Statement of the Problem
       Due to the growing number of individuals that will be requiring geriatric nursing services within the next 10-15 years along with the current nursing shortage, it is imperative to understand why nurses today are choosing to work in nursing home settings and why they remain practicing geriatric nursing.

Significance
       The results of this study can help with retention and recruitment of nurses into the field of geriatric nursing in nursing home settings. The nursing labor force for nursing homes remains inadequate (Mullins & Moody, 1994). Data continues to show that the shortage of nurses will continue to increase in the near future; especially affecting the needs of the baby boomers that will require nursing home care (Barrett, 2001). Nearly 96,000 nurses are needed to fill nursing openings in nursing homes in the United States (Act Now, 2005). As the population ages it can be expected that the demand for healthcare will increase. Accordingly though, there is already a negative image regarding caring for elderly patients. This care is viewed as unchallenging and unrewarding (Philipase et al. 1991, Zukerberg 1991 as cited in Happell 2002). Due to this negative image, nurses in this specialty area aren’t seen as valuable as other areas of practice, which in turn creates a barrier to attracting nurses to work in nursing homes (Happell 2002).
       Therefore, it is imperative that institutions/organizations that employ nurses need to find other mechanisms to attract nurses to work in nursing homes with the nursing shortage already in existence. There is little research focusing on why nurses chose to practice in nursing home settings. Subsequently, it is imperative to understand now why nurses chose this area of practice so that the increased need of geriatric nurses can be addressed in the future.

Theoretical Framework
       Jean Watson’s theory of Human Caring was used as the framework for this research proposal. The purpose statement was: Why do nurses practice in nursing home settings? Watson’s theory has three factors associated with it that are key points to retention and recruitment of nurses. The first area of importance is the lived experience of the nurse while practicing. This lived experience is viewed as a caring moment that becomes a part of the nurse’s life history (Rafael, 2000). While the nurses are practicing they are impacted by the practice and this plays a key role in how they view their role as a nurse. The second area of focus deals with how the whole person is interrelated to individual parts such as in the holistic approach. In essence, the nurses use all of their life experiences and knowledge in interactions with clients as they implement plans of care and treatment. Many facets of care are incorporated in how they practice. Last, the third area of focus in Watson’s theory deals with ways of knowing such as ethical issues and personal knowledge (Rafael, 2000). This brings in all scientific knowledge along with life experiences to the practice of nursing.
       The goal of Watson’s caring theory was to transform the current situation of healthcare of being highly technological to also being and recognizing that human caring is as integral to the success of the clinical practice of nursing (Rexroth & Davidhizar, 2003).
       In summary, the Human Caring Theory by Watson emphasizes human-to-human interactions but also acknowledges that nurses need to have a body of knowledge and a set of values as they practice in their area of specialty. The day-to-day practice of nursing is rooted deeply in a humanistic value system combined with a scientific knowledge base that guides the nurse’s actions (Watson, 1985).

Summary
       In nursing homes, unlike acute care settings, residents/patients are in this setting for a much longer period of time and relationships are built with the nurse, family, and resident/patient. Watson’s theory addresses the experiences nurses have while practicing as one that shapes the nurses life history. These lived experiences will turn into the development of relationships with all parties involved. Since the relationships that are developed appears to be a difference between acute care nursing and nursing home nursing, it is important to find out if this is a key driver as to why nurses chose to practice in nursing homes.

A Lack of the Literature
       There is a lack of literature directly related to retention and recruitment of staff in nursing homes. There was only one study, a quantitative study that focused on why nurses work in nursing homes (Robertson, 1996). In light of this lack of literature, this research is timely and necessary in order to address the growing need of nurses in nursing homes in the next 10–15 years. This study was a qualitative study as it focused on the personal side of why nurses work in a particular nursing home. The aim of the study was to access the relationship aspect of nurses and their jobs in a nursing home, and why they chose to work in this setting.

Methodology
       Phenomenology was chosen as the methodology for this research project because it focuses on lived experiences as the basis for explaining occurrences (Burns, 2005).
       The aim of phenomenology in this research project is to describe the feelings behind why nurses chose to work in nursing homes and what about that experience keeps them wanting to stay employed in the nursing home setting.
       In summary, a qualitative study using a phenomenological approach was utilized to gather data from nurses working in one nursing home. Once the data was collected, it was sorted out in an excel spreadsheet and analyzed for themes. All surveys were kept with the researcher in a file so that data would remain confidential. Data focused on aspects of why the nurse chose to work in this nursing home, why they stay employed there, and what reasons would cause them to terminate their employment there. Data from the study will be used to assist with recruitment and retention strategies to fill the anticipated increased need for nurses working in nursing homes.

Analysis
       As the baby boomers age, and get closer to needing nursing home care and the nursing shortage increases, it is imperative that nursing home providers plan now to have the appropriate number of nurses on staff that are needed. Nursing home providers need to know how to attract nurses to their nursing home and why those nurses stay. If nurses are leaving a nursing home for other types of employment, these providers must be able to evaluate why those nurses left and address those issues. By the year 2010 there will be about 40 million people over the age of 65 in the US. By the year 2050, Americans age 65 and older will go from 1 in 8 to 1 in 5 people.
       Nearly 96,000 nurses are needed to fill in vacancies currently in nursing homes now. In 2002 there were 21.5 % nursing vacancies for nursing staff in nursing homes in the United States (Act Now, 2005). Four years ago, there was almost one quarter of nursing positions vacant. This shortage will only get worse as the demand for nursing home care increases in the next decade. This research study will hopefully provide valuable information to nursing home providers as they evaluate how they retain and recruit nurses.

