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Renfrey Memorial Hospital Board Project Proposal

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    Renfrey Memorial Hospital Board Project Proposal Renfrey Memorial Hospital Board Project Proposal Wanda Goodnough Ashford University Principles Of Health Care Administration MHA 601 Professor Kinsey February 21, 2011 Table of Contents Executive summery2 Introduction3 Shortages of nurses4 Causes of shortages in nurses5 Effects of shortages in nurses6 Solutions to curb nurse shortages7 Solutions most viable for Renfrey Memorial Hospital10 Conclusion and recommendations13 References……………………………………………………………………………………….. 15 Renfrey Memorial Hospital Board Project Proposal Executive Summary

    American hospitals have in the recent past experienced acute shortages of nurses and the problem seems to be worse in the near future if necessary steps are not taken. The shortages currently are more multifaceted as compared to what happened in the past 50 years (Ulrich et al. , 2005). Renfrey Memorial Hospital is such an example that has been faced with shortages in nurses as in the past two years, high rates of nurses have been leaving as a result of stressful working condition making them feel burn out. It resorted to using a pool of nurses from an agency but this proved to be very costly.

    The effects of nurse shortages are beyond our imagination as patients stand a chance of losing their lives and being less satisfied. There have been a number of strategies employed by a number of hospitals in the country to address the problem. The strategies include changing leadership and management style so that nurses are provided with a better working environment, provision of competitive compensation and benefits, relying on federal, corporate and state support in terms of funding and policies, outsourcing nurses, recruiting new nurses among others.

    For Renfrey Memorial Hospital, it is not enough to just try to recruit new nurses but also to adjust the leadership and management style which will see to it that the environment in which its nurses will be working is conducive and supportive hence making them satisfied and motivated. This initiative if executed in the best way will help the hospital address the current problem in the long-term (Aiken et al. , 2009). It is also cost effective as compared to other strategies such as outsourcing. Introduction

    In the recent past a number of organizations have been faced with a myriad of problems, among these problems that has been of concern is the ability to retain employees. Research has shown that the rate of employees’ turnover has been in the increase. This does not leave hospitals out of question as retention of nurses coupled with shortages of the same has left a number of health care facilities in trouble. One hospital that has experience such problem will be used to critically evaluate the issue of nurses’ shortages in the United States of America.

    The hospital in question is Renfrey Memorial Hospital which is located in Midwest and has bed capacity of 200. RMH has provided American citizens with healthcare services for the past 32 years. It is worth noting that it is the only hospital in the region that maintains 24/7 emergency department and an extended hour clinic. Currently, RMH is undergoing a problem in retaining its nurses. Statistics show that approximately 68% of nurses are above 45 years and are faced with retirement. A survey established that the nurses are of the opinion that their work is physically too demanding which is attributed to them being physically exhausted.

    Additionally, most of them felt emotionally burn out. Some reported that working at the hospital and at the same time taking care of their older parents causes stress to them. As a result, the hospital in the past two years have experience the highest rates of nurses leaving the profession forcing FMH to use nurses from an agency. The monetary cost associated with such an initiative has over-stretched the organization. Similarly, the rate on patient satisfaction has tremendously fallen. The shortage of registered nurses has also made it difficult for the hospital to recruited new nurses that would replace the aging population of nurses.

    The emphasis of the paper is thus to evaluate possible solutions to address the problem of nurses shortage and retention and chose the most feasible and cost effective for the hospital to be implemented. It is worth to note that no organization can just react to such a problem in a simple manner. There is need to actively engage professional and take proactive measures in order to cut down the rate of nurses leaving the profession. This not being enough, there is need for healthcare organizations such as FMH to aggressively engage in activities that will help in recruiting and retaining nurses (Jones, 2008).

