The Cause and Effect of Nurse Turnover in Their Organizations - Research Proposal Example

The Cause and Effect of Nurse Turnover in their Organizations Name of Student Institution Review of Related Literature and Studies This section will examine literature related to nursing turnover. It is segmented into relevant literature and studies that have already been undertaken. The section will highlight relevant literature and studies from the United States and other foreign jurisdictions. The first section will highlight relevant literature from local and foreign sources. Local and Foreign Literature Long, Ajagbe, & Kowang, (2014) defined employee turnover as the ratio of persons who left an organization in a particular time period in comparison to the total number of employees in the same period. Employee turnover describes the process of employees leaving an organization and their replacement with new employees. Turnover is grouped into five categories. Foremost is the turnover that is either functional or dysfunctional. It is characterized by poor performers leaving—that is functional turnover—and best performers leaving—that is dysfunctional turnover. Second is the voluntary and involuntary turnover. Voluntary turnover occurs when the employee themselves decide to quit, or they are presented with an opportunity to leave, whereas involuntary turnover takes place when the employees do not have a choice over their employment. For instance, the employee dies, falls sick or the employer terminates their contract. Third is the turnover that is either internal or external. Internal turnover arises when an employee vacates their current position and goes on to fill another position within the same organization. It is mainly due to internal recruitment procedures. For external turnover, the reverse is true. Fourth is the unavoidable and avoidable turnover. An avoidable turnover occurs when the circumstances behind leaving an organization are avoidable whereas unavoidable turnover arises from unpreventable circumstances. The last turnover type is the skilled and unskilled turnover. Skilled turnover results when highly professional and educated employees could put an organization at risk when they leave. The skilled personnel have attached to them costs of replacement and an opportunity cost to the business. On the other hand, unskilled personnel are the untrained and less educated positions held by employees and these positions face a high rate of turnover (Rajan, 2013). Hunt (2015) identified that the biggest factor contributing to nurse turnover is job dissatisfaction. There are various measures to determining job satisfaction. These measures, designed by Mueller and McCloskey in 1990, include factors such as feeling in control, striking a family life and work life balance, coworkers at the organization and extrinsic rewards among others. Lower satisfaction rates are recorded more in the younger nurses: fresh from college. Out of all these measures, remuneration was not a key factor in determining job satisfaction. Hunt also observed that minority nurses have a very high rate of turnover due to a negative work environment. However, further study needs to be conducted to determine why the minority nurses felt more left out than their white counterparts. The density of nursing workplaces is among the largest in comparison to other occupations in the health care system. There are only about two million nurses in the United States. Other jurisdictions like Jordan and Japan have one million and 16,000 registered nurses respectively (Rajan, 2013). World Health Organization (WHO) and the International Council of Nurses (ICN) observed that since the beginning of the century, the shortage of nurses has become a ballooning crisis. In fact, in the years to come, the number of nurses graduating from universities would not be able to reduce the shortage adequately. Moreover, the worrying condition of nursing facilities all across the education institutions compounds to the problem (National Advisory Council on Nurse Education and Practice, 2010). One of the most fundamental factors that nurses review when making a decision to leave or stay is career development (Zhao & Zhou, 2008). Many nurses view promotion opportunities and the possibility of upward mobility as the key decision making factor. Furthermore, the managers at the nurses’ workstations act as the mentors for the employees. If the relationship between the managers and nurses is fragile, then many of them would opt out of the organization. Studies by various scholars indicated that there is a telling correlation between the style of leadership espoused by the managers and nurse’s job satisfaction. Some found the relationship between the intention to leave and leadership style to be weak, but still, the style of leadership does have a significant effect on the working environment. A healthy working environment affects job satisfaction and eventually affects the employee’s intention to leave. Jones & Gates (2007) observed that the direct costs incurred from nurses leaving an organization include advertising costs, recruitment costs and hiring costs. These turnover costs are costly to a medical organization and with the increasing shortage it is now more important to retain employees. Retention of workers is possible if hospitals apply appropriate reward systems such as better salaries and compensation of hazardous work (Alhamwan, Mat, & Muala, 2015). If hospitals do not retain their nurses, then a crisis would be inevitable. The