Respond and give suggestions and feedback to each of your group members regarding their Justification of Need section for the Change Proposal. Provide a peer critique for each of your group members’ proposals. Then, identify other ideas or concepts that they may want to include in order to develop a robust Change Proposal idea.
INTRODUCTION: problem
Purposed PICO question: Due to the nursing shortage, specifically in the hospital setting, can the retention of experienced clinical nurses improve the safety, security, and support for both patients and nurses. A focus on barriers and recommendations for a cultural change initiative.
P: Population or Patient = NURSES
All those involved form the culture and population of the hospital setting nurses, patients, and the institutions are impacted on some level, if nurse retention is poor. The failure to retain experienced clinical nursing staff results in low staff satisfaction and decreased productivity, poor interdisciplinary communication, poor patient outcomes and satisfaction. The institution suffers a financial loss related to turnover costs, decreased revenue, and potential liabilities. (Anderson, 2022) As a result of the global covid-19 pandemic nurses were in high demand and all efforts shifted to recruitment and high-dollar travel contracts. Patient-centered care is very important; however, without the nursing population evenly distributed more rural hospitals are unable to compete and patient care suffers.
JUSTIFICATION:
I: Intervention, Influence, or Exposure
EXTERNAL & INTERNAL INFLUENCES
The change initiative in hospital settings needs to shift from 100% recruit focus to investing in and retaining experienced clinical nurses within establishments. Building this sense of safety, security, and support will allow nurses to provide quality compassionate care and attract other nurses. (Tang, 2019) The retention of nurses has a synergistic effect. By retaining experienced clinical nurses’ all aspects of care improve including but not limited to workplace environment, strengthening of interprofessional treatment teams and communication, and relief of workload and risks. Research has shown by improving nurse to patient ratios patient outcomes improve (Knudson, 2013); thus, increasing institutions finances. Most hospitals, related to the recent covid-19 pandemic, are struggling to retain nursing staff for various reasons. The primary reasons being compensation, lack of preparedness in sighting fear (supply and equipment shortages and unsafe work environment) and age-related risks. During the pandemic crisis hospitals pushed recruitment of nursing staff by way of bonuses, relocation reimbursement, and travel nurse contracts. With healthcare reimbursement trending to a value-based model (Chee, 2016), achieving improved patient outcomes, fewer safety issues, and sustaining a quality workplace environment is a priority. Failure to create, promote, and maintain a culture of safety, security, and support for hospital nurses will result in a perpetuation of high nurse turnover rates, increased quality and safety issues, and ultimately financial ruin. This reactive paradigm has altered the face of healthcare. The nursing population has opened itself up to taking risks for financial gain or leaving the field with a sense of having nothing more to offer
C: An explicit Comparison to the “I” Component
For hospitals to retain nurses a cultural change must occur. Younger less experienced nurses have been presented with the opportunity to travel nurse and cash in on higher paying contract jobs polished with the allure of traveling to new places. Older nurses opted to take early retirement or limit work hours to safeguard their own well-being and health. The population is aging and living longer; thus, shifting the equilibrium of healthcare to unmanageable. This is a population crisis. All potential resources and reallocation of resources must be implemented for the well-being of our communities, families, and friends.
.
O: the Outcome
Implementation of this change initiative will change the hospital culture improving nurse retention focusing on the older experienced clinical nurse population. By applying Lewin’s Change Theory (Shirey, 2013) and building a transformational leadership (Jankelová & Joniaková, 2021), hospitals can unfreeze-change-refreeze and build new cost effective, quality care, improved practice, and patient outcomes. Hospitals can empower nurses (Christenbery, 2019) by improving autonomy, communication, recognition and offer alternatives to high paying travel contracts by shifting the focus away from recruitment to retention. Implementation of critical care or specialty cross-training for flexibility of staff to attract younger nurses seeking higher pay grades, mentoring and patient advocate roles to offer less physically demanding yet fulfilling positions older nurses (Fackler, 2019) are some immediate change recommendations. Compensation methodologies can shift to a recognition platform by mimicking a pay-for-performance scheme. (Kyeremanteng, 2019) Other compensation initiatives to be considered include long-term financial benefits such as improved matching of retainment funds based on years of service, accelerated means to earn pay raises based on number of hours worked, education reimbursement, opportunities for bonuses and recruitment incentives. (Hancock et al., 1987) Work environments will become safer and patient satisfaction scores will improve with improved nurse to patient ratios leading to increased reimbursement revenue. (Silvera, 2016) Mentoring of new hires by experienced clinical nurses will promote the institutions mission, assure continued evidenced-based practice, and minimize patient care risks. (Haines et al., 2021)Utilizing older experienced nurses as patient advocates and/or educators secures the best patient outcomes and satisfaction. (Haines, 2021) Encouraging nurse managers to adopt transformative management styles (Suliman, 2020) will improve nurse autonomy and provide opportunities to strengthen the nursing team. (Jankelova, 2021) Developing open lines of communication between upper-level management and staff will promote an environment of mutual respect and teamwork. (Duncan, 2020)
References
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