Nursing Leadership and Management Field Experience FDP Task

Introduction
Background of the problem
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
According to Schaffer (2013), proper staffing will also help in retention of nurses. The population of patients in need of medical care continues to rise every single day despite shortage of nurses witnessed in the healthcare facilities. The imbalance in the number of nurses has forced the few nurses on job stretch beyond their capacity to ensure that all patients in need of care are attended to resulting to overwork and severe burnout. Employing enough nurses will be a greater relief to the nurses who will find their job interesting and hence reducing turnover (Waddill-Goad AND Sigma Theta Tau International, 2016).
Screening candidates based on job fit. as good population of nurses who quit their job a few years after being employed do so forcefully after being rendered incompetent by the management of the hospital. It is a recommendations that proper screening should be done while hiring new nurses in the facility so as to ensure that they are competent enough to deliver as per the standards required by the hospital( Denhardt, Denhardt and Aristigueta, 2013).
Reich, Jacobs and Dietz (2014) identifies that screening candidates based on job fit before employing them is likely to help in reatinig the nurses. Proper screening will ensure professionalism and competency and therefore recommends that proper screening should be done while hiring new nurses in the facility so as to ensure that they are competent enough to deliver as per the standards required by the hospital( Clipper and Sigma Theta Tau InternationL, (2013).
Roussel (2013) holds that proper management of nurses\ after they are hired is likely to guarantee their retention in healthcare facilities. The leadership of the hospital therefore ought to be trained on effective ways of managing these nurses on after they are employed. This includes building team work and supporting the nurses, motivating the nurses, helping the nurses to cope with work- related stress among other issues.
Best practices
Literature records the retaining nurses in their respective job positions is a possible reality. Several strategies are therefore identified as best practices that when effectively implemented by various institutions will relatively reduce the rates of turnover in the healthcare facilities. As outlined below
Several literatures recommend that developing good and pleasant working environment for nurse will automatically reduce turnover creating favorable and conducive working environment .creating good working environment for nurse includes making working conditions and environment to look attractive for nurses. This further involves includes ensuring that nurses have better pay equating to their responsibilities and other benefits for the nurses. It also involves creating flexible working schedule that allow nurses to have enough time to relax and spend with their families hereby reducing burnout and stress that occur due to over work. Healthcare institutions should also ensure that the environment of work is safe limiting the vulnerability of nurses from work place injuries and hospital acquired infections.
Employment of enough nurses is also a best practice identified by several literatures. Researchers conducted in relations to nurse turnover identify that many healthcare institutions continues to encounter severe shortage of qualified nurses. The population of patients in need of medical care by far outnumbers the population of nurses available in these healthcare institutions. The few nurses available therefore have been forced to stretch beyond their capacity to ensure that all patients in need receive quality services. The few nurses are therefore overworked and suffer severe burnout that most of them opt to quit the jobs. It is therefore recommended that employing sufficient nurses to offer are to the rising needy population of patients with diverse needs will be a best practice that should be considered by healthcare facilities. Employing enough nurses will clear workload encontred by the few nurses, allowing them to have flexible hours of work and to have sufficient rest. This in turn will result in job satisfaction and hence reducing turnover.
As good population of nurses who quit their jobs do so involuntarily due to incompetency. Various literatures identify that screening candidates based on job fit before employing them will be a best practice to be employed by healthcare institutions in order to minimize turnover and ensure retention. It recommends that healthcare organizations employing nurse should determine their extent of professionalism and competency. It is a recommendations that proper screening should be done while hiring new nurses in the facility so as to ensure that they are competent enough to deliver as per the standards required by the hospital.
Various literatures identifies significant role of organizational leadership in ensuring nurse retention. Several studies indicate that ensure good leadership and management of healthcare institution will be a best practice to ensure nurse retention. The management of nurses after they are hired significantly determines how long they are likely to stay on job. Effective management by the leadership of the hospital is likely to witness many hired nurses retaining their jobs. The management of healthcare facilities has various strategies within their power that they can employ to ensure retention of nurse in their facilities. For example, the management and leadership of healthcare institutions should invest in employee development. Employee development d not only keeps nurses involved but also makes them appreciate growing in nursing profession. This in turn will allow for retention of nurses in their respective positions.
Motivation is also another important technique that the leadership of healthcare institution may employ to ensure retention of nurses. The leadership may encourage nurses through continuous motivation. This involves rewaedig and appreciating nurses who have done recommendable jobs. Motivation will not only make the nurses feel appreciated but will also encourage other to place more effort into the profession. Lastly, the leadership of healthcare institutions should guarantee good interpersonal relationships in the healthcare institutions. This include developing and ensuring effective conflict management among employees and good communication among employees and the management of the facility The leadership of the hospital therefore ought to be trained on effective ways of managing these nurses on after they are employed. This includes building team work and supporting the nurses, motivating the nurses, helping the nurses to cope with work- related stress among other issues.
Evidence summary
American Association of Colleges of Nursing (2017) defines nursing turnover as a serious healthcare concern threatening quality of care and ignites shortage of nurses in the healthcare system. Nursing turnover has severe consequences not only to the health institution but also to the entire health system in general. Eckman and Gardner-Webb University (2014) holds that the withdrawal of qualified nurse from nursing profession drains healthcare system of its most proficient health workers therefore affecting the quality of health care. Bowbil, and Antwi (2016) argues that nursing turnover negatively affects the cohesiveness of healthcare providers that is essential in the delivery of quality healthcare resulting into low quality care. Even though nursing turnover is a serious challenge to the healthcare system retention of nurses is a possible dream. Reich, Jacobs and Dietz (2014) holds that providing favorable working condition including better pay and flexible working hours is likely to attract many nurses to remain within the profession. Roussel, L. (2013). Also hold that improved methods of managing nurses is very critical if nurses have to be retained