Creating the Right Culture in Pediatric Nursing – Recruitment and Retention



Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Certified Nursing Assistants (CNAs) harbor shared expectations about their occupational culture. The shared expectations in a positive occupational climate include teamwork, occupational safety, decorum in inter-employee relations, and respectful interactions with management (Hinds, Jichuan, Nelson, Pryor, Roberts-Turner & Robinson, 2014). Positive occupational cultures enhance professional commitment and promote employees’ satisfaction. In nursing contexts, high employees’ satisfaction coupled with enhanced professional commitment optimizes quality of care; hence, yielding improved patient outcomes. On the contrary, a negative occupational culture causes low employees’ satisfaction and suboptimal professional commitment; hence, contributing to low quality of care and dissatisfactory patient outcomes (Hinds et al., 2014). Therefore, it is important for organizational leaders to create and sustain a positive occupational culture within a nursing facility to optimize healthcare outcomes.

Creating Cultural Fitness in Organizations

Cultural values and norms in organizations are created, nurtured and safeguarded by leaders, and manifest as haphazard and cumulative behaviors and beliefs of personnel in an organization (Delaney, Friedman, Macyk, Quinn & Schmidt, 2013). Creation, nurturing and protection of an organizational culture is the primary function of the Human Resource mechanisms within an organization. In particular, the processes of recruitment, hiring and retention of personnel by the Human Resource mechanisms play a central role in defining, nurturing and protecting an organizational culture. Through recruitment and hiring processes, the Human Resource processes strive to identify and handpick potential employees exhibiting the greatest congruence to desired and existing values and norms within an organization (Adams, 2016). On the other hand, retention processes entails the use of performance review systems to identify and retain employees who have demonstrated the greatest adherence to prescribed values and norms of an organizational culture.

Significance of Culture Fit in Organizations

Occupational culture permeates the work processes and managerial practices in an organization. In the context of pediatric nursing, organizational culture influence specific work processes including the tone of communication with child patients during diagnostic processes, the timeliness and competence of providing nursing interventions, and the provision of emotional support to psychologically prepare child patients for treatment procedures (Hinds et al., 2014). On the other hand, organizational culture in managerial practices manifest in internal communications between supervisors and subordinate nurses, the provision of time and resources for individuals’ career development, and the promotion of staff cohesion for purposes of optimizing teamwork (Delaney et al., 2013). The values and norms prevalent in an organizational managerial practices influence employees’ perceptions of fairness in their occupational premises; hence, informing their professional commitments. On the other hand, the norms and values prevalent in work processes guide employees towards meeting job performance targets; hence, influencing the quality of outcomes in their professional duties (Castle et al., 2015).

In Human Resource Management, creating the right culture in an organization entails recruiting for culture fit. Recruiting for culture fit entails identifying and hiring the ‘right’ persons for the underlying job positions (Adams, 2016). In practical contexts, recruiting for cultural fit means that Human Resource mechanisms for recruitment and hiring processes are fine-tuned to identify and absorb candidates with personal and professional values that align with the cultural norms and values of an organization (Delaney et al., 2013). The keen focus on the congruence between personal and organizational values means that recruitments for cultural fit are subjective rather than being based on professional merits. For example, organizations that favor teamwork over professional independence will prefer an inexperienced candidate with teamwork-related personality attributes over a candidate with optimal professional experience but lacks teamwork-related attributes (Adams, 2016). Therefore, creating the right culture through recruitment, hiring and retention entails the application of customized Human Resource practices unique to each organization. 

Creating the right culture requires understanding the professional underpinnings in pediatric nursing. Professional underpinnings in pediatric nursing are informed by evidence-based best practices unique to the provision of nursing care to children (Castle et al., 2015). These best practices prevail in all pediatric organization, regardless of the unique and customized cultural norms and beliefs within each organization. Therefore, Human Resource practices geared towards creating the right culture for a pediatric nursing institution are informed by evidence-based best practices in the field of pediatric nursing (Adams, 2016). Therefore, it is worth first understanding the unique best practices in pediatric nursing and the elements of quality of care and patient outcomes before evaluating the use of recruitment and retention practices to create the right culture in pediatric nursing contexts.

