Executive Summary
Nurses are critical caregivers in hospitals; they affect the quality of service delivery and eventually, the treatment and patient management. Similarly, hospitals search for quality patient service is reliant on a nurse’s responsibility to organizations’ capability to manage the skilled nursing staff. However, the majority healthcare face a challenge of nurse decrease because of the aging nursing workforce. Most nurses are approaching retiring age. Therefore, this trend calls for the provision of work-related incentives and strategies for retaining experienced and new entrants to the nursing field. This will inspire and encourage them to contribute their expertise successfully in the healthcare systems of hospitals.
The increasing nurse turnover in healthcare remains a crucial crisis in the effective delivery of nursing service. The turnover is linked to various causes such as; work environments, compensation structures, and nurse value systems. This trend has been increasing over time because of job dissatisfaction and inefficient retention strategies. To guarantee nurse retention and increase the quality of service, healthcare organizations have to institute fitting strategies to constraint these challenges.
Introduction
A modern nurse demands more out of a job rather than the normal incentive of a paycheck. A nurse’s expectation has varied, in the past few years. Thus, a nurse needs a balanced life, enjoy secure rapport with her employer and achieve professional success, to contribute to the growth of the organization. Therefore employers are challenged to identify the change and develop strategies of winning nurse job satisfaction.
Thorpe (2008) content that, the shortage of labor in the health care sector has underscored the necessity of attracting and retaining competent employees. Although recruiting and selecting healthcare personnel is based on clinical profession such as a pharmacist, employees of different skills are increasingly becoming a challenge to find and retain. Besides, replacing and employee is expensive, this suggests that an organization can spend more fiscal resources in hiring and recruitment, training and lost productivity. In their view Carlisle et al (2011) points out that beyond spending monetary loss, an organization also losses the dedication and knowledge connected with the long-term employees.
This research paper addresses the nurse retention issues at Renfrey Memorial Hospital (RMH). By decisively addressing the crisis, the paper explores the strategies carried out by hospital which faced similar challenge, and singles out two strategies that these hospitals used to alleviate the problem of nurse turnover. Further, the paper explains how these two proposals and the stakeholders who will be involved in implementation of the strategy for the next two years. Finally, the paper recommends one strategy, which can effectively; address the turnover at Renfrey Memorial Hospital (RMH).
Description of the Issue
Renfrey Memorial Hospital (RMH) is a regional hospital with a bed capacity of 200. The hospital has existed for 32 years. It is renamed after well renowned philanthropist, Mr. Gilbert H. Renfrey. Apart from contributing financially to Renfrey Memorial Hospital (RMH), Mr. Gilbert has continuously supported various projects in the Renfrey Memorial Hospital (RMH) within its locality. The hospital manages a twenty four hour emergency and “extended hours” for urgent care in the area. The hospital upholds a 24-hour emergency department in the area, and “extended hours” emergence care clinic.
One of the main crises affecting the hospital is the nurse retention. According to the report commissioned by the hospital, it was noted that that 68% of the nursing staff were over the age of forty five years, the age nearing retirement. The survey also noted that many nursing staff find their work too physically demanding and consequently feels physically fatigued, besides reporting emotional worn out. Also, the survey showed that most of the nurses reported that they were stressed because of caring of the aging parents as well as working at the hospital. These conditions have made the hospital experience the exodus of nurses for the past two years. Because of this exodus, the hospital was compelled to use the services of nurses from agencies on a short-term basis. However, this added cost in terms of personnel and decreased patient satisfaction. Further, the shortage of nursing is hampering recruiting replacement for the retiring staff, retiring in the next two years. Also, the organization faces a critical staffing hitch a head, as it ponders on these crises. Therefore, the organization board is concerned. The organization is pondering of strategic changes that will reduce financial strain and human resources challenge in the future.
Best Practices
Bon Secours Hospital, Virginia
Bon Secours Hospital was founded in 1824, by the Sisters of Bon Secours, a Catholic society based in France (Bon Secours Richmond Health System, 2011). The hospital believes that Bon Secours is “a place to work for life” thus; the meaning formalizes the tradition of honoring age and experience that some organizations support whereas others lack for many years.
