1. Problem Identification
Merely documenting the scope of work that an employee is supposed to undertake does not mean that the employee will remain in the job to carry out their duties. For example, just by delegating duties to nurses in homecare such that some handle admission of clients (start of homecare), re-admission (continuation of or resuming home care) and discharge (Tourangeau et al. 2014). Although this will free other regular visiting nurses hence allowing them to concentrate on the visits themselves, retaining the nurses on the job calls for more hence an improvement of the nurses ITR. Though there is a noticeable shift in the healthcare sector in developing world from hospitals to homecare, there are various factors that have impacted in nurses ITR in homecare. The problem at hand therefore is how to improve nurses ITR in the homecare facilities. This paper presents facts of a typical research conducted in a bid to solve the research problem (Tourangeau et al. 2014).
2. Investigations, evidence, analysis of areas contributing to the Problem
Several studies have reported that there is an inverse relationship between the satisfaction nurses get from their jobs and their ITR. In her report, Ellenbecker points to a figure of 14% as the rate of turnover in Canadian health sector. Nurses also attribute the high rate of their resignation to low job satisfaction (Tourangeau et al. 2014). However, it is notable that job satisfaction is a broad term used to describe various issues about a job. A research designed to investigate the various components that together culminate into employee satisfaction, different groups of registered nurses and registered practical nurses were put in focused discussions and their opinions sought. The intention was to determine whether there was any correlation between the fact that these two groups had different qualifications and if that affected their ITR, apart from other possible reasons which they could have (Tourangeau et al. 2014).
The first item that came out of the two groups and that affected the nurses’ ITR was the nature and scope of their jobs. Some nurses noted that they preferred flexibility in their work. That they preferred to be engaged in a lot of activities which would expose them to different patients rather than be assigned to a particular patient or activity that would restrict their scope (Tourangeau et al. 2014). The nurses also cited autonomy as a characteristic of their jobs that really influenced their ITR. Though some gave preference to autonomous operations where they expressed their desire for authority and ability to make their own decisions, some preferred to be under the supervision of case managers. This preference was most prevalent amongst less experienced nurses who alluded to the fact that they needed to be under supervision of someone so that they could develop their confidence and competence in their work (Tourangeau et al. 2014).
Positive relationships within the work environment, i.e. relationships with clients and with case managers also affects nurses’ ITR in the home care centers. The ability to access case managers and communicate to them is a factor that builds nurses’ ITR. However, some case managers have been portrayed as being too bureaucratic hence impeding the ease of nurses to access and communicate to them (Tourangeau et al. 2014). This does not build a good relationship hence reducing some nurses’ ITR. On the other side, case managers’ role of influencing the rather rigid supervision also impacted positively on the nurses’ ITR.
The nurses also cited that the terms and conditions of their employment had a bearing on their ITR. To this effect, they say that flexible employment terms favored them hence boosting their ITR than rigid terms. They also noted that remuneration for work done greatly impacted on their ITR. They for example stated that apart from adequate compensation for the work they do, they prefer to be paid for any extra works they do within extra time. Also, they should always be compensated for out of pocket expenses that sometimes they incur for the company (Tourangeau et al. 2014). Another employment condition that played a great role in employees’ satisfaction is the freedom to join unions. These they say champion for their rights and this condition impacted on their ITR depending on presence or absence of that freedom to join unions.
The design of work structure also emerged as an issue that affected the nurses’ ITR. Nurse who are assigned a client for a continuously long period of time with a client said that it helped them develop some good relationship with clients. This could help them understand their issues and address them accordingly (AbuAlRub, & AL‐ZARU 2008). The flexibility in schedules also came out as a component of work structure that affected nurses’ ITR in the home care. Nurses, for example, cited that fixed work schedules did not favor them as it even denied them crucial time to be with their families. The work load also determined the nurses’ ITR. They complained about high work load assigned to them which were unmanageable. On the other side, the use of technology to manage work load also came out as having both positive and negative impacts on the nurses’ ITR (AbuAlRub, & AL‐ZARU 2008). This was however common in cases where technology could not be used solely and hence the nurse had to supplement the use of technology with manual work. For example, using smartphones to document certain records and also being required to do the same in printed charts. This appears as duplication of work and is very hectic hence impacting negatively on the nurses’ ITR (Tourangeau et al. 2014).
