Nursing Leadership and Management Field Experience FDP Task

Employment and retention of nurses have been serious concern for many years. The problem has always contributed to the shortage of nurse that has always been experienced paralyzing effective delivery of quality care to the needy patients. From the eve of the golden era of western medicine in 18th century, the increasing demand for nurses has been part of the larger demand for healthcare. The emergence of specialization in healthcare initiated different specialties in healthcare such as pharmacy and x- ray. Nursing at this time was not highly priced because it was known as a vocational skill that was majorly associated with women. In the 20th century when nursing educational mode was introduced, nursing changed from a vocational practice to a highly trained profession. Since then the significant demand for nurses have continued to rise to help in provision of quality healthcare to the needy patients
In the current society, shortage of nurses and misdistribution continues to be a serious health concern globally. The population of qualified nurses is by far outnumbered by the population of patients in need of healthcare delivery. It is believed that nursing turnover in which qualified registered nurses quit their nursing responsibilities continues to be one serious reason as to why the shortage of nurses continues to exist in the contemporary society
Statement of the problem
Nurse retention is a global phenomenon causing significant negative effects in the health systems. According to Robert wood Johnson Foundation (2017 approximately 17 % of new employed qualified registered nurses quit their first nursing job within the first year of their employment. Additional 30% of nurses quit their jobs within the second year of their employment costing American health care system approximately 60, 00 dollars a year. Nurse turnover therefore remains an undesirable trend for healthcare employers and also a significant threat to both the quality of care provided as well to the safety of patients. Nurses quit their jobs because of various reasons. For example, a good portion of registered nurse quit their nursing jobs voluntarily due to individual interest. This group of nurses however want to explore other professional field and therefore chose to quit their nursing jobs. On the other hand, a good population of nurses quit nursing jobs because of unfavorable working conditions. These conditions include working for longer hours that subject the nurses to high level of burnout and work place stress driving them to quit their nursing jobs; underpayment that does not equate to the duties and responsibilities they undertake as nurses; lack of healthy working environment subjecting these nurses to workplace injuries and infections. Additionally, it is also true that a god population of nurses involuntary quit their nursing job. This group of nurses is forced to quit their nursing jobs on the ground of professional in competencies or wok place misconducts. They are therefore dismissed by the management of the hospitals which had employed them. Lastly, the prevailing workplace relationships also influence a good number of nurses to quit their nursing jobs. Bad relationships among nurses themselves or between the nurses and their supervisor results in reduced job satisfaction thereby driving many nurses to quit their nursing jobs.
Despite the cause of nurse turnover, the issue continues to be a serious health concern threatening the delivery of quality healthcare and patient safety. As such, there is significant need to develop effective mechanism that allows and promote retention of nurses in their respective places of work after they have been employed
Practice change, quality improvement, or innovation.
Nursing retention is an initiative that aims and developing and innovative ways of curbing nurse turnover and ensuring long-term retention of nurses in their respective positions and healthcare institutions of work. This initiative will involve various programs that directly or indirectly contribute towards retention of nurses in their various health facilities of work. For example, it will aim at educating leaders of health care institutions on how they can effectively manage nurses after they have been employed to reduce nurse turnover. The initiative will also aim at hiring more nurses and create favorable working environment for the nurses.
Rationale for change
As retention of nurses continue to be a serious challenge to various healthcare organizations. Nurse turnover caries diverse and adverse effects in healthcare service delivery. For example, healthcare institutions spend a lot of resources in hiring and training new recruits. Nurse turnover in healthcare organizations and institution forces these institutions to continuously recruit new professionals to take positions of those who have left. The process of recruiting new nurse is however costly and tie consuming forcing these healthcare institutions to dig deep into their pockets.
It is also true that nurse turnover negatively impacts the quality of healthcare provided. Most of the nurses who quit their nursing jobs are well qualified, trained and competent. The withdrawal of these nurses from healthcare service delivery therefore drains the healthcare system of its proficient employees with the capacity to provide quality care required. The quality of care therefore is compromised. In addition, withdrawal of nurses from their jobs interferes with team work in a given healthcare facilities. Which is the basis of provision of holistic quality healthcare? With teamwork and cohesiveness among healthcare professionals affected, the quality of healthcare provided is likely to go low.
