Hospital Nurses in California - Essay Example

Hospital Nurses in California: Job Satisfaction and Retention In partial fulfilment of the requirements for (Submission date) Abstract This paper stresses that the implementation of a more comprehensive employee reward program and improved working conditions will aid in increasing hospital nurses’ job satisfaction and retention. Many healthcare companies are looking to retain and compete for experienced nurses in today’s job market and are faced with multiple factors that affect recruitment and retention including the aging of the nurse workforce, reduction of entry of younger people into the profession as well as nurses’ job dissatisfaction. Sources of dissatisfaction include working conditions such as inadequate staffing, heavy workloads, the increased use of overtime, lack of support staff, and the inadequacy of benefits and wages. Table of Contents Title / Cover 1 Abstract 2 Table of contents 3 Background information 4 The need for a change 4 Proposed intervention 5 History and background of the intervention 6 Benefits 7 List of references 9 Background Information During the literature review, the researcher learns that while retaining nurses is a common problem faced by virtually all U.S. hospitals, the ever changing environment of the job market in California is forcing many hospitals to consider making changes to the nurses’ work environment, benefits and pay in able to decrease nurse attrition and compete during this nursing shortage (Tucker-Allen 2002, p. 9). The researcher focused the study on four common factors that have been identified as associated with decreasing nurse job satisfaction; these are compensation, work environment, work place benefits, and nurse recognition. Many authors in the literature view believe these factors to be directly related to nurse attrition. Compensation or money is perhaps one of the greatest influences impacting the mobility of nurses (May, Bazzoli, & Gerland 2006, pp. w316-w323). The second factor, working environment, had two commonalities emerge from the research. These were nurse’s workload and inadequate staffing. These two nurse dissatisfactions were most frequently described as concerns for the hospital nurses in determining whether or not to stay at a hospital (Reineck & Furino 2005, pp. 25-30). The third factor, work place benefits, also was discovered as an area of dissatisfaction to the nurse. The research identified hospitals with a lower percentage of nurse attrition usually had better incentives and benefits (Tucker-Allen 2002, p. 9). The final factor discussed in the research literature that had an impact on nurse attrition was recognition. Nurses’ survey ranked recognition for outstanding performance as the type of behavior that should be recognized first (Curley et al 2003, pp. 26-7). All four factors were frequently revealed during the research and found to be major concerns affecting nurse job satisfaction and retention. The Need for a Change Through this review, it was discovered that most health care organizations throughout the country are experiencing the affects of the national nursing shortage and that the shortage is expected to continue to grow through the next decade (Weinstein, Widenor, & Hecker 2005, pp. 529-33). The major challenge associated with this nursing shortage is for organizations to become more competitive and innovative in the ways they retain experienced nurses in their facilities (Cohen 2006, p. 37). It was learned that the creation of a retention program is not enough. To be successful at retention, the entire organization needs to be behind the programs and improvements necessary to achieve success. Creating a successful workforce and culture takes an organizational approach that is leadership driven (Dalessandro & Gilster 2008, p. B27). Finally, it was discovered that it is important for healthcare organizations to address problems related to nurse attrition. Improving nurse job satisfaction and retention through improving existing incentive programs that improve pay and benefits, working environments and nurse recognition will improve morale and productivity at hospitals thus improving customer service, market share, and increasing the bottom line for hospitals that are successful in changing their culture (Tucker-Allen 2002, p. 9). The following pages aim to identify and provide a framework for an intervention strategy that will aid in increasing nurses’ job satisfaction and retention in the U.S., particularly in California. Proposed Intervention The aim of the proposed implementation of a more comprehensive nurse reward program and improved nurse working environment at hospitals is to address the healthcare organizations’ need to lower nurse attrition and improve nurse job satisfaction levels. A pilot program that improves nurse pay, benefits, working conditions, and nurse recognition may be implemented for a trial period of 12 months, starting January 1, 2009 and ending December 31, 2009. During this 12-month period, the improved reward program and nurse working environment will be evaluated on a quarterly basis, and each current quarter will be compared to the prior quarter and previous year to look for improvements relating to nurse job satisfaction and retention levels at hospitals. These improvements should enable participating hospitals to compete against other healthcare organizations looking to recruit or entice nurses to their own facilities by offering better compensation, working environment, workplace benefits, and nurse recognition programs. As the nursing labor shortage intensifies over the coming decade (Weinstein, Widenor, & Hecker 2005, pp. 529-33) organizations whose culture, working conditions, and reward systems attract and retain experienced nurses can expect to be better suited to withstand anticipated nursing shortages (Cohen 2006, p. 1). The ones that do best rely on a mix of flexible work arrangements, employee recognition programs, rewards