High Staff Turnover in the UK Army Hospital - Essay Example

High Staff Turnover in the United Kingdom Army Hospital: The Advantages and Disadvantages of the Possible Solutions EXECUTIVE SUMMARY For five years, the United Kingdom army hospitals has been suffering from high staff turnover as their medical specialists leave the field and transfer to private hospitals with high salaries. High staff turnover is a serious matter in every industry as it involves the leaving of stable staffs after staying for 12 months in spite of the underlying reasons. The United Kingdom has been suffering from 18.1% rate of high staff turnover for the year 2007 in general. Main reason for staff turnover is said to be the lack of satisfaction from the employees’ current job and is being attracted by other jobs from other organisations. Using SWOT Analysis, it was identified that the most possible reason why army medical specialists leave the field is because of the assurance of safety from private hospitals along with the high salary it offers. Thus, this paper suggests the following solutions: (1) enhancing the hiring practices, (2) strengthening communication, and (3) increasing the salaries and benefits. The Royal Army Medical Corps (RAMC) – as expert corps of the British Army which provides medical services to all the personnel and families of the British Army in the course of war or not. Despite its honourable status, it did not exempt itself from the increasing high staff turnover as it has been losing its personnel for 5 years. As of 2007, the United Kingdom hit an 18.1% staff turnover rate (CIPD 2007). This essay will muse over the high staff turnover from hospitals particularly in the United Kingdom army hospital. High staff turnover or turnover itself is the leaving of stable staffs after staying for 12 months in spite of the underlying reasons. Since high staff turnover refers to losing staffs and employees, this is considered to be a very serious problem to any kinds of industries. Turnover of employees within an organisation has positive and negative effects and employees have their own reasons in leaving the organisation. Since there are different causes and reasons why employees leave the organisation, there is a need to study the different reasons and causes of turnover so that the negative effects of turnover can be avoided. High staff turnover carries a large cost in the part of the organisations, thus, every kind of industries will aim to solve this problem right away. Turnover can affect the productivity of the organisations and industries; it is a crisis that is distressing every industry especially those that are in line of service. In hospitals, high staff turnover is equals to shortage to personnel which includes significant people like the doctors and nurses. Shortage in medical personnel causes a variety of problems in the healthcare services provided by hospitals and in turn many patients suffer. With the shortage of medical staffs, there will be no enough doctors and nurses who will attend to patients which seem to have been increasing through time. In the case of army hospitals, their loss is also very crucial since armies are people who are always in danger, who get wounded regularly due to their duties, so having less people treating them might also lead to the shortage in the army. It is important to study turnover since it helps organisations to avoid lose employees that are productive and beneficial. Determining the predictors or turnover is very important so that the organisation can make assessments to avoid high turnover rate. Buerhaus et al (2000) noted that registered nurses comprise a big fraction of the health care professionals in the United States of America. There is an estimated 12M nurses currently working all over the USA alone, but even in the face of this enormous number that nurses hold in the health care service, USA is still on a nursing shortage crises. In a survey on nurse employers done on 2004 done by North Carolina Centre for Nursing, it was found out that staff turnover is in its greatest at long-term care facilities. This was concluded probing on the turnover rates among Registered Nurses (RNs), Licensed Practical Nurses (LPN) and nurse aides (The Daily Record 2005). According to Weinberg (2003), committed nurses are leaving their profession in groups, and new recruits to the profession are not enough to meet the continuing demand. However, it is not only US that suffer in this kind of crisis (Buchan 2002). In UK’s National Health Service, the nursing and midwifery workforce comprises two broad groups of staff – the first group are the registered nurses and registered midwives with a diploma or degree and who have registered with the Nursing and Midwifery Council, on the other hand, the second group consists of nurse auxiliaries, nursing assistants and healthcare assistants (Finlayson et al 2002). Other reasons include career breaks, retirement, maternity leave, (90% of nurses and midwives in NHS are women), nurse education, non-nursing professions, and travel. In 1999-2000, there 634,529 nurses and