High Nurse Staff Turnover and the Strategies to Reduce It - Assignment Example

High Nurse Staff Turnover and The Strategies to reduce it al Affiliation High Nurse Staff Turnover and The Strategies to reduce it Introduction The presence of high nurse turnover within the healthcare sector continues to negatively affect the overall capacity of healthcare facilities, in term of appropriately meeting patient needs, as well as provision of quality care. Accordingly, nursing turnover substantially increases both indirect and direct labor costs, to the concerned institutions, as well as the health sector in general. In this regard, the presence of indirect costs is portrayed in the negative influence experienced on the overall cohesiveness of the work units with direct costs including the recruitment, selection and subsequent training of new personnel. The overall effect is that there is an increase of burdens on the remaining staff, which negatively affects unit output. Consequently, there is little work satisfaction experienced by the staff, with a gradual decrease in quality patient care. High Nursing Turnover Rates Nursing turnover is a problem that continues to negatively impact on the overall effectiveness of the health sector. Punke (2013) avers that nurses play an essential role in the provision of patient care at different facilities, striving towards enhancing patient satisfaction. This is achieved through continuous interaction with patients during their hospital stays, thereby having a direct influence on eventual patient satisfaction. It is appreciated that by having long-term nursing staff that is experienced aids health facilities in providing higher quality health care. However, prior to cultivating such a quality working force, there is need for recruitment of the right/ quality nursing force. Not only is this a critical factor but also further influenced by the need for continuous training and development, processes that are both expensive and time-consuming. These are the key reasons why workforce retention of the right nurses continuously is a major concern for hospital management. This is because when there is a gradual increase in nurse turnover, there is a lot of knowledge and experience lost, let alone the incurred expenses aforementioned. It is hence not only expensive, but also a quality problem that requires proper handling through prevention of turnover as much as possible. Pundits are of the opinion that three core reasons are primarily responsible for the witnessed increase in nurse turnover. To be noted is that the three are experienced on a universal context, given their primary importance in cultivating optimal working environments (Punke, 2013). First, there is the aspect of staffing, which is influenced by a variety of issues critical to increases in nursing turnover. A majority of nurses are prone to exit different health facilities, as a result of concerns pertaining to their proper staffing level/rate. Compounding this is the fact that adequate staffing levels may be present, abate experiencing disorganization. Cases are portrayed of where nursing staff leave hospital facilities due to their perception of being allocated inequitable assignments or difficult patients at greater rates than their colleagues are. Secondly, workplace and patient-doctor relationships are crucial in determining whether nurses will effectively serve at a given station over the long-term (Chiu et al., 2009). Any strain in existing nurse-nurse, nurse-director, or patient-nurse relationships, further propels the likelihood of increased nursing turnover as Ford (2011) presents. Third, there is the aspect of personal reasons where nursing staff leave their current working stations due to a variety of personal influences, which are often out of the hospitals’ control. As personal issues, these may range from family matters, strained social relationships, psychological ‘burn-out’ as a result of compassion fatigue, or immigration. Compassion fatigue is a primary cause of concern regarding personal reasons for increased turnover especially amongst nursing professionals who are exposed to continuous care of many high-risk patients. Another less influential but still critical issue is that of nursing personnel feeling that they have ‘hit a glass ceiling.’ When nursing staff become comfortable with their individual clinical skill-sets, they usually search for an expanded role. In cases where this is not available, there is an influence on their need to move on. High nursing turnover usually negatively affects health facilities in terms of the capacity of meeting patient needs, as well as the overall goal of providing and improving quality patient care (Ford, 2011). Effects of the problem High rates of nursing turnover, affects not only the nursing profession, but more so the existing health sector through direct negative implications on hospital facilities and ultimately the prevailing patient populations. In every context, the effects experienced are negative, impacting in a variety of ways upon each of the stakeholders mentioned. a) Effects on nurses As a result of inconsistencies brought about by increased nursing turnover, a direct effect on the remaining nurse workforce is increased workload, especially due to the existing patient-nurse ratio. Additionally, it is expected that there will be increased job-related stress levels especially given the nature of caring for gravely ill individuals. Other negative effects, both actual and potential include increased pressure on job performance, negative influences on nursing staff healthcare. This is in terms of such high-strain jobs often correlating with significant increases of work-related musculo-skeletal disorders and cardiovascular. At their personal level, strain is evident in terms of strained social relationships, psychological ‘burn-out’ and increased turnover intentions (Punke, 2013). b) Effects on patients Patients in such dire situational contexts, often bedridden, require not only medical healthcare provision, but more so, a conducive environment where their physical wellbeing is catered for in much the same way as their mental/ psychological needs. Due to the rate of turnover experienced, there is lack of creation of the necessary patient-nurse relationships that are essential in aiding