Capstone Project Change Proposal Paper

Nurses form an integral part of the United States health workforce and perform critical roles in helping to achieve universal health in community and primary health settings.  The statistics report by the World Health Organization approximates that globally, there are 29 million nurses and 3.9million are in the US. By the year 2020, an additional 1 million nurses will be needed. However, a major issue of concern is the shortage faced by the nursing profession which has primarily been attributed to nursing turnover. Capstone Project Change Proposal Paper

Nurses’ turnover is a fast-growing global problem facing the health sector which has attracted attention from policymakers, researchers and healthcare administrators. While researchers have associated the lowest rates with a significant loss in the quality of care and finances, the current global high rate of 16-44% can lead to severe consequences in healthcare organizations and the entire American healthcare system, thus the need to address it.

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Using a well-formatted PICOT question to search for supporting evidence from currently existing literature, this paper critically examines the issue of nurse turnover and how it can be effectively addressed to influence positive organizational change. A description of the background of the issue, problem statement, change purpose, search and evaluation of literature will be provided. Besides, the change theory that will be applied, proposed plan of implementation, outcome measures, implementation barriers and how they can be overcome will also be discussed.

Since nurses form the biggest professional cohort of the health workforce, reducing nurse turnover and supporting the professional practice of nurses will benefit and positively impact a sustainable health workforce and patient health outcomes.

Background

Since the adoption and implementation of the Affordable Care Act, the demand for nurses has increased dramatically. As a result, most healthcare organizations experience challenges, the most significant being shortage of nursing staff due to high turnover rates amongst nurses. Nurse turnover impacts negatively the ability to sufficiently address a patient’s needs and provide high-quality care. Turnover amongst nurses has been documented to result in an inadequate staffing level which ultimately increases the stress and workloads of other nursing staff (Bong, 2019). Subsequently, this can result in significant differences in nurses’ attitudes and behavior towards their roles and work performance as evidenced by lower levels of productivity and satisfaction.

Similarly, nursing turnover has been evidenced to result in poor patient health outcomes, increases the rates of medical and medication errors, mortalities and morbidities. Adequate nurse staffing has been evidenced to result in favorable work environments and nurse outcomes primarily characterized by fewer intentions to leave the profession, less dissatisfaction, and burnout which are recurrent problems that lead to turnover amongst nurses. Capstone Project Change Proposal Paper

Problem Statement

As the need for nurses continues to increase due to changing healthcare consumer demographics and healthcare delivery systems, increasing and retaining adequate and skilled nursing staff is a major priority. With the continuing nursing shortage, the majority are left to work under pressure and experience high levels of burnout and stress which ultimately results in poor performance, poor patient health outcomes and financial implications for healthcare organizations (Kutney-Lee et al., 2015). Major contributors to nursing turnover within this healthcare organization have been noted to include: strict control of the work environment and work schedules, wages, and autonomy in nursing practice. The principal objective of this healthcare organization is to provide safe and high-quality care which meets all patient needs. To attain this objective and support the delivery of care, an effective and adequate nursing workforce is mandatory. Therefore, to meet present and future demands for care, a retention program for nurses would address the nursing turnover issues by facilitating effective strategies which support shared governance, ensure better benefits and salary to promote job satisfaction and ensure autonomy in practice.

Purpose of the Change Proposal

            This proposal aims at influencing organizational change that would help to reduce the rates of nursing turnover and burnout and improve the levels of satisfaction and retention among nurses with resultant good patient health outcomes. Therefore, the change will incorporate a retention program with strategies that purpose to reduce stress levels and burnout among nurses’, promote job satisfaction, flexible work schedules and favorable work environments and shared governance in the clinical setting (Özgür & Tektaş, 2018).

PICO(T)

Nurse retention programs have been evidenced to be the most effective strategies for promoting the professional practice of nurses and reducing turnover. These programs entail: providing nurses with professional development opportunities, reducing overtime, giving rewards for excellence and longevity, adoption of nursing residency programs, creating positive working environments and practicing shared governance (Kutney-Lee et al., 2016). This, therefore, leads to the following PICOT question:

Among nurses working in primary care settings (P), does the implementing a nurse retention program (I) compared to no nurse retention program (C) help to reduce nursing turnover and burnout(O) within 3 months(T)?

Literature Search Strategy Employed

A search was conducted using the following search terms: nurse turnover, nurse burnout, and nurse retention program. The search was done using the search engines of CINAHL, EBSCOHost, MEDLINE, and PubMed. For more specific and reliable results, the search was limited to articles in English, published within the previous 5 years. The search yielded a total of 10 articles of which 8 were relevant to the PICO question and were included in the evaluation of literature. Capstone Project Change Proposal Paper

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Evaluation of the Literature

Nurse turnover and burnout have become a serious issue within most institutions providing care. Bong (2019) examined the association between moral distress and nursing turnover rates. Moral distress can be a result of strict work schedules or work environments that hinder the delivery of optimal and quality care. Other studies have reported that promoting positive work environments helps to lower the rates of nursing turnover and levels of burnout (Kutney-Lee et al., 2015).

According to Kutney-Lee et al., (2016), shared governance in professional nursing practice promotes optimal nurse and patient health outcomes. This can be fostered by engaging and empowering nurses in management and decision making since shared governance is a strategy for transformational leadership which improves the experience of a patient. Similarly, Cheng et al., (2016) examined how transformational leadership and social identity impacts care quality, teamwork, turnover and burnout among nurses. Transformational leaders use the right speech and gain the trust of those that they lead, which ultimately predicts a low turnover intention.

