As the nursing executive of a general hospital with more than 1,000 beds, I need to address the nursing shortage in the emergency department. Currently, there are 19 full-time nurses working in the emergency department. That number proved to be sufficient to effectively address approximately 80% of all admissions, but it will be necessary to increase the number of full-time nurses and staff retention rates need to increase in order to further improve care delivery in the department and reduce job burnout rates. According to Buchan and Aiken (2008), the Organization for Economic Cooperation and Development (OECD) identified the following common causes of nursing shortages worldwide: (a) inadequate planning and allocation of workforce, (b) resource constrains for hiring new staff, (c) poor recruitment and retention policies, and (d) ineffective use of available human resources in nursing. Ineffective use of existing resources can refer to one or more of the following: inappropriate skill utilization, poor incentives, and lack of career support. The purpose of this strategic plan is to identify the causes of nursing shortage at the emergency care department and recommend two key priorities for addressing that problem.
Strategic Plan Concepts
This strategic planning process will include the human resources (HR) personnel, finance department managers, and nursing leaders. The role of the HR personnel is to develop, present, and implement a structured mechanism for workforce allocation in the emergency department and improve recruitment and orientation policies for new staff. In collaboration with the finance department, the HR department must allocate resources to the development and implementation of nurse incentives and career support policies to increase employee retention rates. Nurse and physician leaders must be involved in the strategic plan because the hospital values participative leadership, so their role will be to discuss the strategic plan with the nurses in the emergency department and report their input so that the plan can address their needs and benefit from their recommendations.
The Strength, Weaknesses, Opportunities, and Threats (SWOT) analysis is presented in Table 1. The key strengths of the strategic plan are the supportive work environment and participative management the organization values and practices, so it is expected that those internal factors will facilitate the implementation of the nursing shortage solution. However, the new staff will require orientation and supervision, which will further increase the difficult job demands of the current staff. Harmful external factors include the limited capacity of nursing schools and the shortage of nursing faculty, but the current labor market dynamics are a helpful external factor because nurse immigration since 1994 into the United States has tripled (Aiken, 2007).
SWOT analysis of the strategic plan for nursing shortage
Recommendations
Based on the SWOT analysis, the two primary objectives are recommended for this strategic plan. The first objective is to develop effective orientation and training policies for new staff. The second objective is to hire full-time nurses and assign them to the emergency department, but the HR department should first develop recruitment and retention policies to ensure that the hospital is hiring the best staff and to reduce turnover rates, so the hospital will have to spend less resources on seeking out, hiring, and training new nurses frequently.
Supporting Evidence
The development of orientation and training policies is important because the full-time nurses already have high job demands due to the nursing shortage, so if they are required to train and orient new staff without a systematic approach, staff morale and care quality will decrease (Twigg & McCullough, 2014). Once that problem is resolved, the recruiting and retention policies should be developed, and the hospital should start hiring new staff as soon as possible. The recruitment policies need to clarify which roles the nurses will fulfill so that the hospital can hire nurses with the skills needed in the emergency department, whereas the retention policies should cover incentive programs and education opportunities to retain both existing and new staff members. Adequate nurse staffing and education opportunities are considered the most important objectives of this strategic plan because both factors were associated with improved patient outcomes and lower turnover rates (Aiken et al., 2011; Van den Heede et al., 2013).
Conclusion
The strategic plan for addressing the nursing shortage at the general hospital where I work as the nursing executive is designed to increase the full-time staff and reduce employee turnover rates. Based on the SWOT analysis, it was found that the job demands of the nurses are high because the department is understaffed, and hiring new nurses may increase those demands. Therefore, the first key objective of the strategic plan is to develop a policy for orientation and training new staff to reduce the job demands associated with hiring new staff. Second, the hospital should develop recruitment policies to ensure that the new staff has the skill mix relevant to the needs of the department, whereas retention policies will improve the workplace environment for nurses and reduce employee turnover rates. Once those policies are clearly defined, the hospital can start hiring new staff to solve the nursing shortage problem in the emergency department.
References
Aiken, L. H. (2007). U.S. nurse labor market dynamics are key to global nurse sufficiency. Health Services Research, 42(3), 1299–1320. http://doi.org/10.1111/j.1475-6773.2007.00714.x
Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011). The effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical Care, 49(12), 1047–1053. http://doi.org/10.1097/MLR.0b013e3182330b6e
Buchan, J., & Aiken, L. (2008). Solving nursing shortages: A common priority. Journal of Clinical Nursing, 17(24), 3262–3268. http://doi.org/10.1111/j.1365-2702.2008.02636.x
Twigg, D., & McCullough, K. (2014). Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies, 51(1), 85-92. http://dx.doi.org/10.1016/j.ijnurstu.2013.05.015
Van den Heede, K., Florquin, M., Bruyneel, L., Aiken, L., Diya, L., Lesaffre, E., & Sermeus, W. (2013). Effective strategies for nurse retention in acute hospitals: a mixed method study. International Journal of Nursing Studies, 50(2), 185-194. http://dx.doi.org/10.1016/j.ijnurstu.2011.12.001
