Introduction

The role of experienced nurses cannot be undermined within a healthcare setting or facility. In practice, experienced nurses execute their duties quickly and accurately. Thus, experienced nurses contribute greatly towards improving the image of service delivery within the health sector. Experienced nurses also provide mentorship to future nurses. Besides, the nurses contribute to the creation of organizational memory, in addition to performing many other functions. As noted by the American Nurses Association (2009), when populations longevity increases, the demand for nursing services also rise. Despite the rise in the need for nursing services, retaining nurses remain an elusive aspect as demonstrated by the case of Renfrey Memorial Hospital. However, the aspect of retaining nurses is becoming complicated from day to day since nurses are also aging within the United States. The case is affirmed by the fact that in the coming years, a big number of nurses would eventually retire. In the face of the prevailing conditions, hospitals or any other nursing facilities have several options to explore in order to ensure that service delivery goes on as anticipated. Medical centers, hospitals or some other health care entities can consider initiating activities intended to retain nurses for a longer time as they nurture young nurses to assume their roles. The paper argues that with the use of proper approaches, nurse turnover rates can be controlled leading to overall improvements in the performance of nursing facilities such as the Renfrey Memorial Hospital.

The argument that it is possible to lower nurse turnover rates is supported by a study conducted by Buerhaus (2009) who found that many health care organizations managed to lower turnover rates by focusing on strategies that improve productivity and enhancing staff morale. Some of the strategies that have been successful include innovative programs in staffing, presenting training and development opportunities to nurses, and enhancing employee health/wellness projects. Similarly, ergonomic initiatives such as the provision of necessary equipment to help nurses are also useful. Although the provision of such equipment may not influence the staff retention, it might influence morale leading to a better performance. Besides, the provision of such equipment may contribute towards the lowering of costs associated with injuries incurred while working.

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The case under review is about the Renfrey Memorial Hospital, which is a 200-bed hospital that operates across the Midwest. Having operated for a period of thirty-two years, the health facility finds itself facing a number of concerns related to employee turnover and staff retention. As the case demonstrates, sixty percent of the hospital staff is over 45 years old. Hence, a bigger proportion of the staff faces retirement. Such statistics exposes an unpromising state within the hospital. Based on the survey that the hospital commissioned, it was found out that the staff suffered from the physical demands of the daily nursing work, which led to emotional burnout. In particular, the nurses at the hospital found it difficult to care for elderly patients. As a result, the hospital has been experiencing high turnover rates among its experienced nurses. In a bid to resolve the issue at the hospital, the option of hiring temporary nurses for assistance has been embraced. This has led to a rise in the costs and a decline in the levels of patient satisfaction. The problems are compounded since the hospital is facing challenges in hiring nurses to replace those who are about to retire. In order to move forward, the hospital must take decisive steps to ensure it does not collapse because of the human resource and financial problems. As already indicated above, employing the appropriate strategies would be necessary if the hospital is to solve the problem in a satisfactory manner.

Solutions Implemented at Five Hospitals in the US

In the subsequent section, the focus shifts to highlighting five hospitals that employ innovative approaches towards addressing the issue of nursing turnover. The paper focuses on the approaches employed at the Poudre Valley Health System, Lynchburg General Hospital, University Health System of Eastern Carolina, Greenville Hospital System and Bon Secours Health.

The Case of Poudre Valley Health System

The Poudre Valley Health System is one of the health facilities that have succeeded in retaining nurses. Tracing of the organizations strategies goes back to 2001 when its committee was charged with the task of recruiting and retaining nurses who reported high levels of dissatisfaction at the workplace (The Lewin Group, 2009a). Nurses cited a heavy workload and compulsory on-call as major concerns. The state of affairs pushed the organization to devise a strategy to tackle the emerging issues. In particular, the nursing leadership adopted the Base Staffing Model in addressing staffing requirements during peak occupancy times. The application of the model enhanced job satisfaction as nurses underwent considerable control. According to the model, when the facility has a lower census, the hospital asks those who want time off (The Lewin Group, 2009a). In case no nurse is willing to go, yet the census is low, they are asked to work in alternative places within the hospital. The main advantage associated with the model is its ability to allow nurses more time to learn and deal with patient related issues. After the adoption of the model, the turnover among the experienced nurses remained low and its stability improved after the implementation of the model. Similarly, the costs attributable to sourcing for nursing services fell significantly. Overall, nursing cost fell.

The Case of Lynchburg General Hospital

Another hospital that has taken initiatives to address issues relating to the retention of nurses is the Lynchburg General Hospital. A similar case as that of the Renfrey Memorial Hospital took place at the Lynchburg as the levels of satisfaction among the nursing staff fell. Particularly, nurses were unhappy with the application of the traditional model, which entailed pulling nurses from one unit to another based on the prevailing circumstances (Bleich et al., 2009). In response to the concerns, in 2000, the hospital adopted the "Closed Staffing" model. The model is known for its focus on keeping nurses within their units with a an aim of increasing the levels of job satisfaction. However, the overall aim lies in reducing nurse turnover rates.

