Human Resource in Healthcare - Reasons for High Rates for Nursing Turnover - Case Study Example

Student Name: Tutor: Title: Human Resource in Healthcare Course: Table of Contents Executive Summary 3 Introduction 4 Aims & SMART objectives 5 Current Situation/Context 6 Methods and Detail of Analysis 8 Findings & SMART Recommendations 12 Conclusion 14 References 16 Executive Summary Human resource management plays an important role in the delivery of service in the service and hospitality industry. Human capital is an important component when it comes to healthcare investment. The nurses play an important role in the implementation of policies and accomplishment of daily operations. This report analyzes a current human resource issue involve high nurses turnover in a neonatal intensive care unit in a hospital in Riyadh. The level at which nurses are leaving work at the Paediatric department in the hospital is worrying. There reasons that can be attributed to the trends exhibited at this hospital. The report starts with an introduction that sets the pace of the entire essay providing a roadmap and the scope of the research. The department that is the focus of the research has also been introduced in this part. The aims and SMART objectives parts echoes the importance of this report and the focus on employee training and work planning. Efficiency in work planning and nurse training has been emphasized. The context paints the picture of the situation being discussed at the hospital in Riyadh. The Neonatal Intensive Care Unit is the most affected and witnessed a nurse turnover rate of 75%. There is urgent need to address the problem at hand and improve employee retention rate. Method and detail of analysis explains the main discoveries made in the neonatal unit and the inferences that can be drawn from the observation made. The behavior of the nurses and the trend in the unit are an indication of the underlying problems that are in the Paediatric department. Importance of teams’ synergy and appreciation of every team member is important. The findings and recommendations part discusses the observations made making inferences and providing workable solutions to the challenges. The conclusion echoes the main points that have been covered by the report while the references include sources that were consulted in this research. Introduction Goal oriented employee training and workforce planning are important in ensuring employee development through equipping of skills and apportioning or assigning work properly. Employee training is an important part of human resource management (HRM) since it ensures effective use of human capital resource. Workforce planning ensures work is divided, performed and accomplished in the right way contributing to achievement of organizational goals and objectives (Boxall, 2003). Effective workforce planning and employee training can be used to counter high employee turnover and encourage employee growth. National figures from public sectors in Riyadh show high rates for nursing turnover at about 70%, thus resulting severe shortage in the nursing staff (Al-aeeri, 2012). This report illustrates the challenge of high employee turnover with the use of a case study of the public hospital in Riyadh that faces increasing turnover among nurses in Paediatric Intensive Care Unit (PICU). The hospital generally exhibit high standards except for the PICU Department. The mission of the hospitals emphasizes the management commitment in offering the best healthcare services standards for patients through: meeting expectations; offering the optimum support to employees by effective training; and ensuring continuous improvement culture is permeated throughout the organization (Allen & Grisaffe, 2001). ICUs are complex environments with specialist equipment, teams with multicultural backgrounds, a demanding workload, time pressure, and no least, patients that have most severe and life-threatening injuries and illnesses. These factors usually combine causing errors that could have fatal consequences for ICU patient safety. With such a background in mind, there is need of increasing specially trained staff and further training of staff owing to frequent monitoring and frequent intervention for seriously ill patients with emphasis on how work is planned and staffed. Contingency theory holds that definitions Human Resource policies, aims and strategies, operation activities and analyses of the HR department role are only valid if they can be related to the situation of the organization. A contingent approach has to be used by management in the designing and implementation of policy that will match specified organizational circumstances and requires as in the case of the public hospital in Riyadh (Al-Omar, 2004). Many people seek healthcare services in this hospital since it is a public institution. Exploring this topic gives insight into operationalization on important sector in service industry that determines how productive a nation can be (Michie & West, 2004). Without proper focus on the delivery of healthcare services vital lives will be lost and some patients will unnecessarily develop disabilities that could be avoided through more care and efficient operations. Aims & SMART objectives Analyze work planning and staffing at the healthcare organization with special focus on service delivery in the PICU department of a public hospital in Riyadh. Explore the importance of training and workforce planning in the Intensive Care Units to cope with the demanding environment and use of specialized equipment. Suggest ways of improving service delivery, Life is crucial, Workforce planning and staff training is important in service delivery in the healthcare sector where life of people is involved. To explore solutions to high employee turnover in a health care organization. High nurse turnover in the healthcare sector is crippling the delivery high standard service hence not meeting the patients’ expectations. Suggest ways that the hospital to meet the needs of the patients and contribute positively towards a healthy society that can engage robustly in nation building. A healthy nation is a productive nation. Current