tied to performance and overall cultural commitment to creating a great patient experience (Lye et al 2006, p. 20). This type of cultural thinking provides the potential for the organization to implement a plan that may lessen expenses associated with new nurse hires and reduce the funds spent on acquiring nurses from nurse registries. It also provides a significant degree of probability in improving nurse job satisfaction --- by offering company nurses a better working environment, significant pay, and benefit increases --- and the hospital’s bottom line with minimal financial impact. History and Background of the Intervention Many research articles state that hospitals are starting to concentrate more on recruitment and retention efforts to meet their need for nurses (Curley et al 2003, pp. 26-7). For instance at Fallbrook Hospital, according to a recent 2008 company survey conducted within human resources, the current nurse attrition rate is 18 percent. Other companies that have had similar nurse attrition rates have changed their culture and implemented a better nurse reward and benefit program. The strategy effectively lowered nurse attrition levels and claimed to have improved the hospitals’ nurse morale and bottom line. St. Bernardine Hospital in San Bernardino, California has been successful at improving their nurse recruitment and retention by implementing a better nurse reward and benefit program. St. Bernardine hired over 300 nurses and the registered nurse job vacancy rate fell from 17.5 percent to 8.66 percent over a two year period. The hospital’s annual turnover for registered nurses also dropped from 16 percent to 3.55 percent (Tucker-Allen 2002, p. 9). Chief Executive Officer Steve Barron said that the two year campaign at St. Bernardine Hospital has resulted in less reliance on expensive temporary nurses by half, morale boost in employees, and increased market share by more than 8 percent annually over the two-year period. Barron estimates that the campaign, funded by combining the marketing budgets of several departments, has improved the hospital’s bottom line by at least $10 million (Tucker-Allen 2002, p. 9). Benefits The impact of implementing an improved nurse reward program and work environment at hospitals is likely to have the greatest effect on three primary groups within healthcare organizations: acute care nursing departments, human resource departments, and hospital patients. The impact of having an improved nurse reward program and working environment in place for nurses that is supported by the administration is the potential to accomplish the goal of creating an increase in nurse job satisfaction and nurse retention levels at the hospital. This was collaborated by a study of patient care givers in a hospital setting conducted by Gurley & Spence (2003, p.134); the qualitative results revealed that an increase in salary, benefits and recognition from management for work performance are significant areas influencing employee satisfaction and retention. The human resources department will have the task of developing and coordinating with both the financial and payroll departments to revise pay structures for nurses, and of helping to implement the improved nurse reward and recognition programs to company nurses. To provide a greater likelihood of success, the financial department should follow the recommendation of Cohen (2006, p. 37) that turnover costs should be considered when determining labor expenses at different wage rates. Assuming the turnover rate of nurses is 20 percent, a hospital that employs 600 nurses at $46,000 per nurse per year will spend $5.5 million per year in replacement costs (Thompson & Brown 2002, p. 20). Basing on this data for comparison, using an employed nurse number of 50 and the estimated base annual salary for a ten-year experienced nurse working at California hospitals at 60,000 per year, the turnover cost savings of a hospital has the potential to reach an estimated $600,000 per year. According to the Center for Health Design based in Concord, California, the impact of implementing a better working environment for nurses has the potential to improve patient satisfaction and employee motivation. The research shows that improvements in ventilation, ergonomics, and lighting can reduce infection rates and accidents and improve both patient satisfaction and employee motivation (Lye et al 2006, p. 20). Organizations that are able to meet their employee needs are more likely to retain the high-quality staff necessary for excellent patient care (Press Ganey 2007). Lack of administration acceptance is a significant concern for implementing the nurse reward program and making improvements to nurse working environment. Changing the status quo in a rigid, hierarchy based organization is very difficult. According to Schein (1987 p. 93), organizational members are not likely to embrace change unless they experience some need for it. Embracing change typically means that people are dissatisfied with the way things are, quality is below standard, costs are too high, morale is too low, or direction is unclear (Burke 1992 p. 57). If the population needing health care services continues to climb as anticipated, nursing supply will continue to lag behind the demand and nurse attrition levels will continue to escalate, with nurses leaving for better pay, benefits, and working conditions. For the hospital to be able to provide quality patient care, the consideration and implementation of an improved nurse reward system and working conditions has to take place. List of References BURKE, M. (1992). Applied ergonomics handbook. Boca Raton, Lewis Publishers. COHEN S. (2006). Compliment your staff with nonmonetary rewards. Nursing Management. 1-37. CURLEY A, MCCLURE G, SPENCE D, & CRAIG S. (2003). Modernisation. What new NHS?. The Health Service Journal. 113, 26-7 & 134. DALESSANDRO, J. L., & GILSTER, S. (2008). 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