Impact of Nursing Unit Turnover on Patient Outcomes in Hospitals - Essay Example

Project Introduction The paper uses Dorothea Orem’s self-care deficit model in nursing theory to solve the problem in the scenario chosen. The self-care deficit theory is a middle range nursing theory developed to be used in the nursing care unit by Dorothea Orem (1959 to 2001). Also referred to as the Orem model for nursing used in rehabilitation as well primary care setting encouraging the patients to be independent as much as possible to enhance their recovery. The theory is based on the central philosophy that all the patients wish to care for themselves as they have the ability of doing so. Dorothea stated that patients could recover more quickly and holistically if only they were allowed to conduct their daily living activities on themselves to best their abilities. The theory can be applied is solving problems that may arise in the nursing care units both patiently focused problems as well as administrative issues in meeting their needs as well as identifying possible ways of solving and coping with their problems (Orem, 2003). When a patient is unable to conduct their self-, care needs a self-care deficient result. In the hospital, setting it is the job of the nurse to determine the resulting deficits and ways of supporting and solving the deficits. This can be achieved by total compensation, partial compensation as well as educative and supportive assistance. Dorothea described self-care requisites that are necessary for good health of the patient. These include food, water, elimination, air, activity and rest, social interaction, and hazard prevention necessary to ensure good health of an individual. The scenario chosen involves problems in the nursing leadership, in a nursing unit. The manager of the unit ought to recognize the associated problems and develop ways of solving them (Castle, Engberg, & Men, 2007). Scenario A nursing unit is experiencing rapid turnover its nursing staff including nurse managers. A new manager from an outside source is appointed to lead the nursing unit. Similar to the role that is played by a nurse in the care of patients ensuring that patients need to take care of their activities of daily living to improve on their health, the leadership management in the nursing unit needs to recognize the deficits in their system to solve their problem. Description of the problem A major issue in the nursing unit is a rapid turnover of the staff including the manager due to leadership and organization issues that affect them. As a result, a new nurse manager is introduced in to the organization and is required to take care of the leadership and organizational issues affecting the staff. It is crucial for the management to identify that only the staff themselves can recognize the problems and issues that are affecting them and come up with solutions of solving their problems. Therefore, the new manager needs to involve the staff in identifying and solving the associated leadership and organizational problems. The nursing unit is faced with a number of challenges. Like most of other units in many organizations, the nursing unit is struggling to reduce the associated workload associated with a shortage of staff due to high turnover of the staff. The unit has trouble in planning and managing organizational growth through a reliable staffing structure that will work. The average period that an employee spends in the organization working in a nursing unit is only three to five years (Bae, Mark, & Fried, 2010). However, the management recognizes that it cannot compete with other private and public sectors in terms of financial compensation or career path opportunities development. The management has limited funds as well as limited sources of getting the funding. The high rate of staff turnover has impact to the company in terms of the high cost need to train new staff as well as the additional supervision that is required. Moreover, the management faces gaps in the programs and services it is offering. The relationship with the funders and potential funders is declining, needs to be natured and human resources staffing and coordination are poor (Berbiglia, 2011). Using Dorothea Orem theory that by encouraging the patients in performing their daily living activities ought to be the only way of improving their care, then if the manager will involve the staff in identifying and solving their problems will be beneficial. Thus, the model will be helpful in solving the problems as well will help the individuals in dealing with the problem. Dorothea describes self-care as the performance of activities that the individuals initiate by their own abilities and perform on their own behalf to improve their own well-being. Self-care agency refers to human’s power in engaging in individual care and is influenced by general conditioning influences. Staff turnover can be classified in a number of different ways. This includes voluntary and involuntary turnover, dysfunctional and functional turnover and controllable and uncontrollable turnover. Voluntary employee turnover is a major issue that is facing the nursing unit. This includes factors such as lack of career development opportunities in the organization and poor remuneration by the management. However, the employees were not co-operative in solving and identifying their problems and were not compelling to the organizational policies and rules thus did not meet the organizational performance standards (Bae et al., 2010). The disadvantages of high staff turnover normally outweigh the advantages. High staff turnover of nursing service staff is costly in terms of the financial expenditure to be incurred, lowered employee morale, impaired team functioning as well as lowered management potential. The total cost of replacing an employee who has left the nursing unit can be viewed in terms of direct and indirect costs. Direct cost involves the cost of recruitment, selection, hiring and placing the employees as well as expenses to be involved in training and orientation. Indirect costs include the cost of the trainer, cost of promotion and the cost of vacation position during the time of the search. Although the employees who leave a unit are usually replaced by new nurse employees and other staff, the newly appointed employees, will take