Situation/Context This report will look at a hospital that I used to work at that has been experiencing about 75% nurse turnover since most nurses left work after two years of employment. The challenging work environment of Intensive Care Units and heavy load of work pressure can be attributed to this trend of high worker turnover (Al-aeeri, 2012). The challenge is to find ways of ensuring high employee retention in order to focus more on workforce planning and employee training. For the purposes of delivering quality healthcare services, it is important for the management to embark of path-finding mission to identify factors that contribute to high nurses turnover. The hospital has established that nurses in the Neonatal Intensive Care Unit (NICU) stayed for a short time after being employed than other units within the same departments. The nurses seemed not to be happy and whenever they find time they would be discussing in hulled up in small groups discussing about their experience in the unit. Constant contact with patients who are in fatal conditions with no proper stress management skills for nurses could cause a breakdown or instigate a desire to leave. Nurses in intensive care units are expected to be alert always and attend expeditiously to any emergency calls and update the doctor from time to time on the conditions of the patients. These work demands coupled with working in a tense environment can have a lasting psychological effect that may force nurses to seek employment in other sectors or completely change careers (Thompson & Heron, 2005). The nurses in the Neonatal Intensive Care Unit seem not to be happy hence unsatisfied with their conditions of their work or the way they are being treated by other senior medical personnel. Recognition and other intrinsic incentives are required to make the nurses appreciate that their part is important and that they contribute to achievement of objectives and goals of the department. Operations in the unit seem to be disjointed and doctors and other medical staff seem to be harsh to the nurses in the department. Whereas protocol has to be observed in the health institutions, every person contribution must be recognized. The feeling by Nurses that they are the lowest in the job rank hierarchy and hence insignificant in achievement of the hospital mission and vision can be detrimental to their morale and concentration hence impair service delivery. The challenging environment in the department and shortage of skills to handle the frequent monitoring besides demanding work in the unit can be attributed to this problem. The nurses require special skills to cope with the challenges within the NICU since they are dealing with delicate patients who require maximum concentration and undivided attention. The demanding work environment can cause lapses in concentration hence leading to fatal errors that jeopardize patient health and safety (Alonazi and omar, 2013). The nurses have to be at the same time conscious of their emotional and physical welfare to avoid draining themselves to a point of affecting their concentration and work delivery. The hospital administration has to evaluate the management style employed in the department and workforce planning to be done to ensure effectiveness and efficiency. Cultural issues can in be in play since there was high turnover of nurses with Indian origin as compared to nurses with Filipino origin. Filipino nurses maybe more adaptable to the local culture and fit quickly in the small communities away from the work environment hence getting the necessary social support that is important. It is important to explore interpersonal aspects and nationality to determine their impact on of high employee turnover (Leggat, Stanton & Bartram, 2011). Proper workforce planning and nurses training can help in meeting hygiene factors and enhancing job satisfaction in the healthcare sector as will be discussed in the subsequent sections. Methods and Detail of Analysis Staff turnover describes the number of workers who leave the organization within the specific period of time. High turnover is a serious topic discussed by practitioners and academicians owing to its detrimental effect on organizational performance and productivity. Healthcare organizations are adversely affected in the case of high staff turnover since replacing experienced and skilled workers takes time and money. The capacity of the hospital to meet patients’ needs and expectations is directly affected by the commitment and service delivery of nurses and hence high staff turnover has a negative impact. The turnover percentage is measured by comparing the number of workers who involuntary or voluntary quit work and the number of workers who stay at work (Leggat, Stanton & Bartram, 2011). There is a big problem at the hospital in Riyadh and high nurses turnover is an indication of a deep-rooted problem. Absence of morale and happiness for the nurses can be as a result of absence of job satisfaction and work challenge. When a worker is unhappy in his or her job position, he will be unsettled and likely to leave. The demanding work environment without training on proper stress management can cause nurses to be withdrawn and hence leave work for other alternatives. The intense work environment needs proper management skills and avenues of letting the frustrations of the nurses known to the hospital administration. The impromptu group discussion by nurses to discuss their problems can be as result of intimidation and mistreatment by other senior medical staff in the intensive care unit. Absence of avenues to discuss work challenges and air out grievances can lead to such meetings. Harassment from supervisors and lack of proper training to deal with the situation can lead nurses opting to work elsewhere or change careers (Ellingson, 2002). Without a sense of belonging and appreciation the nurses feel used and dumped. Breakdown in operations communication in the unit and absence of proper work planning can cause uncoordinated efforts towards saving lives in the intensive care unit. There is high staff turnover in the hospitality industry and the management has the challenge of