w6 final

Running head: ASHFORD GENERAL HOSPITAL 1

Ashford General Hospital: Analysis and Proposal

Student Name

MHA 601 Principles of Health Care

March 25, 2017

ASHFORD GENERAL HOSPITAL 2

Ashford General Hospital: Analysis and Proposal

Executive Summary

Ashford General Hospital, like many other hospitals across the United States and

globally, face the ever-increasing reality of one of the worst nursing shortage to date. Ashford

General Hospital struggles with nursing shortages rising, due to an aging nursing staff that is

rapidly approaching retirement age; whereas, other portions of nursing staff are hard to retain

due to high levels of emotional and physical burnout. Other causes of nursing shortage include

higher patient to nurse ratios, lack of nursing pools to draw from, and slow growth in nursing pay

scales. Many hospital administrators have referred to the nursing shortage as a major crisis,

which has negative effects on quality patient care.

This analysis examines trends in nurse training, staffing, and wages. The primary focus

will be on hospital employment of the bedside nurses, since more than two-thirds of registered

nurses work in hospital settings. In particular, this analysis examines how wages and work

conditions are fueling nursing shortages across the country; this affects the ability of hospitals to

meet staffing needs. In addition, the analysis will also examine solutions that five hospital have

put into practice in the effort to rectify their own nursing shortages.

In addition to the aforementioned analysis, two viable solutions are provided, which

Ashford General Hospital can put into action within a two-year-time-frame. The aforementioned

solutions will include two stakeholder group analyses. The stakeholder analyses will include a

review of the financial impact, human resources issues, interpersonal dynamics of the hospital

personnel, cultural concerns, and change management issues. This analysis and proposal will

conclude with final analysis of solutions that will assist Ashford University in its quest to rectify

its nursing shortage, and recommendations as to which solution is best for Ashford General.

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Ashford General Hospital Background

Ashford General Hospital has been a major partner in in healthcare, serving its local

community in California for greater than a half century. Hospital services include twenty-four

hour emergency care, and an urgent care clinic that has extended hours of service (“Ashford

General”). Ashford General Hospital’s nursing employment statistics provided, posited that

“Sixty-eight percent of nursing staff is forty-five years of age or older, and its nurses retention

rate is sixty-one percent compared to the nationwide level of sixty-five percent” (“Ashford

General”).

According to the Ashford General Hospital study, staff nurses are experiencing high

levels of physical and emotional burnout, resulting in medical leaves and turnover. (“Ashford

General”). Ashford General has had to utilize “per-diem nurses and traveling nurses, which have

resulted in lowered patient satisfaction, and an increase in personal costs” (“Ashford General”).

The goal at this point in the analysis is to review and discuss solutions that other hospitals have

used to address similar problems in regards to nursing shortages.

Nursing Shortages: Five Hospitals with Workable Solutions

Like most hospitals across the nation and globally, Columbus Regional Healthcare

System has experienced a scarcity in nursing applicants; however, the main problem that

Columbus Regional had was its slow human resource processing of applicants. Columbus

Regional implemented a process in which it could process nursing applicants in fifty percent of

the time it once took to do so. Columbus Regional’s human resource department was provided

by leadership, “…more autonomy to make contingent offers to promising candidates and

interview nurses on the spot” (Management Solutions, 2005, p. 2).

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In addition, Columbus Regional has improved the application process by using an

“automated application system, which saves time and money” (Management Solutions, 2005, p.

2). The aforementioned process allows Columbus Regional to focus in on candidates faster than

its localized competitors. There is still work to accomplish in the effort to realize better and

faster recruitment, but Columbus Regional is on the right tract where overcoming nursing

shortage is concerned.

