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Government, Health, Education, Environment, Nursing, Policy, Health Care, Workforce

Government, Health, Education, Environment, Nursing, Policy, Health Care, Workforce

Redesigning Policies To Increase Nursing Retention Research Paper Samples
Type of paper: Research Paper

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(NRS 441V: Professional Capstone)
– Abstract
A sizeable research shows that the currently witnessed nursing retention problems have significantly hampered the provision of healthcare across the United States. Nursing shortage is directly tethered to the low retention rates and not unless drastic steps are taken to avert this problem, the entire healthcare system is set to experience a hard time ahead. Therefore, this paper intends to explore what are the probable causes of this problem and subsequently give recommendations on the best evidence-based approaches to resolve the issue. Overwhelming evidence shows high levels of work stress and dissatisfaction are the primary causes of this problem. Attrition rates and early retirements in nursing are very high and as such; this paints a clear image of a less satisfied workforce. Therefore, to resolve this problem, there should be a collaborative effort between the government and the hospital management to improve the working conditions of the nurses through increased incentives, remuneration and friendly workforce management policies.
– Problem Description

Picot question
Will redesigning nursing workforce policies help to increase nursing retention rates?
Population: Nurses
Intervention: Redesigning policies
Comparison: Existing nursing workforce policies
Outcome: Increased nursing retention rates
Amidst a biting nursing shortage across the entire health system, one of the problems that are leading to the severity of the problem is the inability to retain nurses. Nursing retention has affected the whole healthcare system with high quitting rates and early retirements. Workplace dissatisfaction has been one of the factors that have occasioned the problem of retention. Human population has increased tremendously within the past decades, and this has put a lot of strain on the current workforce, leading to untold workplace stress and hence lack of motivation. Patients have been the biggest losers as hospitals are grappling the nursing shortage. As a result, the quality of care received by patients has radically deteriorated, and this translates to diminished patient outcomes. For instance, some of the healthcare facilities are compelled to refuse patients or undertake pre-mature hospital discharges as a way to reduce the workload for the current force.
– Solution Description
Evidently this problem has its roots in policies. The government and other healthcare stakeholders underestimated population growth and as such failed to take proactive measures aimed at catering for the health of the ever-increasing population. Therefore, as a solution, there needs to be a policy change at institutional level and governmental level. Managers of healthcare institutions should adopt nursing schedules that aim at reducing workplace stress, perhaps through reducing work hours per nurse. On the other hand, hospital managers should implement ‘performance-pays’ as a way of rewarding nurses who perform outstandingly and subsequently motivating the nursing staff. On the other hand, the government should adopt policies that make nursing a prestigious profession in a bid to attract more people to enroll for nursing courses. This can be done through providing educational advancement opportunities for the current nursing workforce and increasing salaries for nurses. Likewise, the government should avail more educational opportunities for young people who intend to study nursing in colleges. Provision of incentives such as loans and scholarships can attract more young people to enroll for nursing courses, as a way of securing healthcare in the future. By so doing, the healthcare system will manage to reduce quitting levels and foster higher retention levels.
– Implementation Plan
One key aspect of ensuring nursing retention and minimizing the cost of replacing the quitting nurses is to develop a strategy through policy making that can enable nursing as a profession compete for the top cream in the job market and education sector. On a similar note, the idea is to make nursing a profession where the welfare of the nurses is taken into account as an influencing factor in the quality of care provided. Today’s nurses are holistic and are indeed expected to serve more than just the instructions provided by the physician. They are expected to act as advocates for quality care, patient education, as well as act as leaders in their roles (Wieck et al., 2010). However, organizational cultures and the work environment have been seen as an impending factor in ensuring that the nurses perform these roles adequately.