American Association of Colleges of Nursing (2015) concluded that with the upcoming baby booming generation, health care systems would need to be at their best. The recent political and economic environments have worsened the nurse’s turnover situation. The latest economic crisis has brought more uncertainty in the nursing industry. This, coupled with the infamous ‘Obamacare’ has made the industry even more unstable (Silvers, 2013). The present economic conditions do not guarantee that a job would be secure. Most recently, the government has initiated numerous budget cuts and retrenchment programs which have increased pressure on the already worsened nurse-to-patients ratio. The uncertainty in the health care system has reached alarming levels caused by, most of the population being uninsured and a hypersensitive economy (Colosi, 2016). Colossi (2016) suggested that hospitals need to look for innovative ways to retain and attract staff notwithstanding the hard economic situation and the opaque health care reforms. Local and Foreign Studies Various studies have been conducted addressing the issue of nurse turnover, and many have concluded that this has become a serious problem. Darawad (2009) conducted a study of the Jordanian nursing labor market and discovered that the present education programs cannot adequately provide enough nurses that can fill the shortage. Other scholars from the United States also came to the same conclusion and additionally found out that the nursing education programs lack proper faculties and facilities (Buerhaus, Auerbach, & Staiger, 2007). Most of the studies done on this subject stem from the United States, some few western countries and nations from the Middle-east. A study done in 2002 by a few researchers found out that only 41% of nurses from the United States felt satisfied with their jobs and from Canada only 33% were satisfied. Such a scenario raises a lot of questions about how the situation is in developing countries if this is what is recorded in the developed nations. Another study focusing on the job satisfaction in Hong Kong concluded that most of the nurses in private hospitals had moderate stress and were thinking of quitting. The 139 respondents of the study responded that their highest satisfaction was derived from their professional status as nurses. The study also found out that the older nurses were more satisfied with their jobs than the younger ones because they enjoyed job autonomy and better remuneration (Chien & Yick, 2016). Alhamwan, Mat, & Muala, (2015) found out that the turnover rate among nurses in the Jordanian health system was worse than in the United States. This is attributed to the difference in organization factors such as leadership style, career development and remuneration level. The organization factors are directly related to the intention to leave. The study focused on a cross-sectional survey of registered nurses in Jordan. The respondents were asked to fill out a five-point Likert scale responding to queries about their personal and work lives. A similar study by Hayajneh, AbuAlRub, Athamneh, & Almakhzoomy (2009) found out that Jordanian female nurses had a higher turnover rate than their male counterparts. Jordanian female registered nurses had a turnover rate of 37% while the Male registered nurses had a turnover rate of 36%. Shamsuzzoha & Shumon (2008) conducted a study in Bangladesh to examine the actual reasons as to why nurses’ turnover, the unintended consequences of turnover and what the Bangladeshis local industries could do to remedy this situation. The results of the study discovered that the turnover rate in government institutions is higher than it is the private sector. This is because the Bangladeshi government does not provide job advancement to its employees. The study conducted interviews from the top to middle level managers and their employees. The questionnaire focused on the working environment, job security and salaries. The government did not have proper structures, and their management was lacking. The employees almost never received their payments on time. Another study by Arokiasamy (2016) in Malaysia focused on determining why employees leave organizations and the damaging effects that turnover could have on the productivity of an organization. The study was qualitative and focused on reviewing relevant literature to understand why employees leave their organizations and how or if they can, be retained. The study concluded that employees should be treated as assets and motivated at all costs. For a company to remain productive and efficient they must ensure that all the needs of their employees are catered for. McGlynn, Griffin, Donahue, & Fitzpatrick (2012) in a cross-sectional study using 101 participants suggested that managers should pay attention to the professional interactions between nurses and physicians and among the nurses. The researchers discovered that the administrators and other health sector stakeholders need to ensure that the nursing profession is desirable. The industry is experiencing shortages, and there is increasing demand for more nurses. The study also concluded that nurses appreciated good relationships with their colleagues and most of them denoted that effective relationships enabled better care for their patients. In every health care institution conflict is inevitable. Catterson & Price (2008) in a case study focusing on the ways of managing conflict in a health care environment concluded that nurses should endeavor always to