According to Li et al., (2019), work environments impact significantly on the levels of nursing turnover and job satisfaction. Work environments with high incidences of workplace violence resulting in low job satisfaction and high nurse turnover intention. Therefore, ensuring a favorable work environment that can only be attained through management support is key to retaining nurses. In a three-level multisource study that was conducted by Perry, Richter & Beauvais (2018), the five major predictors of nurse turnover and satisfaction were revealed to be: opportunities for advancement, supportive leadership, levels of staffing, the adoption of nursing care practice and teamwork between nurses and physicians.

Özgür & Tektaş (2018) conducted a study which examined the relationship between organizational trust levels and nursing burnout. Other studies have documented depersonalization, emotional fatigue and low levels of achievement as forecasters of nurses trust to an organization (Mizuno et al., 2014). It is generally agreed that reduced organizational trust among nurses increases turnover, workload, motivation, and negatively impacts are quality.

Applicable Change or Nursing Theory Utilized

Goal attainment theory was developed in the 1960s by Imogene King and defines an interpersonal and dynamic relation that a patient develops and grows to achieve specific goals in life. According to this theory, the most significant factors which can hinder the achievement of goals include stress, roles, time and space (Williams, 2017). This theoretical model will be applied in the implementation of the proposed program to determine whether or not mutual goals (health promotion and restoration) between a nurse and a patient are achieved. Nursing turnover and burnout are major factors that can prevent adequate interaction between a patient and a nurse. However, when provided with a favorable work environment, they are likely to provide high-quality care and achieve care goals.

Proposed Implementation Plan with Outcome Measures

This project proposes the adoption of a nurse retention program within the organization to reduce nurse turnover rates and burnout. It is expected that this program will influence a favorable work environment that reduces burnout among nurses’, promotes job satisfaction, independent nursing practice, flexible work schedules and improved patient health outcomes as revealed by post intervention survey (Perry, Richter & Beauvais, 2018). To ensure that the proposed plan is appropriate for organizational practice, collaboration with relevant stakeholders in its development and implementation was considered.

Potential Barriers to The Implementation Plan and How They Could Be Overcome

Possible barriers to the enactment of the proposed plan are: financial, behavioral (nurses’ resistance/reluctance to change) and time. Financial barriers related to short staffing can be addressed by seeking financial support from the organization’s leadership. Some of the components of the retention program may seem too nice to be believed by all nursing staff. Therefore, behavioral barriers where some nurses may seem reluctant to be involved in the change process can be addressed through education. Lastly, the implementation of a retention program will require the involvement of several stakeholders’ formulation of policies and regulations. This can be addressed through the use of the project timeline. Capstone Project Change Proposal Paper

Conclusion

This proposal suggests the adoption and implementation of a nurse retention program that would ensure a reduction in nurse turnover and burnout. The current nursing workforce shortage experienced in the organization due to high nurse turnover rates resulting in financial and health implications can adequately be addressed through a retention program. This program should purpose to: encourage independent practice based on nurses’ training and scope of practice, motivate and inspire nurses through appropriate wages and benefits and to promote flexible work schedules.

The articles that were reviewed supported the adoption of a nurse retention program to reduce nursing turnover and burnout. The implementation of the proposed plan will be facilitated by the goal attainment theory which will also help to determine the achievement of mutual goals involving care between a nurse and a patient. Potential barriers likely to be encountered during the implementation of the proposed plan include: financial, behavioral (reluctance/resistance among nurses) and time.

References

Bong, H. E. (2019). Understanding Moral Distress: How to Decrease Turnover Rates of New Graduate Pediatric Nurses. Pediatric Nursing, 45(3).

Cheng, C., Bartram, T., Karimi, L., & Leggat, S. (2016). Transformational leadership and social identity as predictors of team climate, perceived quality of care, burnout and turnover intention among nurses. Personnel Review, 45(6), 1200-1216. doi:10.1108/PR-05-2015-0118

Kutney-Lee, A., Stimpfel, A. W., Sloane, D. M., Cimiotti, J. P., Quinn, L. W., & Aiken, L. H. (2015). Changes in patient and nurse outcomes associated with magnet hospital recognition. Medical care, 53(6), 550. doi:10.1097/MLR.0000000000000355

Kutney-Lee, A., Germack, H., Hatfield, L., Kelly, S., Maguire, P., Dierkes, A., Aiken, L. H.  (2016). Nurse Engagement in shared governance and patient and nurse outcomes. J          Nurse Admin, 46(11), 605–612. doi:10.1097/NNA.0000000000000412

Li, N., Zhang, L., Xiao, G., Chen, J., & Lu, Q. (2019). The relationship between workplace violence, job satisfaction and turnover intention in emergency nurses. International emergency nursing. doi:10.1016/j.ienj.2019.02.001

Mizuno Tironi, N., de Carvalho Silva, L. G., Gomes Dellaroza, M. S., Lourenço Haddad, M. do  C., & Oliveira  Vannuchi, M. T. (2014). Management impact of staff turnover in the view of nurses: An exploratory study. Online Brazilian Journal of Nursing, 13(4), 549–558.            Retrieved from https://search-ebscohost-            com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=103803243&site=eds-            live&scope=site

Özgür, G., & Tektaş, P. (2018). An examination of the correlation between nurses’ organizational trust and burnout levels. Applied Nursing Research, 43, 93-97. doi:10.1016/j.apnr.2018.07.004

Perry, S. J., Richter, J. P., & Beauvais, B. (2018). The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three‐Level Multisource Study. Health services research, 53(6), 4943-4969. doi:10.1111/1475-6773.12997

Williams, L. A. (2017). Imogene King’s interacting systems theory: Application in emergency and rural nursing. Online Journal of Rural Nursing and Health Care, 2(1), 40-50.

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Capstone Project Change Proposal Paper