midwives that are registered in the UK Central Council for Nursing, Midwifery and Health Visiting, then from the 2000 annual NHS vacancies survey, there are about 10,000 vacancies on the first group. The NHS finds it difficult in both recruiting and keeping hold of nursing and midwifery staffs (Finlayson et al 2002). This difficulty is due to issues regarding pay, the changing nature of the profession, the feeling of value for the staffs and employment opportunities, in London, England alone, staff turnover ranges from 11% to 38%. Even hospitals that were once very highly looked upon for the quality of their nursing care now exert great efforts to fill in vacancies. Turnover can be voluntary or involuntary in nature (Woods & Macaulay 1989). Turnover can be classified into three types, which is voluntary and involuntary turnover, functional and dysfunctional turnover, and avoidable and unavoidable turnover. Voluntary turnover refers to as the individual’s choice to leave, while involuntary turnover refers to those employees who leave the organisation because the organisation itself wants them to leave (Woods 1995). An instance of voluntary turnover or quit reflects an employee decision to leave an organisation, whereas an instance of involuntary turnover or discharge reflects an employer’s decision to terminate the employment relationship. The second classification of turnover is avoidable turnover and unavoidable turnover. Avoidable turnover refers to as on what the organisation can do avoid turnover of employees (Woods et al 1998). Unavoidable turnover is a situation in when the organisation is unable to do anything about the employee leaving the organisation. The third classification of turnover is dysfunctional turnover and functional turnover. Functional turnover refers to an employee leaving the organisation after receiving a positive rating from his employer or from the organisation, while dysfunctional turnover is when employees with a negative or low rating are either terminated because of poor quality of their performance or quit or resign from the organisation because they realized the expected consequences of their performance (Woods et al 1998). As for the reasons why an employee leaves a certain organisation, there are numerous reasons to answer the said question. One possible cause is because of a new job outside the organisation, it is either they are being heaved towards it due to its attractive benefits and opportunities or being shoved to it because of the dissatisfaction that they are feeling on their present job (CIPD 2007). However, the later factor is the more possible cause why employees leave the organisation to join another one because it is rare for an employee to leave his or her present job if he or she is happy with it. Though it is really hard to point out the very reason why employees resign because they seldom state their “real” reason in their resignation letters and exit interviews, however, a research by Chartered Institute of Personnel and Development (CIPD) concluded that a poor relationship of employees to their line managers often pushes them to leave the organisation, in addition, employee departures is also caused by the lack of training and developmental opportunities for employees expects the organisation to help them to grow by honing their knowledge and improving their skills. Furthermore, one of the most common reasons of staff turnover is said to be job stress. Organisational job stress is caused by multiple factors such as changes in stress in the workplace management, long working hours, barriers to career advancement, heightened competition, high pressure deadlines, work overload, excessive rules and regulations, lack of participation in decision-making new technology, inadequate support, conflicting demands from the organisational stakeholders, and personal conflicts. Furthermore, job stress as the effect of tension on an employee by the job pressure to fulfil job assignment and respond to deadlines (Lo & Lamm 2005). There are three important components in understanding the conceptualization of stress. These are stimulus-based, response-based, and stressor-strain approaches. Stimulus-based is perceived stress caused by situational or environmental based stimulus that impinges upon the person. Response-based refers to as an individuals’ psychological or physiological response to stressful environment-situational factors. Lastly, stressor-strain approach defines stress as both the stimulus (source of stress or stressor) and the response (outcome or manifestation of strain) (Lo & Lamm 2005). Two most commonly cited causes of job stress are job ambiguity and job conflict. Job ambiguity occurs when the information regarding expected role behaviours is lacking. This results to unclear work goals, procedures, and the uncertainty about the job itself (Woods 1995). Job conflict on the other hand, refers to the simultaneous occurrence of two or more sets of pressures such that compliance with the other. This results to the incompatibility of expectations on the job. Furthermore, job conflict is