Whereas retention is indispensable for all nurses, the Bon Secours provides a wide range of services to its mature and experienced employees. Bon Secours services are unique because of the level of individualization. Bon Secours’ retention services are classified into four areas. The first one is the mentoring. Mentoring program was launched in 2008, under the “Guiding light” Mentor Program (Bon Secours Richmond Health System, 2011). The program is beneficial as it allows experienced nurses to offer guidance and clinical mentoring to new nurses. The program was introduced to decrease the rate of turnover especially for new nurses. Similarly, the program was to promote nurses to learn that mentoring opportunities are necessary during their career has it instill critical thinking, intuitive and communication styles of experienced nurses.
Bon Secours also has the Elder Care program. The Elder Care program benefit allows home health workers to provide in-home care service for staff aging spouses or relatives. According to Erlich and Bichard (2008) the program has grown to popularity and has been viewed as a success for the organization and the mature nurse workers. The program has proved beneficial to Bon Secours. This is because it has helped the hospital to retain experienced and experienced workers aged fifty to sixty-five years. Otherwise, the nurses would have considered abandoning their jobs to take care for their elderly or aging spouse (Bon Secours Richmond Health System, 2011).
An elaborate work design and Ergonomics is also part of Bon Secours retention strategy. Bon Secours recognizes the physical strain of bedside care. Therefore, they offer work revamp and ergonomic strategies to retain qualified nurses at the bedside. Some notable examples include; lighting, improved flooring, workstation redesign and operation of lift teams to aid in the elimination of patients managing injuries. These initiatives help nurses to be alert at bedsides for; teaching, mentoring and direct patient care, but they are not required to perform all the extensive work involved.
Lastly are the Retirement Arrangement and Flexible Work. Bon Secours Hospitals has independently tailored work and retirement arrangements to match its employee’s needs. The hospital provides work scheduling for each employee. For example, an employee has a choice to select choices of working either during weekend shifts, part time or full-time and on-call as a situation may call for. In 2000, the Bon Secours began designing programs for retaining the elderly nurses (Beatrice et al, 2009).
Scripps Hospital
Scripps Hospital is located in San Diego, California. The hospital operates in a metropolitan environment with a competitive living standard; hence, the high cost of living has challenged the organization’s capacity to develop strategies in recruiting and retaining nurses. The hospital as a detailed employee recruitment and retention programs aimed at motivating its workforce (Scripps, 2011). The organization has detailed a five year plan that addresses talent and retention management. The five year plan is arrived at after evaluating the retirement trend and retention and the probable healthcare systems areas of development. The organization utilizes this information to evaluate potential areas where talent loss may pose a risk to the organization. The retention programs in the organization are framed to retain experienced and mature workers (Erlich and Bichard, 2008).
Scripps Hospital has creatively strengthened its employee retention approach by developing a Physician Leadership Cabinet. The role of the cabinet is to encourage transparency and teamwork among its employees. The council also underscores the experiences and responsibilities of the physician and nursing council by encompassing them in critical decision that impacts them (Scripps, 2011). The council acts as a medium for addressing organizations issues thus harmonizing relationship between administration, nursing leadership and the physician leaders. The council has improved transparency and inclusions of the nursing leadership through its open door communication with the senior management. The open door policy of communication allows the nurses to express their grievances or suggestion on new policy they wish to be implemented. According to the hospital website, the hospital seeks opinion from the employees through; the focus groups, questions submitted to the management and the “Great Place to Work”, an annual employee opinion review (Scripps, 2011).
Scripps also has the talent forecasting and development as a retention policy. The organization develops recruitment and retention plans which are revised annually. The strategy developed becomes part of the organization strategic plan. Through this strategy, the retention plans such as; phased retirement and flexible work provision are developed and implemented when a need arises. The hospital retention strategies are undertaken by the Human Resources department who oversees their implementation. This is due the fact that HR are in constant interaction with employees through occasions such as communication, training and orientation among others.
The organization has aligned the compensation and its associated rewards to ease retention. The hospital compensation programs are designed to reward the nurses aged over 50 years for their service and skills to the organization. Besides, the compensations are aimed at keeping the mature and experienced nurses in the organization. Other strategies implemented by the hospital includes; training plan for all Scripps employees, Gain-sharing through support groups, Elder care plan to support aging parents, phased retirement plan and endowment benefits and attendance incentives.