    Shortages of nurses According to Aiken et al. , 2009 nursing has been thought over the years by American and for that matter other individuals to be an attractive profession. The profession does have ingredients that make it exciting and at the same time a fulfilling one, it offers participants a challenging experience, provide them flexible environment between family life and work life, constitute a myriad of fields such as research, education, administration among others. It is a profession that entails working with people, dealing with holistic demands of man which entails promoting health, uring, preventing, caring, rehabilitating those with health issues. It is a field that needs dedicated individuals. It is no doubt that nurses are important in ensuring that we have a healthy community. On the same note increase in human population, the increased rate of aging population, inadequate resources seem to put pressure on the number of nurses we currently have. As a result the country since 1960 is currently experiencing the highest deficit of nurses. When demand of nurses is in sharp increase, their availability and willingness is continuously declining.

    It has been predicted that by 2020, America will face the worse experience of nurses’ shortages; it is approximated that the gap between demand and supply of nurses will be nearly 260,000 this being three fold as compared to what happened about 50 years ago. The shortage is anticipated to clock 500,000 in 2025 (Ulrich et al. 2005). It is worth mentioning that although experts and healthcare providers agree that America is currently suffering from shortages of nurses, there are no comprehensive data to fully give an insight to the whole picture of shortages in nurses.

    However, there is a number of reliable information that suggests that indeed there is a shortage of the professionals. For instance, the State of California in 1997 had an RN rate of 8. 5% for all categories of employer. Hospitals, nursing homes, home healthcare reported 9. 7%, 7. 0% and 6. 5% in that order (Berliner & Ginzberg, 2006). Another hospital, Dallas-Fort Worth back in 2000 reported nurses turnover of close to 9. 5% and 17. 0% for registered nurses in emergency section and critical care units respectively.

    In Vermont, it was established that the rate for nursing homes, home healthcare and hospital were 16. 0%, 9. 7% and 4. 8%. The later, in hospital rose from 1. 2% to 4. 8% four years later. Causes of shortages in nurses Scholars have suggested that before embarking in providing a solution to a problem it is only rational and responsible enough to try to find the causes of the problem at hand. There are numerous factors that are attributable to the current problem facing FMH as well as other healthcare organization in the United States of America.

    One major cause of shortages in nursing is due to an increase in human population or patients that are aging, having complicated demand for care. All these increase the demand for nurses. The matter is made worse considering the rates at which institution that offer training releases nurses to the fields (Rother & Mourey, 2009). Research did also establish that the shortages in nursing are linked to the amount being earned as compared to other careers options.

    For this reason, instead of having more nursing student more are turning to such field as business among others deemed well paying, full of opportunity and free from emotional and physical stress like in nursing. A survey conducted in 2006 found out that tight schedules, intense workload, lack of flexi arrangement in the workplace as well as compulsory overtime led to increased level of dissatisfaction and lower morale. This had a higher chance of making nurses retire early and sought jobs elsewhere (May et al. , 2006).

    According to Berliner & Ginzberg, 2006 the rate at which the existing nurses are growing old and face retirement coupled with lower rates of replacement has contributed to the current shortages of nurses. Similarly, the rise in demand of using advanced technology in providing healthcare calls for nurses to go back and study in order to acquire wide skills. Other reasons deemed to have caused the shortage include poor leadership and weak management styles, death of nurses due to health concerns, increased frustration in balancing family life and work life, in adequate resource especially funding among others.

    Effects of shortages in nurses The serious negative impact of shortages of nursing is a wake-up call for the healthcare institution as well as other relevant stakeholders such as medical schools, local government and the state at large. It has been established beyond any reasonable doubt that shortages of nurses impact on patient’s outcomes. Additionally, the shortage is also associated with increased rates or medical errors. In hospitals that the ratio between the patients and nurses was high, patients were more likely to recover successfully.