caused by opposing expectations for the role of an employee to be performing (Woods 1995). Moreover, there are other forms of job stress, these are work overload and work underload. Role overload or work overload refers to the tasks of an employee that are difficult and have too much things to do and more effort is required to be done. Work overload can increase a person’s risk for adverse physical and mental health outcomes. Work underload, on the other hand, refers to the tasks of an employee that are very easy and small but still the individual can not accomplish the said task due to failure to meet the individual’s capabilities. Aside from job stressors, there is also what they call individual stressors. This includes gender differences. A woman tends to incorporate more activities into their schedules, such as academics, employment, and family responsibilities. Hence, men see life events as being less stressful compared to women. Women encounter more stressors related to their social life, relationship, child, family, health, and job stress compared to men (Lo & Lamm 2005). They also discovered that men experienced a larger number of stressors related to finances compared to women. It has been found that women have higher levels of stressors in terms of lack of power in organisation and discriminations. Even though some evidence found that women and men have different perception of stressor at work, the direction of this relationship is not clear. Gender differences establish the difference of men and women in handling stress. Gender can be a factor on how a person will handle stress in his or her work and other related factors (Lo & Lamm 2005). Individual perceptions or differences also create an impact on how they will create or how they will perceive stress, because stress only arises when the individual see the situation as negative or stressful factor. Not all the individual experiences the stress the same as the other encounters it, they may see same stressor in a different way because of individual differences. High staff turnover can also be blamed to poor recruitment procedure and selection decisions together with defectively planned induction programme (CIPD 2008). Poor recruitment is due to the demand of the organisation to fill up the vacant positions as quickly as possible. The UK army hospital which is continuously suffering for high staff turnover for 5 years now has been losing its personnel against private hospitals. Using the strengths, weaknesses, opportunities and threats (SWOT) that surrounds the sector, it could be possible to identify the reason why the UK army hospital suffers from high staff turnover. Taking focus on the RAMC, the paper will identify its internal (strengths and weakness) and external (opportunities and threats) factors. The SWOT Analysis is a management method and a framework that simplifies the identifying of the organisation’s strengths, weaknesses, opportunities and threats from the outside which enables the organisation to think of strategic alternatives in a certain situation. As for the corps’ internal factors, the strengths of RAMC are that it has been honoured by numerous gallantry awards. Aside from that, their personnel are also medical specialists apart from being an army, the corps also provides training programs to develop the skills of the personnel, and lastly, it also offers an enormous amount as salary. On the contrary, its weakness lies on the dangers of the profession – medical specialists in the army requires them to be on the field, hence, it cannot be deny that they are betting their life to serve their fellow armies and other victims, somehow, they are allowed to use their weapons to protect themselves. The corps offers a lot of opportunity, the corps requires more medical specialists than normal hospitals, hence, they have a plenty room for medical specialists. In addition, health services is a very significant sector especially in the army since casualties and patients are just around the corner, thus, they could always maximise their skills. When it comes to the surrounding threats, it could not be deny that the private hospitals also needs more medical personnel who has great skills and medical specialists from the army – especially those who have already high ranks due to their ability – could have already garnered the required expertise, thus, they are losing their experienced medical expertise; private hospitals also offers high salaries if not higher, in addition, the workplace is less life threatening compared to war fields. In addition, since the UK army hospital has been suffering from high staff turnover, they are recruiting and taking in trainees that may not be skilled enough for the profession, other medical specialists also may experience shock by performing procedures that they are not yet prepared to perform and it may cause to degrade the performance or their medical services. High staff turnovers causes industries with very high re-recruitment costs, poor skills transfer between employees, low employee morale, reduced employee effectiveness, lack of