After the implementation of the approach, the turnover rates among the experienced nurses declined from 10.5% to 5.6% within a period of three years (Bleich et al., 2009). However, the rates slightly rose later. Another notable finding was seen in the frequency in work attendance. After the implementation of the approach, levels of absenteeism among nurses fell significantly leading to an improvement in overall performance.

University Health System of Eastern Carolina

Another strategy that has been fruitful is that of Renewing and Reframing the Nursing Practice. It was noted that the experienced nurses working at the Pitt County Memorial Hospital suffered from a feeling of being deprived of the education opportunities extended by the hospital (The Lewin Group, 2009b). Hence, the nursing facility had a task of addressing nurse turnover concerns. To solve the issue, experienced nurses at the institution were allowed to renew their nursing related qualification through taking part in a three-day educational experience dubbed the Fanning the Flame." Five sessions of such experience were extended to twenty-five nurses at every session accordingly. The objective of the program was to reward and renew nurses morale through de-stressing them and allowing them to learn about caring and re-evaluating their careers. Hence, gaining knowledge about how one can advance in their career while serving as nurses was underscored within the initiative.

Based on the results of the initiative, it was found that in the year 2007, only three nurses quit their jobs after participating in the Fanning the Flame program. It was apparent that the turnover rates among the experienced nurses declined upon the implementation of the program (The Lewin Group, 2009b). Similarly, those in charge of the implementation reported that levels of job satisfaction had risen remarkably among the participants.

Greenville Hospital System

Greenville Hospital System is one of the hospitals that have adopted strategies to address issues relating to high nurse turnover rates (The Lewin Group, 2009a). The hospital sought to respond to retention concerns arising from the rate at which its experienced nurses quit work. The hospital was also focused on improving patient handling and safety. The strategy was adopted in 2005 when injuries emerging as a result of improperly handling patients increased. Initially, the program was carried out as a pilot project. Hence, the hospital leadership was interested in exploring the ways, through which the injuries could be reduced. Through the adoption of the approach, the hospital hoped to establish the cause of injuries, in addition to their solutions. Particularly, the hospital was focused on lowering costs incurred out of the injuries.

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After adopting the initiative, assistive equipment was integrated into the hospitals online system (The Lewin Group, 2009a). The system allowed the entry of patient assessment reports, an aspect that automatically facilitated the identification of the required tools/equipment. Based on the results, injuries declined significantly. In regard to the retaining of nurses, the hospital reported to have observed very few resignations of experienced nurses. Similarly, the number of nurses planning to quit declined sharply. Experienced nurses cited the rolling out of a safe system as a major influential factor in their decisions not to retire earlier. The major finding of the initiative was that it preceded a decline in turnover rates and reduced the costs associated with turnovers. Similarly, the costs associated with avoidable injuries have been eliminated.

Bon Secours Health

Those hospitals that have managed to retain nurses under the threat of the possible hardships in the healthcare sector have largely embraced the following strategies. In the first place, the hospitals have embraced the culture of aging. For instance, the Bon Secours Health runs a flexible program and extends retirement arrangements, besides providing mentorship and other ergonomic programs (The Lewin Group, 2009a).

Identified Solutions

It is noted that the main problem faced by the Renfrey Memorial Hospital is related to employee turnover and associated costs. Since 60% of the hospital staff is over 45 years old, there is a danger of the nursing staff encountering a serious problem. A survey commissioned by the hospital highlighted that the staff suffers from the physical demands in their work, which lead to an emotional burnout. The burnout is complicated by the fact that the nurses have to care for elderly patients.

Based on the review of hospitals that have dealt with nurse exhaustion and turnover, the strategy involving Renewing and Reframing the Nursing Practice should be considered. The suggestion of the strategy is based on the idea that it proved to be efficient when it was introduced at the Pitt County Memorial Hospital to solve exhaustion-related concerns, which led to high turnover rates. In solving the issue, experienced nurses should be allowed to renew their nursing professional qualification through participating in the three-day educational experience similar to the one dubbed the Fanning the Flame,". During such sessions, nurses renew their emotional strength and morale in serving. By inducing high levels of morale, experienced nurses will be able to work for a longer period (DeWit, 2009). Working for a longer period can allow the experienced nurses to mentor upcoming nurses besides contributing to reducing costs associated with replacing retirees.

According to Lucia, Otto, and Palmier (2009), employing comprehensive approaches should be given due consideration whenever addressing nursing turnover rates. Under comprehensive arrangements, there is an improved level of interaction through training, orientation as well as communication. The primary goal of increasing interactions is to engage employees consistently in order to ensure the correct information flows freely.

