Sexually Transmitted Diseases in Adolescents, Incompatibility of Intravenous Medications, Turnover Rates due to Burnout in Healthcare (24 hours)

High nurse turnover is one of the major issues that nurse leaders and hospital management face. High nurse turnover has a significant negative impact on nurse leaders, hospital managers, nurses, patients, doctors, and the entire healthcare system (Bae, 2022). (i) There are several reasons for high nurse turnover rates among which is burnout which causes physical and mental strain on nurses forcing them to leave their jobs. Nurse turnover forces hospitals to spend more resources hiring and training new nurses and affects the overall morale of nurses and increases the burden of heavy workload as the remaining nurses have to cover the gap left by others (Bae, 2022). The purpose of this paper is to examine the impact of high nurse turnover on nurses’ mental health and how a ten-week mental health program implemented based on Orem’s self-care theory can reduce the rate of this turnover.

The rate of turnover for registered nurses is approximately 26.8 % in the U.S. and the rate of turnover for new graduate nurses is 18.1% with 17.1% of new nurses leaving their jobs within the first year of employment (Zhao et al., 2018). High turnover rate caused by burnout is a major nursing issue that negatively affects nurse motivation and mental health and therefore should be properly addressed (Bae, 2022). The purpose of the ten-week mental program is to reduce the impact of turnover rates caused by burnout on nurses' mental health, therefore, reducing the rate of turnover. (f) The program will address nurses’ mental health wellness and help them cope with work-related stress which causes burnout.

Turnover Rates due to Burnout in Healthcare

PICOT question

The PICOT question evaluates whether a mental health program can help reduce the nurse turnover rate in comparison to the rate of turnover before the program. The intervention aims to address high nurse turnover caused by burnout. The population in this intervention is the critical care nursing staff, the intervention is implementing a mental health program, the comparison is the rate of turnover before the program, the outcome is a reduced nurse turnover rate and the time is ten weeks.

Population

The vulnerable populations to high nurse turnover rate due to burnout are critical care nurses as they are exposed to high stress work. The heavy workloads of critical care nurses as a result of the high nurse-patient ratio affects nurses mentally and physically. Due to the high turnover rate, nurses' performance level reduces increasing the risk of medical errors because they are overworked and their commitment and motivation are adversely affected forcing them to consider leaving their jobs (Kaddourah et al., 2018). Various risk factors increase turnover rates such as unfavorable work environment, job dissatisfaction, salaries and compensations, communication barriers, and high nurse-patient ratio.

According to Kim and Kim (2021), a high nurse-to-patient ratio is one of the major causes of burnout that directly leads to a high turnover. When there is a high turnover rate, nurses have to take additional shifts and take up heavy workloads to cover the gap left by other nurses. A high nurse-patient ratio impacts patient safety adversely and leads to low-quality services as nurses are often exhausted mentally affecting their well-being. According to Dewanto and Wardhani (2021), an unfavorable work environment causes approximately 10% of the turnover rate. When nurses work in a stressful environment with limited resources to perform their duties, they are more inclined to leave their jobs to pursue better options leading to a high turnover rate.

Nursing research

According to Lockhart (2020), improving the nurse-to-patient ratio is an effective intervention that reduces turnover rates caused by burnout. The research conducted by American Medical Association shows that hospitals with a low nurse-to-patient ratio (4:1) have a high nurse retention rate compared to those with a high nurse-to-patient ratio (8:1) (Lockhart, 2020). Reducing the 8:1 nurse-to-patient ratio by half reduces the rate of turnover due burnouts by approximately 25% (Lockhart, 2020). According to Lockhart (2020), over four patients per nurse increases nurse burnout by 23% affecting the mental health of nurses with heavy workloads. This intervention requires a hospital to incur additional expenses to hire more nursing staff.

According to Luo et al. (2019), one effective strategy for reducing the high turnover rate caused by burnout is implementing support groups where nurses can voice their concerns and gain emotional and mental support. These support groups help nurses cope with the pressure that comes with their demanding nursing practice. Nursing support groups are important as they teach better scheduling, discuss well-being and overall nurses' health and provide safe respite areas for nursing staff. According to Luo et al. (2019), support groups help nurses find self-care techniques that improve their mental health and prevent or reduce burnout therefore indirectly reducing the turnout rate.

