The proposed solution to the professional nursing shortage problem is education of more nursing personnel. The solution is intended for the nursing staff of a medical facility. It aims at addressing attrition and turnover that cause nursing shortage. Obtaining peer and organizational support will be invaluable in the successful implementation of this solution. Informal approval by stakeholders will be obtained through feedback on the submitted proposal.
The aim is to encourage leadership buy-in and commitment, physician involvement, and nursing staff participation. Therefore, feedback will be sought from the key administrators, including the nurse manager, clinical operations director, and chief nursing officer. Additional feedback will be sought from the fellow staff (RNs stationed in various units) and physicians.
A formal approval will also be sought from the institutional review board (IRB) to ensure human subjects are protected. An intervention that gains IRB approval is one that occurs within the ethical constraints indicated by the board prior to data collection. Experts within the facility will appraise the proposal to ensure that it meets ethical and scientific validity. The process will also minimize harm to the staff that will be involved in the implementation of the intervention.
Description of Current Problem
The shortage of professional nursing personnel is a significant problem in the USA. Grant (2016) estimates a twofold shortfall in nursing shortage by 2025 relative to the mid-1960s baseline. The worst hit areas will be the Southern and Western regions of the country. Currently, the nursing workforce stands at about three million. This amount is still insufficient despite constituting the largest proportion of workers in the health care industry.
The shortage causes attrition and turnover of the existing staff. It creates a busy work environment characterized by heavy workloads and increased pressure but same wages. As a result, professional nurses opt to retire, leaving no new nurses to replace them. In addition, professional nurses rarely venture into academia, which causes a shortage of qualified nurse educators. This scenario affects the quality of nursing care which could increase the risk of medical errors in a medical facility.
The ageing population in America drives the demand for quality nursing care to handle age-related complications. Grant (2016) estimates that up to 70 million people will need medical care over the next two decades due to the ageing population of baby boomers. Therefore, the demand for quality care is likely to rise; hence, there is a need to train more nurses to meet this demand. However, the nursing shortages may increase the demand for quality medical care, leading to better salaries for nurses. As a result, the nursing profession will become an attractive career for students, raising the supply of nurses.
Proposed Solution
The situation could be changed through educational reforms and better remuneration of nurses to make the profession attractive. Extensive financing of nursing education will attract experienced professional nurses and support quality training. The approach will also raise the quality of the personnel coming out of nursing schools. A quality workforce will mean better salaries for professional nurses.
The nursing shortage problem calls for an urgent intervention that does not compromise the quality of care delivered. Furthermore, chronic nursing shortages will hurt the health care sector and reduce patient outcomes. Therefore, reforms that touch on education and health care systems are needed to raise the number of RNs and other nurses in the country to foster high quality of care.
Conversely, maintaining the status quo could ultimately increase the nursing supply and remedy the deficit. The shortage creates a demand for qualified nursing personnel by hospitals. Medical facilities may be forced to offer higher compensation to RNs and thus, make the nursing a more attractive profession. Therefore, in the long-term, the nursing shortage being experienced will improve the terms of service and increase nursing supply. However, in the short-term, the problem is likely to hurt the quality of care as the number of patients exceeds that of qualified nurses.
The proposed reforms will have a positive impact on nursing shortage given that the lack of initiative would only worsen the health outcomes in the medical facilities across the country. Improving the quality of education and the average compensation payable to the nursing personnel would translate into better patient outcomes, improved reliability/stability of the system, and low turnover (Grant, 2016). This intervention will be implemented in a span of three years in the institution. This timeframe takes into account the period needed for newly educated and re-educated personnel to acquire a sufficient work experience to take over the roles of nurses set to retire over the coming five years.
Rationale for Selecting the Proposed Solution
The problem of nursing shortage is a threat to patient and nurse outcomes in hospitals. It constrains the available nursing resources, increases the risk of medical errors, and causes staff burnout, which leads to high turnover, interrupts care continuity, and affect staff performance. The rationale for selecting a two-pronged solution is to address the institutional and training/educational issues that affect the stability of the nursing labor market.
From an educational perspective, the availability of resources and qualified nurse educators, affects the quantity and quality of the nurses joining the workforce. On the other hand, institutional factors such as low compensation, heavy workloads, and pressure may account for the high turnover rates, which cause a perennial problem of the nursing shortage. The proposed solution addresses education/training (a supply side factor) and compensation to persuade students to study nursing.
Evidence from the Review
Research evidence shows that education or training is a useful tool in curbing the nursing shortage. Ball, Doyle, and Oocumma (2015) describe a condensed educational model based on a preoperative curriculum developed by nurse educators to better prepare students for OR roles. Students who completed the course were found to possess skills useful in OR contexts, saving the facility costs related to orientation. Thus, the study corroborates the view that condensed educational models that cover theoretical and practical/hospital experiences can supply a quality workforce quickly to curb nurse shortages.