The work environment which the nurses operate also influences their ITR. The work environment comprises both the physical, human and emotional environment with which the nurses interact. For example, a home care that allows continuation of studies by the nurses increases their ITR (Cowden & Profetto, 2011). On the other side, proper orientation of the work environment enables the nurses to acquit themselves with the necessary information about their work environment hence improving their ITR. The available resources within the work environment also impacted on the nurses’ ITR. They for example have preference for an environment that provides all the necessary infrastructure that would help them carry out their work (Cowden & Profetto, 2011).
3. Proposed solution and justification of solution
These concerns should be addressed by the home care management if they are to retain the nurses in their facilities. Employees’ motivation and job satisfaction impact on their output hence an employer must strive very hard to ensure that concerns about factors that impact negatively on the nurses’ ITR are addressed (Tourangeau et al. 2014). The appropriate timeline for implementation of the recommendations that follow the analysis of these factors is a five-month short term program and a perpetual long term program. For example, the short term objectives should be dealing with issues that can be acted on easily, these may include increasing employees’ flexibility in their works by allowing flexible assignment of nurses to clients, investing in appropriate technology and avoiding duplication of work and also compensating the nurses for any out of pocket expenditures they incur on behalf of the health care management (Tourangeau et al. 2014).
4. Implementation Plan and timeline
In the long term, the facilities should then start introducing strategies for proper orientation of the nurses, be flexible in terms of autonomy in operations, introduction of a properly designed work structure that can accommodate further training for the nurses and also encouraging a work culture that eliminates all the bureaucratic processes and communication channels that reduce efficiency and coordination between case managers and the nurses (Tourangeau et al. 2014).
5. Implementation of Resources and Cost Benefit Analysis
6. Cost base Analysis
Average cost of training a nurse on part time basis= $2500 (Based on the average time nurses will take to pursue their studies hence cost incurred to replace the specific staff). This should be partially financed by a Home care facility, at a maximum of 70%. This can be leveraged through loan financing to be paid over some period of time hence spreading the financial risks involved.
Cost of improving physical infrastructure; this depends on the infrastructure to be added, replaced or refurbished. This cost depends entirely an assessment of the deficient physical infrastructure.
Miscellaneous expenses arising from employees out of pocket expenditures: These costs vary depending on the extent to which employees use their own money to carry out activities of the company. It can be avoided through issuance of petty cash. This also enhances accountability.
6. Success and Evaluation for Success
These evaluations should be carried in step by step implementation process of the strategic plans. A good evaluation criterion should look consider increased efficiency, timeliness, reduction in overall costs and also an increase in employees ITR.
7. Identification of Key Stakeholders, their importance and engagement with them
The stakeholders to be involved are the nurses, case managers, nurses and outsourced technical support. They are important as they form part of the human capital needed for the successful implementation of the plan.
8. Roles of Scientist, Detective, and Manager of the Healing Environment
The scientist, detectives and managers of the healing environment are to monitor and advice on the challenges arising in the implementation process and propose alternative or mitigation measures.
References
Tourangeau, Ann, Patterson. E, Allissa Rowe, Geraldine M, Lisa Cranley, Marharet Saari, Heather Thomson & Mae Squires. "Factors influencing home care nurse intention to remain employed." Journal of nursing management 22.8 (2014): 1015-1026.
Cowden, T., Cummings, G., & PROFETTO‐MCGRATH, J. O. A. N. N. E. (2011). Leadership practices and staff nurses’ intent to stay: a systematic review. Journal of nursing management, 19(4), 461-477.
AbuAlRub, R. F., & AL‐ZARU, I. M. (2008). Job stress, recognition, job performance and intention to stay at work among Jordanian hospital nurses. Journal of nursing management, 16(3), 227-236.
