Staff shortage is a serious issue for all US healthcare organizations. As it stands, nurse turnover rates vary between 13% and 25%, depending on the facility, with understaffing median levels being at roughly 20% (Metcalf, Wang, & Habermann, 2018). The situation is further exacerbated by the ongoing health crises, such as the Covid-2019 pandemic and the looming growth of the geriatric population, which is expected to double by the end of 2040 (Houle, Eckstrom, & Hansen, 2018). While the problem requires a complex approach on a national level that would include a reform of the educational system as well as various novel motivational and recruitment tactics, each healthcare organization is expected to do whatever is needed to reduce staff shortages.
The reasons why shortages present such a significant problem lie in the fact that low quantities of nurses inevitably affect the quality of patient care while driving prices up. Overworked nurses are positively associated with the number of nursing mistakes, accidents, and hospital-acquired diseases (Metcalf et al., 2018). One of the primary strategies includes reducing nurse turnover rates and retaining their existing staff while actively hiring new ones.
Therefore, reducing turnover rates is one of the primary organizational tasks in our hospital. One of the primary determinants of invoking turnover in nurses is job satisfaction, which in turn is affected by the quality of leadership, burnout rates, physical and mental stress, as well as a plethora of other factors (Zhou, Wan, Qiu, Chen, & Tian, 2017). Therefore, the issues of staffing shortages and job satisfaction are interconnected and must be addressed together.
Impact of Understaffing and Poor Job Satisfaction on the Department
Understaffing and poor work satisfaction have a negative impact on our department in a variety of ways. The first and most obvious impact is the inability to provide maximum healthcare output for our patients (Goodare, 2017). If the department is fully-equipped, it has the potential to administer a full range of care without missing appointments and treatments as a result of understaffing (Metcalf et al., 2018). The second negative effect on the department lies in the fact that staff is forced to work overtime in order to compensate for the current levels of nurse shortage (Goodare, 2017). This results in additional expenses to the hospital for overtime. It also inconveniences the nurses, affects their work/life balance, and places additional physical and mental strain on them.
Finally, long-term exposure to nursing shortages leads to poor quality of care, as overworked nurses do not physically have enough time and mental capacity to spare for each patient, resulting in poorer performance, higher chances of mistakes, and neglect towards certain formalities and rules of care (Goodare, 2017). In particular, the rules of personal hygiene (frequent handwashing, replacement, and maintenance of tools, etc.) as well as the frequency of nursing interactions with patients and with each other (Goodare, 2017).
Finally, the overworked nature of the department functionality resulted in fewer breaks and greater stress placed upon the employees. All of these issues lead to a negative job satisfaction score, which increases care fatigue as well as the desire to leave the profession altogether. According to Goodare (2017), over 33% of all new nurses refuse to continue their careers within the 2-year period.
The Effects of Communication, Collaboration, and Teamwork on Job Satisfaction and Nursing Shortages
The human communication factor is significant for nurses planning to leave or stay in the department. Interaction with fellow workers and patients constitutes a part of non-material rewards that can improve or decrease job satisfaction for them (Galletta, Portoghese, Carta, & D’Aloja, 2016). Effective communication and collaboration between leaders and nurses could improve their output, reduce the number of incidents, and foster trust in their own skills and professionalism.
Likewise, poor communication and teamwork can lead to negative outcomes as well as conflicts between nurses, improper schedule, and inefficient work that drains one’s own physical and mental resolve (Galletta et al., 2016). Communication and cross-team collaboration, when fostered, allows nurses to share knowledge and skills more efficiently, reducing the chances of committing professional mistakes as well as spreading the burden of care on everyone equally (Galletta et al., 2016).
Leadership qualities of nurse managers, as well as individual nurses, play an important role in the success or failure of these endeavors, on a departmental and hospital levels (Lewis & Cunningham, 2016). Transformational and servant leadership styles are noted for creating a more trusting and supportive atmosphere in the hospital, whereas authoritarian and transactional means of control reduce nursing cohesion and increase care fatigue (Lewis & Cunningham, 2016).
At the same time, it must be noted that authoritarian leadership is more warranted in departments where quick decision-making is necessary, such as first aid departments and the ICU (Lewis & Cunningham, 2016). There is conflicting information on the performance of democratic leadership styles due to the fact that there is usually not enough time for everyone to have a solid discussion about what needs to be done, in urgent situations (Lewis & Cunningham, 2016). In ICU, the most experienced nurses usually assume leadership roles and take greater responsibilities in directing other nurses.
Improving Inclusion, Cooperation, and Collaboration in the Department
Workplace satisfaction often suffers because of a lack of inclusion in the department, leading to increased turnover and greater nursing shortages. Nurses, especially younger ones, wish to feel like their work and knowledge matter, and that they get to be involved in the decision-making processes as active members, rather than delegating that responsibility to their more experienced colleagues (Matsumori, 2016).
While in the scope of urgent situations, it may not always be possible, there are other ways of improving cooperation and collaboration in nurses. The first solution is the introduction of workshops where older and younger nurses get to work together on cases that do not require urgent action but allow for both to work together not only in providing care for the patient but also in deliberating their strategy of care (Matsumori, 2016). Such cooperation would allow fostering a team spirit and sharing experiences with each other, thus achieving better cohesion between nurses. Research shows that nurses involved in cooperative activities are more satisfied with their jobs and are less likely to leave the profession (Matsumori, 2016).
The second strategy involves fostering mentorship between new and experienced nurses, with an older nurse overseeing her younger colleague during the first several months of her practice (Williams, Scott, Tyndall, & Swanson, 2018). Such mentorship achieves knowledge and information transfer while creating deep bonds between the participants. Finally, it allows for greater confidence during professional communication in teams, as the younger nurses would share some of the authority of their mentors. As a result, greater quality, satisfaction, and reduced turnover rates could be achieved.
Galletta, M., Portoghese, I., Carta, M. G., D’Aloja, E., & Campagna, M. (2016). The effect of nurse‐physician collaboration on job satisfaction, team commitment, and turnover intention in nurses. Research in Nursing & Health, 39(5), 375-385.
Goodare, P. (2017). Literature review: Why do we continue to lose our nurses? Australian Journal of Advanced Nursing, 34(4), 50-56.
Houle, S. C. S., Eckstrom, E., & Hansen, J. C. (2018). The gift of caring: saving our parents – and ourselves – from the perils of modern healthcare. Rowman & Littlefield.
Lewis, H. S., & Cunningham, C. J. (2016). Linking nurse leadership and work characteristics to nurse burnout and engagement. Nursing Research, 65(1), 13-23.
Matsumori, N. (2016). Nurse’s impressions and changes after the workshops using the pediatric nursing care model. Journal of Nursing Education and Practice, 6(9), 1-10.
Metcalf, A., Wang, Y., & Habermann, M. (2018). Hospital unit understaffing and missed treatments: Primary evidence. Management Decision, 56(10), 2273-2286.
Williams, F. S., Scott, E. S., Tyndall, D. E., & Swanson, M. (2018). New nurse graduate residency mentoring: A retrospective cross-sectional research study. Nursing Economics, 36(3), 121-127.
Zhou, H., Wan, Y., Qiu, Y., Chen, Y., & Tian, S. (2017). Correlation of human caring ability with job satisfaction of nurses in oncological department. Modern Clinical Nursing, 16(9), 55-59.