Monongalia County Hospital
It is also known locally as Mon General. It is a 199 bed hospital found in Morgantown, West Virginia. The hospital is credited for fixing a conducive environment that heightens reliability and longevity by considering the needs of its staff at all level. The hospital functions in a competitive environment. It has devised various strategies that address the retention needs of its staff.
One of the strategies in place is creating a personalized environment that motivates nurses. The hospital employs a casual employee strategy to protect its staff. Hence, this involves creating programs that addresses employee individual needs; the organization also employs an open-door policy which increases open communication between the staff and the organization management. However, the most responsibilities for implementing these retention programs are done by the Human resource department.
Also, the hospital raises the skills of retaining nurses by continuously offering training opportunities. The organization views that a continuous training is essential for providing quality medical care and enhancing a competitive advantage. Employee’s success is promoted during the recruitment and retention. The training opportunities granted to the nursing staff comprise of an eight-week full-time mentorship program to junior and senior nurse, concentrated ten day training after employment; the training is done in-person, classroom, computer and use of medical apparatuses.
The organization has successfully aligned compensation and related benefits to encourage nurse retention. The programs began by the organization include a detailed retirement plan and a detailed contribution benefits. This program has been designed to retain experienced employee by recognizing and rewarding the duration of their contributions. They base their model on the employee’s age and the number of years at the hospital. They have also developed a revamped staff wage structure. This happened five years ago, to provide fairness in compensation for all employees. The wage structure is based on a current market scale.
Carondelet Health Network
Carondelet Health Network is one of the largest and oldest hospitals located in Tuscon, Arizona. It consists of four hospitals and various agencies. Like many other hospitals, Carondelet function in a competitive environment that affects its capacity to absorb and retain nurses. Carondelet is located in an area with high unemployment and shortage of skilled labor, hence; the nurses are of no exception. Because of this fact, the hospital management realized that they needed to act, to attract and retain nurses. One of the strategies in place to achieve this is forming an On-site BSN education program (Marie et al, 2007). The organization management was tasked with asking nurses what they required and what the administration could do to retain them. Majority of the nurses were of opinion that education to them was paramount and that they did not have an opportunity. Hence, the organization took the initiative and established the BSN. The BSN has been critical in improving a nurse critical thinking leading to quality patient care and retention.
Another strategy was fixing a new Human Resource Department dedicated to strategy. A success factor to the organization aptitude to retain the nurse is the focus on workforce planning (Leurer et al, 2007). The Carondelet established a unit in the HRD in 2005. The department was given responsibilities of recruitment and retaining employees. Setting up workforce planning was not only a strategy for employee retention but also was necessary for financial planning for the organization.
Carondelet Health Network has a comprehensive compensation and reward schemes addressing the needs of its employees. One of the schemes in place is the compression pay. The organization has invested financial resources in nurse wages. However, the wage increase is determined by the experience of the nurse and the number of years the nurse has worked with the organization.
Trinity Medical Centre
Trinity Medical Centre is a hospital located in Birmingham, Alabama. The hospital has set up different strategies to augment nurse performance in the workplace. This has eventually delayed retirement for experienced nurses. As Trinity Medical Center (2011) notes, the hospital no longer provides free samples such as televisions for nurses who desire to work an extra shift. However, they have continuously strengthened programs such as career ladder, flexible scheduling on which mature and experienced nurses can collaborate on quality enhancement projects. Besides, the hospital places much emphasis on education, thus; it support nurses through tuition reimbursement. Other programs to enhance nurse training include providing education grant in return for a two-year employment contract.
According to Carlisle et al, (2011) the strategies have contributed to retention in the organization. Stress is an issue which slows down employee effectiveness. The organization offers stress programs like; the Critical Incidence Stress Management service, nurse therapeutic programs and employee assistance programs. This has ensured nurse retention besides raising service delivery Trinity Medical Center (2011).
Another strategy embraced by the organization is fostering a creative work environment. This includes establishing a participatory leadership environment. Participatory environment ensures the nurses voice their concerns by designing workspace, making changes ensure a smooth workflow and patient care delivery process. This ensures the issue of burnout is contained.