Rationale for selecting proposed solution
The decision to adopt new policies as solutions to the ever persistent nursing shortage was based on the review of different literatures that have majored on the causes of the nursing shortage. On the other hand, interaction with the current, retired and nurses who have quit the workforce unearthed that the work environment has not been essentially supportive for the nurses. As such, the solutions lay on the need to work out the policies that can effectively provide a satisfactory work environment. Similarly, a review of the costs and benefits of implementing this solution proved that it would ultimately be viable to retain the current workforce as opposed to replacing the quitting workforce (SPENCE LASCHINGER et al., 2009). This would also act to attract new entrant into the profession especially the young people who have always had the aspirations to join nursing. The key has been to bring nursing to a level where as a profession it can compete in the job market with other professions especially in terms of pay packages and satisfactory work environments.

Supporting Literature for implementation
An aging workforce, job dissatisfaction, changing patient demographics and lack of satisfactory work environments are the primary causes of the nursing shortage today (Tillot et al., 2013). This then underlines that while the resources may be continually available, the appropriate management and distribution of these resources to key aspects of nursing has not been entrenched. This is more in line with what Renter et al. (2014) identifies as magnet designed organizations that focus on positive work environments defined by emerging needs within the professions. Continued education and attractive pay packages are the major aspects that can be adopted from the magnet designed organizations that would go a long way in facilitating the workplace that motivates the workforce.
On the other hand, an organizational culture defines how well the policies will be implemented and adopted to completion. This brings to the fore the critical role of the Nurse Manager in ensuring full adoption of the policies that will create an enabling environment for nurses across all diversity in demographics and ideologies. According to Wieck et al. (2010), the Nurse Manager must provide channels that link the new nurses to the experienced workforce in such a way that they are nurtured in skill and leadership. This, Wieck et al. (2010) notes would be one of the intrinsic sources of motivation of the young nurses by placing more responsibility on them and giving them a platform where they can be involved in decision-making and policy reviewing.
In Dunn (2012), the relationship between the nurse and the patient plays a crucial role in the outcome. However, the relationship can only work well when the nurse is provided with an environment that alleviates fatigue and psychological stress. Such an environment should give the nurse the freedom to make decisions that suit the patient without necessarily relying on the instructions provided by nurse leaders or physicians. This autonomy can however impact negatively especially when the welfare of the nurse is sidelined SPENCE LASCHINGER et al. (2009). Nurses may potentially use the autonomy to make decisions that compromise on the quality of care especially by omitting procedures when under pressure to serve more than one patient. As such, Dunn (2012) calls for collaborative cultures within the workforce. The author also notes that if nurses have to work collaboratively with other specialties in healthcare, the utmost aspect is providing them with sustainable pay packages that are at par with other professionals within healthcare. Along this view, then all indications point to a particular weakness in policies as opposed to availability of resources. Restructuring the nurse’s education system, the salary and pay package system and the work environment will essentially provide the short-term and long-term solution to the nursing shortage.

Description of implementation logistics
Nurturing leadership, open up avenues for continued education and sustainable pay packages that can match other professions are three major strategies that need to be considered when thinking about the welfare of the nurse. This begins with creating organizational cultures that support independent decision-making and collaborative approaches in delivering care. Nurses need to be appreciated not as assistants to the physicians but equal partners. When this is achieved, motivation is gained, and the work environment supports nurturing leadership for nurses. On the other hand, emerging technological changes require that nurses and physicians be allowed to gain continued education so as to remain relevant in the care they provide (Dunn, 2012). This implies that governments and organizations should be in a position to provide funding for such programs collaboratively and thus begins with efforts to legislate such allocations at federal and state levels.
In another perspective, wages and salaries as well as performance pays based on merits should be implemented. The level and quality of service delivery in any organization is proportional to the salaries and wages provided as well as other intrinsic motivational factors such as the performance payments. These should be retained and documented within the organizational policies through a collaborative deliberation of such payments (Dunn, 2012). At federal level, legislation should provide for such motivational payments as well as ensure that there are strict regulations that govern how these payments are awarded through merit. The full implementation at federal and organizational level will take up to 12 months considering the lobbying involved in adoption of proposed legislation. At organizational level whoever, the proposed solution should kick-off as soon as approval is granted by the leadership since current policies can still provide a significant solution for the short term. On the other hand, issues such as organizational culture that will need to be reviewed across all healthcare institutions do not require any demanding resources for adoption.

