Using Job Embeddedness to Promote Retention

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Nurse retention is both challenging and tricky today. Why some nurses stay, and others leave is not always easy to predict and can be different across settings. That is why the concept of job embeddedness becomes important. Job embeddedness is the collection of forces that influence employee retention. It can be distinguished from turnover in that its emphasis is on all of the factors that keep an employee on the job, rather than the psychological process one goes through when quitting.

I learned this concept early in my leadership career when I was redeployed to become the nurse recruiter in a large urban VA medical. Historically the VA had never had recruitment or retention issues, but all that changed during an epic nursing shortage in the early 1980s. The medical center where I worked had significant vacancies in a newly constructed SICU – so serious that we had to go on diversion for most surgical cases. It became a hot political mess for our medical center director. We never had a nurse recruiter when I was asked to step in and manage recruitment. Part of the challenge was that we had lost our surgical ICU head nurse so filling that position was also critical.

I was excited when I received an application from a highly qualified critical care leader who had just relocated from another state. She had no VA experience and lived about 40 minutes from the hospital. As I looked at her application, I wondered what was driving her to seek employment with us. She had a great interview with the Chief of Surgery, the CNO, and the staff members. Without a doubt, she was knowledgeable and had some creative ideas about staffing.

Yet when I interviewed her, she seemed incredibly sad. I finally asked her if anything was wrong. With tears in her eyes, she then said – Rose – I can’t lie to you. The reason I am seeking this position is that I have few options. I have an eight-year-old son who is very ill and needs open-heart surgery. We moved because my husband lost his job and just found a new one in this area. His health insurance will not cover us for at least three months and has an 18-month exclusionary clause for pre-existing conditions. My son won’t be able to have the surgery he needs. I have looked at all the options, and the VA is one of very few employers where I will have coverage for everything from my first day of employment.

I told her that I would get back to her after I discussed it with our Chief Nurse. I dreaded the conversation – our leader was a childless, retired army colonel who was a pretty no-nonsense person. I could not have been more wrong in how I expected her to react. I presented the whole story, including my recommendation to hire, and waited for her response. She told me that she thought this leader had a far better reason for wanting this job than most others that she interviewed. We hired her, and her son had the surgery. Sadly, he did not survive, and I was sure she would leave, but she did not. She told me that our hiring her was one of the greatest acts of human kindness that she had ever experienced, and it kept her with us until she retired.

This was my first experience with job embeddedness or something that makes it very hard to leave an organization. Any of the following can create job embeddedness:

Links – to the community, a team, or others in the organization (ex. a best friend at work, a spouse working in the same facility).
Fit with the nurse’s values and personal goals – compatibility of a nurse’s values and beliefs with others in the community or a debt of gratitude.
A Sacrifice that could be associated with leaving – long commute, great health insurance, loss of leave, seniority, job stability, selling a house, or moving to a different school district.

In my work as a recruiter, I learned the importance of evaluating job embeddedness when recruiting candidates. The more job-embedded a nurse was, the more likely she or he was to stay.

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