Care Approach
Context of the Problem
According to the American Association of Colleges of Nursing (AACN) (2014), the US is projected to face a shortage of nurses, which will intensify as baby boomers begin to age, making the need for healthcare to grow. This shortage is expected to grow and spread across the US from 2009 to 2030, despite recessions when jobs are normally few. One of the factors that will contribute to the shortage is the recurring problem of nurse turnover. It has been noted that there have been a problem in healthcare organization’s retention focuses to prevent nurse turnover and keep professional nurses at work. Therefore, this study deem it appropriate to discuss the issue of nurse retention, as it affects both patients and nurses alike; as patients’ quality of care deteriorates, the increased workload for the remaining nurses reduces their job satisfaction (Letvak & Buck, 2008).
Description of the Issue
The problem of nursing retention has become a complex issue, summing up many parts of the whole of the healthcare system. Most health care experts note that assumptions, policies, safety and quality of the nursing job must be considered when determining the causes of this problem. According to the Nursing Solutions Inc. (2014), the average nurse turnover is about 14%. Quite alarming is that, according to the 2013 survey by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, a significant segment of the nursing workforce represented by 55% is nearing the age of retirement. 37% of the newly licensed registered nurses claim that they want to change their job after working just for one year. However, AACN (2014) notes that the figure could be higher, as when new nurses begin their job, they normally report negative emotions, with fear and feelings of being overwhelmed and powerless. Inexperience, strong desire to support and tenuous working relationships have been noted as the main reasons why newly licensed nurses do not proceed with their first employer (Curtin, 2003). However, in all nurse turnover cases, analysts attribute their cause to poor government policies in training, recruitment and retention. Further, health care organizations should also be blamed for having failed to recommend to employers appropriate measures that will help to retain nurses (AACN, 2012). Nonetheless, the quality and safety of their work environment may also jeopardize their retention. In this case, It has been noted that higher rates of infection, nurse-to-patient ratio and increased patient mortality may also contribute to high nurse turnover (Curtin, 2003).
Impact of the Problem
First, the nursing turnover will ultimately increase the workload for the existing staff, which will decrease their job satisfaction and their performance. The remaining nurses may have deteriorating emotional and mental health due to increased stress and burnout, which will cyclically push them to quit their jobs. Generally, the hospital will have reduced productivity, but increased losses. However, the ultimate loser of the retention problem is the patients; when the retention is low, patients will experience high infection rates, medication errors, decreased satisfactions, falls and deaths (Letvak & Buck, 2008).
Gravity of the Problem
The gravity of this matter is being felt in the healthcare, especially those who are supposed to receive their services. For instance, currently, it has been published that the current level of vaccination is very low, and therefore bodies of some babies would not be so healthy (Odinson, 2014). As already discussed the level and morale of staffing is correlated with the patient’s quality of care. A low staff retention will lead to increased patient mortality, high infection rates, medication errors, decreased satisfactions and falls (Jones & Gates, 2007).
Solutions to the Problem using PICO (Mbemba et al., 2013)
P (participants) - nursing staff with high rate of turnover
I (intervention) – proposed improvement in the effectiveness of interventions to promote nurse retention and presentation of taxonomy for potential strategies in which nurse retention can be improved.
C (Comparator) - Doing nothing/ maintaining the status-quo
O (Outcome) - reduce job turnover in the healthcare sector
Therefore the PICO question will be:
Do nursing staffs with higher rates of turnovers benefit from the proposed improvement in the effectiveness of interventions to promote nurse retention and presentation of taxonomy for potential strategies in which nurse retention can be improved to reduce job turnover in the healthcare sector?
Solution
In order to get the solution, 517 nurses (P) participated in an interview that took the form of screened publication. The researchers used the PRISMA criteria to assess the quality of their interview reports, on the proposed improvement in the effectiveness of interventions to promote nurse retention and presentation of taxonomy for potential strategies to improve nurse retention, as intervention (I). However, in the study, the comparator (C) was deemed as maintaining the status-quo. For the nurses with low retention tendencies, it was expected that after the proposed intervention, they will show reduced job turnover (O). The results showed that financial incentives would have a greater impact on improving retention in the nursing sector. The other factor included work places that have supportive relationships, information and communication, and improved quality and safety of the working environment. However, additionally, issues such as nurse shortage, nursing standards and competencies and nursing quality and safety education should be addressed (Mbemba et al., 2013).
References
American Association of College of Nursing (AACN). (2014). Nursing shortage. AACN. NCHE.
Retrieved on 09 October 2014 from <http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage>
Curtin, L.L. (2003). An integrated analysis of nurse staffing and related variables: effects on
patient outcomes. Online Journal of Issues in Nursing, 8 (3).
Jones, C.B & Gates, M. (2007). the costs and benefits of nurse turnover: a business case for
nurse retention. The Online Journal of Issues in Nursing, 12 (3).
Letvak, S. & Buck, R. (2008). Factors influencing work productivity and intent to stay in
nursing. Nursing Economics, 26 (2).
Mbemba, G. Et al. (2013). REVIEW open access interventions for supporting nurse retention in
rural and remote areas: an umbrella review. Human Resource for Health, 11 (44).
Nursing Solutions, Inc (NSI). 2014.2014 National Healthcare & RN Retention Report. East
Petersburg, PA: NSI Nursing Solutions.
Odinson, T. (2014). One third of nurses are leaving their jobs and losing faith in
vaccines. PRN. FM. Retrieved on 09 October 2014 from http://prn.fm/one-third-nurses-leaving-jobs-losing-faith-vaccines/
