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The profession of nursing in today’s world has tremendous turnover that impacts the quality of care and patient outcomes. As an employer this also poses as a financial burden on the organization. According to the American Association of Colleges of Nursing (AACN), turnover cost for nurses range between $22,000 to $64,000. This has been a challenge to employers as the financial impact of nurse turnover is inconsistent and the measurements have variability in costs reported through different unions. The purpose of this analysis is to provide a literature review of the past decade to assess current recommendations to improve nursing shortages and retention.
Organizations as a whole need to look at improving the quality of care provided to patients and effectively controlling the cost of care. This focuses attention on the steadily increasing costs of health care in the recent years and nursing shortages in the field. Healthcare organizations require a stable, skilled, and fully engaged nursing staff to provide effective levels of patient care in every skill set.
However, this is challenged by a shortage of 1 million nurses in the United States projected for 2020 (AACN, 2019).
With a evidence based approach, addressing the high turnover rate with nursing staff, and improvements in pay, in leadership and how management approaches staff. This is how to improve quality of care with this evidence based approaches that should be implemented to lower staff turnover and keep nurse retention at a low (McConnell, 2016). There are other significant roles such as stakeholders. These stakeholders are patients, nursing staff, providers, boards, unions, and big corporations.
Stakeholders would see a positive change with patient and staff surverys including satisfaction, safety and benefits outweigh the risks. There is a diverse nursing staff mix that is required; this includes education and competency with the increasely complex case mix and organizational challeneges (McConnell, 2016).
The rationale for nursing retention is that addressing the high turnover rate with nursing staff for organizations improvements and requirements. In 1987 the federal law started requirements for nurse staffing in long term care (LTC). The Nursing Home Law Reform was then started due to a dispute that safe nurse staffing ratios were needed. This law required that all LTC facilities had an RN staffed eight consecutive hours seven days a week, licensed nurses 24 hours a day and sufficient nursing staff to meet reisdents needs (CMS, 2019). With an improvement in nursing retention, patient satisfaction will increase, along with patient and staff safety.
The focus on nursing retention and it’s relation to a nursing theory is to describe a theoretical model of job retention for long term care nurses. There has been predicted severe nursing shortages and an increasing demand for long term care services that have made the retention of experienced, qualified nursing staff a priority for many health care organizations. The theoretical model is an integration of the findings of empirical literacure and research related to intent to stay and retain, components of this theory of nursing evidence based practice and findings from earlier research to develop a way to measure nurses' job satisfaction (Hughes, 2017).
The theoretical model focuses on job satisfaction of long term care nurses. This includes the internal and external priorities as well as job characteristics. Theoretical nursing theory also shows that job satisfaction has a relation to retention and indirectly related through intent to stay. Individual nurse characteristics are indirectly related to retention again shown through intent to stay. The individual characteristic of tenure is indirectly related to retention through autonomy, as an intrinsic characteristic of job satisfaction, and intent to stay. This proposed model of Theoretical nursing can be used to guide research that explores gaps in knowledge about intent to stay and retention among all nursing staff (Hughes, 2017).
The literature review is to examine recent findings related to the issue of nursing shortage and retention, the causes and challenges in terms of costs and the impact of turnover on patient, nurse, and organizations, and to find the implications to retain good nurses. Most literature to date has looked at factors contributing retention and a few shortage costs and implications on these organizations. Considering there has been 320,000 Americans who have applied to nursing school in 2010, only 78,000 graduated and 23% are currently working as nurses in the field. If we look at nurses after graduation, about 30,000 stay in the nursing field and 50% leave their first job after just two years (Zurmehly, 2018). This has compounded with the nursing shortage and retention as to the staffing problem and is increasing with age of the nursing population and their anticipated retirement.
It’s not that long-term care facilities don’t want to support their nursing staff in their professional growth. It’s that many organizations struggle with staffing and retention giving the nurses time to do so. The study The secrets of Success for Nursing Staff Retention in Long Term Care specifically looks to improve recruitment and retention of nursing staff. They understand that lower staff turnover rates lead to better care at lower costs. This study looks into the growing number of strong orientation programs are closely linked to nursing staff retention. Long-term care organizations with effective orientation programs tend to have agreement among the leadership, nursing educator and human resources on what’s needed to adequately prepare nurses to work in their environment; designate an experienced nurse preceptor who works closely with new hires, providing them with timely feedback and professional nursing skills; and comparison to the supports available to nurses in long term care.
With this study the rational showed, having an orientation for new hires to be effective at boosting the confidence, skill and retention rates of long term care nurses (McGlynn, 2017). Data from this study showed that in long term care nurses with a preceptor and leadership with education helped new nurses build skills and confidence, but also impacted others on the nursing staff, as well as the organization overall. “It’s a good way for a nurse to have an impact and make change in the workplace,” said McGlynn. Data from this study also showed that the skilled nursing homes that piloted thses programs lowers nursing staff turnover while increasing job satisfaction and patient satisfaction. This further illustrates the power of committing to supporting and developing nursing staff at the organizational level.