the reason behind this trend whether negative or positive including non-competitive salary package, inflexible supervision, poor working conditions, threatened job security, unsatisfactory work environment and culture, imbalance between personal life and work; absence of career growth, and dissatisfaction in interpersonal relations with colleagues and supervisors (Hausknecht & Trevor, 2011). This trend can be witnessed in what is happening in the public hospital in Riyadh. High turnover among nurses impacts negatively on the productivity of any hospital and can impede the accomplishment of both long term and short term goals besides failing to meet the expectations of the patients and the local community at large. Neonatal Intensive Care Unit at Riyadh hospital, however, calls for an alternative approach to workforce planning and nurse training to deal with the current challenge of high turnover and enhance retention in the Neonatal Intensive Care Unit (Alonazi & omar, 2013). It is important to explore any cultural issues that compel Indian nurses to leave work more than the Filipino nurses. The nurses may lack skills in change management hence experiencing culture shock in a new environment. All nurses from different cultural backgrounds have to have a sense of belonging to fit in the new environment. New nurses have to be helped to settle in the workplace. Saudi Arabia is among developing countries experiencing high nurses turnover and this could lead to nurses shortage which eventually leads to high dependency on foreign nurses in the healthcare sector. Since the official language used in Saudi Arabia is Arabic, Saudi patients would prefer to be attended to by Saudi female nurses who can explain in detail and clarify doctors’ instructions on drug prescription and specified dosage, but in the absence of Saudi female nurses it becomes difficult to effectively communicate with doctors with limited knowledge of Arabic (Mebrouk, 2008). In the face of increasing Saudi’s nurses turnover there is undesirable situation whereby a profession in nursing is not anymore a career choice among the younger generation within Saudi Arabia. The hospital could be caught up in the same trend of nurses preferring other jobs than a career in healthcare sector. However, the huge exodus from the Neonatal Intensive Care Unit begs for other answers than a general trend in the healthcare industry. The nurses seem to be unhappy at their work owing dissatisfaction (Perry & Kulich, 2008). The issue of job satisfaction has to be explored further since it can have a bearing on work performance resulting in low productivity. The recruitment of experienced nurses could benefit high stressful areas. Rotation strategy has to be introduced to allow the nurses to have a feel of other departments. More work incentives have to be used to attract and retain high qualified individuals with a passion for their work (Armstrong, 2012). Alternative work training has to be provided to equip nurses with necessary skills to deal with a demanding work environment and management of specialized equipment in the Intensive Care Unit. The nurses need to be highly motivated to improve employee retention level and avoid extra costs on recruitment and training of new staff members. There could be a lapse in the synchronizing of activities between the nurses in the NICU and other professionals like physicians hence causing frustrations for the nurses. The multidiscipline has to be handled properly to avoid conflicts or the nurses feeling overwhelmed by the duties delegated to them by other physicians. The nurses have to feel recognized in the role they play in in patient health and safety. In a longitudinal survey carried out among nurses in another hospital, poor communication, low decision making latitude and reutization opportunities were main indicators of intent to leave (Kar & Alcalay, 2001). The overlap of professional roles usually proves to be challenging in the profession of healthcare collaboration across disciplines. The fields of expertise usually overlap on interdisciplinary teams as well as team members tend to perceive role overlap as draining and a source of confusion. A balance has to be struck between the essence for collaboration in meeting team goals and the essence of discrete disciplines to ensure boundaries are maintained (Thompson & Heron, 2005). Territorial issues are often played out in the manner in which the team deals with overlapping roles as well as implicit rules. The role of nurses in the neonatal intensive care unit has to be recognized and accorded respect by other senior personnel that they work under. Overlapping functions trigger perceptions of competition and caused professionals like social workers, nurses, occupational therapists, and physicians to rate members from competing professions negatively, whereas rating their group cells very highly (Ellingson, 2002). The work teams within the neonatal intensive care unit have to be synchronized to that they work synergistically towards achieving departmental and long term hospital goals. Frictions among members of different teams may cause frustrations thus leading to some nurses opting to quit and be transferred to other departments, leave the hospital or change career (Park & Shaw, 2013). Nurses in the hospital in Riyadh may be feeling intimidated by other colleagues in the same department. Findings & SMART Recommendations The hospital in Riyadh has to appreciate the importance of proper work planning and employee training to boost their morale (Tamkin, Cowling & Hunt, 2008). The high nurse turnover at the hospital is appalling but can be managed if specific strategies are implemented to overturn the situation. Intense and demanding environment can be managed through further training nurses and proper work planning in the neonatal intensive care unit. Effective communication among medical staff in the department can deal with uncoordinated operations in the unit (Beck, 2001). Money incentives alone cannot make nurses happy and their work. Hygiene factors like recognition and career growth through promotion can boost nurses’ morale. The nurses should not feel the lowly ranked