Best Practices in Pediatric Nursing

Pediatric nursing faces unique needs and challenges compared to other niches of nursing care including geriatric nursing and neonatal nursing. Pediatric contexts of nursing involve dealing exclusively with children. The National Institute of Nursing Research asserts that child patients have lower emotional and cognitive capacities than adults (Camp & Chappy, 2017). In most circumstances, infants and toddlers admitted in pediatric nursing units cannot comprehend their medical conditions; hence, pediatric nurses assume the sole role of interpreting the medical needs of child patients (Delaney et al., 2013). One best practice in pediatric nursing is to minimize medical errors arising from the inability to accurately discern the medical needs of a child patient. Therefore, pediatric nursing require optimal critical thinking skills, empathy and sensitivity to enhance pediatric safety when dealing with children. 

Also, the safety of pediatric nursing is undermined by the high dependency tendencies of hospitalized children. Most sick infants and toddlers are nonverbal and totally dependent on their caregivers for food and comfort. On the other hand, school-aged children may be verbal but still lack the emotional and cognitive capacities to engage competently with their caregivers (Camp & Chappy, 2017). All sick children expect their nurses to be friendly and reliable in their times of need. Unfortunately, child patients may not necessarily communicate their needs in a manner that can be clearly understood by all nurses. In this context, best practices in pediatric nursing require appropriate interpersonal skills including patience, compassion, and attention to detail to discern the unspoken needs of nonverbal patients in pediatric units. Failure to correctly and timely discern the needs of pediatric patients lead to unnecessary fatalities.

Also, pediatric nursing requires transcultural competence. Child patients admitted in pediatric units come from varied socio-economic backgrounds. The varied socio-economic backgrounds of patients mean that child patients and their parents harbor different knowledge and beliefs towards nursing care services (Castle, Holl, Lin, Nijika & Spreitzer, 2015). Consequently, pediatric nurses must be culturally competent to discern the unique beliefs and expectations of patients from diverse socio-cultural backgrounds. Absence or limited cultural competence in pediatric nursing lead to communication breakdowns and counterproductive relationships between patients and nurses; hence, undermining the quality of care and patient outcomes (Camp & Chappy, 2017). In applied settings, best practices involving cultural competence in pediatric nursing include proficiency in the patients’ native languages and harboring positive attitudes towards the foreign norms and beliefs of patients from exotic cultural backgrounds. Therefore, nurses’ cultural competence, professional competence, and personal competence provide the underpinnings for best practices; hence, informing recruitment and retention practices in pediatric nursing. 

Quality of Care and Patient Outcomes in Pediatric Nursing

Besides evidence-based best practices, the human resource processes for recruitment and retention of culturally-fit pediatric nurses are also informed by the targeted dimensions of quality care and patient outcomes. Desirable patient outcomes in pediatric settings include but not limited to low waiting times for patient admission, decreased pressure ulcers in pediatric units, and reduced catheter-related infections (Carson, Chadwick, Cynthia, Mixer & McArthur, 2015). Also, parameters of patient outcomes include improved patient-nurse collaborations during treatments, timely discharge of pediatric patients, and reduced deaths attributable to medical errors and suboptimal work-related processes of pediatric care (Luanne, 2017). 

The quality of care in pediatric units is directly proportional to the ability of nursing personnel to minimize and even prevent unnecessary deaths in pediatric wards. 18% of deaths in pediatric institutions are attributable to medical errors ranging from catheter-related bloodstream infections to delayed admission of emergency cases to intensive care units (Janhunen, Kvist & Paivi, 2017). The quality of care for bloodstream catheters depends on the professional competence of nurses. In the administration and care for bloodstream catheters, pediatric nurses are tasked with the proper selection of catheter sites, the use of adequate aseptic techniques to maintain catheters, and the timely removal or replacement of intravenous catheters (Delaney et al., 2013). On the other hand, the timely admission of emergency cases to intensive care units depends on the knowledge and attitudes of the nurses towards emergency cases. Overall, significant undesirable medical outcomes in pediatric units result from the professional and personal incompetence of pediatric nurses. 