Another strategy that should be considered is that employed at the Poudre Valley Health System. In this regard, adopting the Base Staffing Model should be considered. Of particular concern is how to extend considerable control to nurses such that their contributions are taken into account in decision-making process. Under the strategy, nurses should be allowed to work in flexible shifts to allow them adequate time to relax before reporting to work. Similarly, as D'Antonio (2010) observed, whenever nursing services are not in a high demand, the experienced nurses should be allowed time off. Taking such an approach is likely to yield positive results, as the elderly nurses will find additional motivation to work for longer periods of time. Eventually, the strategy would help resolve the turnover problem besides helping in cutting costs associated with recruiting and training new nurses.

Analysis of the Two Solutions

One of the solutions that have been suggested is Renewing and Reframing the Nursing Practice. The strategy is critical in addressing the problems related to exhaustion. As the case of Renfrey Memorial Hospital demonstrates, the vast majority of the nurses are not satisfied with their routine activities. Hence, renewing and reframing the nursing practice would prove ideal in refocusing the experienced nurses drive to serve. Donahue (2010) who observed that through taking part in such exercises, nurses are able to regain motivation and a desire to work for longer hours affirms the position. Hence, the fear of experienced nurses leaving would be mitigated.

The adoption of the Renewing and Reframing the Nursing Practice would affect various stakeholders in different ways. As for the patients, they would benefit from being served by experienced nurses during their stay at the hospital. As for the upcoming nurses, they are likely to benefit from having more time to learn the nursing profession from the experienced nurses. Thus, the nursing profession would be impacted positively. For the hospital administration, many benefits would accrue from adopting the strategy. For instance, patients would be served well besides having a better prepared and more motivated nursing team. Since the turnover rates are expected to decline, the hospital administration would gain immensely from superior services. In addition, the hospital administration would be spared the hustles of recruiting and training new nurses since the turnover rates are expected to decline. Third party players such as the larger part of the society would also gain from the strategy, as it is likely to contribute to the overall welfare of people. Another stakeholder likely to be influenced is the HR department, which would incur reduced expenses and duties dealing with replacing departing nurses. The department would not have to carry out replacement of nurses as often as it would have before the adoption of the strategy.

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The other approach that is suggested is the Base Staffing Model. In the past, the nursing profession used to work without evidence. The primary reason for adopting that approach was an absence of information. However, currently, the state of affairs has improved since there is a wide array of information, which nurses need to base their actions. Nevertheless, one problem is that evidence base model takes a long time to be implemented into the nursing practice. It is noted that the evidence base model does not focus on filing gaps, but concentrates on addressing issues correctly. Evidence base staffing and scheduling should focus on attaining positive clinical outcomes. Under the proposed approach, focus is on allowing nurses considerable control in decision-making. In particular, nurses are allowed the flexibility they require during work. Adopting the approach is likely to have considerable effect on various stakeholders.

Patients are likely to be impacted based on the quality of services that they would receive from nurses who enjoy flexibility at the workplace. Another stakeholder who is likely to be influenced as a result of the adoption of the policy is the hospital administration. The administration stands a chance to streamline the delivery of nursing services based on work volumes. Similarly, the administration is likely to encounter reduced pressure since it is not likely to be required to source for resources to carry out nurse replacement exercises. The HR department at the hospital is also one of the stakeholders that are likely to be impacted by the adoption of the approach. Just as the hospital administration, the HR department would incur fewer costs in recruiting and training new nurses since the approach is likely to reduce nurse turnover rates. Another stakeholder in the set up is the larger society. The society is in a position to gain from the above strategy owing to the potential of having experienced nurses working for a longer time, which translates into better nursing services. As a profession, the nursing profession is also likely to be impacted by the approach in terms of building evidence in support of retaining experienced nurses with a view to mentoring the upcoming nurses. Overall, the hospital stands to incur lesser costs from adopting the approach to resolve nurse turnover problems.

Recommendation

Based on the assessment of the Renfrey Memorial Hospital case, adopting the Base Staffing Model is viewed as the best approach towards resolving the recurrent concerns. The reason the approach is deemed the most appropriate is that it is likely to spur nurses through higher motivation and boosting morale besides reducing operating costs. In the same way, the approach promises to lower HR expenses that are related to recruitment and training of nurses as discussed earlier. The approach is equally preferable because it is not likely to lead to a cultural shift since nurses will be required to make slight adjustments in the manner they work. As Buerhaus (2009) observed that, varying nursing ratios to meet changes in the demand for their services is a formidable approach that enhances the delivery of nursing services in hospitals encountering nurse shortages.

Making use of comprehensive approaches should be considered when addressing nursing turnover rates. Comprehensive arrangements lead to an improved level of interaction by way of training, orienting and communicating. Primarily, the objective of increasing interactions is fulfilled by consistently engaging nurses in a bid to enhance the nursing practice.

Conclusion

It emerges that the nursing profession has to contend with the issue of nursing turnover rates. Nursing turnover rates pose a danger to the nursing practice and outcomes as demonstrated in the paper. Evidence in the paper also shows that various options are available for hospitals that seek to address the concerns. However, it is held that hospitals must adopt appropriate approaches in order to succeed in addressing the nurse turnover problem.

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