quicker recovery. A higher rate of turnover further means that the ratio of patients to nurses is unworkable resulting in lower standards of quality care. With such contexts being presented at my workplace, the potential result is that of more deaths occurring. This is especially true, due to the nature of the patients’ illnesses, which require continuous quality care provision (Ford, 2011). c) Effects on the hospital High turnover rates negatively impact upon hospital facilities in a variety of ways. As such, it is a core issue that impacts upon the entity’s overall profitability and performance under such case contexts. This is informed by the fact that any healthcare organization requires not only a stable work environment, but also fully engaged and highly trained nursing staff, necessary in the provision of effective patient care levels. In terms of the financial implications of losing a single nurse, evidence portrays that it is equal to about twice the annual salary paid. Thus, in losing these critical employees the facility has and continues facing negative bottom-line impacts in different ways. There is a decrease of patient healthcare quality provision, unfortunate loss of patients, an increase in both absenteeism and accident rates, increased medical staff and nurse turnover, increased staffing expenditure, and increased costs related to contingency staff. With such high rates of turnover, novice nursing staff is also less likely to envisage long-term work-stay at the facility (Chiu et al., 2009). d) Effects on healthcare sector While the facility under question experiences the negative effects of high turnover rates directly, the national healthcare sector is also influenced. This is in terms of reduced quality care provision, increased death rates as a result of the decline in quality-based healthcare, disproportionate movement of crucial nursing workforces, thereby impacting negatively on the national agenda on greater provision of quality healthcare. This further leads to increased public pressure on the governing administration as to why despite increased resource allocation, the healthcare sector continues producing less that optimal results. Strategies and Mitigation Measures: Towards Reduction of Nursing Turnover To be noted is that high-demand job contexts need not be necessarily high-strain professions. However, in contexts where high-demand environments are combined with little or no job control i.e. low decision authority or low skill discretion, can result in negative perceptions of the profession (NCSBN, 2014). As Alexander, Bloom and Nuchols (1994) allude, nurses may perceive their job description and role-play as being highly stressful, and this may subsequently cause harm to their own health. In this regard, job control does have a moderating effect on the existing association between negative health-related outcomes and high job demands. This is important in the contexts of the nursing profession, given the input gained from the Job-strain model, which predicts four categories of job environments. These are as a result of the different combinations achieved when the aspects of job decision latitude and job demand are interrelated. These are active jobs where both job control and job demand are high, high-strain jobs where job control is low vis-à-vis job demand being high, low-strain jobs where job control is high vis-à-vis low job demand and finally passive jobs where both job control and job demand are low. To reduce the negative impacts of job strain, social support is needed especially so concerning the nursing profession. Thus, social support in the workplace is crucial towards facilitating successful strategies aimed at coping with the prevailing high-strain workplace environment (Alexander, Bloom & Nuchols, 1994). This is achievable primarily through buffering or prevention of any potential harmful effects, which may emanate from the tasking responsibilities of the existing nursing fraternity. According to PriceWaterhouseCoopers (2007), support may be inclusive of amongst others: varying resources essential towards assisting the nursing fraternity in the workplace, i.e. co-workers’ help, availability of task-related information, overall concern from fellow staff members and praise and/ or feedback from unit supervisors. Through this, the nursing fraternity at the health facility can be further aided in adequately coping with the tasking responsibilities at hand. This is especially essential because of the prevailing unfavorable patient-nurse ratio at the facility. By increasing not only job satisfaction, but also the perceived workplace performance output, and work-force encouragement, the facility’s management would be appropriately tackling the prevailing rate of nursing turnover experienced. In addition, the presence of supervisory support would aid in significantly reducing this scenario. Further positive input can potentially emanate from factors influenced directly by facility administrators and positive/ conducive work climate. Accordingly, the unit under which I work can be aptly categorized as high-strain, given the prevailing high job demand vis-à-vis low job control. This is influential in understanding why there is present, a higher level of turnover intentions of the nursing fraternity present (PriceWaterhouseCoopers, 2007). With low social support, the prevailing rate of turnover is not expected to reduce, unless the aforementioned measures are enacted. Pertinent in this regard, is the presence of continuous social work/ job support, which can positively aid in alleviating the situational context present. Thus, as Chiu et al. (2009) portrays, through design of job descriptions that give nurses greater skill discretion and decision-making authority can substantially aid in turning the tide towards enhanced nurse retention. This is informed by the fact that conducted research portrays a major predictor of turnover intention being primarily because of job satisfaction best tackled through psychological empowerment of the existing nurse workforce. Hence, within our working station, there is need for consideration of different aspects, such as projected length of stay, infection rates experienced, potential occurrence of medical errors and incidences of falls all of which are influential in increasing