Voluntary Nurse Turnover

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VOLUNTARY NURSE TURNOVER 1

VoluntaryNurse Turnover

RachelWells

Stephen Payne

David Levin

Brittney Vargas

Farah Osmani

Maryville University

ProfessorAvonelle Rand

August21, 2016

Nurse turnover affects the stability of health organizations in termsof human resource and patient care. The health industry operates onthe ability to cater for the needs of patients and the performancemetrics would include accessibility, cost, and quality of service.High voluntary nurse turnover would affect all these metricsnegatively for a particular institution and eventually the wholeindustry. In 2011, healthcare jobs made up 20% of all new jobs postedthat year (Collini, Guidroz, &amp Perez, 2015). Therefore, thisincrease in job opportunities can make holding on to staff difficult. A good example is a hospital with few nurses where those availableare overwhelmed with work and produce poor service as a result. Theinstitution ends up losing money with decreasing number of patientsand cost of damages. Nurses are a vital part of many healthcareenvironments and can be detrimental to the success of anorganization. Nursing positions are increasing with time creatingmore opportunities and providing more competition for theseinstitutions. Collini et al. (2015) found out that the averageamount of nurses who leave their jobs make up around 14% yearly. Thepercentage shows that turnover is a real issue that organizationsmust deal with in a bid to stay successful. The cost for each nursewho leaves a job is estimated at over $10,000 (Duffield et al.,2014). Loss of staff and financial resources will only continue togrow as more nurses retire and the need for more patient care emerges(Mizuno et al., 2014). The continued need for nurses, increased jobopportunities, and the current rate of turnover enhances theflexibility of nurses to the detriment of health organization.

Consequences of Increases inNurse Turnover and their Solutions

The effects of patient care show how turnover can be so devastating. Increased turnover has been proven to decrease the quality ofstandards for any organization (Mizuno et al., 2014). New employeesrequire more training and supervision to become proficient. Thus,organizations with high turnover are at increased risk forunintentional patient injury and errors (Warshawsky, Rayens,Stefaniak, &amp Rahman, 2013). These injuries can range fromimproper medication administration to falls and other traumaticevents. In doing so, the stay of these patients and the need for carerises at the expense of the organization. This also decreases thetrust in the organization, possibly causing patients to go elsewherefor medical treatment. The quality is also affected as increasedturnover has been proven to augment hospital-acquired pressureulcers, which is an additional cost of treatment and care that ispaid at the expense of the organization. It can cost around $20,000for each hospital-acquired pressure ulcer, which can quickly bankrupta budget (Warshawsky et al., 2013). This puts more pressure to cutcost, which only elevates the risk of more injuries and causes morestrain on other non-medical staff when turnover increases. Theincrease in cost can directly create budget constraints that mayaugment nurse to patient ratios. The available nurses areoverworked, which reduces job satisfaction, as well as amplifies therate of turnover. It has been proven that decreasing the nurses on aunit will increase infection and patient mortality (Collini et al.,2015). Therefore, the hospital faces both ethical and legal problemsfrom the routine activities.

Nursing turnover can create major issues thatput the patients and the organization at risk, which has been aproblem for organizations for many years, but has increased since2011 as iterated by Collini et al. (2015). The increase of patientsand rise in nursing staff retiring has also created issues of anursing shortage. This nursing shortage has increased the researchand efforts to decreasing turnover. Many successful organizationshave put a lot of resources and effort into increasing nursingretention and this will only continue as the need arises. Theconstant processing and education can easily bankrupt resources andcreate tension in an environment. Increased stress load and constantturnover is a clear determinant of job dissatisfaction andwillingness to leave (Mizuno et al., 2014). Organizations need toinvolve nurses in the hiring process, as well as other factors intheir environment. Lack of participation in decision-making has beenshown to be a factor in increased turnover. This lack ofparticipation can cause seasoned nurses to leave, which can be a hugeloss to an organization. New nurses also leave due to feelings ofincompetence and lack of supervision. Without seasoned nurses towork as a resource, the medical facility may suffer big loss. Whilesalary places a big part in turnover, employee engagement is thecritical indicator (Collini et al., 2015). Nurses need to feel thatthey have a voice and can change their environment, which means thatqualified nursing management is vital to any organization. Qualifiedmanagement, seasoned nurses who can teach, and stress management areall vital components to keeping staff and running an effective unit.