    It is also true that when the ratio is high, the quality of care provided to patient is higher which translates to lower rates of mortality. A study carried out by Aiken found out that close to 20,000 Americans die every year when check in hospitals that nurses are overworked, on the same note 31% of patient to scheduled to undergo surgery in hospitals characterized by shortages of nurses are at risk of dying and close to a fifth of almost 100,000 deaths per year is as a result of medical errors linked to shortages of nurses (Aiken et al. 2009). Shortages of nurses have also led to a higher number of inpatients as well as other categories of patient to be less satisfied. Such records negatively tarnish the image of a given healthcare organization. When nurse to patient ratio is low, the rate of patient survival after surgery is higher. In general, shortages of nursing in the long run means that the country will have more people with poor health and higher chances of dying despite the fact that causes of such death can be prevented (Rother & Mourey, 2009).

    Solutions to curb nurse shortages It is not only FMH that has been faced with shortages in nursing. Examples of hospitals that have experienced hard times in retaining nurses include; Baptist Health South Florida, Dallas-Fort Worth, Bradford Health Services – Birmingham, Massachusetts General Hospital, Braxton County Memorial Hospital and Albert Einstein Medical Center in Philadelphia. All these hospitals have used not only one but several strategies to curb shortages of nurses.

    An examination of the strategies used by these hospital shows that they all used a mixture of short-term and long-term strategies to address the issue of shortages of nurses (Morgan & Lynn, 2009). Among the efforts and strategies include changing the style of management and leadership, emphasis on nurse education, temporary staffing/outsourcing, offering competitive compensation, offering nurses a flexible working environment, retention of nurses, using Versant RN residency among others. Baptist Health South Florida is one hospital that once faced acute shortages in nursing.

    Employing the Versant RN residency program, the rate of nurses’ turnover declined from 10% from 22% within a span of one and a half years. The program allows those nurses fresh from college to be assigned to or paired with a nurse deemed veteran and of high integrity to be train for a period of eighteen weeks. It is worth noting that one cause of nurses to resign or change profession is due to stress and lack of being well acquainted to the demands of the nursing profession (Berliner & Ginzberg, 2006). All these are reduced when a fresh nurse is under the guidance of a veteran nurse.

    As noted by Jones, 2008 most of the hospital that faced serious shortages in nurses as well as in retaining them realized that they had a weaker leadership and poor management styles. Leaders are the ones who need to be in the forefront to show their followers the best way to achieve the organization goals and objectives. An example of a hospital that employed stronger management is Braxton County Memorial Hospital. It’s traditional model used in running the organization was a hindrance to collaborative management.

    The structure of management was changed into being lat so that the hierarchies are reduced which led to increasing structures of nurses. This gave nurses were given a chance to take part in decision making, take responsibility of their actions, incorporate creativity in doing their work, all these resulted to a more satisfied nursing staff. Strong management thus is key in helping creating nurses that are satisfied having high morale hence addressing the existing shortage (Rivers et al. , 2005). The same strategy has been used elsewhere to retain nurses that are at the verge of retiring.

    This has been done by the management meeting the specific needs, aspirations and demands of nurses as well s addressing the problem that work against staff morale and satisfaction. On the same note May et al. , 2006 observed that providing nurses with all necessary resources do help them accurately and wit ease to accomplish their task. The kind of leadership and management dictates how this is done. For instance provision of computers as well as other vital medical equipment ensures that nurses execute their responsibility in an effective manner.

    Additionally, having in structure a system of sharing information within the hospital has been hailed in ensuring that nurses are always updated and not left in the dark hence feel part of the community. A group of hospital, six to be specific in Alabama has joined resources and committed $1. 3 million in order to support nurses’ enrollment in nursing teaching institution. The initiative was dubbed ‘Nurses Now’. This is a long-term strategy that will definitely help address the current shortages not only in the state but also in the entire country. American hospitals have also employed outsourcing nurses from agencies to counter the problem.

    The strategy is usually considered a bold initiative but only effective in the short-term (Morgan & Lynn 2009). Considering the cost of the initiative and the retention of existing nurses, the later has been established to be a better option. Similarly, Albert Einstein Medical Center in Philadelphia is a typical example of a hospital in the United States that effectively tried to use competitive compensation and benefits to its nurses as well as other staffs. After carrying out a survey, stress, as a result of tight work schedule necessitated the hospital to draft and offer nurses a flexible working environment.

