Palmetto Hospital’s Nursing Understaffing

Inadequate nurse staffing levels affect almost all aspects of the delivery of health care services. According to the American Nurses Association, the nursing shortage can increase to 1 million RN by 2020 if the issue is not properly addressed (as cited in Zinn, Guglielmi, Davis, & Moses, 2012). The aim of this paper is to outline an implementation plan for increasing nursing staffing levels in the Palmetto Hospital. It will also present measurable outcomes of the change, and indicate potential barriers to its implementation.

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High rates of nursing turnover in the Palmetto Hospital play a key role in the nursing shortage; therefore, the reduction of turnover rates is an essential component of a staffing strategy that is being proposed. In order to ensure the appropriate number of staff in each unit of the hospital, it is necessary to implement nurse residency program that is designed to “increase retention and decrease turnover by providing the new graduate nurse with the tools and resources for success in the practice setting” (Zinn et al., 2012, p. 654). The implementation of the residency program is supported by the American Association of Colleges of Nursing (AACN) that recognizes it “as a means to prepare nurses for the profession” (Zinn et al., 2012, p. 654). In order to implement the nurse residency program as a method for alleviating the problem of nursing shortages in the hospital, it is necessary to obtain organization-wide endorsement for it. Therefore, nursing leadership on all levels, educators, human resources, nursing teams and other stakeholders have to be convinced of the program importance since its inception.

Another step that has to be taken is to institute a conducive organizational infrastructure. To this end, management of the hospital will assess organizational resources, in order to ensure that a planning team and a program coordinator have sufficient means for making feasible all program deliverables. An essential component of this step is to have clearly defined roles and responsibilities of the implementation team. Throughout the duration of the implementation of the residency program, the coordinator will be responsible for the best transition experience of graduates. They will use the most current evidence from different sources such as “internal organizational perspectives, recommendations from national policymakers, and findings from existing programs” (Bratt, 2013, p. 105) to modify the program structure to better fit the needs of the Palmetto Hospital. It is also important to seek the support from the Secretary of Health and Human Services in order to partially “redirect graduate medical educational funding from diploma nursing programs” (Zinn et al., 2012, p. 655). Moreover, the organization will help to assess measurable outcomes of the program implementation.

The implementation of the program will be conducted over 15-17 months. During this time new graduates will be provided with educational and psychosocial support for improving their socialization in the new setting. The start of the orientation of each graduate nurse will be based on the date of hire and will include 1 week of HR orientation and 1 week course of basic arrhythmia. Another step in the implementation of the program requires all graduates to attend two-week long critical care class. The participants of the program are expected to pass it before starting a year-long orientation in the hospital. An important element of the program is 5 intensive leadership classes that will be offered to all nurse managers and preceptors over 8-month period. The leadership classes will help them to better understand their leadership and management styles, thereby making them more effective leaders. Another goal of the 5 classes is to help the participants of the program to improve their mentorship attributes, so they will be able to provide graduates with the safe and nurturing learning environment.

The project of reducing understaffing in the Palmetto Hospital will also concentrate on the elimination of existing barriers between the experienced and inexperienced staff. It will help graduate nurses to feel that they are a great asset for their new teams.

Outcome Measures

The outcome measures include but are not limited to nursing staffing levels, retention rates, competencies, and patient care outcomes. It is also expected that nurse residents will increase confidence in their knowledge and skills due to extensive learning experiences provided by the program; however, the improvement of these competencies will not be measured after the program completion. Nurse managers and preceptors will also participate in the ongoing evaluation of program effectiveness. They will be offered evaluation sheets after each of the 5 leadership classes. The key measurable outcome of the program is to reduce a turnover rate in the hospital from 17 percent to 10 percent within the first year of the program implementation.

Potential Barriers to Implementation

A potential barrier to the implementation of the program is to obtain endorsement of unit-level managers. In order to overcome this obstacle, it is necessary to conduct a one-on-one dialogue in which the benefits of the program will be outlined. Another barrier to implementation of the program is to obtain approval for nursing residency curriculum. The barrier will be overcome with the help of partnership with the AACN (UNC, 2014).

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The nursing residency program is an effective way of addressing the issue of understaffing in the Palmetto Hospital. The implementation of the project will be conducted over 15-17 months and will require a creation of a conducive organizational structure.


Bratt, M. M. (2013). Nurse residency program: Best practices for optimizing organizational success. Journal for Nurses in Professional Development, 29(3), 102-110.

UHC. (2014). Innovative implementation of the UHC/AACN nurse residency program.Web.

Zinn, J., Guglielmi, C., Davis, P., & Moses, C. (2012). Addressing the nursing shortage: The need for nurse residency programs. AORN Journal, 96(6), 652-657.

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