The nursing profession is often viewed as challenging, and the issue of nurse shortage and turnover is typical of many healthcare facilities. Studies indicate that nurses can choose to leave their organizations because of a range of external and internal factors (Chan, Tam, Lung, Wong, & Chau, 2013; Nei, Snyder, & Litwiller, 2015). Therefore, much attention is paid to developing approaches that can be discussed as effective in order to address the problem of shortages and prevent nurses’ turnover.
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In this context, nurse leaders and managers are viewed as responsible for affecting the situation and creating more comfortable conditions for nurses. The purpose of this paper is to describe the issue of nursing shortages and turnover in healthcare facilities, compare and contrast different approaches used by nurse leaders and managers to addressing this identified problem, and describe the approach or solution that can fit the personal philosophy of nursing.
The Issue of Nursing Shortage and Turnover
Nursing shortage and turnover are issues that influence the quality of care provided in healthcare facilities. The problem is that nurse shortages in healthcare organizations are the result of nurses’ fatigue and burnout. Furthermore, nurse shortages lead to further burnouts, and a turnover rate for the nursing profession increases (Chan et al., 2013). Factors that can influence nurses’ desires to leave an organization include working environments and responsibilities, job tasks and associated challenges, weak organizational cultures, burnout, the lack of job satisfaction, and the lack of communication and cooperation among other aspects (Chan et al., 2013; Nei et al., 2015).
According to Chan et al. (2013), nurses choose to leave those organizations where nurse teams are weak, and the staff does not feel the support of managers. In their studies, researchers claim that nurses require a lot of assistance in order to succeed as professionals in challenging environments of their facilities, and if nurses’ interests and needs are not addressed in some organizations, high levels of nurse shortages can be observed (Keys, 2014; Nei et al., 2015). From this point, nursing managers and leaders are often viewed by the nursing staff as key actors in changing the situation and improving job satisfaction to prevent increases in turnover rates.
Nursing Leaders’ and Managers’ Approaches to Addressing the Issue
In spite of similarities in titles, nurse managers and leaders seem to apply different approaches to performing the same roles. In organizations, nurse managers perform roles of administrators who are responsible for managing the work of nurses in a unit, planning activities, setting goals, delegating tasks, controlling the quality, monitoring relationships with patients, and budgeting (Kallas, 2014). Nurse managers work with staff schedules, control the performance of nurses, and assign tasks.
These persons should ensure that their unit works effectively. However, in contrast to nurse leaders, managers concentrate on completing tasks and organizing activities rather than on building strong relationships with a nursing team. Therefore, managers’ approaches to addressing the shortage and turnover problems differ significantly from the approaches of leaders.
Nurse managers concentrate on applying certain systems and programs that can be used to optimize processes and reduce nurses’ fatigue to prevent their turnover. Managers also improve schedules and principles of cooperating in order to retain nurses (Kallas, 2014). While speaking about this approach from the perspective of leadership theories, it is possible to state that some nurse managers can be viewed as situational leaders because their primary goal is to address problems or situations observed during a certain period of time.
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On the contrary, nurse leaders are more concentrated on building relationships with other nurses and developing interactions. They tend to retain nurses and motivate them to stay with an organization not through changing schedules, but through inspiring and accentuating a nurse’s mission and an organization’s vision. As a result, the commitment of those nurses who work with leaders increases (Keys, 2014). According to the leadership theory, those individuals who follow the principles of transformational leadership can be viewed as most effective in motivating nurses to concentrate on their roles as caregivers and supporters for patients.
From this point, the approaches of nurse leaders in addressing the problem of shortage and turnover are not of an administrative character (Kallas, 2014; Keys, 2014). Nurse leaders are focused on ensuring that all members of their team feel comfortable while working in a facility, and changes in schedules or some rewards can be viewed only as additional tools to motivate nurses after inspiring them, educating, and supporting with the help of other techniques.
The Approach Fitting the Personal Philosophy of Nursing
The approach used by nurse leaders, which is the combination of administrative or regulatory tools with communication and motivation of staff, can be discussed as being in line with the personal philosophy of nursing. The reason is that there is a belief that a good manager should act as a good leader (Kallas, 2014; Keys, 2014).
Therefore, to create specific conditions in facilities that will be effective to prevent turnover, it is necessary to demonstrate not only organizational skills but also abilities of a motivator, an educator, a mentor, a team builder, and a conflict manager (Kallas, 2014). Nurses state that they choose to work in those facilities where they like teams and feel support. Therefore, modifications of only external factors without influencing internal ones cannot be effective in preventing nurse turnover and associated shortages.
The selected approach fits the personal, professional philosophy of nursing because it can be described as individual-oriented. In this case, an individual is not a patient, but a member of a working team (Keys, 2014). Furthermore, this described approach is related to the personal leadership style because, while being a participative leader, much attention is paid to building positive relationships with other nurses in order to ensure that they are motivated to participate in decision-making processes and work as a team.
Despite titles used in healthcare organizations in order to distinguish between nurse managers and nurse leaders, it is important to focus on key differences in their approaches to solving various issues and problems. Increased nurse shortages and turnover rates can be discussed as significant issues to address. Managers usually try to overcome these problems while changing policies, regulations, norms, and plans. Their approach can be viewed as task-oriented.
On the contrary, nurse leaders often apply the person-oriented approach, and they usually try to address the issue while improving communication with nurses to increase their commitment and job satisfaction. This approach is typically based on the application of different leadership theories, including participative and transformational ones, among others. The approach, which is based on combining leadership and managerial tools in order to address the issue, is viewed as most correlated with the personal philosophy of nursing.
Chan, Z. C., Tam, W. S., Lung, M. K., Wong, W. Y., & Chau, C. W. (2013). A systematic literature review of nurse shortage and the intention to leave. Journal of Nursing Management, 21(4), 605-613.
Kallas, K. D. (2014). Profile of an excellent nurse manager: Identifying and developing health care team leaders. Nursing Administration Quarterly, 38(3), 261-268.
Keys, Y. (2014). Looking ahead to our next generation of nurse leaders: Generation X nurse managers. Journal of Nursing Management, 22(1), 97-105.
Nei, D., Snyder, L. A., & Litwiller, B. J. (2015). Promoting retention of nurses: A meta-analytic examination of causes of nurse turnover. Health Care Management Review, 40(3), 237-253.