Recent attempts to reorganize the delivery of health care services, along with cost reduction, has resulted in the deterioration of working conditions for staff nurses (Gormley, 2010). Not only do the negative changes in the working climate have a serious impact on the retention of both new and experienced employees, but they also lead to the worsening of the system and patient outcomes (Gormley, 2010). The challenge to decrease staff turnover rates at the Kendall Regional Medical Center was an issue of increasing priority.
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The role of nurses and physicians in the management of STEMI is vital for the improvement of the D2B time (Zughaft & Harnek, 2014). A multidisciplinary team approach to acute coronary care dictates the necessity to have well trained and coordinated personnel (Zughaft & Harnek, 2014). The nurses assisting in PCI are responsible for the administration of medications, assessment of puncture sites, and obtaining consent for the procedure from either a patient or their family among other duties (Zughaft & Harnek, 2014).
The high turnover rates of the nurses in the emergency department, along with the changes of personnel in CVL and interventional cardiology departments, at the Kendall Regional Medical Center were the clinical problems associated with the decrease in quality and quantity of care. A systemic approach towards solving these problems led to the improvement of both staff and patients outcomes.
The issue of nursing turnover is recognized as being multidimensional and immensely complex with multiple factors affecting every facet of the health care system (Hayes et al., 2012). The ability of an organization to retain its employee base has become a subject of increased attention. A recent study indicates that 26% of health care employees rated their job stress as high (Mosadeghrad, Ferlie, & Rosenberg, 2011).
Among the reasons contributing to low job satisfaction are work inequality, shortage of staff, work overload, time pressures, and lack of promotion prospects (Mosadeghrad et al., 2011). Not only does nervous tension result in lower motivation and employee morale it is also associated with physical and physiological health issues (Mosadeghrad et al., 2011).
Poor leadership, workplace bullying, and health problems are among the most important factors contributing to high rates of employee turnover (Hogh, Hoel, & Carneiro, 2011). Negative treatment in the workforce has a direct relationship with the intention to leave (Hogh et al., 2011). Employees that are being frequently bullied are three times more likely to leave a job in comparison with non-bullied employees (Hogh et al., 2011). A study conducted by Hogh et al. suggests that there is a positive association between the decrease of exposure to verbal abuse at work and nursing turnover rates (Hogh et al., 2011).
A cross-sectional study of Iranian hospital employees shows a reverse relationship between job stress and the level of QWL (Mosadeghrad et al., 2011). It reveals that the structural approach to the improvement of employees’ satisfaction reduces turnover intentions and increases staff retention rates. Therefore, hospital managers should adopt comprehensive strategies for coping with job stress and improvement of their QWL (Mosadeghrad et al., 2011).
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A systemic, long-term approach to the decrease in employee turnover rates reduced the costs of recruitment and subsequent training of new staff (Hogh, 2011). The first step in tackling the issue of high nursing turnover rates was the implementation of more effective strategies aimed at measuring nurse’s satisfaction with their job. Employee satisfaction surveys, which allowed assessing various aspects of organizational experience, were regularly conducted (Mosadeghrad et al., 2011).
Another effective strategy implied the creation of an organizational environment conducive to developing open communication and problem solving between employees from different hierarchical levels (O’brien-Pallas, Murphy, Shamian, Li, & Hayes, 2010). It contributed greatly to the increased retention and productivity rates at the Kendall Regional Medical Center. Instead of taking a short-term approach and trying to solve the issue by recruiting more staff and increasing fringe benefits, management of the medical center focused on changing the organizational culture and creation a better work environment. It led to a higher level of employee satisfaction, which was reflected in monthly surveys.
The employees’ quality of life (QWL) is closely correlated with the level of job stress (Mosadeghrad et al., 2011). Another approach was to provide changes in senior management behavior and increase employee involvement in policy development and decision-making. According to a recent study, 9. 2% of the nurses reported being bullied during the first year of work after graduation (Hogh, 2011). The management of the Kendall Regional Medical Center instituted programs for monitoring the psychological work environment and was able to drastically reduce instances of bullying.
If given a chance to correct the change process I would introduce localization initiatives in additions to the programs stated above. Findings from the recent study revealed that the lack of promotion opportunities has a great effect on the turnover rates. Therefore, providing employees with better promotion opportunities would significantly reduce the problem of low QWL (Mosadeghrad et al., 2011).
Risks of not Making a Change
A collaborative effort of physicians, nurses, and other health care professionals along with the support from a multidisciplinary team of hospital administrators are the key to reducing D2B time (Stowens, Sonnad, & Rosenbaum, 2015).
Even though, the administrative support is a prerequisite for empowering the staff, practical solutions to the change also come from the individuals directly involved in the process of care provision (Peterson, Syndergaard, Bowler, & Doxey, 2012). Therefore, it is necessary to ensure that the staff members that take an active role in the reduction of delays associated with D2B time for STEMI patients have extensive education and experience working in a team.
If the change is not implemented the organization faces the risk of having ever-increasing turnover rates. It might result in the deterioration of patient care and the higher chances of medical error (O’brien-Pallas et al., 2010). The use of temporary nurses threatens the quality of health care and morale of permanent staff members. On the other hand, an experienced health care team shows higher teamwork scores, thus increases the likelihood of successful reduction of D2B time (O’brien-Pallas et al., 2010). Therefore, a comprehensive, long-term approach to the decrease in employee turnover rates will reduce high organizational costs and increase the quality of health care.
Gormley, D. (2010). Are we on the same page? Staff nurse and manager perceptions of work environment, quality of care and anticipated nurse turnover. Journal of Nursing Management, 19(1), 33-40.
Hayes, L., O’Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F.,… North, N. (2012). Nurse turnover: A literature review – An update. International Journal of Nursing Studies, 49(7), 887-905.
Hogh, A., Hoel, H., & Carneiro, I. (2011). Bullying and employee turnover among healthcare workers: a three-wave prospective study. Journal of Nursing Management, 19(6), 742-751.
Mosadeghrad, A., Ferlie, E., & Rosenberg, D. (2011). A study of relationship between job stress, quality of working life and turnover intention among hospital employees. Health Services Management Research, 24(4), 170-181.
O’brien-Pallas, L., Murphy, G., Shamian, J., Li, X., & Hayes, L. (2010). Impact and determinants of nurse turnover: a pan-Canadian study. Journal of Nursing Management, 18(8), 1073-1086.
Peterson, M. C., Syndergaard, T., Bowler, J., & Doxey, R. (2012). A systematic review of factors predicting door to balloon time in ST-segment elevation myocardial infarction treated with percutaneous intervention. International Journal of Cardiology, 157(1), 8-23.
STEMI Alerts Decreases Door-to-Balloon Times. Western Journal of Emergency
Stowens, J. C., Sonnad, S. S., & Rosenbaum, R. A. (2015). Using EMS Dispatch to Trigger
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Zughaft, D., & Harnek, J. (2014). A review of the role of nurses and technicians in ST-elevation myocardial infarction (STEMI). Eurointervention, 10(T), T83-T86.