Running head: NUR-300 FINAL PROJECT 1
Running head: NUR-300 FINAL PROJECT 2
Drawing Connections and Relevance
Southern New Hampshire University: NUR 300
March 31, 2019
There are common themes that support the reasons and the costs behind the overwhelming statistics regarding increased nurse turnover and unsteady nurse retention. Outside of individual factors—such as age and level of education—that cause nurses to leave their organization or the profession altogether, the common factor that is behind increased nurse turnover is a lack of job satisfaction. Nurses are dissatisfied with the social work environment of the organizations they work with. This environment is defined by a lack of good leadership, a lack of proper collaboration and communication, and burnout stress due to the physical demands necessary because of scheduling issues and inadequate staffing.
Connections to the Literature
To promote positive change in nurse retention, organizations should consider employing a mentorship program to combat the feeling of being without support that nurses often feel within the profession. Mentoring is beneficial for both new nurses and experienced nurses. Experienced nurses are granted the opportunity to hone their leadership skills, build professional relationships and develop stronger problem-solving skills. New nurses, when paired with a mentor, are allowed the room to build confidence, competence and develop the skills that will assist them in transitioning into their new position, thus, increasing job satisfaction and nurse retention. (Ennis, Broadbent, Happell and Reid-Searl, 2013; Schroyer, Zeller & Abraham, 2016).
Connections to Legal and Licensure Implications
For all health care professionals, licensed by the state, laws and regulations are set in place defining their scope of practice. In keeping with the terms of the nursing professional license, the American Nurses Association (ANA) has clearly defined the scope and standards of nursing practice as a guideline for delivering quality patient care (2010). The scope of practice of nurses can also be defined by hospital policies and procedures. If a nurse does not meet the accepted standards of practice, he or she may be accused of violating a standard of care or found negligent if his or her negligence caused a patient harm, also referred to as malpractice in the medical profession.
Some might argue that nurses continue to perpetuate this potential of “losing our license” to justify being overly cautious and engrain this culture of anxiety and fear regarding licensure for generations to come. But the fact remains that patients value nurses and can recognize a workforce that is demoralized as result of inadequate staffing or other professional issues. In healthcare, where our consumers are often sick, exhausted, and in pain, they do not deserve to hear that someone is too busy for them, nor do they need to sense that they are being shirked of high-quality care. The Shirley Keck v. Wesley Medical Center case is one in which a 63-year-old woman was admitted to a hospital for pneumonia, found brain damaged prior to her discharge, requires 24-hour care, and settled with the hospital for $2.7 million. It was reported that the failure to appropriately monitor the level of oxygen, per the nurse (plaintiff) was due to the hospital being high understaffed.
In 1999, California passed legislation mandating patient-to-nurse ratios for its hospitals, which went into effect in July 2003. The California legislation was motivated by an increasing hospital nursing shortage and the observation that lower nurse retention in hospital practice was related to burdensome workloads and high levels of job-related burnout and job dissatisfaction. One year after the establishment of the nursing law, Aiken, Clarke, and Sloane (2002) noted that California reported their nurse-license rate grew by more than 60% compared to other states.
Ethics is an integral part of the foundation of nursing. The Code of Ethics for Nurses was developed by the ANA which established the ethical standard for the profession and provided a guide for nurses, including primary goals, values and obligations to use in ethical analysis and decision-making (ANA, 2010b), Maintaining safe care is the first ethical and legal duty of any hospital, and of all health professionals. However, due to insufficiency of staffing, many nurses find it difficult to carry out their obligations, creating an ethical dilemma, whereby one must choose between caring for their own welfare or the needs of their patients. One ethical obligation nurses are to fulfill during their daily duties involves ensuring they protect patients from any harm (ANA, 2010b). Nonetheless, factors such as moral distress, burnout and decrease in job satisfaction compromise that ethical responsibility, creating poor quality of care.
Healthcare organizations require a stable, well-trained, and fully-engaged nursing staff to provide effective levels of patient care but the challenges of nurse turnover pose a threat to this foundation. The costs and consequences of burnout and turnover are significant and raise several implications for health-care delivery. While research fails to indicate significant correlations, it is worth mentioning that nursing turnover has tremendous impact on the quality of care and patient outcomes in addition to creating a financial burden for the institution. A healthcare implication worth examining in depth are the reasons why nurses are leaving health care organizations or the profession altogether.
Overall Healthcare Relevance
Brewer et al. (2011) estimated the costs of newly licensed RN turnover to be $856 million for organizations and to range between $1.4 and $2.1 billion for society. In as the financial implications are worth mentioning, as aforementioned, it is crucial to understand the reasons behind nursing turnover. One study associated health-related factors such as disability or illness from work-related injuries, and high physical demands to reasons for leaving the job or profession (Mazurenko, Gupte, & Shan, 2015). This very study also corroborated previous research that dissatisfaction, high stress levels, leadership compensation, and opportunity for advancement influences nurses’ decision to leave an organization.
Helpfulness or Hindrance to Patient Care
Despite the dearth of information on the correlation between nurse turnover and patient care, one study has found that “Instead of RN staffing, job satisfaction might be a potential mediator for the relationship between RN turnover and patient outcomes because high turnover on a unit can lead to low job satisfaction of the remaining staff, resulting in poorer patient outcomes” (Park et al., 2014, p. 1219). The study specifically used the incidences of unit acquired pressure ulcers (UAPU) to determine that while RN staffing might not exactly be the mediator between nurse turnovers and UAPUs, better outcomes of UAPUs on units can be achieved through organizational efforts to maintain stability within a workforce (Park, 2014).
American Nurses Association. (2010a). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author.
American Nurses Association. (2010b). Code of ethics for nurses with interpretive statements. Silver Spring, MD: ANA, American Nurses Association.
Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. (2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. (16): doi:10.1001/jama.288.16.1987
Brewer C.S., Kovner C.T., Greene W., Tukov-Shuser M. & Djukic M. (2011) Predictors of actual nurse turnover in a national sample of newly licensed registered nurses employed in hospitals. Journal of Advanced Nursing 68 (3), 521–538.
Mazurenko, O., Gupte, G., & Shan, G. (2015). Analyzing US nurse turnover: Are nurses leaving their jobs or the profession itself. Journal of Hospital Administration, 4(4), 48-56. https://doi.org/10.5430/jha.v4n4p48
Park, S. H., Boyle, D. K., Bergquist-Beringer, S., Staggs, V. S., & Dunton, N. E. (2014). Concurrent and lagged effects of registered nurse turnover and staffing on unit-acquired pressure ulcers. Health services research, 49(4), 1205–1225. doi:10.1111/1475-6773.12158
Shirley Keck v. Wesley Medical Center, (Sedwick County (KS) District Court, Case No. 99C2307, 2000)