Bringing nurses into any large organization requires substantial time, energy, and finances. But it is a miniscule investment compared with the effort of retaining nursing talent, which requires consistent assessment and intervention to promote a healthy and positive work environment where nurses can advance. 

The United States has the highest number of Americans over the age of 65 than at any other time in its history. In 2029, the last of the Baby Boomer generation will reach retirement age, meaning 71.4 million individuals will be 65 years or older—30 million more than in 2011.

 This translates to a need for more nurses. By 2030, it is estimated that there will be a shortage of 500,000 nurses.

 Having the knowledge of this looming gap is not enough. Nurse leaders must focus today on stabilizing the workforce by employing creative strategies to retain experienced staff and those who join the organization over the next several years. 

Continuous professional development (CPD) of nursing staff is associated with improvements in patient safety and nursing quality outcomes as well as increased nursing satisfaction.

 Nurses view CPD as key to attaining, maintaining, and increasing knowledge and competency when they have relevant opportunities and support.

 Employers should provide professional development opportunities that meet the needs of their nursing staff, recognizing that staff are at different developmental phases in terms of content and delivery. Allowing nurses to take advantage of development opportunities on paid time during their shift improves participation in professional development and allows nursing staff to balance work and family life. 

Meet the Needs of an Intergenerational Workforce 

Never before has the workplace spanned across 4 generations. The current workforce includes Baby Boomers (born between 1946 and 1964), Generation X (born between 1965 and 1980), Generation Y (born between 1981 and 1996), and Generation Z (born between 1997 and 2015). Nurse leaders should strive to meet the needs of team members who hold different values in terms of work-life balance, degree of autonomy, level of feedback, and formality and structure of the work environment.

Many nurses believe the only path to advancement is to leave the bedside and move into an educational or administrative role. This narrow model strains system resources, taking the most competent practitioners and moving them into nonclinical roles. Career advancement programs or clinical ladders encourage retention, increase competency, and improve staff satisfaction and engagement while maintaining the expert practitioner in the clinical role.

 As nurses advance up the career ladder, leaders can develop creative positions that maintain the primarily clinical role but also allow their nurses to contribute more fully to the quality, safety, satisfaction, leadership, or educational outcomes of the unit. 

Oncology nurses are prone to moral distress and injury due to the complex psychological, social, and emotional relationships they develop with patients during the diagnosis and treatment trajectory.

 Lack of adequate resources, the knowledge they are providing futile care, and grief all contribute to moral distress and injury. Lack of resiliency has been associated with poor retention, absenteeism, and negative mental health. Resiliency has been defined as the “nurse’s adaptability to reduce their vulnerability to workplace adversity, thus diminishing the negative effects of job demands.”

Promote staff resiliency by strengthening staff members’ abilities and providing resources for social engagement, self-care, mindfulness, and effective coping through stressful situations. 

Nurse leaders are responsible for ensuring staff members have the resources and knowledge to provide optimal patient care, obtaining feedback from staff to improve the work environment, and inspiring a growth mindset throughout the organization by leading by example. Being active and present on the nursing units and developing relationships with nursing staff promotes open communication and improves engagement. Transformational nurse leaders inspire nurses to develop the future vision through intellectual stimulation and innovation. 

I appreciate the emphasis on work-life balance, generational perspectives, and worker engagement that has become such a central element in today’s workplaces because it has helped me to better understand and respond to the values and motivations important to my team members, both individually and collectively. Demonstrating through actions, policies, and supportive resources that your focus is not just on getting nurses in the door but on keeping them on the team for years to come is critically important to successful nurse employment—and it is likely to improve performance in patient experience, internal communication, and care quality. 

Andrew Storer, PhD, DNP, RN, NP-C, FAANP,

 is vice president and deputy chief nursing officer at Roswell Park Comprehensive Cancer Center in Buffalo, New York.

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Articles

Encourage professional development, foster resiliency, and engage nurse leaders to create an environment that not only brings in new nurses, but keeps them.

After Recruiting Oncology Nurses, Focus on Retention

Over the past decade, there has been increased advocacy on the part of many influential voices in our profession to require the Doctor of Nursing Practice (DNP) degree for entry-level nurse practitioner roles.

In 2004, the American Association of Colleges of Nursing endorsed the posi- tion of moving from master’s training to the doctorate as the level of preparation necessary for nurse practitioners by 2018.

 In 2018, the National Organization of Nurse Practitioner Faculties changed the commitment to require the DNP as entry level for nurse practitioner practice by 2025.

Although there is not currently a requirement for the DNP for nurse prac- titioners, in keeping with this goal, many programs have already made this transition and eliminated Master of Science in Nursing (MSN) as a degree offering for nurse practitioner specialties.


The DNP was first offered in 2001 by the University of Kentucky as a mechanism to equip nurse practitioners with expanded knowledge to help them navigate a rapidly changing and increasingly complex health care environment. Expanding from fewer than 50 programs in 2006 to 357 programs in 2020, the DNP has become a highly—but not universally—sought-after achievement in nurse practitioner education.

