Nursing Care Delivery Models and Organizational Structure - Essay Example

? Nursing Care Delivery Models and Nursing Turnover The shortage of skilled nurses is a great challenge faced by hospitals today. As new models of health care have been widely adopted, demand for nurses is high more than ever before. Retaining the available team intact and limiting employee turnover have become the prime importance in hospital management. Hence, it is essential to test a person’s team work qualities before the recruitment. Volumes have been written on the causes and effects of nurse turnover. However, this paper tends to research how factors like organizational structure and care delivery models can influence nurse turnover rates. Introduction Health care sector across the world has been experiencing an unusual increase in nursing turnover for the past few decades. According to the NSI (2013) report, the hospital turnover rate increased to 14.7% and registered nurses is 13.1%. Nursing Solutions, Inc projects hospital turnover to be over 15.5% and RNturnover14% by2014. However, it is important to assess to what extent nursing care models and organizational structure can cause nurse turnover in modern hospital settings. This detailed analysis based on the available literature will suggest what advice Jamie Johns (in the given case context) as a Quality Improvement Leader can give to her Chief Nurse Officer on appropriate care delivery models. Impacts of Nurse Turnover Nurse Turnover is a major risk factor that affects the hospital’s functioning and effort for ensuring quality patient care. Nursing turnover causes huge amount of financial loss to the hospital. Losing a single nurse can bring about the loss of twice the nurses’ annual salary. Therefore, loss of nurses adversely affects patient care thereby causing loss of patients, increased staffing cost, absenteeism, and accident rates. Poor communication with the management regarding their needs, low remuneration, and lack of career opportunities and career development in the hospital they work can also increase nurse turnover. Solutions for nurse turnover have been researched on a wider basis. According to Hunt (2009), the most important suggestion is to make the job attractive; and this process involves increasing job incentives, flexible scheduling and job sharing, adding career development activities. A major after effect of high turnover rate is that the existing staff is always forced to adjust with the newcomers. A study by Baernholdt and Mark (2009) showed that both rural and urban hospitals can improve nurse job satisfaction and turnover rates by changing unit characteristics, creating better support services and a work environment that supports autonomous nursing practice. According to the very findings, rural hospitals can also improve the work environment by providing nurses with more educational opportunities and thus career development. Scarcity of qualified nurses makes turnover so prevalent in the health care industry. The increase in job opportunities makes the existing nurses confident enough to leave their present organization and find a new one. Organizational Structure and Nurse Turnover Only by implementing key strategies, hospitals can put a curb on the turnover rate of nurses. Nursing is the largest occupation within the health care industry with 2.4 million people working. In recent reports by the International council of Nursing (Trust, 2006), one of the main reason for shortage of nurses relates to work environment. Studies have proven that a positive organisational climate plays a key role in job satisfaction and in lowering turnover rates. But the strength of organisational climate and job satisfaction is more compared to organisational climate and turnover rate. As Stone, Hughes, and Dailey (2008) point out, low job satisfaction leads to burnout, frequent leaves, higher rate of turnover, or loss of nursing profession. The work environment, especially the organizational structure has much to do with nursing turnover rate. A pleasant relationship with the hospital management and the colleagues prevents the out flow of nurses from the hospital. If there is no proper staff coordination and healthy communication with the head of the department, nurses tend to suffer from strained relationship. This can be controlled by conducting frequent job satisfaction surveys and thereby making necessary changes in the work environment. In this context, it is important to learn the common issues associated with staffing, patient needs, and staff needs, all which can directly influence nurse turnover. 1. Staffing For the proper functioning of a health care organisation, adequate number of skilled staff is essential. The success of a hospital depends on the number of well trained competent staff members who can give quality care to the patients. There should be an action plan among the nurses. They should be clearly aware of who should perform a particular task. Some nurses may feel they are attending to ‘more difficult to handle cases’ compared to their counterparts in other hospitals. The only panacea for this is having a software based staffing system. To avoid the problem of inequitable assignments, a perfect system for tracking the work load of each nurse is advisory. According to Punke (2013), these factors can be kept under control by ensuring the equal management of high risk patients by everyone of the team and by providing career development activities throughout the job. 2. Patient needs Satisfaction of the patients determines the reputation of the hospital. The needs of the patients are to be catered without fail. Number of patients in each unit should be manageable by the available staffs. Crowded wards and limited staff can lead to total failure of the hospital system. To meet each patient’s requirement, there should be prior preparation from the side of the staffs. Experience of the staffs is crucial in giving proper care and attention to the patients. Patients have to be categorised according to their care needs. 3. Staff needs Satisfied staff becomes more productive giving best quality and cost effective care. For further growth and development, advanced training should be given to the staffs. And, flexible timings, incentives, and attractive pay scale are also priorities in staff requirements. 4. Communication system There should be effective communication between the hospital management and the staff members. Regardless of the care delivery model adopted, there should be unity between the staff members. There should be planning among the staff members regarding the strategies to be adopted in each unit. Important Care Delivery Models There are different types of care delivery models that can reduce nurse turnover. Nursing care models helps in bringing about a systematized approach in the work of nursing staff. Some of the most prominent care delivery models are Total patient care, Functional nursing, Team nursing and Modular nursing. 