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Similarly, the patient-nurses collaborations amidst admissions to pediatric units depend on the prevailing occupational atmosphere within a nursing facility. 37% of unnecessary deaths in pediatric medical institutions were attributable to poor communication and lack of collaboration between patients and medical personnel (Luanne, 2017). Patient-nurse collaborations depend on the dispositional attitudes of both the patients and the nurses. Constructive relational coordination in nursing units is created and nurtured from the moment of patients’ admission to the time of discharge form the nursing units. Pediatric nurses can create and improve their collaborations with child patients by engaging in friendly, timely, and frequent communications (Camp & Chappy, 2017). Positive relational coordination plays a central role in not only reducing the incidences of medical errors, but in also improving patient satisfaction (Carson et al., 2015). Therefore, quality of care and patient outcomes related to relational coordination can be improved by recruiting and retaining pediatric nursing personnel with excellent interpersonal skills.

Lastly, quality of care and patient outcomes in pediatric nursing depend on professional collaborations between the different categories of nurses. Registered Nurses (RNs), Certified Nursing Assistants (CNAs), and Licensed Practical Nurses (LPNs) perform different functions within a pediatric nursing unit (Camp & Chappy, 2017). However, all the different functions of the three groups of nurses are geared towards meeting the nursing needs of the patients. Therefore, the RNs, CNAs, and LPNs must collaborate willingly and constructively to enhance the effective and efficiency achievement of quality of care objectives. Collaborations and teamwork in professional context depend on whether or not the team members harbor shared goals and beliefs (Hinds et al., 2014). The congruence of goals and beliefs in workplace teams depend on the adherence of shared values and norms defining the occupational culture. Therefore, patient outcomes and the quality of care in pediatric nursing units depend on the personality predisposition of employees to embrace cultural norms and best practices for pediatric nursing care.        

Recruitment and Retention for Cultural Fitness

In the United States, the practice of pediatric medicine is growing exponentially. In 2015, over 350,000 registered and certified pediatric nurses were practicing in the United States against a demand of 751,000 licensed and certified pediatric nurses. The high demand coupled with the low supply of licensed pediatric nurses means that pediatric nurses could more easily from one employer to another. Annually, the pediatric nursing workforce record approximately 48% turnover (Carson et al., 2015). The turnovers occurred within 5 years after employment. Consequent to the low supply of pediatric nurses coupled with the high turnover rates in the workforce, pediatric medical institutions are facing challenges recruiting and retaining the best pediatric nurses in their organization (Rubinson, Smith & Webb, 2011). Consequently, managers of pediatric hospitals fail to optimize their quality of care and patient outcomes because of the challenges faced in obtaining and maintaining a culturally-fit workforce; hence, the need for tailored recruitment and retention strategies.  

Culture-Fit Recruitment Strategies

Talent Pipeline Approach

The challenges related to recruiting and retaining a culturally-fit body of pediatric nurses can be counteracted through the use of customized recruitment and retention strategies. In the context of recruitment, Human Resource Managers in pediatric healthcare institutions can obtain a culturally-fit nursing workforce by employing the pipeline approach of recruitment. The pipeline approach involves creating and sustaining a steady pool of talented employees through continuous sourcing programs (Janhunen, Kvist & Paivi, 2017). Most employers recruit their workers periodically from the body of unemployed candidates who have already completed their education and in most cases have gained professional experience since completing nursing school (Camp & Chappy, 2017). Unfortunately, the population of unemployed nurses may not contain talented nurses because most of the talented candidates are already employed, meaning the unemployed population comprise of rejects during employment interviews. 

The most talented nurses can be sourced from campus populations. Campus students in nursing schools lack the workplace experience for nursing duties. However, approximately 50 nursing students in campus students contain at least 5 highly flexible recruits who can be molded to fit the culture of any organization (Delaney et al., 2013). Campus recruiting strategies involves developing partnerships with reputable learning institutions that allow talented students conduct internship programs during school breaks. Allowing nursing students to complete internship programs in real-world pediatric institutions enables Human Resource managers to observe and identify the potential students that can fit into the occupational cultures of their organizations (Rubinson, Smith & Webb, 2011). Upon completion of their academic studies, the already-identified students can be absorbed into the organizational workforce before they are snatched by other competing employers in the pediatric industry. The internship programs must run continuously and attract a sizable pool of talent to ensure that the human resource managers have readily-available access to culturally-fit candidates whenever there are job openings. 