or decreasing nursing turnover. Augmenting the above is that fact that due to shortages of time as well as resources critical in providing optimal patient care, there is need to address both not only in the short-term, but also in the long-term. The facility’s management further needs to recognize that job-related stress can, and is a major cause of a number of injuries to mental and physical health of the nursing fraternity (Chiu et al., 2009). This is informed by the fact that such high-strain jobs are often correlated with significant increases of work-related musculo-skeletal disorders and cardiovascular ailments as Atencio, Cohen and Gorenberg (2007) allege. Thus, job-related stresses fundamentally affect the working nurses, in terms of attendance and job satisfaction, hence being a leading cause of higher nursing turnover rates. Towards this end, the facilities management needs to empower the existing nursing workforce, through provision of greater job control, autonomy and improved working conditions. Additionally, there the is need for implementation of constructive work-team models, within the facility’s workplace setting, essential in enhancing overall involvement and output of the nursing fraternity. This is especially vital concerning their decision-making capacity. By providing such conducive environments where self-leadership is present, the nursing workforce will be provided stronger feelings of self-control, purpose, mental job redesign and competence. This results in the employee force becoming more efficient as a result of not only increased job satisfaction, but more so due to overall decrease in turnover intentions. Unit supervisors can further play a crucial role through provision of both support and job information to the nursing workforce, hence significantly reducing turnover. The nursing workforce further needs to continuously support each other, individually and as a team (Atencio, Cohen & Gorenberg, 2007). Boudreau and Ramstad (2007) portray that through access to mentors, with whom the nursing fraternity may share their experiences and problems, in addition to seeking advice, provides a vital social support platform for novice nurses. The hospital facility’s nurse supervisors and/ or management should also seek a variety of avenues through which clinical nurses present can be offered better working conditions. This is through an increase of both practical assistance and social support at the workplace. An example would be through provision of sufficient resources and pertinent information critical towards betterment of the employee force. This can be achieved through showing concern for the nursing fraternity’s daily work, enhanced decision-making, listening to opinions of nurses, and the offering of more task-relevant praise and feedback. The facility’s management through the utility of frequent employee satisfaction surveys can substantially show whether the nursing staff within individual units are happy and satisfied with their work. Such data can further pinpoint the areas of concern, for instance if there is a decrease of job satisfaction as is the case in my current job placement. From this, management can initiate the necessary steps towards addressing such issues, hence preventing turnover. Issues concerning staffing can be substantially tackled through introduction of software-based systems of staffing and scheduling. An example of technological input is in terms of systems that can keep track of the types of patients to which each nurse is assigned. This aids in the prevention of inequitable assignments, with the data further aiding the hospital in overall evaluation of its staffing practices. Through retrospective analysis, the facility’s management can therefore enhance the manner in which job-specific tasks are performed, through utilizing accrued data in driving decision-making processes (Boudreau & Ramstad, 2007). Conclusion High strain job categories are often negatively affected by workforce turnover rates, as influenced by the prevailing situational contexts present. This is not only true in the nursing profession, but in all complex organizational environments. The nursing fraternity is a very highly stressful profession, where nurses need to deal with different emotionally-laden situational contexts. Here, nurses deal with issues such as fear of making fatal errors and/ or grieving for terminally ill and dying patients, all contribute towards the experience of a unique and special type of stress. Accordingly, while changes within the working organizational environment such as provision of greater autonomy and job control to nurses are essential, there is need to also focus on other core issues. The presence of tremendous individual pressures related to the workplace is a critical issue of concern. This is adequately alleviated through society’s regard for the nursing fraternity. Through restoration of previously existing respect, gratitude and recognition, the prevailing workplace contexts can eventually be tackled. References Alexander, J. A., Bloom, J. R., & Nuchols, B. A. (1994). Nursing turnover and hospital efficiency: An organizational-level analysis. Industrial Relations, 33, 505-520. Atencio, B., Cohen, J. & Gorenberg, B. (2007). Nurse retention: is it worth it? Nursing Economics, 21. Boudreau, J.W., & Ramstad, P.M. (2007). Beyond HR: the new science of human capital. Harvard Business School Press, Cambridge, MA. Chiu, Y.L. Chung, R.G., Wu, C.S. & Ho, CH. (2009). The Effects of Job Demands, Control, and Social Support on Hospital Clinical Nurses’ Intention to Turn Over. Applied Nursing Research, 22: 258-63. Ford, S. (2011, Nov 8). High Nurse Turnover leads to more Injuries. Nursing Times.net [Nursing Practice- Management], retrieved from: http://www.nursingtimes.net/nursing-practice/specialisms/management/high-nurse-turnover-leads-to-more-injuries/5037532.article NCSBN. (2014, July 7). Nursing Home Quality Deficiencies Increase in Facilities with High Nursing Staff Turnover. National Council of State Boards of Nursing (NCSBM)-News & Events, retrieved from: https://www.ncsbn.org/890.htm PriceWaterhouseCoopers (2007). What works: healing the healthcare staffing shortage. PriceWaterhouseCoopers, LLP. Punke, H. (2013, July 12). 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.html Read More