    Most nurses were having a difficult time trying to balance their family life as well as work life (Johnson, 2009). There were those who were taking care of their aging parents while others were having a challenge of their young children. After a close deliberation, it the hospital and its nursing staff arrived at an arrangement where the later would report to work when they are comfortable. This helped them balance work and family life leaving them satisfied hence lower rates of turnover. On the same note competitive compensation comes with a flexible benefit packages.

    A number of hospitals in the United States realized that due to a diverse work force, there was need to have varied and suitable kinds of benefits to suit their diverse workforce. For instance, Bradford Health Services developed a variety of benefit packages for its nurses. It provided younger less experience nurses with opportunity for further training as compared to the older experienced nurses who preferred trading such benefit with a decreased premium on health insurance. As suggested by Buerhaus, 2008 there are also a broader category of strategies employed by states and the federal government.

    For instance the federal government through an initiative dubbed Nurse Reinvestment Act of 2002 is full of strategies that would help health organization recruit and retain nurses. The initiatives there in include nursing education offering student scholarships, development of faculties, supporting diversity in place of work. Six years ago, a grant worth $1. 1 million was made available to support training of nurses that was to be a partnership between Northern Metropolitan Hospital Association and Lienhard University school of Nursing.

    State as well as corporate support has also played a major part in trying to address shortages of nurses as well as retention. These initiatives have been deemed to be of a long-term benefit to the entire healthcare fraternity and the country at large. Solutions most viable for Renfrey Memorial Hospital After close examination of the various strategies used to address shortages of nurses, two which include change in styles of leadership and management as well as provision of competitive compensation and benefits would yield positive results both in the short-term and long-term.

    A number of scholars have proved that the kind of leadership and management usually dictates organizational success and performance. It thus goes without saying that the same does influence organizational culture and the way of doing things (Buerhaus, 2008). This encompass among other factors wise use of resources, showing examples to the subordinates, creating n environment where there is effective communication, provision of flexible working environment, active involvement of staff in decision making, fostering training and career development.

    All these aims at ensuring that the working environment is indeed very conducive leading to a satisfied workforce having high level of morale. For instance, leadership and management style that foster sharing of information through a flattened hierarchy will help FHM nurses to talk to the management or administration and strike a deal for a flexible working arrangement that will ensure nurses comfortably take care of their aging parent and at the same time carryout their duties as nurses with minimal stress (Black, 2005).

    Similarly, good leadership and stronger management in the hospital will ensure that nurses actively participate in making decisions. When this is successfully done, the benefits include ownership of the decision arrived at, nurses will feel part and parcel of the hospital thus give their best in terms of service (Rivers et al. , 2005). The only problem is that arriving at decision will take more time. For this to be realized FMH needs to provide leaders and mangers training which will definitely cost dollars but worth the anticipated outcomes.

    There is need for changes in the organizational structure that will propel the whole initiative. It is worth to note that the good leadership and stronger management in the hospital will impact positively to all relevant stakeholders. More importantly, patients stand a chance to gain as they will be served by motivated and satisfied nurses hence medical errors associated with stress and fatigue will be much less hence better healthcare services and less risk of dying.

    The initiative in the long run will ease the administration the pressure and cost of outsourcing nurses from agencies since the rate of nurse retention in the long-term will be high (May et al. , 2006). This also translates to having human resource that are experienced, reduced expenditure of replacing the nurses leaving hence a balanced accounts book. When nurses are satisfied and motivated offering patients with better services, it goes without saying that the hospital will cut itself an edge in the world of health services provision (Jones, 2008). Quality service will thus be its competitive advantage.

    Strictly speaking the hospital will generate more income from saving s that could be used to hire temporal nurses, gain more from receiving increased number of patients. The second strategy that I believe will help FMH is providing its nurses with a flexible competitive compensation and benefit packages. Although a number of medical professional claim that monetary and non-monetary benefits are not that important to addressing shortages of nurses, the synergy it brings when combined with the previous strategy-goo leadership and strong management is unimaginable in curbing the problem.