Emory Healthcare “is a university-based health care system comprising seven entities

[six hospitals and one clinic]; all located in Atlanta, GA, area” (Adams, Kaplow, Dominy,

Stroud, 2015. p. 52). Emory Healthcare faced a great challenge because of the enormous task of

staffing several health care systems. The nursing shortage was taking a great toll on Emory

Healthcare’s profits due to an inadequate staffing system, which did nothing to overcome the

severe nursing shortage that plagued the organization. Emory did have an internal float pool;

however, Adams et al, argued that an “internal float pool was not efficient” (p. 53).

An internal float pool was not efficient due to “poor reporting, and having different cost

centers to deal with; therefore, the alternative was an internal nursing agency, which reduced

costs and maximized utilization of nursing resources” (Adams et al, 2015, p. 53). The new

internal nursing agency system allowed Emory Healthcare to better utilize their staff in all areas

of the system. Having its own nursing agency allowed Emory Healthcare to staff their facilities

with nurses who were company trained in the areas of Emory Healthcare’s internal policies and

procedures; thereby reducing errors and staffing costs at the same time.

At Spartanburg Regional Medical Center in the Greenville, South Carolina, an “…online

shift auction akin to eBay for nursing shifts, which is a staffing model used in other fields, such

as the airline industry” (May, Bazzoll, & Gerland, 2006, p. 317), is used to combat nursing

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shortages. The bid system allows nurses whom wish to work overtime to do so, which is more

cost effective than using nursing agencies to fill the shifts that are open. May et al, noted that

“Hospitals also achieve greater confidence in the quality of nursing care because internal

pools often rely on nurses currently on staff who are seeking additional shifts or previously

employed nurses who desire fewer hours or more flexibility” (p. 317).

May et al, (2006) posited that many hospitals use flexible schedules to overcome nursing

shortages; the Cleveland Clinic is one of those hospitals that utilize this type of system.

Cleveland Clinic’s flexible schedule staffing program includes “two-hour parent shifts for nurses

with obligations that limit their availability to work long hours” (May et al, 2006, p. 319). May

et al, also wrote, “This strategy has allowed units to bring in an extra nurse during particularly

busy periods and has attracted a number of nurses back to the field” (p. 319).

Cleveland Clinic and many other hospitals have been investing more money into training

nurses. Training nurses included investing in new nursing schools, and the hiring of new nurse

graduates. Flexibility is one of the main factors that aids Cleveland Clinic in working towards

better staffing ratios, while also attracting new staff to work at their facilities.

In response to the severe nursing shortage crisis, Children’s National Medical Center

(CNMC) initiated a “one-hundred day nurse recruitment and retention plan” (Robinson &

Pinkerton, 2004, p. 91). CNMC’s recruitment plan included, “increasing part-time options,

weekend pay incentives, increased educational incentives such as tuition reimbursement,

expansion of its recognition program, and increasing pay in order to be competitive in the health

care market” (Robinson & Pinkerton, 2004, p. 91). The aforementioned recruitment plan

resulted in positive and effective outcomes.

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CNMC experienced many internal adjustments over the one-hundred day recruitment

plan process. Accommodating training groups and limiting overtime of CNMC’s present staff

created challenges; however, with any change management program, challenges will arise, which

requires re-evaluation strategies, and a reinforcement of goals. What CNMC did in the process

was to create both systematic change and systemic change within its staffing process, and its

organizational culture. Frates (2014) hypothesized that “Systemic change involves altering

organizational beliefs and thought processes; whereas, systemic change entails the recognition of

the interrelationship and interdependencies within the system and its subsystems and the

embedment of the system in its environment [Carr, 1997], (Chapter 10, Section 5).

In the five hospitals that were reviewed and used as subjects for this analysis, the main

focus was the “need to change” (Frates, 2014, Chapter 10, Section 3) that which was not

effective in overcoming the challenge of a nursing shortage crisis. Each of the five hospitals had

to perform certain actions in order to realize positive change and goal accomplishment. Frates

hypothesized that there are basic strategies that help to accommodate change; however, there is

one strategy that encompasses the actions of the five aforementioned hospitals applies the most.