This study utilized data of new nurses that applied the education lessons immediately, the nurses were educated on reviewing charts and identifying evidence-based practice recommendations, and the use of preceptors and other senior nurses throughout the organization (McGlynn, 2017).
The U.S. Bureau of Labor Statistics predicts the demand for registered nurses to grow from two million to 3.2 million in the last decade, a 60% increase according to AACN (2019). In this study they examed the problem that facilities are having with great difficulty recruiting new nurses and retaining current ones.
The U.S. Bureau of Labor and Statistics also states that in the United States, the biggest group of nurses will be expected to retire by the year 2020, Effective Retention Throughout the Career Continuum by Isgar. This then pushes health care facilities’ to go beyond their limits. In this study it shows part of the reasons a nurse’s early retirement includes the desire to decrease their workload, freedom and flexibility of schedules, and that veteran nurses do not feel valued by their leadership. It is particularly important to have accurate and positive leadership and in the facility, which the nurse’s work, in any discipline, but this is particularly, true for the profession of nursing (Isgar, 2018).
There are two main strategies that have been tried by addressing the discrepancy between the supply and demand in the nursing field. The first is to increase nursing programs enrollment rates, and the second, is to import nurses from other countries. This latter treads on controversial grounds unfortunately; given the situations in other countries and nursing pools that have to be shared. The only strategy to help increase nursing student enrollment is to improve the shortage and so far this has not worked according to the American Association of Colleges of Nursing, U.S. nursing schools will need to increase the number of graduates by 90% to fill the gap. The gap that exists between in health care leadership and the clinical staff is being told that recruitment and retention is being done and leaderships approach is to empower the staff to facilitate this within the facility (AACN, 2019).
The objective of the analysis is to synthesize on nurse staffing and patient outcomes along with the impact of the nursing experience on patient outcomes. We have seen nursing turnover and the significant effects on nursing retention and satisfaction. The inadequate staffing levels and acuity with workloads along with the negative impact this has on nurses, their well-being and patient outcomes (Bland & Gates, 2019). Research shoes that the decrease in the number of nurses working in long-term care facilities is due to increased patient acuity, workloads and demand for outstanding patient care. Organizations are starting to see incidence of missed shifts due to reported illnesses increased when nurses were asked to work overtime or are mandated to stay not only 12 hours, but up to 16 hours. This also proves that high workloads affect nurses’ performance and mental health.
As healthcare grows our need for nurses is too, unfortunately our number of nurses is declining. Without the number of nurses we need, patient’s care and safety are now compromised, as nurses are becoming overwhelmed at their jobs, nurses are distressed and dissatisfied. With the acuity of patients getting less manageable with the nursing to patient ratios there are many nurses showing frustration and job burnout, this will lead to high turnover lower job retention (Gindel & Hagerstrom, 2014). With nursing being short staffed especially in long-term care facilities the force this has been found to guide to poor patient outcomes.
Working with nursing leadership in a contemporary fashion and helping them focus on making the facility and staff that are focused on an environment that creates advancement and autonomy will not only help hire new nurses, but also keep the nurses that have stayed at the facility. Working with leadership and with more staff they can staff adequately while nurses can have shorter shifts, job sharing, and work schedule flexibility this would help leadership retain veteran nurses (Gindel & Hagerstrom, 2014).
In addition to decreased employee and patient satisfaction, higher nursing turnover rates also resulted in patients and their families’ disengagement, illness exacerbation, and patient rehospitalizations were reported according to AACN (2019). Organizations with low levels of nursing shortage or turnover were likely to have fewer patient falls and nursing medication errors with high turnover. Additionally, when there is positive impact on patient satisfaction, and increased team building, working less hours showed fewer occurrences of severe medication errors, falls and staff illness.
In the conclusion the data of the studies shows the need to continue to maintain current knowledge in a profession that is rapidly changing and developing, along with orientation programs including preceptors, educators and leadership. There are a variety of opportunities to enhance nursing knowledge (Curtis, Wiseman, Kennedy, Kourouche, & Goldsmith, 2015). A nurse working in long term care needs an education program designed, developed, and implemented with improving nursing knowledge, job satisfaction, and retention at a LTC facilities. In these studies they found that a significant increase in nursing knowledge following orientation participation, which was one of the project goals. Facilities need to be proactive in improving their long term care knowledge in order to provide the best evidence-based care to the to their patients and increase the quality of care along with patient satisfaction. This goal will help improve clinical decision making skills as well as improve overall patient health outcomes. Therefore we should see overall nursing retention increase along with sufficient staffing and staff satisfaction.
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