Please read the uploaded paper and write on the paper what should be corrected or if its alright , need commas, or is it talking about what they are trying to say just like you are a teacher writing statement boxes that need to be corrected

Running head: NURSING TURNOVER 1

6

NURSING TURNOVER

Nursing Turnover – The Cost, Causes and Sustainable Solutions

Avrile Remy

Grand Canyon University: HLT 364

March 23rd, 2017

The job of a hospital Administrator comes with a lot of responsibility. Managing all the components of a hospital is very complex and requires the right leadership team as well as talented and dedicated frontline staff. Caring for patients is very labor intensive and the largest segment of the hospital’s workforce is made up of nurses. Nurses are the backbone of any hospital because they bridge the gap between the patient and almost all the other departments in the hospital. The have the maximum amount of touch point with the patient and therefore can make the most impact on their stay at the hospital. The value of nurses cannot be overstated and it is for that reason nurse attrition is such a major issue for hospital Administrators. What further compounds this problem is that there is already a shortage of nurses in the U.S. “The U.S. Bureau of Labor Statistics has projected that by 2014, the U.S. labor force will face a shortage of 1.2 million RNs” (Reitz & Anderson, 2011, p. 320). Reducing turnover should be a major objective of any administrator. Considering this constant nursing shortage, finding and keeping good nurses is paramount. This paper will seek the cost and causes of nurse turnover and propose some sustainable solutions.

The Cost

According to Reitz & Anderson, (2011), “Some experts estimate the total costs of one RN leaving a current position to be as much as $67,100” (p. 320). The obvious tangible cost come from the loss is the investment made in orientation and training, the overtime paid to cover open shifts, loss of productivity, job posting expenses to recruit and new nurse and all the other cost of onboarding another nurse. The intangible cost that also will have an impact is associated with the low morale from the remaining staff because of the disruption in the work place, this instability will typically affect patient care and cause more problems for clinical managers and the Administrator. “The indirect financial costs of turn-over include increased workloads on coworkers who must pick up the slack from empty positions and adverse publicity about organizations that have increasingly high levels of turnover. Indirect costs may be difficult to measure but they have a distinct impact on employee morale and productivity” (S. A. Collini et al, 2015).

The impact to patient care makes nurse turnover a major problem for quality control and the hospital’s ability to be compliant with internal and external regulations. The area of patient care that is impacted is infection control that can lead to hospital acquired infections, which is has major consequences with The Centers for Medicare and Medicaid (CMS). When nurses are under pressure they may accidentally over look proper hand hygiene and forget to wash their hands or change their gloves in between caring for patients which give way to the spread on infections. This can cause an increase in the patient’s length of stay if they become exposed to an infection. Since the passage of the Affordable Care Act, there has been monetary penalties assessed to hospital that have poor patient outcomes. Therefore, Administrators need to remedy any issues that contribute to adverse quality in patient care. “Several studies have demonstrated that more nurses at the bedside can reduce secondary infections and patient mortality” (S. A. Collini et al, 2015). Nurses are the frontline staff and the more stability there is in that workforce the better it is for the entire hospital and the other supporting departments.

The Causes

The question then becomes what are the underlying causes for such high turnover with nurses. It is true that the health care industry has a high rate of turnover across all disciplines, however, nurses take in this area. According to S.A Collini et al (2015), employee engagement seems to rank very high among the prevailing research on this topic as to predicting and reducing nurse turnover. “Engagement, simply defined as the relationship an individual has with his/her work is related to employees’ decisions regarding their employment, their commitment to the organization and their behavior and interactions in the workplace” (S.A Collini et al, 2015, p.170-171). Given the long hours that nurses work it is understandable that they need to feel good about the organization that they work for. Low levels of engagement and poor work culture all plays a part on the intent to leave or stay. As cited by S.A Collini et al (2015), “Hallberg and Schaufeli (2006) reported strong negative correlations between employee engagement and emotional exhaustion, cynicism, depressive symptoms, somatic complaints, sleep disturbances and intention to leave”. This is an area that Clinical leadership at the hospital needs to pay close attention to and remediate as soon as possible.

Interpersonal relationship is another area that closely follows engagement which play a factor in nurse’s intention to leave their jobs. Caring for patients is a demanding and stressful job so have morale support from leadership and the people you work with is a critical component of the daily work life. “Existing research on clinical care populations indicates that the factors affecting turnover in such environments are similar to those in other populations but, because of the stressful and demanding environment clinical care professionals work in” (S.A Collini et al, 2015, p.171). People need to have a comfortable professional work environment that they look forward to coming to everyday. That is a shared responsibility of all the staff to help create this environment, however, Administrators should take the lead on ensuring that with the appropriate management style.

Solutions

Most administrators will concur that reducing retention is or should be a priority for their organization. However, for some there is a disconnect between acknowledging that and having an effective employee retention program in place. There are ways to work toward reducing the turnover rate with nurses but the commitment for action needs to come from the organization’s leadership. Reitz & Anderson (2011), offer some practical solutions for employee retention in the paper called an “An Overview of Job Embedness”. They suggest first to implement mentorship programs for all nurses especially the new grads who are struggling to become established in the field. First year nurses are more prone to change jobs because they can’t handle the pressure of the job. They also suggest offering benefits program that will be difficult to find anywhere else and capitalize on the uniqueness of the organization to create a great work environment. “The identification and development of an effective approach for predicting which employees are likely to stay at their jobs could provide a foundation on which to base strategies to increase nurse retention” (Reitz & Anderson, 2011, p.320). Another approach for increasing retention is to consider whether the management style of the clinical leadership is driving nurses away. “Research findings continue to support the importance of effective management in creating a positive work environment…Some research suggests that turnover intention is influenced more by supervisors or managers than by co-workers” (Hayes et al., 2012, p. 889). There needs to be ownership of this process by the Administrator to be effective.

Conclusion

Nurses have a very important role in the medical field and there is a perpetual shortage of qualified and experience nurses, thus the issue of retention is a major barrier for organization. There is a lot of research that has been done that outlines all the major reason for turnover and retention. Organization need to start associating the high price they pay and will continue to pay if they do not actively work on effective retention programs. The demand for nurses makes this a competitive job market with constant external pressure from recruiters, so making the current job the best place they want to be is critical for retention.

References

Collini, S. A., Guidroz, A. M., & Perez, L. M. (2015). Turnover in health care: the mediating effects of employee engagement. Journal of Nursing Management, 23(2), 169-178. doi:10.1111/jonm.12109

Hallberg, U. E., & Schaufeli, W. B. (2006). “Same Same” But Different? European Psychologist, 11(2), 119-127. doi:10.1027/1016-9040.11.2.119

Hayes, L. J., O’Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., … North, N. (2012). Nurse turnover: A literature review – An update. International Journal of Nursing Studies, 49(7), 887-905. doi:10.1016/j.ijnurstu.2011.10.001

Reitz, O. E., & Anderson, M. A. (2011). An Overview of Job Embeddedness. Journal of Professional Nursing, 27320-327. doi:10.1016/j.profnurs.2011.04.004