Solutions for Renfrey Memorial Hospital
The situation at Renfrey Memorial Hospital (RMH) presents a remarkable experience in the health sector. The issues mentioned by the nurses such as feeling burnout, recording physical fatigue among other issues calls for a fitting strategy as applied to other similar hospital faced with similar problem. However, by embracing the strategy of implementing masterly work design and ergonomics, the issue will be mitigated. Work design and ergonomics at Renfrey Memorial Hospital, will not only add a value for the staff retention, but will help nurses to adapt to the workplace environment, support work in the way it should be, provide personalized space, promote appropriate nurse control and train nurses in the proper handling and use of equipments.
In the five hospitals mentioned in the paper, particularly the Bon Secours, it has embraced the strategy of Elder care. This has created a more encompassing working model where nurses are able to take care of their aging parents, relatives and spouses besides contributing to quality delivery at the hospital. Similarly, this strategy can be of importance for Renfrey Memorial Hospital (RMH) in retaining some of its mature and experienced employees (Cottrell, 2011).
Analysis of the two Solutions
According to Mwachofi et al (2011) eldercare is one area that is gaining much publicity in healthcare. The strategy aims at balancing the output of a nurse at the hospital and that of caring of her aging spouse, relatives and other members of the family. Eldercare provides a win-win situation for an organization and its employees. Thorpe (2008) illustrated that for formulating an eldercare as a strategy for nurse retention, various stakeholders are involved. One of the stakeholders is a nurse. Thorpe (2008) explains that a nurse no longer accept performance or responsibilities as their eventual goal outcome, or remains in a system that is inept, fragmented leading to dissatisfaction to a patient. Rather, nurses seek avenues strengthening professionalism through a system that allows flow of patient care at the same time increasing on the skills and knowledge (Mwachofi et al, 2011). Hence, they are critical stakeholders of ensuring a system that improves balance between the organization, their relatives, and themselves is present to avoid a stressful condition.
Carlisle et al (2011) argue that Human Resources provide an arguably pivotal decision in shaping an organization strategy. Hence, they synchronize or separate organization identity and competitive advantage. They provide a critical role in shaping organization work structure by developing training needs, implementing organizations human resource needs, devising retention strategies and compensations skills. They, on the other hand, define roles, and help nurses identify satisfiers to increase job satisfaction. Thus, to ensure the eldercare strategy works, they play a distinctive role. The hospital administration, through the senior management contributes to overall performance of an organization.
The goal of any given healthcare organization is providing a working environment that promotes job satisfaction. This is through providing a healthy working environment which strengthens service delivery. Policies adopted by the administration directly affect the quality of patient care. The Eldercare strategy demands additional costs for the organization. According to Cottrell (2011) the financial departments headed by accountants need to ensure enough finance is available to cater for the new policy. The value of the strategy can doom, if the finance department does not cooperate. This is because the new strategy will increase costs for salaries and other expenses connected to the program.
The strategy will have an impact to the organization and the nurse. The organization will face the challenge of aligning a new strategy with the needs of the organization. This will involve delegating the Human Resource department to ensure training opportunities for the nurses, restructuring work patterns and designs, and allocating extra resources for salaries and other expenses.
Integrating the new strategies at Renfrey Memorial Hospital (RMH) will require careful planning and change management components to ensure a smooth transition. One of the strategies which will be involved is plan review. Carrying out change in any given organization is complex and a dire task. As Leurer et al (2008) notes it has been the trend and strategy is getting more with the enlarged degree of change in organizations and companies. Whether the change is being bound by external concerns or being brought about within by an organization or organization leadership. In achieving a change strategy, a series of meeting and discussions need to be held by executives and top management in the organization.
Renfrey Memorial Hospital (RMH) has to establish a repeatable, conventional process. It should base on accrued input. The hospital has to design training for the stakeholders to be affected that is the nurses, human resources and other management employees in the organization to set the tempo success (Cottrell, 2011).
Also, the Renfrey Memorial Hospital (RMH) has to build confidence in its leadership. Trust is primarily the idea that an individual will not be affected when susceptible. The hospital leadership has to demonstrate complete uprightness, consistency, sincerity, and fairness always acting in morally and communally accountable ways. Equally, communication should care about its employees and the organization. These characteristics translate to trust; that leaders must obey.
Lastly, Renfrey Memorial Hospital (RMH) leadership has to explain the vision for change to all employees. This is to enable employees understand the direction for the company to ensure that everyone in the organization understand the purpose of change, and the result the organization desires to achieve.
