Background
One of the main problems facing employers and state medical institutions is a significant staff turnover, which is usually understood as the process of personnel changes caused by the dismissal of some employees and the arrival of others to replace them. The main reason it is necessary to deal with staff turnover is the inevitable decline in the quality of work and staff motivation (Wubetie et al., 2020). If the management does not attempt to retain employees, then those who leave and those who remain in the organization know they are not appreciated here. The attitude toward work becomes alienated, while trust in the employer crumbles.
Staff turnover is generally determined by the percentage of those dismissed compared to those hired over time. The cost of staff turnover for a company is sometimes very high. Therefore, the employer affected by this problem needs to analyze the causes of its occurrence and find effective ways to prevent employee dismissals (Wubetie et al., 2020). This paper aims to analyze the issue of nurses’ turnover related to stress in the emergency room and propose a solution for increased retention.
The desire to leave a job or existing company permanently at some point soon, owing to a variety of reasons, is known as turnover intention. According to Wubetie et al. (2020), “in the nursing profession, the turnover of nursing jobs or professional resignations remains a serious problem associated with the crisis” (p. 97). Emotional pressure is a crucial factor leading to turnover because, due to burnout, employees tend to do their jobs ineffectively.
Workplace stress is complicated by the many written and unwritten rules and prohibitions governing workplace behavior. In psychology, stress is understood as a state of mental stress that occurs in a person under the influence of complex, difficult, unfavorable circumstances of their activities and daily life or in special, extreme situations. Adverse physical effects of the environment, extreme situations, and physical and mental injuries can act as stressors.
It can be argued that professional stress is, first of all, a consequence of a decrease in professional motivation, and that burnout and the preservation of passion for work are the two poles of the relationship between a person and a profession. Several studies have shown that the gradually developing professional deformation of medical workers quite often leads to the fact that, with a high degree of burnout, there is an increasing tendency to a negative, often even covertly aggressive attitude towards patients (Mathisen et al., 2022). It also impacts one-sided communication with them through criticism, assessments, and pressure, from which, naturally, both parties suffer.
Specifically, it concerns nurses in medical emergency rooms. The emergency team’s primary resource for understanding the urgency and scope of patient care requirements and how best to handle them is the emergency nursing staff (Mathisen et al., 2022). Emergency nurse turnover significantly impacts the organization because emergency department leaders want to maintain a skilled and qualified nursing workforce.
Investigation
Studies show that burnout syndrome accompanies everyday routine professional activity, which often requires doctors to have quite intense, spontaneous, not necessarily conflicting, but, for various reasons, emotionally stressful communication with patients. Therefore, it is by no means associated with its extreme conditions. Then it becomes clear why the frequency and intensity of this syndrome are noticeably higher among nurse practitioners than surgeons or therapists.
The focus of occupational stress is the correspondence or discrepancy between a professional’s potential capabilities and the social conditions of their activity. Therefore, this problem is considered complex by the specialists of the communicative profession—their social environment (Mathisen et al., 2022). The aspect of emotional contagion in burnout syndrome is very important, and it also emphasizes its social nature.
Evidence
It is indispensable to view the existing statistics to identify the severity of the issues. According to McDermid et al. (2019), “82% of ED nurses had moderate to high levels of burnout, and nearly 86% had moderate to high levels of compassion fatigue” (p. 2). It signifies that most nurses are exposed to severe stress from working in an unhealthy environment. Considering this number, it can be presumed that hospitals, specifically, emergency departments, lack a structured approach towards personnel retention. Ultimately, it is evident that not many organizations are ready to take on changes due to the absence of resources.
Analysis
Emergency department nurses are mostly stressed since they have to work with cases of different severity. Studies have shown that there “is a high turnover rate ranging from 18 to 68%” among emergency room personnel (Wubetie et al., 2020, p. 97). This signifies that the primary area for development is facilitating working hours, since most nurses tend to work overtime due to a lack of personnel.
In addition, more professionals must be attracted to the department to ensure a smooth workflow (Mathisen et al., 2022). Lack of training regarding stress resistance also contributes to the issue’s development. Hence, the workers must undergo education on building resistance to stressful situations.
Contributing Factors
Among the characteristics of communicative professions that significantly affect the development of stress, they note: limitation of the possibility of using the existing personal potential; monotony of work. McDermid et al. (2019) note that “the work environment is a factor that contributes to increased stress, which impacts nurse retention rates in the ED” (p. 5). This study also establishes that critical incidents greatly increase turnover (McDermid et al., 2019). These include a high degree of uncertainty in assessing the work performed and dissatisfaction with social status. Only after that are low wages and unsatisfactory working conditions considered stressful factors, considering them important but not, as it often seems, leading sources of professional stress for medical workers.
Proposed Solution
Altering responsibilities and direction may significantly improve staff satisfaction. New graduate transition programs have been shown to improve staff retention and lessen emotional exhaustion. Similarly, mentorship initiatives boost overall work satisfaction and staff retention (Mathisen et al., 2022). Shift length is one of the most frequently cited reasons for nurse turnover, as organizations using a 12-hour shift report problems with staff retention (McDermid et al., 2019).
Enhancing the working environment can also benefit employee retention, reduce emotional fatigue, and improve staff satisfaction. Reducing weekly and extra overtime and doing away with mandated overtime are two methods for lowering employee turnover. Creating collaborative management initiatives that allow nurses a say in hospital planning, workflow, and policy can also be beneficial.
