Nurse Staffing

According to Suzanne Gordon “ whether young or old, nurses are disillusioned because they believe that health care systems guided by bottom-line concerns simply don’t recognize the specificity of their work” (234). Nursing is more demanding than many other professions or occupations, due to the combination of difficult patients, exhausting schedules and arduous physical work (Gordon 235). It can take a significant emotional toll on many, hence the higher levels of burnout. Job dissatisfaction as a result of increased workloads and unreasonable demands, such as inappropriate nurse staffing levels, was cited as the number one reason that drives many experienced nurses to leave the profession (Sanford 38+). Studies have shown that such working conditions also affected the retention of new graduate nurses by leaving their first hospital jobs within two years of graduating (Sanford 38+).

In “Patient outcomes in the field of nursing: A concept analysis”, researches completed a concept analysis on job satisfaction as a means to make managers aware that the nursing workforce should be stabilizes especially in a time of a world-wide nursing shortage. (Liu, Aungsuroch, and Yunibhand, 2016, p84) Researchers completed this analysis by utilizing the Walker and Avant concept analysis model. The Walker and Avant model, established in 2011, is comprised of eight steps: a) selecting a concept, b) determining the purpose or aim of the analysis, c) identify all possible uses of the concept, d) determine the essential attributes, e) construct an example of the concept in use, f) construct illegitimate, related, contrary, borderline, and invented examples, g) identify antecedents and consequences, and h) define empirical referents. (McEwen & Wills, 2014,

Gordon, S., Buchanan, J., & Bretherton, T. (2008). Safety in Numbers: Nurse-to-Patient Ratios and the Future of Health Care (pp. 1-2). Ithaca, NY: Cornell University Press.

The nurse manager in today’s health care has a solid role in providing a healthy working environment. Healthy working environment is the basis for safe and better patient outcomes. Healthy working environment in a unit depends on the inspiration, motivation and support from the nurse manager and the management in all the ways. So as a nurse manager in a unit, the change I wish to initiate is the safe staffing patterns. Safe staffing patterns are always important for safe working environments to deliver excellent patient care. Staffing and scheduling means providing an adequate staff mix to meet the needs of the patients (Grohar-Murray & Langan, 2011). Nurse manager should know how to schedule and skill mix to provide adequate

There are many challenges facing today’s nursing leaders and managers. From staffing and scheduling, to budget cuts and reduced reimbursements, today’s nursing leaders must evolve to meet the ever changing health care environment. Constance Schmidt, Chief Nursing Officer at Cheyenne Regional Medical Center (CRMC), identified retaining experienced registered nurses (RN) as one of the biggest problems she faces as a nursing leader. She went on to state “Nationally, most hospitals have more than 60% of their nurses with at least 5 years of experience. At CRMC, it’s the reverse. We have more than 60% of our nurses with less than 5 years of experience” (personal communication, March 28, 2014). The two largest factors affecting those numbers are the nursing shortage and nursing retention. The first, the nursing shortage, was identified years ago and has been researched countless times. Some projections indicate the number representing the gap between available registered nurses, and the positions needing to be filled, could be over a million before the end of the current decade. The latter, retention of nurses, is a problem in every health care facility in the nation. Nursing turnover results in both a significant financial cost to hospitals, and a significant impact on the community through its effects on patient outcome.

Current internal and external hospital stressors are impacting NCs nursing shortage. With the release of many reports from different sources suggesting a change is needed. Most have been accurate in their projections; however, the struggle continues. Strong implications for the direction the crisis is heading, from campaign research to thesis and dissertations, written by professional groups and organizations add credibility to the cause; however, the shortage remains. Although some would argue that job satisfaction has no bearing on the nursing shortage and more pressing problems are prevalent; for example, the ageing population, undereducated nurses, patient safety and more positive patient outcomes; therefore, this paper highlights suggestions for change, with a concentration on nursing dissatisfaction and the nursing shortage.

The purpose of this article is to discuss appropriate nurse staffing and staffing ratios and its impact on patient care. Although the issue is just not about numbers as we discuss staffing we begin to see how complex the issue has become over the years. Many factors can affect appropriate nurse staffing ratios. As we investigate nurse staffing ratios we can see the importance of finding the right mix and number of nurses to provide quality care for patients.