Resources required for implementation
The proposed solution is based on the adoption of policies as opposed to restructuring of any major physical infrastructure. As such, a multidisciplinary approach is required between organizational staff as well as key stakeholders on the health sector and legislative or political leadership. Through the nurse leaders and professional organizations, it will be less demanding to formulate and deliver the proposed legislative agendas that will support the proposed solution. Similarly, with the level of influence that the professional organizations and in particular the American Nurses Association wields, the lobbying of support for the legislative recommendations will be done within the proposed timeframe (Saunders, Evans & Joshi, 2005). Evaluation for this program will be based on the assessment of nurse quitting rates upon a year’s full implementation of the proposed solution. This will also provide a reflection of the positive work environment as achieved through the proposed policies.
On the other hand, evaluation will also be accessed on the enrolment trends in nursing colleges which will reflect a new passion for the course as instigated by friendlier funding and career advancement programs in the nursing curriculum. At organizational level, the evaluation will be based on the how new nurses adapt seamlessly to the organization and their ability to demonstrate good-decision making and practice autonomy. This will reflect a new found ideology for nurturing informal leadership skills within the workforce.
As identified, the nursing shortage as a problem finds its origin from the workplace environment that does not offer any motivation to the working staff. When the work environment tends to an extra level of strain to the staff, issues of dissatisfaction and work stress tend to be more rampant. The solution lies in developing strategies and policies that facilitate a more satisfactory work environment. Hence, the need to motivate the nurses by reviewing their salaries, equipping them well and the setting up of facilities and infrastructure that can significantly reduce the strain (Dave et al., 2011). At educational level, it is critical that the key stakeholders regularly make a review of the curriculum in relation to other careers. This should be aimed at trying as much as possible to place nursing profession at par with other professions in terms of career advancement plans and leadership and nurturing skills (Sheldon, 2013).
McClelland’s Human Motivation Theory identifies three major aspects that can help set up a highly motivated team. The theory identifies that a need for achievement, affiliation need and a need for power as the three major motivational factors that drive people to achieve good results within the workplace even when the tasks are overwhelming (McClelland, 1987). As such, the nursing shortage problem is solely based on the lack of a motivating environment where nurses feel as though they are subordinate to physicians and other high ranking nurses. However, the modern nurse’s role is highly holistic and independent. Thus according to McClelland’s Human Motivation Theory people are driven by different motivational factors and thus the workplace should place measures that provide such motivation.
There are those who seek to achieve better, and this should be associated with the need for increased salaries, ‘performance-pays’ and other forms of intrinsic motivation (McClelland, 1987). On the other hand, those who work to seek affiliation tend to value the relationship between them and the institution, the career or those they serve. As such, they tend to value the relationship between them and the organization. It is thus critical that the organizational provides a platform for reciprocating and safeguarding the relationship. In a similar aspect, the organization should seek to nurture informal leaders from within its workforce. There are those who feel motivated by power and the need to ascend the organizations management ladder (McClelland, 1987). The organization should thus provide the channels that help identify the hardworking nurses who demonstrate leadership skills and provide them with avenues to ascend the organizational ladder as they seem to serve best at higher levels of responsibility.
McClelland’s Human Motivation Theory implies that there are three forms of motivational that drove workers in any organizational; affiliation, achievement and power. As a nurse leader, the primary focus is to identify the dominant motivating factor for each of the members within the workforce so that their role is aligned to the motivational factors. This alignment then forms the structural plan along which the members can work to achieve their motivation. While some may need to work in a collaborative environment, others will seek to work in a competitive environment (Sheldon, 2013). The nurse leader must thus be at the core to developing structures that provide such working environment where members are highly motivated. Achieving a highly motivated workforce means high retention rates and reduced nursing shortage levels.