confront their problems as this would enable all the parties involved air out their opinions and ensure that, in the future, there is a better partnership and coherence. The researchers suggested that if conflict is avoided, then the risk of built up anger and resentment could lead to staff turnover and poor performance. The increased rate of turnover among the registered nurses negatively affects health care institutions. Since nurses comprise the largest group in the health care system, the costs associated with replacing nurses are enormous. Strachota, Normandin, O'Brien, Clary, & Krukow (2003) discovered that the cost of replacing one nurse would cost a health institution more than $40,000. Another study by O'Brien-Pallas et al. (2006) discovered that there are huge cost savings associated with reducing nurse turnover. The cost saved by reducing turnover by about three percentage points would equal to at least $800,000 for a 500-bed hospital capacity. Considering that these studies were done more than nine years ago, and accounting for the indirect costs associated with the increased turnover rates, the costs of nursing turnover would skyrocket. Therefore, it is important for researchers and hospital administrators to identify appropriate retention strategies. Relevance of Literature to Research Many researchers have concluded that the phenomenon of nurse turnover has become a global problem. Hence, if the problem is to be resolved, then its underlying causes and effects must be analyzed. The literature discovered has illuminated a variety of causes that lead to nurses leaving their organizations. Some of these causes identified include job dissatisfaction, micromanagement by hospital administrators, lack of proper conflict management systems at the workplace, poor remuneration, lack of job advancement, among others. So, understanding the underlying factors of job turnover, improves the ability of policy makers and hospital administrators to come up with appropriate measures that could help reduce nurse turnover. The literature also boosts our understanding of the effects that turnover has had on the health care system. All the previous studies undertaken illustrate the consequences associated with letting turnover rates increase. Evidence-based research offers stakeholders the proof needed so that they could actually do something to curb the shortage of nurses in the health care sector. Understanding the work environment that nurses operate in enables this research answer questions as to why some work environments are preferred by nurses and others are not. Additionally, the literature sheds light on how turnover affects the performance of the health care organizations. Consequently, if performance is to be improved, then nurses must be satisfied. Moreover, the world healthcare systems are in peril, and the increasing turnover rates may result in a complete disaster of the health care system if left unchecked. Research Methodology This chapter focuses on how the study would answer the question; why do nurses decide to leave their organizations and how does this action affect the overall performance of the health care system. Research Method Zikmund (2010) defined research methods as the techniques and methods applied during data collection and analysis. This study would apply a systematic review of literature from multiple academic sources. It would scan multiple databases such as Ebcohost, Francis and Taylor Library, Wiley Online Library, among others. During the search, keywords applicable would be nurse turnover, nurse productivity, job satisfaction, nurse-patient relationship, nurse retention, nurse shortage and turnover costs. However, indexing problems may arise, and it is prudent that reference lists are scanned to see if relevant material to the study can be identified (Sousa, Driessnack, & Mendes, 2007b). Internet searches of government institutions, consultancy services and nursing associations would be conducted. Such searches could yield fact reports, unpublished research studies, government sanctioned studies, media releases and different theses discussing nursing and employment related issues. The search will limit its scope to at most ten years for relevance purposes. These databases would provide information on the relevant costs related to employee recruitment, hiring and training. Also, to be considered, is the costs associated with employee termination. The study would use a bit of qualitative and quantitative standards to gauge the productivity of employees. The qualitative aspect will focus on comparative studies and an online survey (Driessnack, Sousa, & Mendes, 2007a) Turnover costs will be categorized into four phases in regards to the employment process. These phases are hiring, training, formal employment and lastly termination. Accounting records from government facilities would be used to derive these costs. Nonetheless, it is expected that cost estimates would be made depending on judgment or if data does not exist. The estimated costs would be at lower bounds rather than upper limits. Population Sample and Sampling Techniques The number of documents reviewed will depend on the number of hits resulting from the database searches. Even so, the target of the population sample would be a maximum of 100 documents. Out of this, 70 would be picked based on relevance and age. The relevance and age criteria would be based on; i. Year of publication with emphasis being placed on documents after 2005 and afterward with the exception of relevant