In the past 3 decades, there has been a significant increase in nurse shortage with the numbers expected to fall even more by the end of 2020. Most researchers, healthcare managers, and nurse leaders assume that the issue has been resolved but the truth is it is far more disastrous. Nursing shortage has many negative implications within the healthcare system. Registered nurses have a high demand in the market place, wherein the current RN workforce of over 2.7 ˘million is expect to grow above 3.5 million by 2022 (AACN 2014). Due to the increasing number of elderly patients, acute and chronic diseases, and expanding population, the need for nurses is bound to increase exponentially. However, many US nursing schools and colleges have not been able to expand to the prerequisite capacity which has often led to the rise in nurse shortage (ANA 2012). Nurse turnover has been closely associated with nurse shortage, wherein an estimate 17.3% of nurses leave their first job within a year while 33.5% of nurses leave their job within 2 years (Kovner, Brewer, Fatehi, & Jun 2014).
Nurse managers and leaders play a key role in assessing and managing nurse distress and overall nurse turnover in the healthcare system. It is important for nurse managers to identify any pitfalls or limitations within the healthcare system that may hamper or turn negative for the nursing workforce (Warshawsky, Havens, & Knafl 2012). The nursing staff often complain of workload, stress, lower wages, limited facilities, lack of personal time, poor increments, inter-professional disputes, and lack of communication between preceptor/manager. Most of these factors may contribute to a high turnover, wherein nurses are most likely to leave their jobs within 2 years. The nurse manager-staff relationship is of prime importance in the healthcare system, any disputes between the two could have negative consequences on staff members and patients (Regan & Rodriguez 2011).
This paper provides an overview of how nurse managers and leaders could provide efficient and effective strategies that not only encourage and motivate nurses to stay and continue with their jobs but also reduces the overall nurse shortage crisis.
Nurse managers and leaders approach to nurse shortage/turnover
Nurses managers and leaders play an inspirational role in the healthcare industry and have a defined but challenging role in managing nurse shortage/turnover. The nurse manager and leader should regularly co-ordinate with their staff members to address key issues that may have affected the workplace environment. Some of the key strategies that nurse managers and leaders should implement are as follows:
Encourage and facilitate workplace flexibility
It is important that each of the staff members to work in a flexible workplace wherein they are privileged to manage their work, ensure they have personal/family time, and educational opportunities. Flexibility builds positivity towards the work and most nurses may destress with other recreational or optional activities that they may come across while away from their workplace.
Promote career development
Nurse managers should ensure that most of the nurses have at least a bachelor’s degree and motivate the rest to pursue higher degrees such as a master’s or doctoral for skill and knowledge enhancement. Nurse managers should motivate nurses to learn new skills, adopt new strategies, and participate in continuing education. Most healthcare organizations that focus on career development have lower rates of nurse turnover. Career development encourages a nurse to stay in the organization and facilitates nurses to learn, strive, and act to adhere by the vision and mission of the organization. Nurse leaders can implement new learning and educational opportunities while nurse managers may address key gaps in learning and career development. Both, the manager and leader can co-ordinate and address the key gaps in career development and promotion.
Staff discussions/meetings
Regular meetings and discussions with the staff members helps build professional relationship and reduces the incidence of miscommunication or disputes. Nurse staff members have a right and privilege to voice their opinions and belies about the organization’s workflow process, limitations to design/structure of organization, disputes regarding promotion, recreational activities, facilities, and salaries of staff members (Van Bogaert, et al. 2015). The objective of staff discussions is to prevent or discuss disputes that may have been avoided or underreported within a unit/department. Nurse managers can assess and report issues of nurse shortage, organization restructuring, administrative needs, and inventory issues with the staff members. This helps in creating a transparent and positive workplace environment. The minutes of the discussion/meeting can be reported to the nurse leader and administrative team to help build a comprehensive network of team members (Al-Sawai 2013).