Justification for Solution
Considering that many medical organizations utilize standard 8—or 12-hour shifts, adhering to this standard regardless of the circumstances is indispensable. However, numerous facilities, specifically emergency departments, impose extra hours on nurses because of staffing issues. As a result, the professionals are made to work overtime for no payment, which leads to physical and mental exhaustion (Mathisen et al., 2022). Hence, it is suggested that working hours be normalized and shift times controlled for at least several months to trace the statistics of turnover and retention. Even though this strategy does not demand extra financial investments, it is the most efficient in providing personnel with sound working conditions.
In addition, when hiring nurses in the emergency department, it is vital that they know their duties so that they are aware of their actions. Typically, nurses are multifunctional and take on additional responsibilities, which leads to burnout as they do not manage to fulfill anything properly (McDermid et al., 2019). Thus, it is recommended that nurses in the emergency department agree on the list of obligations, as a lack of clarity results in lowered performance and turnover.
The other proposed solution is exposing nurses to educational training related to working in stressful conditions. Regularly, emergency room work demands a quick response without involving an emotional component. However, not many professionals are resilient to stress, making it difficult to keep working for an extended period. Consequently, providing needed education on how to be more stress-resistant is indispensable to avoiding turnover.
Cost-Benefit Analysis
Organizations will not have to invest immense sums to implement these solutions. Medical facilities will spend no money on tracking shift times because it only requires one’s readiness to monitor them. As a result, working standard hours is expected to increase retention levels. Furthermore, correcting a list of nursing duties in the emergency department will likely take several weeks without spending money because it entails a documentary procedure within the organization (Wubetie et al., 2020).
Nonetheless, a hospital should invest in nurses’ education to provide high-quality services and sustain a sound working environment. An estimated $1,800 should be invested annually in each nurse’s training. Stress-resistance courses usually demand more time to cover the material and practice the skills obtained. In addition, such training is considered top-level since working in stressful conditions is far more resource-consuming. Regardless of such expenses, nurses will likely perform their duties faster and more efficiently without burning out.
Timeline
The primary operation is tracking the shift time, the easiest step to complete. It will take several weeks to adjust to the process; however, the results may be obtained in a month by checking how nurses feel without working extra hours. The next solution is writing down the specific nursing duties to avoid overload. Developing and proposing this update will take approximately two weeks to a month. Finally, the educational part will likely last at least three months annually since each nurse should obtain new skills regularly.
Stakeholders
Importance
Professional stress is a problem not so much for difficult people as for unresolved situations in relationships and in the structure of interpersonal interaction, such as unclear designation of social roles and functions and insufficient emotional support from colleagues and management. Hence, these people should become key stakeholders in addressing the turnover issue. Nurses are the key participants who should track their physical and emotional condition and report management changes.
In turn, managers must track the implementation process of change. Finally, the other stakeholders are professionals such as surgeons, therapists, and others working in the emergency department. These individuals are greatly assisted, and their performance is partially dependent on nurses.
Engagement/Feedback
Initially, nurses will be asked to participate in a survey to check whether the proposed solutions actually work. If the progress is visible, the managers may report a higher retention rate and positive work-related feedback from the employees. Finally, other emergency department professionals will be surveyed on how their productivity and work quality have changed since the realization of the action plan. All these people will be supervised during the intervention to follow the progress and identify strengths and weaknesses.
Implementation and Success
The success of implementing the proposed solutions can be measured in several months by evaluating the retention rate. Upon implementing the first step, the quality of care is expected to increase. It can be assessed by the number of emergency department discharges and the length of their stay.
Another crucial indicator of a program’s success is the number of nurses who did not quit. The statistics should be compared several months after implementation to pinpoint the pitfalls. In addition, a questionnaire can identify nurses’ satisfaction levels. Finally, other healthcare professionals may notice increased performance and quality of care.
Role as Scientist
As a scientist, I researched numerical data regarding the chosen issue. In addition, I compiled the facts from the existing research, which was a kind of literature systematization. Finding the information needed to form the theoretical basis is part of scientific investigation. It was pretty easy to retrieve data because there are many studies on nurses’ turnover and retention. Ultimately, this role taught me to differentiate between different designs of work, which alleviated the information gathering process.
Role as Detective
A detective’s role normally incorporates information retrieval for further analysis and conclusion-making. As a detective, I gathered the most essential facts from scientific research and concluded that stress leads to high turnover rates; however, it could be fixed by applying specific actions. Based on the obtained factual data, I established a solution proposal necessary for restoring the working environment. As a result, a deep problem analysis helped invent a step-by-step action plan.
Role as a Manager of the Healing Environment
As a manager of the healing environment, I aimed to view the chosen problem as one eligible for solution. This signifies that the problem of turnover related to increased stress among emergency room workers can be fixed if working conditions change. This role involves implementing facilitation strategies, that is, the application of mitigating techniques for a better working environment. As a manager, I suggested several methods, such as shortening shifts, engaging nurses in special training, and creating collaborative management. Although implementing these novelties may take a while, the outcomes are expected to be beneficial.
References
Mathisen, J., Nguyen, T. L., Jense, J. H., Rugulies, R., & Rod, N. H. (2021). Reducing employee turnover in hospitals: Estimating the effects of hypothetical improvements in the psychosocial work environment. Scandinavian journal of work, Environment & Health, 47(6), 456–465. Web.
McDermid, F., Judy Mannix, & Peters, K. (2020). Factors contributing to high turnover rates of emergency nurses: A review of the literature. Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses, 33(4), 390–396. Web.
Wubetie, A., Taye, B., & Girma, B. (2020). Magnitude of turnover intention and associated factors among nurses working in emergency departments of governmental hospitals in Addis Ababa, Ethiopia: a cross-sectional institutional-based study. BMC Nursing, 19, 97. Web.