One of the most effective techniques for solving the issue of nurseturnover involves analyzing the underlying push factors. The causewould be particular individuals or simply an emerging trend inhealthcare. Unfortunately, the buy-in for the problem has manycomponents, making the solution far from an easy fix. Nurses,organizational leaders, management, and lawmakers are all to blamefor the problem at hand. One study found out that all participantsreported unfriendly coworkers or hospital staff as one of the reasonsfor leaving (Tuckett et al., 2015. It is not unheard of within thenursing profession for seasoned staff to belittle new nurses and actconfrontational towards them. This demeanor can be offensive andoften causes nurses to seek employment elsewhere. Ineffectivecommunication between nurses and the management affects thepsychological welfare of the staff more so, nurses underscoremanagerial negligence as a strong motivator to resign from work(Tuckett et al., 2015). They argue that the management gives agreater priority to business matters than the welfare of patients.

Goals and Objectives

The above situations denote the variousreasons why a nurse would opt to leave a given institution. Giventhat the nursing profession is vital to the success of anyorganization, short and long-term solutions must be implemented toinitiate a direction towards resolution. In the short term, the goalof increasing job satisfaction among nurses needs to be a priority.In a bid to achieve this, hospitals must improve communication amongtheir administration, management, doctors, and nurses. Anothershort-term goal would include reducing the cost spent on replacingnursing staff from turnover rates. By accomplishing these twoshort-term goals, the long-term aim of staff retention could beobtained. Overall benefits in staff satisfaction, patientcontentment, and a decrease in funds spent on patient falls andinjury could be obtained after strategic planning by stakeholders.

Hospitals, healthcare organizations, and patients are the mainbenefactors from strategic intervention based on these goals. Inessence, hospitals should identify specifically what is causingturnover within their facility. Lefton (2012) posits that nursingturnover is caused in part by employees feeling unappreciated,undervalued, and unrecognized for their contributions at work.Therefore, both nurse managers and leaders can implement short-termgoals that aim at improving work environments in a bid to increaseemployee job satisfaction and learn skills aimed at valuing workers(Tuckett et al., 2015). Developing programs aimed at employeerecognition and rewarding nurses for exemplary behavior helps tomotivate nurses and strengthen the workforce (Nevidjon &ampErickson, 2011). When feeling appreciated for their work, nurses aremore likely to act as role models for others, a fact that helps toincrease employee teamwork and overall morale of the institution(Lefton, 2012). Monetary incentives such as increasing pay to matchsurrounding area hospitals and bonuses for overtime work, acting as acharge nurse, and guiding new hires, are ways that the management canuse to show recognition to staff doing more than the job requires,and inspires those who are not currently engaging in those activitiesto take part (Nevidjon &amp Erickson, 2011). Administration andexecutives should work to be present on the floors. By walkingthrough the halls, engaging with employees, and taking an eyewitnessaccount of what is going on, it will not only give administrationinsight, but help staff to see a visible support system available tothem.

DataCollection and Analysis

Nurse turnover in healthcareinstitutions is a problem that affects patient care (O’Brien-Pallaset al., 2010). It is necessary to understand the rationale behindvoluntary nurse turnover and come up with appropriate interventionsto help address the situation. Datashould be collected to help provide a deeper understanding of thefactors related to nurse turnover. Data collection would then occurin form of a survey targeted at health officers in theseinstitutions. Most of the participants would be nurses, as well asother stakeholders in the industry such as hospital directors andintermediate managers. Ordinal data would be collected, which isbased on questions that are asked in the survey. Answers to thesurvey questions would be based on five primary categories, that is,strongly agree, disagree, neutral, agree, and strongly disagree. Response to the questions posed will form the basis of the data thatis collected.

The data would be collectedfrom nurses working in different hospital set-ups. The choice ofnurses emanates from the need to gain a broader understanding of whatcauses nurses to quit work in a typical hospital environment(O’Brien-Pallas et al., 2010). Participantsof the study would be selected from different hospitals to guaranteediversity in the sample size. A total of five hundred nurses would bechosen from fifteen hospitals located across the state.Questionnaires with the survey questions would only be sent to nurseswho offer to participate in the study. Those registered with thenurses association would be enrolled for the survey. However, thoseoutside the identified scope stipulated would not participate in thestudy, and that would serve as exclusion criteria.