Emphasize on team work
Nurse managers should focus on individual staff roles but promote team work to complete tasks and achieves goals at a faster pace. Team work in the healthcare has been to known to create a positive workplace environment, lower rate of conflicts, and an indirect relation to nurse turnover. Most nurses prefer to apply their skills and knowledge but at the same time emphasize on team work and efforts. A nurse manager who promotes team work is bound to have positive results and fewer conflicts to resolve (Negussie& Demissie 2013).
Focus on organizational needs with staff nurses
A key to reduced nurse turnover or shortage is the implementation and improvement of organizational needs among staff members. Most nurses feel that the organization has not improvised on the workplace structure or needs. Nurse managers play a challenging but complex role in addressing the organizational needs with the staff nurses (Tsai 2011). Nurse managers can take feedback from their staff members to improve organizational needs.
Inter-professional collaboration
Nurse managers and leaders have to focus on team building and inter-professional collaboration to reduce nurse turnover, enhance positive workplace environment, motivate new nurses, and reduce the rate of nurse shortages and workload. Inter-professional collaboration helps staff nurses to communicate, learn skills, share knowledge and adopt new strategies with physicians, unit managers, pharmacists, administrative team, paramedical staff, patient caregivers, nurse managers, and leaders. The objective of such collaborations helps nurses to identify new skills, learn from their mistakes, and enhance their clinical decision-making skills which would improve overall health outcomes (Nancarrow, et al. 2013).
Roles of nurse leader versus manager
Nurse managers are recognized by their assigned duties and responsibilities within the healthcare organization. Nurse managers have the power of controlling and modifying tasks and duties of teams to meet goals as per the organization’s vision and mission. A nurse manager may not necessarily have leadership skills and roles. Staff members abide and respect nurse managers by authority and designation within the organization. However, nurse leaders may not have a recognized position but have the capability of influencing team members with their excellent interpersonal and communication skills. Nurse leaders are the ones who nurse staff members look upon as a role model and motivator. Most often conflicts between a nurse manager and staff nurse are resolved by a nurse leader, thus implying the recognized role of the manager but the perceived role and recognition of the nurse leader (Lorber & Savič 2011).
Florence Nightingale theory of a leader
Florence nightingale has been recognized for her environmental theory and is known as the first nursing theorist. As per the theory, a leader is known to abide by key principles, possess key skills and knowledge, and have a collaborative approach to team management (Karimi & Masoudi Alavi 2015). As per Nightingale, leaders in the healthcare sector possess 10 key skills which are positive attitude, commitment, courage, discipline, empathy, loyalty, humour, contrarian toughness, initiative, and aspiration. Nurses who possess any of these skills are bound to become leaders or eventually recognized as leaders in their organization. It is not necessary for a manager to become a leader, wherein the latter is perceived by recognition and the former is forced upon by organizational structure and designation (Kreitzer 2015).
Personal and professional philosophy
My personal experience with nursing leadership and professional philosophy for efficient leadership management are based on the 5 C’s and key principles of leadership.
The 5 C’s of leadership: A recognized nurse leader would be charismatic, convincing, credible, capable, and creative. A nurse leader would have a personality that would inspire the nurse staff to follow suit and have a positive convincing method to persuade others to solving a problem. A nurse leader abides to be honest and may not compromise their integrity under any circumstances. Nurse leaders are meant to build a strong relationship among team members, vendors, and clients. A competent nurse leader would be highly skills and often sets the standards high for staff members. Lastly, nurse leaders are creative in their roles and often develop and implement innovative strategies for problem solving, team building, and conflict resolution (Kowaslski & Yoder-Wise 2003).
Principles of leadership: Implications for nurse shortage and turnover: There are 4 key principles that every nurse leader should have with respect to preventing nurse shortage/turnover. Commitment to excellence, building a positive culture/workplace, focus on staff satisfaction, and creating an inter-professional team network. Nurse leaders and managers have to work collaboratively to provide a positive workplace, increase job satisfaction, reduce conflicts, and enhance team network to prevent nurse turnover (Marguis & Huston 2009).
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