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Interdisciplinary Recruitment Team

Besides the talent pipeline approach, a culturally-fit workforce can be recruited through the use of a robust interdisciplinary recruitment team. The work processes in pediatric nursing are dynamic courtesy of the fast evolution of evidence-based practices occasioned by the fast pace of knowledge growth and technological advancements (Carson et al., 2015). Therefore, the hiring process must be fine-tuned to move at the same pace as the evolution of evidence-based best practices in pediatrics. For example, latest evidences in child development psychology must be used to inform the recruitment and hiring of pediatric nurses.

A robust interdisciplinary recruitment team must incorporate specialists from not only the field of human resource management, but also from relevant fields including family medicine, child development psychology, oncology and pediatric physicians (Janhunen, Kvist & Paivi, 2017). Inclusion of experts from relevant specialties into the recruitment team ensures that the skills and qualities of potential pediatric nurses during recruitment processes are assessed accurately based on the latest developments in all fields directly and indirectly related to pediatric nursing. Collegiality in the interdisciplinary hiring team should be optimized to ensure unanimous decision-making during the identification and absorption of culturally-fit pediatric nurses (Cater & Tourangeau, 2012). During recruitments, customized and culture-centered interview questions should be used to complement the robust and multi-perspective efforts of the interdisciplinary recruitment team. 

Employee Poaching

Lastly, the traditional practice of employee poaching can be used to recruit culturally-competent pediatric nurses. The pediatric care industry hosts several private and public health institutions offering varied salaries and benefits to their employees. 53% of annual turnovers among pediatric nurses were attributable to search for better remunerations in better-paying domestic and overseas health institutions. Lowest paid Registered Nurses (RNs) in the pediatric sector earn approximately $43,620 annually while highest paid pediatric RNs receive annual incomes approximating $91,740 (Cater & Tourangeau, 2012). Therefore, health institutions lose talented and culturally-fit pediatric nurses to competitors offering better remunerations. In this regard, offering high salaries in the pediatric industry will entice qualified and culturally-fit nurses to join the organization. During employee poaching, the Human Resource managers should consult with other administrators, particularly the finance managers, to confirm the fiscal sustainability of attractive remuneration practices (Hinds et al., 2014). 

Culture-Fit Retention Strategies

The pediatric nursing sector is already suffering from workforce shortages (Carson et al., 2015). The high employees’ turnover further worsens the staff inadequacy. Some pediatric nurses leave organizations in search for better occupational cultures and climates abroad. Other pediatric nurses leave their organizations for other occupations outside the health sector. For example, 14% health workers in the United States leave their professions for entrepreneurship pursuits 5 years after their employment (Camp & Chappy, 2017). The loss of workers to competitors and to entrepreneurship pursuits means healthcare institutions suffer from persistent shortage of workers. Pediatric nurses leave their organizations for three primary reasons including poor employment relationships, difficult work surroundings, and discouraging organizational values and norms (Janhunen, Kvist & Paivi, 2017). Therefore, retention strategies in pediatric nursing should aim at creating a favorable organizational and occupational culture to prevent or minimize the loss of culturally-fit nurses. 

Provision of Career Growth Opportunities

An organizational culture that encourages staff retention is characterized by presence of career growth opportunities, presence of sufficient work-life balance mechanisms, and presence of adequate knowledge and work infrastructure capacities (Adams, 2016). Regarding the presence of career growth opportunities, it is important for human resource managers to promote workers from within the organization. Vacant job positions should be filled by qualified and culturally-fit candidates from the organization’s workforce. Hiring from within the existing workforce allows companies to select the workers that have demonstrated consistent and deep adherence to values and norms prescribed by the organizational culture (Castle et al., 2015). Also, recruiting from within enables employees to remain committed in their workplace responsibilities in the hope of progressing up the corporate ladder (Cater & Tourangeau, 2012). Pediatric nurses are more likely to remain committed and exercise cultural compliance in pediatric health institutions that offer opportunities for career progression. 