– Evaluation Plan
Developing and evaluation is a critical component/phase of the change program. The evaluation plan acts as the baseline upon which the objectives, variables and timelines are gauged to determine how well they suit the expected final outcomes. Thus since the evaluation plan acts as the guide to achieving the outcomes, the program designer must ensure that the evaluation plan can provide information that is relevant to the program. This then avoids the wastage of time by the program implementers on information and activities that have little or no significant impact on the final outcomes (Ma, 2000). The evaluation plan is based objectives, the evaluation questions, the reasonable timelines, performance measures and methods/procedures of data collection relevant to determining how well the outcomes and the objectives have been met. The nursing-shortage-problem implementation plan focused on the change of strategy/policy as the proposed solution to the identified issue of the nursing shortage (Oliver, 2010). As such, and like in any other issue or problem in nursing practice, the identified population was the nurses, the problem was the nursing shortage occasioned by a myriad of factors, the intervention was the adoption of new policies and the timeline for the implementation was set at a reasonable one year.
Objectives and Outcomes
Objective 1: Create a positive work environment for nurses by increasing salaries and autonomy for nurses, nurturing leadership skills and providing channels for career advancements.
Outcomes: A positive work environment for nurses will help in retaining the current workforce, reduce turnover rates and subsequently increase job satisfaction. Nurturing leadership skills will act as the basis for motivation within the workplace as nurses are enabled to practice autonomy thus feeling more responsible. The evaluation plan will focus on monitoring the turnover rates in the past few years and engage former nurses who have quit the workforce to determine the reasons for their decisions to quit. On job satisfaction, the evaluation plan will engage the current nurses and nurse leaders to make a comparative analysis of their views on whether the current work environment is satisfactory or the nurses (Saunders, Evans & Joshi, 2005). The divergent views of the nurses against those of the nurse leaders will form the basis for the reviewing of the proposed solutions (Ma, 2000).
Objective 2: Increase enrollment in nurse colleges
Outcomes: The key objective for any organization is to ensure continuity in the workforce. This is achieved through retaining the current workforce and at the same time replacing the retiring or aging workforce. As such, the rates of enrollment at nursing colleges will facilitate the availability of the workforce that replaces the outgoing group while also proving the workforce that can help bridge the current gap in nurse-patient ratios. The focus will thus be on the trends in enrollment in nursing colleges nationwide. Where there are cases of low turnout at enrollment, further analysis will be done to determine the causes. Subsequently, effective measures to attract enrollment will be employed such as offering incentives to potential nurse student enrollees. Similarly, the evaluation plan will monitor the completion rates an annual basis and determine whether the rates are harmonious with the comparative enrollment rates (Saunders, Evans & Joshi, 2005). Where there is no harmony between the enrollment and completion rates, a taskforce will be formed to investigate the causes and report the findings and recommendations within six months (Ma, 2000).
Methods
Questionnaires
The key stakeholders will be used to provide with questionnaires upon which they will be required to give their views on selected issues that are relevant to the problem in question and their role in the nursing sector. The selected participants will be picked from the current workforce and will include registered nurses, nurse practitioners, nurse educators, nurse informaticists, Nurse Managers, leaders of professional nursing organizations at state and federal levels and nurses who have quit or retired in the last one decade. These questionnaires will focus on job satisfactions views, leaderships nurturing, motivation within the workforce and enrollment. It will also focus on views on reasons for quitting at early stages of the career from former nurses (Oliver, 2010).
Interviews
Some selected participants will be subjected to interviews to gain a hands-on experience of the trends in nursing and the current policies designed to improve retention and minimize turnover rates (Ma, 2000). The interviews will focus more on nurse leaders and leaders of professional nursing organizations. These will also be relied upon in understanding the views of the nurses who have quit since the interview provides a platform where they can air their views in a concise manner.
Survey of organizational data
One of the critical aspects of the evaluation process is to combine quantitative and qualitative data to draw appropriate conclusions. A realistic approach to this process will be to make a detailed mathematic analysis of the trends in nursing colleges focusing on enrollment and completion rates in the last decade. Similarly, the rates of licensing, certification and registration of nurses for the last one decade will be analyzed to guide a clear picture of the trends. Finally, this data will be caused against the comparative views of the nurses, nurse leaders and other stakeholders who will be considered worthy participants of the evaluation process.