RN dissatisfaction has been linked to high patient-to-nurse ratios due to nursing shortages. Coshow, Davis, and Woloson (2009) investigated the relationship link between tenure and job satisfaction among RNs. Nurses who had stayed at the facility for many years were found to be more dissatisfied than newly recruited ones due to factors such as “pay, fulfillment, and staffing” (Coshow, Davis & Woloson, 2009, p. 15). This finding indicates that salaries and workloads influence nurse satisfaction. The dissatisfaction could account for the high attrition rate and the low numbers of students willing to take up nursing as a profession.
An effective transition of nurses from nursing schools in the health care system is an efficient strategy for addressing the nursing shortage (Gordon et al., 2014). A national transition program is critical in facilitating the transition of graduate nurses into practice and enhancing their preparedness. Rudman and Gustavsson (2012) note that burnout during student learning indicates a lack of readiness to take up nursing roles. Therefore, addressing burnout through integrated training programs could better prepare graduate nurses for practice and increase job satisfaction. Education or training has also been linked to critical thinking and satisfaction in nurses (Zurmehly, 2008). It is clear that education and job satisfaction through better pay are essential in curbing the nursing shortage.
Description of Implementation Logistics
The integration of the solution within the workflow is required to achieve the desired implementation outcomes. For this project, an interdisciplinary nurse-driven approach will be adopted to ensure that the solution penetrates through all personnel cadres.
An initial gap analysis will identify the desired pay and the nature of education or training that nurses require. Subsequently, the educational barriers that cause a nursing shortage in the context of the facility will be evaluated based on the nursing staff feedback. A condensed three-month training course developed through an interdisciplinary process will be integrated into the facility’s HR processes. The course will allow graduating nurses to transition smoothly into practice to curb nursing shortage at the facility.
The implementation committee will comprise of an interdisciplinary team led by the clinical operations director. The committee will comprise of the chief nursing officer (CNO), clinical operations director, two unit managers, a physician, and three RNs. The clinical operations director will oversee the implementation process while CNO will conduct staff training based on the developed curriculum. The staff (RNs and physicians) will initiate the change in the facility by undertaking the course. The retraining will foster the change process and integrate the program into the organizational culture.
Resources Required for Implementation
- Staff – the implementation team will be made up of the chief nursing officer (CNO), clinical operations director, two unit managers, a physician, and three RNs. Their roles will be as described above.
- Educational materials – pamphlets, handouts, posters and PowerPoint presentations containing details of the training as per the curriculum will be required. The training materials will be in an electronic format for easy access. Workshops will be held to train the program delivery staff that will supervise or teach the course to nurses.
- Assessment tools – a range of tools will be used to monitor the outcomes of the program. Questionnaires and periodic surveys will be used to obtain direct feedback from participants and trainers. On the other hand, pre- and post-tests will assess the knowledge of participants at baseline and after intervention to determine the success rate of the program.
- Technology – IT infrastructure, including educational tools like video conferencing, will be required in the training. Additionally, health informatics software will be needed to compare and analyze the data.
- Funds – financial resources will be required to educate the staff, print or produce learning materials, and gather and analyze data during the project.
- Staff – as stated above, the clinical operations director will oversee the implementation process. The staff (RNs and physicians) will initiate the change in the facility by undertaking the course, while the chief nursing officer will evaluate the change.
References
Ball, K., Doyle, D., & Oocumma, I. (2015). Nursing Shortages in the OR: Solutions for new models of education. AORN Journal, 101(1), 115-136.
Coshow, S., Davis, P., & Wolosin, R. (2009). The ‘Big Dip’: Decrements in RN satisfaction at mid-career. Nursing Economic, 27(1), 15–18.
Gordon, C. J., Aggar, C., Williams, A. M., Walker, L., Willcock, M., & Bloomfield, J. (2014). A transition program to primary health care for new graduate nurses: A strategy towards building a sustainable primary health care nurse workforce? BMC Nursing, 13(34), 1-13.
Grant, R. (2016). The U.S. is running out of nurses. The Atlantic. Web.
Rudman, A., & Gustavsson, J. (2012). Burnout during nursing education predicts lower occupational preparedness and future clinical performance: A longitudinal study. International Journal of Nursing Studies, 49(8), 988-1001.
Zurmehly, J. (2008). The relationship of educational preparation, autonomy, and critical thinking to nursing job satisfaction. Journal of Continuing Education in Nursing, 39(10), 453–460.