Frates stressed the importance of empowering action by “Providing staff with necessary

resources to support the change, eliminate hindrances, and allow for productive feedback while

acknowledging and recompensing efforts and accomplishments” (“Theory in Action,” 2014,

Chapter 10, Section 3). That said, there are key findings that ranged across all hospitals that

would be of most value to Ashford General Hospital’s quest to adopt strategies that will help the

organization overcome its personal nursing shortage.

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Key Findings

Nursing shortage solutions require a team effort. Hospital leadership, human resource

staff, nursing and physician staffs are all valuable sources for creating innovative solutions in the

goal of enhancing the nursing staff. Cost effective ways to recruit nurses is to utilize internal

staff float pools, invest in nursing schools, provide in-hospital training programs for student

nurses, and adapt schedules by being flexible. In addition to the aforementioned strategies,

utilizing online application processes helps to provide faster responses, and saves money and

time. The next portion of this analysis and proposal is to provide two viable solutions that

Ashford General Hospital can implement within the next two years.

Two Viable Solutions

Ashford General Hospital can implement two solutions over the next two years that will

enhance its ability to work towards the goal of increasing the nursing staff. The first solution

would be to create a specific goal with a specific date in mind. For instance, the hospital could

start by initiating a program that allows student nurses to attain their clinical experience at the

hospital. Student nurses will be able to work and train with an experienced nurse, which is two-

fold in its purpose; it provides the nursing student personal hands on experience, and it helps the

training nurse to have someone to assist them with their nursing duties. That said, it also allows

experienced nurses to share and pass on their knowledge. In addition, it provides an opportunity

for the hospital to offer student nurses job opportunities post-graduation.

The second solution is to offer flexible scheduling to nurses that want to return to work,

but only wish to work part-time or per-diem shifts. Flexibility includes re-evaluating pay scales

to compete in an open health care market, not just locally, but at a national level. Within the

scope of flexibility is the idea of recruiting by providing hospital staff from other departments

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within the hospital, incentives to become a nurse, such as offering tuition reimbursement and

sign-on bonuses. Lastly, to add to the two aforementioned solutions; it would be a good idea to

offer Ashford Hospital staff members a referral fee for the referral of any registered nurse,

which results in the hiring of a nurse(s). The next step in this analyses and proposal, is to

provide two stakeholder groups analyses for the two aforementioned solutions..

Stakeholder Group Analyses Based on First Solution

Different stakeholders influence the decision-making process within the healthcare

organization. Each stakeholder group has its own concerns and agendas where problem solving

is concerned within the health care environment. The stakeholder groups that are affected by

nursing shortages are owners, stockholders, organizational leaders, human resources, nursing

staff, ancillary staff, customers, and the community that utilizes health care facilities for their

health care. That said, the first solution to the nursing shortage at Ashford General Hospital

would impact many stakeholder groups, which include: owners, shareholders, leaders, human

resources, physician staff members, and nursing staff; however, the stakeholder group most

impacted would be the internal stakeholders, such as executive leadership, mangers, nursing staff

members, employees and patients. Lastly, the nursing school, instructors, and nursing students

would be impacted on a different level.

Executives would have to get the approval of owners and/or shareholders in order to

implement a nursing training program. Once approved, the executives would have to conduct

group meetings to decide on the specific goal and a specific timeframe for each process that the

hospital needs to implement in order to start the nursing recruitment process. The next step

would be for the executives to conduct a group meeting with managers and human resources

staff. Policies for allowing nursing students to train within the acute care setting will need to be

ASHFORD GENERAL HOSPITAL 9

developed. Human resource would need to be able to conduct background checks, and collect

personal information on the nursing students before allowing them to train within an acute care

setting with live patients.

Training modules for staff nurses whom will be buddying up with students, will also have

to be created to use as protocols for all actions of student nurses. When nursing students

participate in hospital clinical experiences, nursing instructors also attend to oversee the training

process, to guide students’ actions, and to answer student questions. Thus, nursing staff

members need to learn how to evaluate student performance in a professional and helpful

manner, and to communicate effectively by providing feedback to both the student and nursing

instructors.