Provision of Work-Life Balance Opportunities

Besides career growth opportunities, retention is influenced by the opportunities for work-life balance. Pediatric nurses have other personal engagements outside their professional responsibilities. Personal engagements include caring for children and engaging in vocational travels and recreations. The work schedules in organizations must allow for flexible juggling between work and life activities (Delaney et al., 2013). Use of compressed worksheets allows pediatric nurses to work for complete their weekly duties in five days from Monday to Friday; hence, leaving Saturday and Sunday for life-related activities. Also, pediatric nurses should be granted leave whenever family-related emergencies arise in the middle of their busy work schedules. A flexible occupational culture that give nurses time to juggle flexibly between their professional duties and the life commitments make employees feel valued by their employers (Cater & Tourangeau, 2012). Consequently, feeling valued by the employers encourages loyalty to workplace norms and values and promotes occupational commitments; hence, reducing turnover. 

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Provision of Training and Work-Related Infrastructure

Moreover, provision of relevant employees training and the equipping of pediatric nursing units with adequate facilities encourage retention of employees. Evidence-based practices in pediatric nursing emerge from frequent research projects. Most of the new evidence-based practices involve the use of inventive and innovative work processes to improve quality of care and patient outcomes in pediatric nursing (Janhunen, Kvist & Paivi, 2017). For example, latest evidence on the molecular sequencing of tumors yielded inventive treatment procedures for pediatric cancer treatment. Inventions and innovations in treatment procedures necessitate pediatric nurses to undergo relevant trainings on the use of emerging treatment procedures (Delaney et al., 2013). Therefore, pediatric nurses must undergo constant training and development programs to remain up-to-date with developments in pediatric medicine. Failure to remain up-to-date with developments in healthcare leads to obsolesce of skills; hence, progressing to employees’ dissatisfaction (Castle et al., 2015).   

Employers are responsible for providing constant training and development programs to pediatric nurses. The training and development needs of the workers must be matched with the workers’ career goals (Rubinson, Smith & Webb, 2011). For example, employers must allow pediatric nurses to attend professional conferences and seminars to advance their knowledge in latest pediatric developments. Also, employers must create a culture where nurses are allowed to take career breaks to advance their respective educations. Regarding the provision of adequate work-related facilities and infrastructures, pediatric nurses commonly work in hazardous environments, especially when attending to patients with communicable diseases (Carson et al., 2015). Thus, pediatric institutions must provide protective medical gear to foster personnel safety. A combination of training and development opportunities with adequate infrastructure for personnel safety encourage loyalty to employers; hence, reducing incidences of turnover among pediatric nurses. 

Gaps in Current Research

Existing research highlights identifiable strategies for cultural-fit recruitment and retention in pediatric nursing institutions. However, existing research fail to provide a succinct evaluation of the effectiveness of the recruitment and retention strategies in real-world contexts. Apparently, there is shallow knowledge on the factors contributing to cultural fitness in the recruitment and retention of pediatric nurses. Pediatric nursing possess unique attributes different from those in other niches of nursing care (Cater & Tourangeau, 2012). Unfortunately, current research fails to pinpoint the interaction between recruitment and retention strategies and the unique contexts of pediatric nursing. Therefore, current literature on culturally-fit nursing retention and recruitment remains shallow with respect to the specific context of pediatric nursing. Thus, future works should be directed on studying the effectiveness of culturally-fit recruitment and retention strategies in the primordial contexts of workforce challenges of pediatric nursing care. 


In conclusion, developing the right culture in pediatric nursing institutions involve recruiting and retaining pediatric nurses with desirable professional and personality attributes. In pediatric nursing, developing a culturally-fit workforce is beneficial in optimizing quality of care and subsequently improving patient outcomes. Recruiting and retaining for culture fitness is informed by the targeted patient outcomes and the evidence-based practices contextual to pediatric nursing. Among the recruitment strategies for culturally fit workforce include the use of talent pipeline approaches, application of employee poaching, and the use of interdisciplinary recruitment teams. On the other hand, retention strategies for culture fitness include provision of training and work-related infrastructure, provision of work-life balance mechanisms, and provision of career growth opportunities. There recruitment and retention strategies can create a conducive environment in pediatric nursing institutions; hence, improving quality of nursing care.  

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