Variables
The relevant variables for this study will include job satisfaction and motivation. These will be monitored by applying ‘direct indicators’ or ‘other-work indicators’ and the Facet Satisfaction Scale (Oliver, 2010). The focus will be on pay hours of work, future prospects (job security and promotion); difficulty of the job, job content (prestige, interest and independence) and interpersonal relationships. Quantitatively, the variables to be assessed include the turnover rates in the last one decade and the comparative rates every year after the full implementation of the proposed solution. Enrollment rates ion colleges and the completion rates will be monitored to determine whether the proposed policies have had any significant impacts on the rates and the trends (Saunders, Evans & Joshi, 2005). The evaluation of these trends will be conducted every one year upon full implementation of the proposed changes.
– Dissemination Plan
Dissemination of data is an essential element of any project since it keeps all the stakeholders of the project updated and informed on the progress of the project. It will be a waste of resources time if the benefits of the project are not communicated to the parties affected by the project. Thus, it is of great significant that the government, colleges that offer nursing courses, nurses, hospitals administration and the general public comes aware of the devastating effects of the nursing shortage. Therefore, it’s paramount to find a medium that will make sure the information reach the end users and the general nursing community without distortion of any part of the data (Parekh et al., 2010)
The best strategy to disseminate the findings of the project is through a journal both in hard copies (publications) and softcopies (emails, website). These venues will make sure all the stakeholders get the information in the original form without any fabrications. The essence of this journal strategy is to make an everlasting impact that will last for long for years. In addition, the distribution of the information would be easy, and all the parties will get the information at their convenient time. Since the internet is widely used, the audience reached by the website will be bigger at a low cost. Thus, all the stakeholders can take their time to read the journal at the comfort of their workstation through the computer or the publications. This will give all the stakeholders chance to evaluate the findings of the project and give their recommendations in various discussion platforms. Furthermore, the nursing community in general can have access to information since it would be on the internet and various collections of nursing publications. Thus, when the nurses search on the internet about the nursing shortage they can come across the journal and get the information. Moreover, the publication of the research can be used as an additional reference for other researchers in the future (Mashiach, 2011).
– Review of Literature
Tillot et al. (2013) identifies that nursing shortage is a result of an aging workforce, aging population, job dissatisfaction, shortage within the nursing faculty and the lack of an engaging and collaborative environment is care settings. Tillot et al. (2013) utilized a systematic review of past literature aimed at assessing the factors that deny the workers an opportunity to engage their colleagues constructively in practice. The study notes that the management should focus on developing an environment where communication and staff collaboration and engagement is considered a primary element of the organizational culture. The study is highly applicable in nursing practice since it identifies the major issues that have held back nurses or at other times motivated them to engage with colleagues in making decisions pertaining care. This information can then be utilized to develop policies that can significantly help retain nurses in the workforce.
Duffield et al. (2011) examine the impact of nurse managers and their relationship with the other staff in the delivery of quality and timely care. The study used a secondary analysis if 94 randomly selected wards from a total of 21 public hospitals. The data was collected for a period of two years upon which this information was subjected to a logical and mathematical analysis using SPSS version 16 software. All nurses (n=2488 with 80% turnover rate) within the selected wards were presented with a survey that they were required to complete. The survey included a 49-item Nursing Work Index-Revised [NWI-R] which also included other job satisfaction measures such as satisfaction with nursing as well as intention to quit the career. The subscales of the survey were then calculated with leadership that formed the domain of interest having a total of 12 times. The subdivision of wards was based on those that reported positive or negative leadership. The results indicated that the positivity or negativity of the ward was solely based on the nurse manager leadership skills. A good leader was described as visible, consultative, can work with flexible work schedules and was able to recognize and praise the role played by others. Combining leadership with practice has been proved to be a key aspect of encouraging and keeping the workforce motivated. The study advocates for the open management systems in nursing that essentially form the core concept nurturing and encouraging nurses in practice.