team identity, a bad reputation as an employer, reduced productivity, excessive recruitment costs, and poor customer relations (Latino Hire 2008). In order to avoid high staff turnover, it is said to be important for the management to recognize that they will take a huge responsibility for the crisis since they are the ones who controls the work environment, work load and the workers themselves. The following should be considered to fully avoid high staff turnovers: (1) hiring practices, (2) communication, and (3) increase in benefits. Hiring practices should be handled personally by the management or those who are in the position high enough to be able to tell which among the applicants are competitive and skilled enough for the field. Doing this, the applicants would be personally tested and judged whether they are fitted for the job. The downside for this solution is that the time needed to fill in the vacant position would be longer and could result in the neglect of patient’s health. Communications should be done in order to reach an agreement between the staff and the management. Daily meetings between the staff and management should be practice regularly in order to tackle issues and problems that could affect the patient’s health. On the other hand, the downside for this is that most nurses and medical staffs could not afford to attend such meeting even though it is their welfare being talk about especially if it is in the army hospitals since the working environment are always on alert. Lastly, there should be an increase the salary and benefits of medical specialist. The medical specialists sacrifice their time, family and even their own safety and welfare. Although they sacrificed a lot for their job, their salary and benefits could not amount to the sacrifices they have given thus most of them, after a long time of working as a medical specialist for the army, they may start to look for another job, specifically, in private hospitals that could compensate for their daily living and personal sacrifices. By increasing their salary and benefits, the management of the hospital are giving attention to the sacrifices and dedication of their medical staff to their job. The only downside for this is that increasing the salaries and benefits would amplify the financial burden on the British Army, thus, the government and it may also burden the citizens. So far the best solution that this paper could offer would be the increase in salary and benefits. By doing this, nurses and other medical staff in the army hospital would think twice or completely change their mind about looking for a new job. Furthermore, by increasing the salary and benefit, it might be possible that quality of job and services being offered by the nurses could improve. According to Capko (2001), 15% of staff turnover in 5 years is still acceptable while 20% is already regarded as high. Since losing staffs in hospitals affects the patients greatly, high staff turnover should be solved at an early point in time. The army is a very significant part of the government, thus, taking care of their health is as important. An army hospital is considered to be under the government, thus, it is publicly run. Staffs primary reason in transferring to private hospitals is the wage and the work environment. The army hospitals should look over their environment and management so that they could study how they could meet the needs of their staffs for the sake of the patients. Reference Army Medical Services. 2007. Royal Army Medical Corps [Online]. (Updated 14 May 2007). Available at http://www.army.mod.uk/medical/royal_army_medical_corps/ramc_index.htm Buchan, J. 2002. Global nursing shortage. British Medical Journal, 324, 751-2. Buerhaus, P.I., Staiger, D.O., & Auerback, D.I. 2000. Implications of an aging registered nurse work force. Journal of American Medical Association, 283(22), 2948-2954. Capko, J. 2001. Identifying Causes of Staff Turnover [Online]. (Updated April 2001). Available at: http://www.aafp.org/fpm/20010400/29iden.html Chartered Institute of Personnel and Development. 2007. Employee Turnover and Retention [Online]. (Updated August 2007). Available at: http://www.cipd.co.uk/subjects/hrpract/turnover/ empturnretent.htm Finlayson, B., Dixon, J., Meadows, S. & Blair, G. 2002. Mind the Gap: The Extent of the NHS Nursing Shortage [Online]. (Updated 7 September 2002). Available at: http://www.bmj.com/ cgi/content/full/325/7363/538#B1 Latino Hire. 2008. High Staff Turnover [Online]. (Updated 2008). Available at: http://www.latinohire.com/allarticles/31/RecruitmentHiring/HighStaffTurnover.html Lo, K. & Lamm, F. 2005. Occupational Stress in the Hospitality Industry - An Employment Relations Perspective. New Zealand Journal of Employment Relations, 30(1), 23.  Retrieved May 7, 2008, from ProQuest Direct Complete database. (Document ID: 854123901). Woods, R.H. 1995. Managing Hospitality Human Resources. Educational Institute of the American Hotel and Motel Association, East Lansing, MI. Woods, R.H., & Macaulay, J.F. 1989. 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