The Renfrey Memorial Hospital (RMH) will have to confront fiscal impact in terms direct and indirect costs. Such costs will be incurred in compensations benefits, salaries, training, retention and fixing an ergonomic for safety. Other costs will be involved in maintaining and overseeing the programs. Hence the hospital management needs to have a financial contingency for this plan.
Conclusion / Recommendation for the Solution
Most organization requires a safe working environment to increase employee efficiency. In this case, I would recommend Renfrey Memorial Hospital (RMH) to adopt exemplary work design and ergonomics to boost nurse job satisfaction and job fulfillment. Mwachofi et al (2011) argues that work design and ergonomics encourages an average worker in any environment to work comfortably and contribute to the organization success. Older nurses will tend to be active through 2020, thus the strategy of work design and ergonomics. Job design and ergonomic will assist nurses to check vulnerabilities of occupational hazards present in the healthcare, especially after attaining 40 years (Mwachofi et al, 2011). This hazard includes emotional burn out and physical exhaustion among other challenges.
The strategy will assist the organization by:
- Nurses walk a lot when collecting or finding for equipments and supplies, hence; this makes them physically exhausted. Physical design will significantly reduce this problem
- Decentralization of nursing stations to closeness between a nurse and the patient will be enhanced by the work design and ergonomics.
- Patients are physically compromised at Renfrey Memorial Hospital (RMH), hence the strategy will help in alleviating this problem.
Deisell et al (2010) illustrates that the nurse job responsibilities can be redesigned to decrease risk situations. For instance, job with high stress can be substituted with less stressing tasks, taking short breaks after duty. This will reduce burnout, minimize back pain and eyestrain. Similarly, fitting chairs appropriately will increase comfort to reduce injuries at the patient bedside.
The hospital management has to establish enough resources to ensure the strategy works. This will include; establishing the fund for purchase of new ergonomic equipments, labor and training among other requirements of the strategy. This will make the strategy implementation easy and enhance service quality. Human resources department will need to readjust to the new changes. They will need to devise plans for new changes to be effective. Deisell (2010) argues that Human resource department plays a significant role in effecting change policy in a given organization. Through their role, they can devise change management structures to ensure new strategy is aligned with the organization goals. This will be through; training, compensation and benefits and communication with the top management about the success gained (Beatrice et al, 2009).
References List
Beatrice, I.J.M., Dam, K., Hasselhorn, H. M., (2009) “Intention to Leave Nursing: The Importance of Interpersonal Work Context, Work-Home Interference, and Job Satisfaction Beyond the Effect of Occupational Commitment”, Career Development International, (14), 7, pp.616 – 635
Bon Secours Richmond Health System. (2011). Caring for our Nurses: Moving Nursing Forward. Web.
Carlisle, J., Ramudu B., Fish, A., (2011) “Training Needs of Nurses in Public Hospitals in Australia: Review of Current Practices and Future Research Agenda”, Journal of European Industrial Training, (35), 7, pp.687 – 701
Cottrell, T. L., (2011) “Moving On: Salaries and Managing Turnover”, Bottom Line: Managing Library Finances, (24), 3
Deisell, M., Diaz, E. M., Shihab, S. A., Baker E. K., (2010) “New Ways of Thinking About Nurse Scheduling”, Journal of Advances in Management Research, (7),1, pp.76 – 93
Erlich, A., Bichard, J., (2008) “The Welcoming Workplace: Designing for Ageing Knowledge Workers”, Journal of Corporate Real Estate, (10), 4, pp.273 -285 Leurer, Leurer D., Donnelly G., Domm, E., (2007) “Nurse Retention Strategies: Advice from Experienced Registered Nurses”, Journal of Health Organization and Management, (21), 3, pp.307 – 319
Mwachofi, A., Walston, S. L., Badran A. A., (2011) “Factors Affecting Nurses’ Perceptions of Patient Safety”, International Journal of Health Care Quality Assurance, (24), 4, pp.274 – 283
Scripps. (2011). Scripps Clinic Ranks High for Delivering Quality Patient Care. Web.
Thorpe, K (2008) Harnessing the Power: Recruiting, Engaging, and Retaining Mature Workers, Conference Board of Canada.
Trinity Medical Center. (2011). Nursing Leadership Group. Web.