Nurse turnover also have severe repercussions in the cooperate image of healthcare institutions. It portrays healthcare institutions as unstable and therefore scares away other qualified professionals who would have wanted to join. In addition, it lowers the confidence of patients making them doubt the efficiency and effectiveness of the facility in providing healthcare. This has long term business effects in the profitability and sustainability of the healthcare institutions. Based on the above negative consequences of nurse turnover, there is significant reason as to why nursing rotation initiative should be implemented
Literature review
Nursing turnover is defined as the event in which qualified registered nurses quit their jobs shortly after being employed either voluntarily or involuntarily. Nursing turnover has always remained a significant challenge in the health system affecting various healthcare institutions and organizations globally (American Association of Colleges of Nursing, 2017) . Approximately 17 % of newly employed registered nurses quit their nursing responsibilities within one year after being employed. An additional of 33% also quit their nursing job within the second year of employment (NSI Nursing Solutions Inc, 2013). Nurse turnover is an undesirable trend for healthcare employers that not only threatens the quality of care given but also threatens the safety of patients. Nurse retention initiatives therefore are innovative ideas developed to help healthcare institutions retain employed nurses (Sherwood and Barnsteiner, 2012).
Neal-Boylan (2013) outlines that nurses quit their nursing positions because of various reasons both voluntary and involuntary. Voluntary reasons as to why nurses quit their jobs include personal desire for change, desire for geographical location among other reasons. Involuntary reasons that might force nurses to quit their jobs include closure of the health facility of work, retirement among similar reasons. Capotosta and Gardner-Webb University (2013) holds that the persistent effects of nursing turnover have trigged several studies attempting to understand behind this health concerns. Several researchers therefore have identified several factors that work either independently or collaboratively to hinder retention of nurses in healthcare institutions
Kramer, Halfer, Maguire Schmalenberg (2012) hold that poor working environment is one of the important factors that hinder retention of nurses and therefore promoting turnover. Most healthcare institutions do not have good and conducive working environment that attract nurses to work for long , most healthcare facilities for example lack important equipments that nurse require to effectively deliver their jobs, making significantly difficult for the nurses to efficiently deliver. On the other hand, safety of nurses in healthcare institutions is not guaranteed. They remain significantly vulnerable to work place injuries and healthcare injuries because most of the institutions do not address the safety of nurses in workplace with expected seriousness (Sherwood and Barnsteiner, 2012). This therefore forces drive many nurses to quit their jobs to engage in other profession that they consider safe for their health. Good working environment also includes issues of payment. Despite the significant role that nurses play in healthcare service delivery. Most of the nurses are underpaid compared to other professions. The salaries and enumeration that nurses receive do not equate to the nature of their work. This therefore rives many nurses to quit nursing jobs to look for better paying job opportunities (Globsyn management conference 2014, 2014).
According to Waddill-Goad and Sigma Theta Tau International (2016) burnout contributes a good parentage of nurse turnover. According to much healthcare institution are understaffed. The population of nurses in these facilities is outnumbered by the large population of patients who need healthcare services. The small population of nurses therefore is forced to work for longer hours to provide the required services to the large population of patients. Longer hours of work deny the nurse enough time to rest. This therefore results in significant burnout and wok- related stress that at the ends drives may nurses to quit
RN Work Project and Robert Wood Johnson Foundation (2012) also identifies that personal reasons also contribute in nurse turnover. Toren, Zelker, and Porat (2012) identifies that a good population of nurses quit their jobs because of personal reasons. For example, they quit because of personal choices to change their line of work while other would just want to change their geographical loacatiosn. Such nurses opt to qui t their jobs.