There is the minimal issue of costs to the hospital in the form of liability insurance. The

actual cost for allowing student nurses to perform studies in a clinical setting is minimal as it is

limited to the background checks and any liability insurance coverage, which can be linked to the

hospital’s currant liability coverage. Nursing students preform duties without pay, and the

hospital does not provide health insurance; therefore, no costs are incurred in these areas.

Although registered nurses are helping to train students, the students provides help with baths,

feeding, bed changes, passing medicines, along with other helpful duties , which provides help

for the training staff nurses.

There are always ethical, legal, and diversity risk factors involved in the process of

training the student nurses. Ashford General can implement a specific orientation for student

nurses, which can cover ethical, legal, and diversity risk factors. These types of orientations are

conducted twice a year, since nursing hospital clinical training is conducted over two semesters

per year. This type or program helps to instill ethical and legal practices in student nurses.

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Within hospital student nursing orientations, the hospital can provide legal policies, such

as patient privacy and discrimination laws, internal ethical policies and practices, and specific

guidelines as to what the student nurses is allowed to do and not to do while conducting clinical

studies within the hospital environment. The aforementioned process is similar to regular

hospital employment orientations; however, the orientation program can be designed within a

limited scope of practice. Legal issues can also be limited by training the nursing staff to oversee

students properly. The next stakeholder analysis is slightly different.

Stakeholder Group Analyses Based on Second Solution

Stakeholders involved in the second solution to the nursing shortage at Ashford General

Hospital include owners, shareholders, executives, human resource staff, managers, nursing staff,

and patients and their families. If Ashford hospital were to adopt a flexible scheduling solution,

it would require the stakeholders to weigh the benefits and costs. Owner and shareholders would

have to agree that it is in the best interest of the hospital to provide the nursing staff more

flexibility, in order for the hospital to provide better nursing staff coverage. This solution makes

a lot of sense, and is adaptable to the needs of the hospital. The executives would have to

determine how flexibility fits into the hospital’s overall financial goals and patient care goals.

Nursing pay scales would have to be re-evaluated to be competitive in the area of part-

time and per-diem employment status. Hospital staffing policies would need to be revised to

reflect call-in or call-off priorities, in the event of patient census changes. Hospital employee

benefits would have to be reevaluated to include flexible staffing; meaning health and life

insurances, and employee earned vacation hours. Nursing managers would have to be creative

when scheduling nurses who would want to split shifts, or work around family needs. In order to

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attract more nurses, the hospital would have to implement a tuition reimbursement program for

exiting non-nursing employees whom wish to attend nursing school.

In addition to the aforementioned flexibility programs, the hospital’s executives and

human resource director should implement a registered nurse referral bonus program. The

employee whom refers the nurse, would get a referral fee if the referred nurse were hired by the

hospital. The hospital can offer a sign-on bonus program to any nurse that is hired. The sign-on

program has a specific dollar value, but comes with the stipulation that the hired nurse must

contract to work for the hospital for a specific amount of years. The sign-on bonus incentive

does contain upfront costs, but it limits cost by limiting turnover of nurses. Nursing turnover is

limited the more time that the nurse invests in working for the hospital. In addition, when nurses

form friendships with other staff members, and adapts to the hospital’s culture, there is a higher

probability of retaining the nurse, all which helps reduce turnover costs.

Robinson and Pinkerton (2004) argued that, “The focus on limiting cost by decreasing

turnover rates and increasing nursing productivity has been the driving force; in addition, to the

cost of replacing a nurse, quality of care is also affected by nursing turnover” (p. 958). That said,

the aforementioned flexibility process are the most ethical, legal, and diverse options that

hospital stakeholders can consider when searching for solutions to nursing shortages.

