Change in a Healthcare Organization

Organizational Change: Nurse Retention and to decrease turnover

Healthcare organizational change implies the transition from its current state towards future state in order to boost service delivery. The healthcare industry is dynamic and in order to preserve the quality of healthcare delivered to their clients, it must adapt to the various factors of change. Nevertheless, because the transition from one organizational state to another affects nurse retention and turnover, it must be a difficult task.

Borkowski (2005) claims some of the most efficient strategies for adaption to change in the healthcare industry, target the cultural aspect of health delivery. In the evaluation of change management; efficiency is not measured by the size, yearly revenue, or rank on the chart list.

He further asserts that the feasibility of particular change strategy depends on the knowledge of detecting and circumventing the commonest obstacles to nurse retention and decrease turnover which include:

• Cultural resistance, skepticism, and complacency of the nurses; the phenomenon of change is usually difficult and may trigger some degree of resistance across the organization. A change initiative normally, will provoke diverse reactions from the nurses in a health organization, in the sense that while some may understand the importance for change others may be contended with the present organizational state and may perceive the a change as intrusion of privacy.
• Communication barrier; this problem may create a misunderstanding which can eventually thwart a well developed initiative leading to waste of resource. Ensure that the concept has been understood. Begin by defining the objective and the vision of that initiative to the nurses.
• Lack of accountability and alignment; this element is important for long term efficiency. If a project is inconsistence with the nurse’s objective and responsibility for the outcome of change, it would not command a substantial attention from the nurse. Most organization plunge into implementation of the initiative without ensuring the alignment between practice and objectives; and that the nurses are held responsible for the outcome.
• Inadequate leadership support; leadership involvement is indispensable for realization of success. This claim is supported by records that the most successful strategies implemented have had an equivocal back-up from the CEO and the executive team.
• Micromanagement barrier; this is where the leader supervises the team heavily not only in their course of implementing the plan but also in celebrating the success of that initiative. This impact negatively on the nurses’ morale because they feel unappreciated, leading to their resignation.
• Over-tasked workforce; overworking and scarcity of resources are the main reason for complain whenever an organization endeavors to implement a fresh change of plan.
• Insufficient scheme and structure; the chance for success is greatly dependent on the availability of the right schemes and structure to facilitate the initiative. This may entail the proper computer system and software; practice management structure; and executing the best plan to head the change. The foundation for change should be simple principles, and flexible to fit a specific circumstance.
• Lack of regulatory schemes to determine and maintain result; a challenge in change implementation is normally experienced when it come to sustaining the result of the change. A mechanism to sustain result of the change should be designed to ensure long term success. A regulatory scheme is important to detect defaults earlier before they disrupt the project.

Organizational change, decrease turnover and increase retention

In the contemporary health care industry recruitment and retention of fresh graduate nurses is important. Most importantly adequate support and resource availability motivate nurses to remain in the profession (vanWyngeeren, 2010).

• Causes of nurse shortage (Lynn, 2010): shortage of nurses can be attributed to
  • few nurses in the practice,
  • aging nurse fraternity
  • poor leadership, management skills and resistance to change
  • increased force on nurses in the workplace,
  • misconception that nursing is a woman thing, resulting in low men turn up,
  • increasing demand for nurses in other medical settings
  • unsatisfactory work atmosphere.
• Nurse recruitment and retention facts: the following factors affect nurse recruitment and retention. It is more cost effective to focus on nurse retention because for example replacement of a critical care nurse requires about 185,000 US dollars. Also it has been established that 50 percent of work satisfaction depends on the relationship with the superiors. Again, according to the 2001 Testimony by AHA before U.S. State House of Representatives, the enrollment in RN plan has decreased by 22% from 1993. Lastly, the mean age of RN is 43 years.
• Concern for recruitment and retention strategies: Buerhaus argues that different approaches should be considered when tackling this matter. He suggests the following specific changes. Firstly restructuring of the advertisement. Secondly, the workplace environment should meet the specialized progression opportunities, the reputation of the facility, technological prospect, and compensation for practicing mothers. Thirdly, the healthcare institution should consider the generational difference between workers. Fourthly, the organization should nurture millennial workforce state such as; capacity to identify and solve problem at their own convenience; value independence; and the opportunity to further their studies and improve their skills.

In 2001 Heinrich claimed that low wages and few benefits accounted for nurse aide turnover. According to the bureau of labour statistics, nurse aides’ benefits and wages were lower than the average worker, particularly for those employed in home health care and nursing homes. For instance in 1999, the average hourly wage for nurse supporters employed in nursing homes was $8.29, relative to 9.22$ for service workers. This wages is too little to accommodate benefits like Medicaid and food stamps.

Moreover, elements which determines turnover are include staffing level and workloads, courtesy from the administration, administration acknowledgement as well as involvement in problem solving (Heinrich).

Conclusion and recommendations

According to NHIS there is no single approach for the various obstacles to change in health care organization. Nevertheless there are distinct approaches for different barrier, for different persons and particular situations. These approaches are described below;

• Use of educational materials; these include online tools, videos and DVDs, journals, leaflets, booklets, CD-ROMS, and computer programs to update the health care personal on the latest development in their faculty.
• Conducting educational meetings; this entails use of workshops, conference a, lectures and trainings to enlighten the professionals on the latest progress in the faculty.
• By conducting educational outreach visits (academic detailing); this involves visit by trained experts to healthcare professional in their own practice regarding current top practice.
• Through opinion leaders; opinion leaders exercise their influence to mobilize health care practitioners to deliver quality care. These people are respected among and their junior colleagues hold them with high esteem. They can impact no the organizational changes in various ways including signing a letter associated with the guidance, participating in outreach visits, writing journal articles or giving speech.
• Other methods include; clinical audit and feedback, reminder systems, and patient mediated approaches.

Reference List

Borkowski, N. (2005). Organizational behavior in health care. Sudbury, A: Jones and Bartlett Publishers.

Heinrich, J. (2001). Nursing workforce: multiple factors create nurse recruitment and retention problems. American organization of nurse executives, Perspective on the nursing shortage: a blue print for action.

Lynn, W. (2010). Retention Priorities for the Intergenerational Nurse Workforce.

NHIS National institute for health and clinical excellence. (2007). How to change practice: understand, identify and overcome barriers to change. London; UK. p. 19-25.

vanWyngeeren, K. (2010). Increasing New Graduate Nurse Retention From a students nurse perspective. RN journal. Massachusetts College of Pharmacy and health sciences school of Nursing.