    It is worth to note that the benefits and compensation packages deemed important by in older nurse in most cases will not appeal to younger nurses (Johnson, 2009). Thus through a well-established communication structure, a deal may be stroke between the hospital management and nurses on how best to develop a flexible and suitable compensation and benefit packages. Such an agreement through careful consideration will ensure that the account is not unnecessarily allocating huge monies that do not yield positive results.

    Nurses will also feel satisfied and highly motivated hence remaining and offer their services to the hospital. Since nurses feel motivated patients will benefit as they will be served by nurses experiencing very low or no stress at all hence receiving better services translating to better health (Morgan & Lynn, 2009). However, there are a number of issue that need to be done by the hospital for instance outsourcing experts in the field of compensation and benefits package and undertaking long deliberation to arrive at desired arrangement. Conclusion and recommendations

    From the review of the issue of nurses shortages and retention problems facing FMH, the best single solution that will address the problem is having in place a good leadership as well as management styles. I chose this strategy since it is well understood that those in the forefront always determine how any organization will be run (Black, 2005). It is leadership and management styles that will catalyze creation of a better working environment, better and flexible packages for compensation as well as other benefits that in the long-run brings about a satisfied nurse with very high level of morale.

    This most probably curbs the high rate of nurses’ turnovers. In my view, the strategy is the best and viable since it involves use of financial resources in an affordable and reasonable manner as compared to other initiatives such as provision of a flexible compensation package, committing million of dollars to support nursing scholarships among others (Berliner & Ginzberg, 2006). Similarly, the strategy covers the interest of the diverse workforce as all will have an avenue of voicing their concerns.

    The process although will call for proper change management that will help ensure that the entire strategy is smooth. Generally, a nurse centered strategy is the way to go for FMH to solve the problem at hand. References Aiken, L. Cheung, B. & Olds D. (2009). “Education policy initiatives to address the nurse shortage in the United States” Health Affairs. 28(4):646-656. Berliner, H. & Ginzberg, G. (2006). “Why This Hospital Nursing Shortage is Different” Journal of the American Medical Association. 88(21):2742–2744. Black, R. (2005). Organizational Culture: Creating the Influence Needed for Strategic Success. London: Taylor & Francis. Buerhaus P. (2008). “Current and Future State of the US Nursing” JAMA. 300(20):2422-2424. Glazer, G. & Alexander, C. (2008). “Legislative: The Nursing Shortage: A Public Health Issues for All” OJIN: The Online Journal of Issues in Nursing. 14(1):11-21. Gostin, L. (2008). “The International Migration and Recruitment of Nurses” JAMA. 299(15):1827-1829. Johnson, J. (2009).

    Health Organizations, Theory, Behavior, and Development. Sudbury, MA: Jones and Bartlett Publishers. Jones, B. (2008). “Revisiting nurse turnover costs: Adjusting for inflation” Journal of Nursing Administration. 38(1): 11–18. Lynn, M. & Redman, R. (2006). “Staff Nurses and Their Solutions to the Nursing Shortage” Western Journal of Nursing Research. 28(6):678-693. May, J. Bazzoli, G. & Gerland, M. (2006). “Hospitals’ Responses to Nurse Staffing Shortages” Health Affairs Web Exclusive. 25(4):316-323. Morgan, J. & Lynn, M. (2009). Satisfaction in nursing in the context of shortage” Journal of Nursing Management. 17(1): 401–410. Rivers, P. Tsai, K. & Munchus, G. (2005). “The Financial Impacts of the Nursing Shortage. ” Journal of Health Care Finance. 31(3):52-64. Rother, J. & Mourey, R. (2009). “Addressing the Nursing Workforce: A Critical Element for Health Reform”. Health Affairs. 28(4):620-624 Ulrich, B. et al. (2005). “How RNs View the Work Environment: Results of a National Survey of Registered Nurses” Journal of Nursing Administration. 35(9): 389–396.

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