According to Jeffrey (2012), a good number of registered nurses are forced to quit their nursing responsibilities by the management of the facility. These categories of nurse are either found incompetent to provide the quality of care expected by the facility and therefore are dismissed on the grounds of incompetency. Additionally, some nurses are forced to quit their nursing responsibilities within their first years of employment due to disciplinary actions. These groups of nurses are found guilty of unethical practices within the facility (Henkel, 2014).
Various studies conducted into the issue of nursing turnover have outlined that relationships within the facility significantly influence a good number of nurses to quit their employment soon after getting the job. Glembocki, Fitzpatrick and Creative HealthCare Management (2013) hold that, if the relationships among nurses in a unit are significantly strained, these nurses are likely to yield little satisfaction in their jobs and therefore opt to quit. Additionally, conflicting relationships between nurses and their managers or supervisor also drives many registered nurses to quit employment shortly after being employed. Several factors have been indentified that are likely to make relationship among nurses or with their manager sour including improper role definition and incompetency (Goleman, 2013).
Shepard and Shepard(2013) identifies the role that the leadership of healthcare institutions play in hindering retention of nurses in these facilities in employee turnover is very significant. Holds that Leaderships of healthcare facilities are tasked with various responsibilities that when well performed are likely to result in employee retention. For example, hospital leadership should motivate and encourage junior employees making them to feel valued and enjoy job satisfaction. On the other hand, leadership of healthcare facility should work towards promoting good working environment. Lastly, leadership of health facility has the responsibility of developing policies that promote retention of nurses and other employees in the facility. However, incompetency and lack of commitment by the leadership of the facility is likely to result in the influx of nurses quitting their responsibilities shortly after being employed.
The significant impacts of nurse turnover are very adverse not only to the healthcare institutions but also to the recipients of healthcare services. Li and Jones (2013), state that nurse turnover is very costly. For example, Martin, Hartman, Whittle and Catlin (2014), American health system loses approximately 60,000 dollars due to turnover. Additionally, In Mason, D. J., In Gardner, In Outlaw and In O’Grady, (2016) argue that the inability of the healthcare facility to retain its nurse’s triggers is costly to these healthcare facilities. The hospital spends a lot of resources to hire and train nurse to acquire competencies in particular areas. Losing these nurses therefore requires that the facility continuously recruits nurses, a process that is relatively costly and time consuming.
Mohr, Young, Burgess (2012) identifies negative consequences of nurse turnover on the quality of healthcare. Large population of nurses who quit their nursing jobs is well qualified, trained and competent. The withdrawal of these nurses from healthcare service delivery therefore drains the healthcare system of its proficient employees with the capacity to provide quality care required. The quality of care therefore is compromised (Eckman and Gardner-Webb University (2014). On the other hand, Bowbil, and Antwi (2016) argue that the withdrawal of nurses from their jobs interferes with team work in a given healthcare facilities which is the basis of provision of holistic quality healthcare. With teamwork and cohesiveness among healthcare professionals affected, the quality of healthcare provided is likely to go low (Warshawsky, Rayens , Stefaniak and Rahman, 2013).
Nurse turnover also have severe repercussions in the cooperate image of healthcare institutions. Hill, J. H., & University of Sheffield (2012) identify that nursing turnover pictures health institutions as unstable and therefore scares away other qualified professionals who would have wanted to join. Grove, Burns and Gray on the other had argues that nursing turnover lowers the confidence of patients making them doubt the efficiency and effectiveness of the facility in providing healthcare (2013). This has long term business effects in the profitability and sustainability of the healthcare institutions. Based on the above negative consequences of nurse turnover, there is significant reason as to why nursing rotation initiative should be implemented
Even though nursing turnover continues to be major challenge to the global health system, it is situation that can be well contained and retention of nurses achieved. For example Reich, Jacobs and Dietz, 2014 holds that making working conditions and environment to look attractive for nurses will be a major step towards achieving retention of nurses. Cho, Lee, Mark and Yun (2012) explain that lucrative payments and other good allowances given to nurses will retain them. Additionally, Flexible working schedule will allow nurses to have enough time to relax hence reduce burnout