Flexibility attracts nurses who need to have positions that allow them to still participate in

personal lives, while at the same time limiting burnout and stress related turnover. Flexibility

lowers legal liability because there is more staff to care for the patients. Lastly, flexibility

provides an opportunity for healthy organizational culture diversity. These are positive, rather

than negative, attributes to consider. After review of the two solutions, the question that remains

is, which solution would best suit Ashford General Hospital?

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Best Solution Recommended for Ashford General Hospital Nursing Shortage

The best scenario would be to implement the first aforementioned solution within the first

year, and then the second aforementioned solution within the following year. Both solutions are

valuable in combating nursing shortages, while proving to be cost effective. The first solution

offers an opportunity to train future nurses, which also provides the hospital with a good way to

provide hands-on assistance for the nursing staff during the times that student nurses are training

at the hospital. In addition, it provides Ashford General Hospital with the opportunity to recruit

new nurses from the pool of nursing students. New nursing graduates typically are offered

nursing position at hospitals, at the lower level of nursing pay scales. Having student nurses

does not cause a drastic cultural shift, as all nurses were students once; therefore, nurse tend to

enjoy the added help and the opportunity to pass on valuable experience. The second solution

would require a bit more change management.

Macphee and Suryaprakash (2012) wrote that the implications of nursing management, is

that “Constant change is a global reality” (p. 249). Implementing change within Ashford

General Hospital, where flexible staffing is concerned, is a mandatory undertaking. Hospitals

must be creative and flexible in creating new ways to attract and keep nursing staff. Flexible

nursing will take additional steps, new policies, additional costs, and organizational change, but

it will be worth the patient satisfaction. Flexible nursing programs create the ability to have

sufficient staff, which limits negative outcomes seen in nurses whom are overworked,

emotionally and physically burned out, while at the same time reducing turnover. The Human

Resource department will have more work to do, but they will also meet recruiting ratios easier,

which limits the constant stress of trying to find nurses to apply for open positions. Flexibility

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drives down legal liability, because there is more staff to care for patients. Spacing out the

changes over a period of months to a year, allows staff members to adapt to change.

The aforementioned changes will require transformational leadership. Shermerhorn,

Hunt, Osborn, and Uhl-Bien (2010) wrote, “…transformational leadership occurs when leaders

broaden and elevate their followers’ interests, when they generate awareness and acceptance of

the group’s purposes and mission, and when they stir their followers to look beyond their own

self-interests to the good of others” (p. 324).

In the case of Ashford General Hospital, leaders must rise to the occasion to lead and

guide their staff into changes that will ultimately better the care of patients, provide adequate

staffing, and reduce the probability of staff turnover. In doing so, the hospital will effectively

reduce costs and legal liabilities, reach organizational goals, and prepare for the future. In the

end, it is diversity, which can promote a competitive advantage. Jones and George (2007)

reflected on diversity as an “approach that reflects the needs of its employees, customers, and

environment (p. 31). That said, Ashford Hospital should not hesitate to implement these

changes, rather it should begin now, so that it can insure its future adaptability to constant health

care changes.

In conclusion, the analysis of Ashford General Hospital provided great insight into the

nursing shortage crisis that not only affects Ashford General, but also hospitals across the globe.

The analysis provided identifiable reasons for the nursing shortage. The analysis of five separate

hospitals solutions for addressing nursing shortages provides valuable ways in which Ashford

General Hospital can overcome its own nursing shortage issues. This analysis provides two

solutions for Ashford General Hospital to utilize in the process of recruiting new nursing staff

members. Lastly, recommendations extrapolated from the solutions given, proved to be the best

ASHFORD GENERAL HOSPITAL 14

course of action that would best serve Ashford General Hospital’s immediate staffing needs and

future goals. In the end, “an organization that invests in the education of its employees is

investing in human capital” (Clark & Allison-Jones, 2011, p. 18). That said, investing in nursing

students provides the means to address Ashford General Hospital nursing shortage.

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