Proposal

Implementing a mental health program can reduce the turnover rate caused by burnout among critical care nurses. When implementing this program, there are numerous resources required. The intervention would allow nurses to examine their mental well-being and take care of their health. It also gives nurses insight into how to deal with the pressures and challenges of the nursing profession. When implemented effectively, this intervention has the potential to reduce nurse burnout because it addresses all stakeholders involved and who work with nurses such as doctors, nurse leaders, and other clinicians.

Resources

These resources include a printed guide to help nurses cope with burnout, online support forums, training courses, a venue, therapy platforms, a computer, a tablet or a projector, and a thought record diary among others (Lockhart, 2020). (i) The individuals that would be involved in implementing this intervention are hospital managers, nurse leaders, nurses, and other physicians such as doctors and psychiatrists. (ii) Nurse can play an advanced role in ensuring that this intervention is implemented effectively to reduce the rate of turnover that leads to nursing staff shortages. Nurses with advanced skills are able to provide leadership, and use their critical thinking skills to solve problems that may arise during the program. (iii) The program is expected to run for ten weeks upon implementation where the rate of turnover after the mental health program will be compared to the turnover rate before the implementation of this intervention to determine its effectiveness.

Orem’s self-care theory

Orem’s self-care theory is the ideal nursing theory that one cause use as a foundation when implementing this intervention. According to Dorothea Orem, the founder of Orem’s self-care theory nurses should be responsible for their care, be self-reliant and provide quality care to patients who need their services (Khademian et al., 2020). This theory is best-suited in dealing with burnout which causes a high turnover rate as nurses have to be responsible for their care including mental well-being first before they can offer their best to their patients. this theory requires nurses to maintain autonomy, benevolence, nonmaleficence, and justice on themselves before they can do the same for their patients. self-care in form of mental health program helps nurses cope with burnout and therefore reduces the turnover rate.

High turnover rate negatively impacts patient care, therefore, affecting patients' quality of life. It also adversely affects the cost of care as patients are forced to spend a long time in hospitals. High nurse turnover also affects hospital managers who have to spend a significant amount of time screening new nurses who have high qualifications and skills that suit the hospital's needs (Zhao et al., 2018). A high nurse turnover rate is also costly to patients and hospitals as the former incur additional medical costs due to low-quality patient care and prolonged hospital stay while the latter spends more on training new nurses, hiring additional nursing staff, and providing incentives to retain experienced nurses.

References

Bae, S. H. (2022). Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review.  International Nursing Review,  69(3), 392-404. https://doi.org/10.1111/inr.12769

Dewanto, A., Febrina, S. S., & Wardhani, V. (2020). The importance of nurses’ cognitive and emotional engagement in developing hospital quality culture.  Enfermería Clínica,  30, 97-101.

Kaddourah, B., Abu-Shaheen, A. K., & Al-Tannir, M. (2018). Quality of nursing work life and turnover intention among nurses of tertiary care hospitals in Riyadh: A cross-sectional survey.  BMC Nursing,  17(1), 1-7. https://doi.org/10.1186/s12912-018-0312-0

Khademian, Z., Ara, F. K., & Gholamzadeh, S. (2020). The effect of self-care education based on orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: a quasi-experimental study.  International Journal of Community-Based Nursing and Midwifery,  8(2), 140. https://doi.org/ 10.30476/IJCBNM.2020.81690.0

Kim, H., & Kim, E. G. (2021). A meta‐analysis on predictors of turnover intention of hospital nurses in South Korea (2000–2020).  Nursing Open,  8(5), 2406-2418. https://doi.org/10.1002/nop2.872

Lockhart, L. (2020). Strategies to reduce nursing turnover.  Nursing Made Incredibly Easy,  18(2), 56. https://doi.org/10.1097/01.NME.0000653196.16629.2e

Luo, Y. H., Li, H., Plummer, V., Cross, W. M., Lam, L., Guo, Y. F., ... & Zhang, J. P. (2019). An evaluation of a positive psychological intervention to reduce burnout among nurses.  Archives of Psychiatric Nursing,  33(6), 186-191. https://doi.org/10.1016/j.apnu.2019.08.004

Zhao, Y., Russell, D. J., Guthridge, S., Ramjan, M., Jones, M. P., Humphreys, J. S., & Wakerman, J. (2018). Cost impact of high staff turnover on primary care in remote Australia.  Australian Health Review,  43(6), 689-695. https://doi.org/10.1071/AH17262