conceptual frameworks from before 2005 ii. The documents should be in the English language iii. The documents should focus on analyzing causes of turnover, the effects of turnover and the costs related to turnover. The turnover should primarily concentrate on the impact on nurses either registered or enrolled working in various health care environments. Research Instrument The main tool for gathering relevant information for this study would be peer reviewed literature. This literature would be sourced from internet databases as aforementioned. However, this does not limit the study to only secondary sources. Primary data could also be gathered through the conducting of surveys. These surveys would offer more information for a comprehensive comparative study. The survey would assist in gathering information about people’s beliefs and attitudes towards the issue of nurse turnover (McMillan & Schumacher, 2010). An internet based survey would be the most appropriate since the internet is more accessible compared to other traditional survey methodologies. Internet access has surpassed the 75% mark in America so it would be easier to apply a survey software with a custom questionnaire. The user-friendliness of these software’s would ensure more replies and simplification in the collection and inputting of data (Alessi & Martin, 2010) Data Gathering Procedure The primary focus of this study is to understand why nurses leave their organizations, the costs incurred due to that action and what remedies could be applied to reduce the turnover rate. Therefore, evidence of this aim would be derived from predominant studies that are either published in peer reviewed journals or are unpublished from government websites and professional organizations. These types of studies have a high-quality guarantee and their findings are deemed valid. The initial step would be to identify the relevant literature associated with the aim of this study. Then, the identified studies would be grouped into relevant categories of nurse turnover, turnover cost and nurse retention. Data from the online questionnaire survey would also be incorporated into the study. The questionnaire was formulated with questions derived from the literature reviewed. There would be seven questions, and the answers would vary from strongly agree to strongly disagree. These questions focus on understanding the perception that nursing students have about the health care industry. The survey would be posted online on the school intranet. The survey is not limited to final year students, but available to all nursing majors. To ensure confidentiality, the survey would not require any names from the students but only their year of study. This survey would then be evaluated together with the reviewed literature. Even though the survey is a primary data source, the main source of data for the study would be the reviewed literature. The survey would only support the secondary data. Statistical Treatment of Data Conducting a cost benefit analysis of nurse turnover and retention would provide invaluable data. But this requires that all benefits and costs are quantified and compared. Many health organizations have failed in quantifying all the costs and benefits and focus only on the easy to capture costs and benefits. These easily obtained costs include direct costs such as advertisement costs. Productivity lost from turnover is a relatively difficult cost to estimate. Overall, the costs attributable to health care activities, especially those that follow from third parties, prove cumbersome to value precisely (Folland, Goodman, & Stano, 2013). For instance, these third party accrued costs or benefits, known as externalities, occur outside the organization. If a nurse is retained, then patients and the society would reap the benefits associated with a reduced turnover rate (Needleman, Buerhaus, Stewart, Zelevinsky, & Mattke, 2006). Other issues arising from administering a cost benefit analysis include things like the discount rate applied during the calculations. Discount rates describe what earnings the organization has foregone in terms of alternative investments. It is also prudent not to confuse some costs as benefits. For example, the health care organization could envision that certain strategies would retain their employees yet they failed to consider the increased salaries and compensations awarded to the nurses. (Finkler, Kovner, & Jones, 2007). Therefore, there are certain costs related to retaining nurses in the organization and these should properly be accounted for. Since a cost-benefit analysis possesses inherent difficulties in accurately analyzing nursing turnover an alternative measure could be the cost-effectiveness analysis. This approach examines the costs of turnover relative to the qualitative benefits. The approach has one over-arching assumption: that is, benefits are desirable to the organization, and it is difficult to assign a monetary value to that benefit (Jamison et al., 2006). That is to say that, the study would focus on quantifying the costs, but the benefits would be given a qualitative measure. However, it is prudent that all costs are acknowledged. Sullivan (2007) advised caution, noting that not all nurse’s turnover is equal. Nonetheless, for this study turnover would be considered equal for uniformity purposes. This is true for internal and external turnover and voluntary and involuntary turnover. References Alessi, E. & Martin, J. (2010). 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