Wieck et al. (2010) is a literature review based on the analysis of online survey of staff from 22 hospital settings in which job satisfaction and perceptions of safety using the Nurse Manager Desired Traits survey/tool and the Nursing Work Index-Revised tool. The results indicated that satisfaction levels were high with the nurse/physician relationship abut lower for the nurse control of practice. On the other hand, younger nurses were said to have less satisfaction in practice as compared to older nurses beyond the age of 40 years. Wieck et al. (2010) helps in identifying nurturing as a critical aspect of retaining and encouraging the young nurses. On the other hand, the need for a stable staff, revamped incentives for motivation, nurses’ safety and empowerment of the nurse councils are identified as playing a significant role in retention and keeping the staff motivated. The recommendations can be helpful in drawing up policies that can ultimately help in ensuring a better environment that serves the interest of the nurses to the fullest.
In a similar study to Wieck et al. (2010), the study by Twigg & McCullough (2014) employed a systematic review of 41 articles all relating to nurse retention. Thirty-nine of the sources revealed that Nurse Managers play a key role in adopting strategies that can ably create a positive working environment for the nurses. The recommendation provided here can be adopted to develop policies at organizational level that can aid in nurturing skill of the young nurses and motivating them to remain in the service.
Renter et al. (2014) identifies the work environment and nurse satisfaction as a key to improving the nurse retention rates. Renter et al. (2014) is a literature review of related sources collected from renowned medical and clinical databases. The study was based on a PICO question “How does nurse retention in acute-care hospitals with Magnet designation compare to nurse retention in non-Magnet hospitals?” The results indicated that Magnet designation provides a positive environment as compared to non-magnet acute care settings. Magnet designed organization have programs that facilitate career development for the nurses, funding continuing education for their workforce and promotion of employee education. Renter et al. (2014) establish that as long the best solution is to make all possible costs to retain current workforce since the costs of hiring a new workforce highly overwhelm the costs of retaining. On the other hand, loss of current workforce is accompanied by loss of experience and expertise coupled with an unstable organizational culture.
Dr. Wang in his many years in the health care professionals has observed that many nurses and doctors are becoming specialized in their area of expertise such as urology, hematology, and pulmonary disease among others. Although this meets the doctors’ expectations of efficiency, professionalism and quality care, it’s a divergent from the core function of a nurse which is providing care to all the patients irrespective of the disease or illness the patient is suffering from. Additionally, due to poor numeration packages, nurses have resulted to take administration position is various healthcare facilities to gain more allowances. Thus, due to these scenarios many health facilities are facing a shortage of nurses. Therefore, although specialization is an excellent idea move in the nursing professional, Dr. Wang proposes for review of policies which govern the nursing professional so that the they can make sure nurses are paid according to their experience and the kind of specialization they are engage in. Furthermore, the hospital administration should be able to design work schedule that accommodate nurses social life. As such, nurses should be given ample time to be with their loved ones at home not confined to the hospital all their life. Additionally the hospital administration should work out mechanism and working ethics which will make sure the nurses and doctors work in harmony. In the case of a conflict there should be guidelines on how to solve the disputes so as the patient is given the best treatment from professionals.
Dunn (2012) looks at the positive side of nursing professional that keeps nurses in the professional despite wide negativity about nurses as has been portrayed by previous research. Moreover, it also looks at the impact nurses have on the patient as they administer health care to the patient. On the hand, previous research have shown nurse leave the professional due to job dissatisfaction, getting opportunities elsewhere, retirement, fatigue and psychological stress. The research employed Schoenhofer and Boyking nursing theory as the framework for this research. Thus, this theory asserts that nurses are supposed to have an attribute of a caring and nurturing relationship. These are the core values which should drive nurses. Hence, nurse should be looking forward to alleviating the suffering of the patient by forming a good relation with the patient. The research found out that the nurses do their job simply because they believe it is the right thing to do. Additionally some see it as a way of giving back to the society since it was ethically correct.

 

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