The process would entailsending out a questionnaire to all the identified participants of thestudy, and they would be expected to provide answers based on theframework provided. The data collection process would be done withthe assistance of the group members.Each group member would be assigned a particular role including theidentification of potential participants. Next, we would be sendingout the questionnaires to the identified nurses and they would beexpected to provide answers. After answering the questions, theparticipants would be expected to return the questionnaires forfurther analysis. A different group member will assist in compilingthe data to facilitate the analysis process. Analysisof the data would be conducted using regression analysis. The choiceof ordinal data makes it appropriate to employ a regression methodfor analysis (Harrell, 2015). However, the analysis would be based onthe variables chosen for the study as highlighted in thequestionnaire. Thefollowing step involves data presentation as a reflection of analysisconducted. The presentation would indicate the various instances ofcomparison between the chosen variables. The connection between thehigh voluntary nursing turnover and the variables provides concretestatistical evidence.

Problemsand Solutions

The issue of voluntary nursingturnover greatly affects the nursing profession concerning viabilityand accessibility. The trend proves to create problems for thenursing organizations, as well as doctors and patients since nursesplay a strong role in intermediary care and ensure smooth running ofoperations. The resounding themes from this research are increasedpay, enhanced benefits, increased engagement, perfection incommunication, improvement in engagement, communication betweennurses and physicians, and eighteen weeks engaged residency in newgraduate nurses.

One study looked atdifferent units and hospitals across the United States, and found outvarious reasons for nursing turnover and how to address and fix thesesituations. According to Staggs &amp Dunton (2012) “A unit in agovernment-owned hospital can be expected to have 39% lower RN andtotal turnover than an otherwise identical unit in a non-governmenthospital” (p 1142). They also found out that the reasons behindthis difference were believed to be the “variations in salary,benefits, and location” (p. 1143). It would imply that an increasein benefits could certainly help retention and decrease the number ofnurses voluntarily leaving.

Another study looked at theretention of nurses and found out that an increase in the workingrelationships with physicians gave the nurses a reason to stay withthe unit. According to Galletta et al. (2013) &quotimproved workingrelationships of nurses with physicians not only give the nurses onemore reason to remain with a unit, they also increase the extent towhich nurses’ individual commitment to the unit translates toincreased retention (p 1781).” This is an example of howphysicians can take ownership of the units that they work closelywith and make sure that there is a positive relationship with thenurses. Therefore, with the increase of a feeling of belonging aswell as physician collaboration, it will help enhance retention ofnurses to that unit. Teamwork between nurses and doctors creates asense of comfort because shared problems and mutual respect reducespsychological pressure.

Another way to examine theneeds of nursing retention is to look at the younger generation ofnursing specifically. One study looked at this exact mindset. According to Ramoo, Abdullah, &amp Piaw (2013) “there aredifferent aspects that are needed to be taken into account for theyounger groups of nurses vs. the more experienced nurses (p 3149).” One way to make sure that newly graduated nurses get the experiencesthey need is through a preceptorship program. According to Lee,Tzeng, Lin, &amp Yeh (2009) “preceptorship programs for new gradsincreases satisfaction, decreases errors and increases retention (p3208).” These two studies indicate that proper training and betterperspective of professional life reduces turnover rates among theyounger generations of nurses.

Implementation andCommunication

The money factor should neverbe relied on as a strategic solution since its availabilityfluctuates with time. Nonetheless, the nurses view money as adeciding factor because increased workload should indicate highercompensation rates. A more viable solution exists in fostering betterinterpersonal cohesion at the workplace. The cohesion between variousmembers of the staff creates an innate need to maintain the workingsituation irrespective of the challenges. Nurses are less prone tojob dissatisfaction if their emotional needs are met. We would thenconclude that communication plays a crucial role in resolving theissue at hand. This can be implemented through collaboration fromthe CNO of an organization with the CMO. Through their collaborationand communication, there could be a set plan to put a nursing surveyinto place. There should be questionnaires on the physicians thatthey currently work with and how they rate their communication andcollaboration (O’Brien-Pallas et al., (2010). They should also askhow they feel about benefits, knowledge base, and overallsatisfaction. This survey should be mandatory, and unless there is a100% response rate, there cannot be an implementation. Then, oncethe data is gathered, the physicians with the weakest ratings shouldbe addressed. There should be an address to the entire medicalstaff, but the ones with the lowest ratings should be addressedindividually with an emphasis on the newly implemented ideas. Thiscould then be implemented as a part of the evaluations of the nurses. As a part of their yearly evaluation, they must take the surveyagain and rate the doctors. The physicians would then get an updatedresult every year during their annual evaluation as well. That way,it has the longevity and ease of implementation. If the medicalpractitioner is not found to increase scores, then there is room forcorrective actions.