Summary, Interpretation and Recommendations
       There were several themes noted in the survey that was provided to participants. One such theme listen why the nurse would leave employment would be due to a negative work environment. Spetz and Adams (2006) stated that overall the work environment is extremely important to the retention of staff. In addition, Buerhaus et al (2005) reported that nurses indicated that improving the work environment was a key factor to helping with the nursing shortage. In addition to the work environment being a key area that needs to be a positive experience for the nurse, unacceptable workloads were also mentioned as a reason why some nurses in this study would leave the nursing home. Cox et al (2006) stated that an unreasonable workload might be a major source of nurse dissatisfaction, which directly impacts retention.
       Other findings in this study point to the fact that nurses chose to work in nursing homes because of flexibility of scheduling. In a research study conducted by Robertson and Cummings (1996) their results indicated that long-term care registered nurses were attracted to long-term care nursing because of flexible scheduling. Another area of agreement with this survey and other research was the area of developing relationships. Andrews points out, “nurses’ relationships with older people in long-term care environments differ from relationships that their counterpart’s in hospitals have with younger clients. Nurses and older people in long-term care have more prolonged contact and, in turn, this has consequences for the nature of the relationships that develop between both parties” (2005). These relationships sometimes develop because of the greater opportunity for conversation, which often entails issues related to other than what the nurse is providing care (Andrews, 2005). Running (1997) points out that nursing practice is founded upon relationships. Another study by Robertson and Cummings (1996) also points out that reasons why nurses are attracted to work in long-term care is because of relationships that are developed.
       The overall interpretation of this study is that the results are in line with a few other studies identified that related to nurses working in nursing homes. Nurses who work in nursing homes wish to have an environment that they enjoy working in, flexible scheduling, and enjoy the relationships that are developed with the seniors in which they provide care. However, there were more reasons provided by the nurses who participated in this study other than the relationships developed with seniors which attracted them to work in nursing homes. In fact, the work place environment, necessary tools, and flexible scheduling seemed to be more prominent of reasons as to why the nurses who participated in this study are employed there. Relationships that are developed were also listed, but not as frequently as the others.
       This survey could have been improved by opening up the sample size to include several nursing homes, including a mixture of rural and urban homes, nursing homes under sole proprietorships or homes within a chain network. This would allow an opportunity for more nurses to provide input as to why they work in a nursing home. In addition, the researcher would be able to compare results to nurses working in single owned nursing homes versus chain facilities along with nursing homes in urban areas versus rural areas. Lastly, I think it would be a good idea to survey nurses who are graduating to see what area of practice they are going into and to evaluate what their training has been in the area of geriatric care. In fact, it would be a good idea to conduct this survey as the baby boomers begin to utilize long-term nursing care to compare if the relationships that are developed with the current generation of seniors with the relationships that will developed with the next generation of seniors.
       The significance to nursing that this survey provides is a reiteration that nurses in general appreciate a work place that is pleasant to work in. Nurses also work best with flexible scheduling and when they have the tools necessary to do their jobs. These issues aren’t specific to nursing home care, but rather healthcare in general. In addition, there is great significance to understanding why nurses chose to work in nursing homes because of the known increased need of nurses when the baby boomers start to utilize long-term nursing care. When this demand is realized, it will drain the current nursing pool, which is already limited in numbers. Since there is a shortage of nurses now and research indicates that there will need to be more nurses in nursing homes to meet the demand in 10–15 years, nursing home providers must plan now to work with the nursing profession to try to make the nursing home environment one that meets nurses’ needs and that is attractive to future graduating nurses.
       In summary, this research study has just tipped the iceberg of an issue that will affect the nursing profession in the near future. There will be an increased need for nurses in nursing homes to address the rising needs of the baby boomers, as they will soon require that type of care. Research indicates that nursing homes on any given day have many vacant nursing positions and this will only get worse as current nurses begin to retire. This study attempted to find out why nurses working in one nursing home began employment there, why they remain employed there and what reasons might make them leave their employment there. The study framework is based on Jean Watson’s theory of Human Caring, which is centered on the nurse to patient interaction and how those interactions create caring moments which impact both the nurse and patients forever. This theory was used because of the focus on the relationship between the nurse and patient. Results from this study paralleled a few other studies that addressed this same issue. However, most of the studies focused on nursing recruitment and retention of the overall healthcare system, not specifically to nursing homes. These results primarily centered on nurses wanting a pleasant work environment, the necessary tools to do their jobs along with flexible scheduling. The issue that was raised that is specific to nurses working in nursing homes is the fact that unique relationships are built with the patients receiving the care from the nurse. These relationships are different in that they typically involve more than just discussion about the health issue being treated. This relationship that was referenced is why Jean Watson’s theory was used as a basis for this study. “Only after the establishment of a relationship, within which the nurse has come to know the client as a person, can he or she begin to utilize themes or theories to assist with the provision of nursing care” (Running, 1997). In closing, if nursing home providers and the nursing profession do not focus on recruitment of nurses into nursing homes, failure will bring about profound negative consequences for nursing and society as a whole (Robertson & Cummings, 1996).