Learning Objective #1: discuss the importance of a work culture assessment and implementing evidenced based interventions that are based on this assessment.

Learning Objective #2: identify the processes for completing action plans to design unit and system wide interventions as well as engage staff in the solutions to retention.

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Throughout the years the nursing profession has cycled through periods of a shortage or an excess of registered nurses.  Today we are experiencing a shortage of registered nurses that has been fueled by a number of factors including a change in the demand for nurses offering more opportunities in diverse health care settings.  Our economic growth has created more career choices to women that may be reflected in the decline of enrollment in nursing programs.  Lastly, the nursing work force is aging, where the mean age is 41 years, and only 12% of the RN work force is under 30 years old.  The questions asked by administrators are what are retention interventions, how effective are they are in reducing turnover, and what is their cost? 
This paper describes the work accomplished by the University of Iowa Hospitals and Clinics Nurse Retention Project.  A committee, made up of various nursing positions ranging from staff nurse to CNO, used the Iowa Model of Evidenced Based Practice to Promote Quality Care to guide the project.  The project encompassed assessing the work culture through survey development and distribution, determining data driven interventions based on opportunities for improvement identified through this assessment, developing and implementing action plans, and evaluating outcomes.  Action plans were developed between the nurse manager and staff nurses with assistance from committee members.  Unit based and system wide evidenced based interventions were implemented based on the action plans and included strategies to increase recognition, manage workflow, and improve staffing.  Outcomes were assessed by reassessment of the work culture allowing us to trend the data for changes in attitudes/perceptions.  In addition, we monitored vacancy rates that dropped from 13.3% to 1.98% over a 27 month period.  The tools used and evidenced based strategies implemented are presented to illustrate how this project was completed.