In the first article chosen, “Why are Nurses Leaving? Findings From an Initial Qualitative Study on Nursing Attrition,” the research method used was qualitative. The specific type of research design used was phenomenology. The participants were interviewed about their person experience of what it was like working as a registered nurse. The research question for this study was, “What is the experience of RNs who leave clinical nursing?” The sample is registered nurses (RN) with a minimum of 1 year of clinical practice and no clinical practice in the last 6 months. The sample size was ten, which were a majority of females (80%),

(ANA 2015; Brewer & Kovner, 2008). The high turnover rates can decrease the number of RNs

America is one of the most affluent countries in the world, but is also a nation that has a healthcare industry that is in much turmoil. One of the more pivotal influences of this turmoil is nurse turnover rate. Nurse turnover does not have a universal meaning, consequently making it difficult to associate turnover rates in healthcare facilities and geographical areas. In all actuality, “"Nurse turnover" is an undesirable trend for healthcare employers. It 's expensive, it 's disruptive, and it threatens the quality of care and patient safety” (Kovner, Brewer, Fatehi, and Jun (2014). All throughout America healthcare organizations demand a steady, extremely trained and completely engaged nursing staff to provide efficient levels of patient care. However, a budding shortage of experienced nurses has led the United States healthcare industry to a continual increase in the turnover rate among registered nurses. As a matter of fact, “Hospitals are experiencing an estimated 16.5% turnover rate of registered nurses (RNs), increased from 14.7% in 2012” (Yarbrough, Martin, and Alfred, 2014). Turnover costs of these leaving nurses are as much as a universal problem throughout the healthcare industry, occurring at staggering prices. According to Yarbrough, Martin, and Alfred (2014) “Estimates of RN turnover costs range from US$44,380 to US$63,400 per nurse—an estimated US$4.21 to US$6.02 million financial loss per year for hospitals.” This ascending trend in turnover rates is a clear

For years, the great nurse-patient staffing ratio debate has ignited opinions and flared tempers on both sides of the issue. Innumerable studies have been conducted regarding various aspects and effects of staffing ratios. The business side of healthcare continues to clash with the clinical side of operations, and to date, California remains the only state in the United States thus far that has enacted legislation mandating nurse-patient staffing ratios. The business office representatives see only dollar signs, fearing the cost of recruiting, training, and retaining more nurses. Nurses and clinicians on the front lines see much-needed relief from patient care assignments laden with too many patients, or patients whose acuity is too high to safely care for with the current lack of mandated nurse-patient ratios. This paper examines the potential effects of enacting or legislating safer nurse-patient staffing ratios.

Additionally, the study found that a high patient to nurse ratio resulted in greater emotional exhaustion and greater job dissatisfaction amongst nurses. Each additional patient per nurse was associated with a 23% increase in the likelihood of nurse burnout, and a 15% increase in the likelihood of job dissatisfaction. Moreover, 40% of hospital nurses have burnout levels exceeding the normal level for healthcare workers, and job dissatisfaction among hospital nurses is four times greater than the average for all US workers. 43% of nurses involved in this study that reported job dissatisfaction intended to leave their job within the upcoming year. (Aiken et al.)

Retaining a stable and sufficient supply of nurses is an important hospital and nationwide concern. Numerous factors affecting retention of registered nurses comprises of practice autonomy, managerial respect, workload, and inclusion in decision making, flexible schedules, education, and pay (“Recruitment”, 2013). Hospitals not capable of retaining qualified registered nurses may result in the loss of experienced and knowledgeable staff. Additionally this will lower hospital productivity during this transition. High turnover rates for registered nursing staff may also impact job fulfillment and nursing moral altogether. Retaining qualified registered nurses will enhance patient care quality and satisfaction.

The researchers surveyed 3186 nurses on staff at 56 hospitals; 52 academic hospitals and 4 non-academic hospitals. The researchers compared the results of the nurses’ surveys with information about the location of the hospital (rural or urban), the hospital environment (managerial support, good relationships among team members, the nurses’ involvement in decision-making), the nurses’ educational levels, and the staffing (nurse:patient ratio). The researchers also interviewed nurse managers and leaders to evaluate their input on nurse retention and nursing shortages in a qualitative portion of the study. In the article “Effective strategies for nurse retention in acute hospitals: A mixed method study”, the researchers state “the results show that nurse staffing and the quality of the nurse practice environment (i.e. managerial support of nursing care, good relations between doctors and nurses, nurse participation in decision-making and organizational priorities on quality of care) are significantly associated with intention-to-leave the hospital” (Van den Heede et al., 2013, p. 192). This association is related with increase nurse satisfaction with environment and staffing is related to decreased intention to leave the hospital, or an inverse relationship. These researchers also shed light on the fact that Magnet hospitals have far better nurse retention and nurse satisfaction. Thus, focusing on and achieving a Magnet status can be an effective

Nurse turnover is defined as “the number of nurses changing jobs within an organization or leaving an organization within a given year” (Baumann 2010). Retaining nurses is one of the most important issues in health care as its effects range from challenges in human resource planning, to high costs in financial and organizational productivity (Beecroft et al, 2008), to workgroup processes and morale, to patient safety and quality of care (i.e. patient satisfaction, length of patient stay, patient falls, and medication errors) (Bae et al, 2010). Nursing Solutions Inc (NSI) reported the national average turnover rate for hospitals increased from 13.5% in 2012 to 14.7% last year. Nurses working in Med/Surg had more turnover