time to become fully effective i.e. a period between six to eight months. The higher the rate of employee turnover in the unit, the fewer the nurses, are left to take care of the patients. When the rate of turnover is high in the unit, then the quality of care rendered to the patients is compromised and is very poor resulting to medical and legal risks (Clarke, Allison, Berbiglia, & Taylor, 2009). A unit suffering from high staff turnover rate ought to suffer from low morale, as well as decreased group cohesiveness, thus poor coordination. However, nursing field is considered as one of the fields that experiences a high rate of staff turnover to employee’s dissatisfaction. Thus, nursing staff turnover is an expensive phenomenon that needs to be understood properly and well controlled. The constant losses of recruited and qualified nurses and other staff lost from the profession constitute one of the major limitation for nurse managers as in the case presented above. While recruiting enough nurses in to thee profession is laborious and time consuming, retaining the staff is difficult thus making reduction in the staff turnover rate among personnel to be one of the most costly management strategies in most of the nursing units. However, employee initiated staff turnover can have a number of benefits for an organization. Research conducted indicates that the employees performing poorly are likely to quit. Organizations, therefore, need ideas and innovation to keep their employees. Reasons for staff turnover among nurses are not easy to identify. They vary among different individuals as well as from one health care institution to the other (Seed & Torkelson, 2012). Strategy for resolving the issue By Using Dorothea Orem, theory that states that by encouraging the patients to perform their activities of daily living to be a way of improving their care, then if the manager will involve the staff in identifying and solving their problems that the unit is facing. The unit is facing a shortage of nurses and staff to take care of the patient. Therefore as an effort of reducing the associated work load, if the patients can be able to conduct daily living activities by themselves than the work load will be reduced. This is an essential step before the unit hires additional staff to take positions that were left vacant. Thus, the model will be helpful in solving the problems as well will help the individuals in dealing with the problem. To deal and reduce the rate of employees turn over the unit needs to improve on its enumeration as well as providing developmental opportunities to the staff (Bae et al., 2010). Rationale Human as resources are the most significant and dynamic of all the organizational resources, therefore, will require considerable attention from the management by involving them in solving their problems if they have to achieve full potential in their work and ensure attainment of the organizational strategy. Human resource training and development ensures that the employees know what is done and how to do it to improve efficiency, as well as a source of motivation. Allowing the patients to perform their activities by themselves is essential to reduce the associated work load due to inadequate staff. Training and development are important in increasing the knowledge and experiences of the employees as well as increase commitment and motivation to the staff. Ethical and legal aspects However, even as the patient ought to take conduct the activities of daily living to improve their care, it is important to consider the ethical and legal aspects. Patients’ rights should be protected. The nurse ought to respect each patient and offers assistance if the individual cannot perform activities by their own. The nurses should ensure they practice fidelity to the patient care by remaining faithful to the commitment of patient care. Justice should always prevail by treating every patient fairly and always providing truthful information when asked. The manager should treat all his staff equally even when solving their problems in order to improve care, as well as the staff satisfaction. The legal implication of practicing in nursing is tied to state and federal laws, scope and public expectations of the nurses to perform at a professional standard. If the standards fall below the standards and scope of practice, the nurse is exposed to litigation (Galletta, Portoghese, Battistelli, & Leiter, 2013). Expected outcomes 1) To reduce the associated workload resulting from high turnover of the staff nurses. 2) To reduce the rate of employees turnover in the unit through provision of training and developmental opportunities 3) To solve the organization problems by incorporating the staff in identifying and solving the associated leadership and organizational problems 4) To plan and managing organizational growth through a reliable staffing structure that will provide success to the unit 5) To bridge the associated gaps offered in the programs and services and improve the relationship with the funders as well as enhancing human resource planning and coordination. References Bae, S.-H., Mark, B., & Fried, B. (2010). Impact of nursing unit turnover on patient outcomes in hospitals. Journal of Nursing Scholarship : An Official Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, 42, 40–49. Berbiglia, V. A. (2011). The Self-Care Deficit Nursing Theory as a curriculum conceptual framework in baccalaureate education. Nursing Science Quarterly, 24, 137–145. Castle, N. G., Engberg, J., & Men, A. (2007). Nursing home staff turnover: impact on nursing home compare quality measures. The Gerontologist, 47, 650–661. Clarke, P. N., Allison, S. E., Berbiglia, V. A., & Taylor, S. G. (2009). The impact of Dorothea E. Orem’s life and work: an interview with Orem scholars. Nursing Science Quarterly. Galletta, M., Portoghese, I., Battistelli, A., & Leiter, M. P. (2013). The roles of unit leadership and nurse-physician collaboration on nursing turnover intention. Journal of Advanced Nursing, 69, 1771–84. Orem, D. (2003). Self Care Theory in Nursing : Selected Papers of Dorothea Orem. Springer Publishing Company. Seed, M. S., & Torkelson, D. J. (2012). Beginning the Recovery Journey in Acute Psychiatric Care: Using Concepts from Orem’s Self-Care Deficit Nursing Theory. Issues in Mental Health Nursing. Read More