Nurse Retention - Research Paper Example

Change Project/Nurse Retention Contents 0 Introduction Currently the U.S. is experiencing shortage of registered nurses (RNs) owing to the fact that the nursing colleges and universities are struggling meet the enrollment requirement to meet the rising demand for nursing care. The problem is projected to get worse with the ageing of the baby boomers generation and rising need for health care. At the national level the parties concerned are busy working to raise awareness of the looming crisis, develop legislations and strategies to mitigate the shortage of nurses. At the institutional level, health care institutions are also developing mechanisms to retain and develop the nursing staff they have and attract and identify the best available nurses from the training institutions. The current and projected shortage Indicators shows that the U.S. nursing shortage is projected to grow to 260,000 registered nurses by 2025 (Buerhaus, 2009), the Bureau of Labor Statistics (2009) reported the in spite of the job cuts in all the major industries, the health sector institutions added 21,000 new jobs in the month of June 2009 and more jobs are likely to be added in the near future. A research conducted by the Council on Physician and Nurse Supply in 2008 showed that the US health care needs 30,000 additional nurses to be graduated annually to meet the nations healthcare needs (Bureau of Labor Statistics, 2009). The Health Resources and Services Administration (2006) projects that the US nursing shortage would grow to more than one million nurses by the year 2020. It has been observed that due to the shortages, the recruitment and retention of nurses in the health institutions is a big challenge (Health Resources and Services Administration, 2006). 1.2 Change management This section reviews Kurt Lewin’s classical approach to change management, specifically the application of force field analysis in the implementation of a nurse retention program at any local healthcare facility. Kurt Lewin’s classical theory is based on a systems approach to change management. According to him a state of equilibrium in a system is achieved when the forces acting for change equals the forces acting against change. The driving forces usually exhibit consciousness, reasonableness, economy etc. as opposed to the restraining forces which are negative, illogical, unconscious etc. These forces are real and needs to be taken into account when you are implementing a change program. Lewin’s model involves the process of unfreezing, moving and refreezing. In terms of organizational change it the unfreezing process will involve facilitating an environment for change involving creating the right conditions to remove people from their existing environment. This is the most challenging phase as most of the time, the change agents will exhibit resistance because people are usually accustomed and attached to their environments. The moving stage will involve transiting the people to from their initial environment to the desired one. This is the most confusing stage for both the individuals and the system as a whole. Good leadership is mostly required at this stage. The Refreezing stage reestablishes stability and is characterized by high productivity in a system (McCarthy, 2010). 2.0 Force field analysis on local health institutions In a local health facility context we have to analyze the likely driving forces and the restraining forces and establish the resources and constraints of implementing a nurse retention program. This section presents a force field analysis describing the political, economic, technology and capacity issues than needs to be considered when developing and implementing a nurse retention program in local heath institutions. 2.1 Restraining forces A review of existing literature reveal the following external restraining forces that may impede the successful implementation of nurse retention programs: lack of support from the Government to develop legislature and policies to address the shortages; disinterest from students to pursue nursing courses; competition for nursing staff from bigger hospitals; lack of capacity in the enrollment of nursing students etc. The internal restraining forces include all those factors that contribute to job dissatisfaction in the health facility. Such factors include low compensation, difficult working conditions, poor internal recruitment and retention programs, lower wages, fewer benefits, poor leadership, lack of recognition by hospital management, poor hospital management structures (McCarthy, 2010). With the current recession in the US market, the issue of nurses’ shortage has not featured more prominently in US politics, with the current budget on health favoring national health insurance scheme. However there have been ongoing campaigns by the bodies administrating the nursing sector to sensitize the public and policy makers on the issue of nurse shortages in the country. Lack of interest by potential students in the market is also a restraining force in the implementation of a good nurse retention program. Lack of interest translates to poor enrolment rates which further contribute to the current shortage, thus straining the existing practitioners due to burdening workload. The indications from the national wage and employment data from BLS shows that nurses receive lower wages and have fewer benefits than other workers generally; this is particularly true for the nursing homes contribute to the higher number of health facilities in the local areas. In the current environment, the local institutions cannot compete with hospitals and other well-paying private institutions. The local health care facilities have poor remuneration packages, lower technology, poor working conditions thus losing their staff to bigger better paying hospitals. At the same time, the fresh graduates from schools usually prefer bigger hospitals in the private sector than the local health institutions. Internally, the working conditions may dictate the success or failure of a staff retention program. It has been observed that the reasons for job dissatisfaction amongst the nursing staff include increased pressure to accomplish work, the need to work overtime, and stress related illness. It has been found out that most of them would opt to leave the field due to field related problems (McCarthy, 2010). Frequent changes due to nurse shortages are also a factor contributing to job dissatisfaction. Local facilities exhibit higher staff turnover as compared to larger hospitals. These higher staff turnover demoralizes the existing staff as they operate in unstable environments and further contribute to both increased costs to the facility and problems with quality of care. Low compensation packages in the nursing profession contribute to job dissatisfaction, the impact is even worse if you compare the compensation packages between local health facilities and bigger hospitals. The physical demands of nurse work and other factors of the workplace environment are also restraining factors for the successful implementation of nurse retention program in the local health (McCarthy, 2010). The nurse aid jobs are physically demanding requiring moving patients, cleaning, standing for long hours and dealing with uncooperative patients. These menial works can be made easier by the adoption of technology. However the local institutions do not have enough money to procure the required technology thus leaving their nurses harassed by the job demands. Internally the nursing fraternity is sparingly involved in the planning and administration activities of their health institutions. These important activities, more so decision making enhances the status of professionals in an organization. Good management and leadership demand the involvement of stakeholders in matters likely to affect them in their daily routines (Health Resources and Services Administration, 2006). 2.2 Driving forces A review of literature has shown that the following driving forces contribute to a successful staff retention program: more training opportunities for nurses; adoption of modern methods for managing workload and schedules; more opportunities for career advancement; respect from administrators and management; overall organizational recognition; improving the workloads and staffing levels; establishing clear roles and encouraging participation of the nursing fraternity in decision making. In addition the institutions need to adopt collegiality as a management model in the health facilities. This approach encourages involvement of employees in decision making, encourages employee participation, consultations and a positive workplace culture (McCarthy, 2010). 3.0 Conclusion A successful Nurse Retention Program should be informed by the political, environmental, social and technological factors affecting the health sector in the modern US. Such a program should address issues that contribute to job dissatisfaction in the nursing fraternity like low compensation, difficult working conditions, poor hospital management, lack of recognition by hospital management, inadequate funding for nurse capacity development etc. At the same time such programs should adopt collegial approaches to the running of the institutions while at the same time encouraging the adoption of technology. References Buerhaus P (2009). The Recent Surge in Nurse Employment: Causes and Implications. Health Affairs July/August 2009. Accessed November, 17 2011 from http://content.healthaffairs.org Bureau of Labor Statistics (BLS) (2009). News release July 2, 2009. Accessed November, 17 2011 from www.bls.gov/news.release/pdf/empsit.pdf Health Resources and Services Administration, 2006. What is Behind HRSAs Projected Supply, Demand, and Shortage of Registered Nurses? Report. Accessed November, 17 2011 from http://bhpr.hrsa.gov/healthworkforce/reports McCarthy, C (2010). Change Management Strategies for an Effective EMR Implementation. Chicago: HIMSS Read More