Even if I could offer handsome compensation packages to lure good OR nurses to my three-OR hospital, it wouldn't be enough to retain them. While a good wage is important, one way to keep good nurses is to act as their advocate and include them in decisions that affect their professional lives. Thanks to our policy of "inclusion," I have lost only two nurses to other jobs in 14 years - and three of our 13 OR nurses have been with us nearly 20 years. And this is despite our rural setting, the hospital's fourth sale and the nursing shortage.

While an inclusion policy may sound like flippant "management speak," it is serious business that requires commitment. Most, if not all, OR nurse managers are overwhelmed with administrative duties, and tuning out nurses is a lot easier than listening to them. But we can't position ourselves in authority and expect employees to perform well simply out of a sense of duty.

We need to motivate them by working beside them as peers and advocating for them as leaders. I scrub in when needed, strongly support their sensible capital equipment requests and, yes, fight for salary increases. I recently conducted a survey to determine competitive call-pay rates in our region and used the results to help obtain a pay increase - the battle was hard fought, but the nurses are grateful to have had an advocate. We also allow flex staffing: Nurses can go home when their work is done and take turns staying home on those rare days when the caseload is especially light.

The OR nurses and I review the budget in detail monthly. Thanks to this, and even distribution of responsibility through rotating inventory-management assignments, our nurses don't pull stock willy-nilly from the shelves. They think about whether a suture can be available on the back table instead of opened.

The nurse manager must facilitate regular, effective communication. We have a notebook at our secretary's desk that contains everything we need to tell each other: infection control updates, memos from administration, surgeon preferences, case changes and special requests. Everyone writes in the book and signs it twice a week. Even surgeons are not outside the scope of inclusion: For example, when our orthopedic scrub nurse went on vacation, we alerted our orthopedic surgeon, and he chose to reschedule a particularly challenging case for the next week.

Our inclusion policy fosters a sense of belonging and promotes teamwork. Nurses happily relieve each other during or after grueling cases. They support our surgeons, and they don't bicker or complain in the OR. They turn over rooms during free moments between cases, which has reduced our average turnover time to 25 minutes. This sets the tone for a smooth-running OR and helps ensure excellent, efficient care.

Thanks to our policy of inclusion, I believe my nurses and I will work together for many years to come - not because we have to, but because we want to.