Although the discussion on whether to require a doctorate for practitioners is not exclusive to our field, nursing is one of the few health care professions that do not require education at the doctoral level. Pharmacy, dentistry, optometry, psychology, physical therapy, occupational therapy, and audiology either require or offer doctoral-level education.

Key Points for and Against DNP Requirements


Both within and outside the profession of nursing, the calls for and against requiring a DNP have been increasingly prevalent over the past decade. Those who support the DNP for entry-level practice argue that it places nurse practitioners on education parity with other health professions. Advocates note that the DNP degree reflects the quality and rigor of education that nurse practitioners receive to provide health care.

The health care environment is more complicated than ever before and propo- nents of a DNP requirement stress the benefits additional education provides in key areas, such as evidence-based practice, quality improvement, health policy, interprofessional collaboration, and organizational leadership, better preparing nurse practitioners to practice and lead in the contemporary health care environment.

Those who oppose a mandate for the DNP argue that extant research demonstrates that nurse practitioners are contributing to effective patient care and positive clinical outcomes without a broad doctoral requirement. Research has shown that nurse practitioners are already providing high-quality care with no statistically significant difference in outcomes compared with physicians. Evidence also shows that patients cared for by nurse practitioners are more likely to receive education on health promotion and to report higher satisfaction with their care.

Opponents also cite a lack of differentia- tion between MSN- and DNP-prepared nurse practitioners, as they have the same scope of practice. Some physician organizations have noted that confusion could result for patients in clinical settings when multiple care providers, physicians and nonphysicians, identify themselves as a “doctor,” which is a concern that has been widely dismissed, as no 1 profession owns exclusive rights to the title.

It remains to be seen whether the goal of requiring a DNP by 2025 will come to fruition. However, as more nurse practitioners attain the DNP, research is needed to assess the impact of enhanced education on clinical and health system outcomes. Does the DNP make a difference in care? We can’t answer that yet.

As a senior nursing administrator for a comprehensive cancer center, I think doctoral education provides benefits that are particularly relevant and useful for nurse practitioners working with oncology populations. The number and complexity of treatment regimens today and the constant introduction of entirely novel treatment approaches, including next-generation immunotherapies and cellular therapies such as CAR T, underscore the importance of outstanding and consistent education for nurse practitioners.

Few can argue that more education for nurse practitioners would not help
to drive further improvements in health care outcomes, especially for patients with cancer—who are a vulnerable population, requiring highly complex and 

well-coordinated care. I have also seen nurse practioners play a critical role in targeting and successfully addressing ineq- uities in care and care access in rural and underrepresented communities, driving meaningful progress toward one of the most critical goals for the oncology field.

I was one of the first 300 people to earn a DNP when I earned my doctorate in 2008. Over the years, I have observed that DNP education has made me a more effective practitioner and team member.

My education helped me to better navigate the challenges and opportunities of modern oncology nursing, particularly in areas such as leading interprofessional teams, coordinating complex care, using informatics to transform health care, and advocating for equitable health policy. It helped make me a more confident and broadly informed nurse and manager. Knowing how to obtain, analyze, and integrate information is just as important for today’s nurses as professional knowledge itself.

I believe the DNP is an investment in education that gives one a foundation to provide even better care for patients, and I would recommend the doctorate for any nursing professional seeking greater professional opportunities. 

Andrew Storer, PhD, DNP, RN, NP, FAANP, is vice president of nursing and deputy chief nursing officer at Roswell Park Comprehensive Cancer Center.

1. AACN position statement on the practice doctorate in nursing. American Association of Colleges of Nursing. October 2004. Accessed February 22, 2022. https://bit.ly/3h8m2i6

2. The Doctor of Nursing Practice degree: entry to nurse prac- titioner practice by 2025. National Organization of Nurse Practitioner Faculties. May 2018. Accessed February 22, 2022. https://bit.ly/3h93e28

3. DNP fact sheet. American Association of Colleges of Nursing. Updated October 2020. Accessed February 22, 2022. https://bit.ly/35iyI34

4. Kurtzman ET, Barnow BS. A comparison of nurse prac- titioners, physician assistants, and primary care physi- cians’ patterns of practice and quality of care in health centers. Med Care. 2017;55(6):615-622. doi:10.1097/ MLR.0000000000000689

5. Newhouse RP, Stanik-Hutt J, White KM, et al. Advanced prac- tice nurse outcomes 1990-2008: a systematic review. Nurs Econ. 2011;29(5):230-251.

6. Crausman RS, McIntyre B. Use of the doctor title in clinical settings. J Med Regul. 2009;95(2):4-5. doi:10.30770/2572-1852-95.2.4

Advocacy and opposition continue to grow regarding the National Organization of Nurse Practitioner Faculties’ goal of requiring the Doctor of Nursing Practice degree (DNP) for entry-level nurse practitioners.

Andrew Storer, PhD, DNP, RN, NP, FAANP

Articles

After Recruiting Oncology Nurses, Focus on Retention

Will Requiring the DNP Improve the Quality of Oncology Nursing?