Conclusively, there are manydifferent aspects that healthcare organizations can do to helpincrease the retention of nurses. One is to enhance benefits likegovernment-owned hospitals have as a non-salary based solution forbetter retention. With the idea of using them as a model, the problemof instability reduces. Another cost-effective technique is to getthe physicians involved in the retention of nurses. Concernedinstitutions should ensure that doctors take ownership and havepositive interactions with the nurses to help build a complete senseof belonging for the latter in that unit. The final strategy, inthis case, is reduction of turnovers through residency programs. An18-week residency program helps the newly graduated nurses to get anunderstanding, as well as a basis of knowledge. This is much morethan just an orientation timeline but builds up the entire process ofgetting a nurse with zero experience ready for nursing, as well asgives them a sense of belonging and ownership. Increasing nursingsatisfaction through physician communication and collaborationeliminates the financial burden of retaining the staff for thegovernment and the institutions. Thus, the outlined ideas coupledwith the existing solutions in healthcare would positively reduce theeffects of voluntary turnover for the country.

References

Collini,S. A., Guidroz, A. M., &amp Perez, L. (2015). Turnover in healthcare: the mediating effects of employee engagement. Journal ofNursing Management, 23, 168-178.http://dx.doi.org/10.1111/jonm.12109

Duffieldet al., (2014). A comparative review of nurse turnover rates andcosts across countries. Journal Of Advanced Nursing, 70,2703-2712. http://dx.doi.org/10.1111/jan.12483

Gallettaet al., (2013). The roles of unit leadership and nurse-physiciancollaboration on nursing turnover intention. Journal of AdvancedNursing, 69, 1771-1784.http://dx.doi.org/10.1111/jan.12039

HarrellJr., F. E. (2015). In Regression modeling strategies: withRegression modeling strategies with applications to linear models,logistic and ordinal regression, and survival analysis (2nd ed.).[Google Books]. http://dx.doi.org/10.1007/978-3-319-19425-7

O’Brien-Pallaset al., (2012). Nurse turnover: A literature review – An update.International Journal of Nursing Studies, 49, 887-905.http://dx.doi.org/10.1016/j.ijnurstu.2011.10.001

Leeet al., (2009). Effects of a preceptorship programme on turnoverrate, cost, quality and professional development. Journal ofClinical Nursing, 18, 1217-1225.http://dx.doi.org/10.1111/j.1365-2702.2008.02662.x

Lefton,C. (2012). Strengthening the workforce through meaningfulrecognition. Nursing Economic$, 30, 331-339.

Mizunoet al., (2014). Management impact of staff turnover in the view ofnurses: an exploratory study. Online Brazilian Journal Of Nursing,13, 549-558.

Nevidjon,B., &amp Erikson, J. I. (2001, January 31). The nursing shortage:Solutions for the short and long term. Online Journal of Issues inNursing, 6. Retrieved fromhttp://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workforce/NursingShortage/Resources/NursingShortageSolutions.html

O’Brien-Pallaset al., (2010). Impact and determinants of nurse turnover: apan-Canadian study. Journal Of Nursing Management, 18,1073-1086. http://dx.doi.org/10.1111/j.1365-2834.2010.01167.x

Ramoo,V., Abdullah, K. L., &amp Piaw, C. Y. (2013). The relationshipbetween job satisfaction and intention to leave current employmentamong registered nurses in a teaching hospital. Journal ofClinical Nursing, 22, 3141-3152.http://dx.doi.org/10.1111/jocn.12260

Staggs,V. S., &amp Dunton, N. (2012). Hospital and unit characteristicsassociated with nursing turnover include skill mix but not staffinglevel: An observational cross-sectional study. InternationalJournal of Nursing Studies, 49, 1138-1145.http://dx.doi.org/10.1016/j.ijnurstu.2012.03.009

Tuckettet al., (2015). ’Why nurses are leaving the profession … lack ofsupport from managers’: What nurses from an e-cohort study said.International Journal of Nursing Practice, 21, 359-366.http://dx.doi.org/10.1111/ijn.12245

Warshawskyet al., (2013). The effect of nurse manager turnover on patient falland pressure ulcer rates. Journal of Nursing Management, 21,725-732. http://dx.doi.org/10.1111/jonm.12101

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