in the department when their contribution is crucial. High impact changes are areas where human resource interventions can make a big difference to the bottom line impact with regard to quality, cost, efficiency and patient care. Work planning and training will lead to efficiency, quality and cost reduction (Gollan & Perkins, 2007). Disjointed operations can a sign of absence of proper work planning and insufficient skills to deal with the intense atmosphere. Nurses’ turnover is a major challenge for hospital administration and other workers. Job training as well as customer service strategies have to be used to improve employee retention (Ulrich & Brockbank, 2005). It is not only the length of employment that affect employee stability but factors like formation of social ties, importance of familiarity with the job setting, and other intangible and tangible benefits which emanate from long service. The issue with the Indian nurses has to be probed further. Employees also stay at the safe organization since they are able to forge good relationship with their fellow workers (Ferris et al, 2008). The environment the hospital should encourage formation of social groups and engagement. Work rotation should allow nurses to have some free time to engage in interpersonal social events that encourage good relations with co-workers. The fact that Neonatal Intensive Care Unit work environment is demanding and requires maximum attention, it is important for nurses not to work for very long hours to avoid monotony and boredom (Swift, 2012). Nurses on duty have to be relieved after six hours to allow them to relax and come in for another shift after plenty of rest. The nurses should be involved in work planning by their supervisors and head of department. Strategies that are well-thought-out and human resource planning, selection and recruitment initially offer an organization with the needed workforce, further training usually needed to offer employees with job-specific skills that enable the workers to survive over time. High staff turnover decrease the return on investment with regard to human capital and consequently leads to reduced investments (Armstrong, 2012). High retention levels will encourage the public hospital in Riyadh to increase the budget on human capital management. Training has to be integrated with a clear path of career development to encourage the nurses to give their best. Where there is no chance for progression in the career ladder, nurses may resign and seek jobs elsewhere where they are assured of career growth. Career growth has to come with both intrinsic and extrinsic incentives. Stability in employment and assurance of career growth encourage nurses to stay. The nurses need special training on time management and dealing with stressful environment (Leggat, Stanton & Bartram, 2011). The nurses need to understand how to apportion their time between work and personal life so that there is no crisis. Organizations may recoup their investment in certain training and they will be very much willing to share some or part of the costs of specific training as opposed to general training. Specific training to equip the nurses with required skills to cope in the demanding work environment within the NICU is important. The nurses should be trained on balancing personal life time and work duties. Frustrations can lead to dissatisfaction where nurses feel their work is creeping into their personal life commitment. The Riyadh hospital needs to have an avenue that addresses any grievances in the course of their service delivery (Mebrouk, 2008). Assigning of roles has to be done without making nurses feel intimidated or overburdened in their service delivery in the department (Shaw et al, 2005). Counseling can help nurses to cope with the challenges within the neonatal intensive care unit in the hospital in Riyadh. Conclusion There is a remarkable observation in the nursing career where the young generation is opting for other jobs than a career in nursing. The hospital in Riyadh is a typical example of the situation and trend in the healthcare sector. The neonatal intensive care unit is a demanding unit that calls for maximum concentration. Nurses working in the department have to feel appreciated before they give their best in service delivery. Sometimes the contribution of nurses towards achievement of the mission and vision of the hospital is not recognized. Operations of the hospital are largely dependent on the availability of adequate and skilled nurses. The nurses have to feel as part of the large team in the Paediatric department. The neonatal intensive care unit in particular has critical patient who require constant attention and therapy. The nurses have to be alert and standby for anything while working here. Absence of effective time management and stress management skills can affect personal life of the nurses. The nurses need to have a balance between work and personal life to avoid being overwhelmed. Time management skills would be vital in helping the nurses to settle in their workplace. The environment in the hospital in Riyadh has to be optimal for the nurses to deliver their best services. The grievances of nurses in their profession have to be communicated promptly to the management of the hospital. Boundaries and separation of powers among different medical disciplines should not hinder service delivery as long as there is effective communication. Wrangles between teams are bound to affect service delivery. Work teams need to have proper integration and synergy to avoid conflicts in the department. The nurses have to be fully involved in the work planning and assigning and duties to avoid the feeling of being picked on. Overlapping functions result into a feeling of competition within teams in the department. The hospital has to know how to deal with the differences among teams and appreciating each other’s roles. A hospital has to improve its retention capability if there is any hope of ensuring standard and quality service delivery. When experienced nurses leave a hospital, a big gap is created that takes time and money to feel. 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