue that our in‐depth case study provides a relational and socio‐material understanding of the organisational politics implicated in organising care work in the face of workforce shortages.

The workforce crisis in healthcare: Moving the debate to bridge evidence and policy

“…46 Governance gaps and policy failures at macro-and meso-levels are especially visible when looking at the inequitable geographical distribution and mismatches between need, demand and supply of HCWs. [31][32][33] They are also responsible for poor attention to equity measures and persisting gender inequalities, 12,13,30,39,40 as well as for the missing support for new nursing roles 43 and mental health needs of HCWs. 30 On a positive note, identifying poor governance as major problem highlights that change is possible!…”

“…The findings presented in many of the articles echo demand for, and benefits of 'interconnected strategies'. 6,9,23 They provide in-depth insights into factors such as 'solidarity, alignment and synergy of efforts', 25 a 'multisectoral approach', 32 'intersectoral' planning, funding and collaboration, 18,24 'multi-level governance and coherent coordination mechanisms', 30 'skill-mix reforms', 23 'structural investments', 43 'dialogue' 27 and, more generally, 'political will' 18 and 'regulatory and policy factors'. 26 An illustrative example of the need for multi-level and transsectoral HCWF governance approaches can be seen in the research on refugee and displaced HCWs.…”

“…Benefits of effective governance include inclusive work arrangements and investment in HCW training/education, such as 'interprofessional work' and 'communication', 42 'coaching programs', 44 'leadership competences', 43,45 and broader commitment to diversity, equality and inclusion. 30,40 The research presented in this Special Issue also illustrates the importance of global knowledge exchange.…”

“…41 Finally, the Special Issue investigates the capacity for HCWF recruitment and retention, accentuating organisational and professional levels. The articles reveal the benefits of interprofessional practice on nurses' workload in hospitals, 42 the impact of changes in nursing roles on retention drawing on findings from the Netherlands, 43 needs and benefits of implementation of coaching programmes in countries of the European Union, 44 and investigation in leadership competences in medical education in countries in the Pan American Health Organisation region. 45…”

The influence of psychosocial work environment, personal perceived health and job crafting on nurses’ well-being: a cross-sectional survey study

“…Recently, studies suggest that implementating organizational citizenship behaviour among nurses can inhibit negative occurrence that may impact patients' health and well-being [ 17 ]. Furthermore, nurse differentiation and job crafting are effective retention strategies [ 18 ]. Overall, ICU nurses worldwide are not adequately prepared to handle the job demands brought on by the crisis, significantly impacting their ability to provide optimal patient care [ 19 ].…”