1. Total Patient Care Here, nurse is the decision maker regarding patient care. He/she plans, organises, and performs care and this is one of the oldest nursing care models. This model is commonly employed in Intensive Care units and Post anesthetic care units. The model has advantages like un-fragmented patient care and high degree of autonomy. This model has some disadvantages also. For instance, each registered nurse will have a different approach to patient care; it is not very cost effective and sometimes lacks RN availability. 2. Functional Nursing Here, staff members are assigned to particular tasks, and unskilled workers are trained to perform routine simple tasks. This approach is mainly utilised in operation theatres. According to Swansburg (2002), major advantage is that care will be given economically and efficiently. This is cost effective as it requires only minimum number of RN’s. This model is time saving since it completes many tasks simultaneously (p. 231). The disadvantages are that too many caregivers tend to confuse the patient and hence a well coordinated care is unlikely. Also, in this model, the work normally assigned is less challenging for the staffs. 3. Team Nursing As Kelly (2013) points out, in Team Nursing model, a registered nurse is assigned to be the team leader and coordinates the care given to a group of patients. It is used in most inpatient and outpatient areas. Advantages involve high quality care with proper subordinates. It ensures the collaboration of team members in decision making and expertise (p. 250). Discontinuity is pointed out as a disadvantage of this model as daily team assignments in this model vary. The model fails if there is no strong team leader with effective communication and leadership qualities. This is time consuming as it demands more planning. 4. Modular Nursing This is a modified version of team nursing. Each unit is divided in to modules and each module is under the control of a team leader. The same caregivers attend consistently to a particular geographical area. According to Booyens (2008), the advantage of the model is that it ensures holistic and un- fragmented care. It also provides more RN involvement in planning and care coordination. Effective communication and geographic closeness are also some of the benefits of this model. The disadvantage is that it involves high cost to stock each module (p. 125). Recommendations According to Anderson (2012), an important aspect noted is a nurse’s chance of leaving an institution is very high in the initial years of employment; and the strategy to mitigate turnover is ensuring a comprehensive hiring process according to each candidates work style and motivations. Considering the given context, out of the above said care delivery models the best one which can be employed is team nursing. The case says that a team concept of nursing had been used throughout the hospital at the initial stage. Hence, the failure could be attributed to some sorts of strategic flaws like the absence of an effective leadership. To illustrate, a strong team leader is a requisite in Team Nursing Model. Here every staff has equal importance in decision making. There is more coordination and planning in effectively providing quality care to the patient; and hence, the model can be applied effectively in acute care division, which includes the ICU, intermediate and medical-surgical units of the hospital and also in outpatient settings alike. As each member of the team utilizes his/her expertise the outcome will be the maximum. Un-fragmented care can be ensured to the patients through proper planning. As every member is recognised for his/her work, personal conflict is less likely, and motivation and team spirit would always be high. Altogether, this model would enhance staff satisfaction and thereby less staff turnover in various units. In total patient care model, autonomy is given only to the registered nurse. So responsibility is high for the RN. This can lead to high staff turnover. In the case of functional nursing the situation is exactly contrary to total patient care. Here the chances for advanced career growth is very less as the nurse’s role is less challenging with too many staff for caring a patient. This again can be a cause for staff turnover. The modular nursing model is close to team nursing but due to its disadvantages like high cost and spatial separation it is less appealing and in turn may affect staff turnover rates. Conclusion The stability of a hospital or a health care organisation largely depends on highly trained nursing staff to provide excellent patient care. The issue of nursing turnover affects the performance and profitability of an institution. It is understood that working environment has a pivotal role in retaining staff to a particular organisation. Nursing working environment consists of multiple factors like staffing level, work responsibility, management, co-worker harmony and professional incentives. If any of these factors are negatively affected there will be frustration and chances of high nurse turnover. Hence these attributes have to be given special attention for retaining staff in that particular organisational set up. Implementing a measure or indicator of staff stability and examining the cost of staff turnover is helpful for managers and policy makers in this regard. At the same time, care delivery models also have a significant role in staff turnover. Hospital management should identify the flaws in their organisational structure and care delivery models. It should improve the system if necessary so that it can avoid unnecessary nurse turnover and loss. A close analysis of the context and various care delivery models, Team Nursing Model seems advisable for Jamie Johns to suggest. References Anderson, C. (March 14, 2012). Managing doctor, nurse practitioner turnover rates key to collaborative care. Healthcare Finance News. Retrieved from http://www.healthcarefinancenews.com/news/managing-doctor-nurse-practitioner-turnover-rates-key-delivery-collaborative-care-model Baernholdt, M & Mark, B. A. (2009). The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. Journal of Nursing Management, 17(8):994-1001. Booyens, S. W. (2008). Introduction to Health Services Management. South Africa: Juta and Company Ltd. Hunt, S. T. (2009). Nursing Turnover: Costs, Causes, & Solutions. SuccessFactors, Inc. retrieved from www.uexcel.com/resources/articles/NursingTurnover.pdf Kelly, P. (2013). Essentials of Nursing Leadership & Management.US: Cengage Learning. NSI. (2013). 2013 National Healthcare & RN Retention Report. Retrieved from http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/NationalHealthcareRNRetentionReport2013.pdf Punke, H. (July 12, 2013). 3 Biggest Causes of Nurse Turnover. Becker’s Hospital Review. Retrieved from http://www.beckershospitalreview.com/workforce-labor-management/3-biggest-causes-of-nurse-turnover.htm Stone, P. W., Hughes, R & Dailey, M. (2008). “Creating a Safe and High-Quality Health Care Environment”. In Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication. Swansburg, R. J. (2002). Introduction to Management and Leadership for Nurse Managers. Jones & Bartlett Learning. Trust, B. (2006). The Global Nursing Shortage: Priority Areas for Intervention. The Global Nursing Review. Retrieved from http://www.nurse.or.jp/nursing/international/icn/report/data/2005kangosifusoku.pdf Read More