Doctoral Study Proposal: High Turnover of Nurses

Background of the Problem

In this section, it is necessary to provide an overview of the business problem that will be examined in the research. As a rule, new nurses have to work under very stressful conditions and such situations can be observed in many medical institutions, including Vanderbilt University Hospital. As a result, many of these professionals choose to seek a job in a different organization or even decide to leave the medical profession (Chitty & Black, 2011). This tendency implies that a great number of healthcare professionals choose to leave their jobs due to some reason. In many cases, the well-being of patients depends upon their competence. When hospitals are understaffed, the needs of patients are unmet. Moreover, good teamwork is hardly possible if employees cannot work with one another for a long time (Wolper, 2011). This study is supposed to examine the reasons why there is a high turnover of nurses on the general surgical floor. This phenomenon leads to increased costs for medical institutions and impairs the quality of healthcare (Cho et al. 2012). This is why it should be addressed by policy-makers and the leaders of healthcare organizations.

Problem Statement

The main task is to find ways of improving the turnover rate of nurses to decrease hospital costs and increase quality nursing care. Statistical findings indicate a very alarming trend, in particular, in 2015 the anticipated shortage of nurses in the United States will be approximately 20 percent at the very least (Hauck & Fitzpatrick, 2011, p. 270). Nevertheless, the current turnover rate of nurses is 21.3 percent per year (Hauck & Fitzpatrick, 2011). The specific business problem is how hospitals can ascertain the reasons behind the high turnover of nurses, identify the factors that can improve work experiences of nurses, and acquire an understanding of the meaning of nursing lived experiences working on surgical floor. In the near future, surgical floors may become significantly understaffed, thus, it may have catastrophic effects on the performance of the present staff. Medical organizations may not ensure the highest quality of patient care. Additionally, it is very expensive to replace skilled and experienced employees (Cho et al., 2012). Therefore, this problem has two consequences, namely poor quality of patient care and increasing medical expenses.

Purpose Statement

The aim of this study is to investigate the factors that increase the turnover of nurses in medical organizations, especially in surgery departments. The main task is to understand how these professionals perceive their work and what kind of things make them dissatisfied with it. This problem has been examined in many quantitative studies (Hauck & Fitzpatrick, 2011; Cho et al., 2012). However, qualitative research can throw a new light on this problem. In particular, it is necessary to identify the factors that can improve work experiences of nurses or prompt them to quit their job. The study will be using qualitative research methods, in particular, phenomenological design. The research will involve semi-structured interviews of 20 nursing from Vanderbilt University in Nashville, TN, who have been working for at least ten years in a surgical unit. Such persons have vast experiences of working in medical organizations and know why nursing professionals may decide to leave (Gormley, 2011; Duffield et al, 2011; Hegner et al., 2010). By interviewing these professionals, one can understand the forces that compel many nurses to quit their job. This is why this research method has been chosen.

It should be noted that there is growing demand for nurses, and this profession can offer many opportunities to young professionals. This is the reason why policy-makers should be able to voice their opinion about the functioning of healthcare system. Their opinions should be taken into account by people who shape healthcare policies.

Nature of the Study

This research study will be based on the use of the qualitative design and phenomenological methodology that can throw light on the experiences of nurses who have worked in medical organizations for a long time. A qualitative design is the right choice for this study as it will allow for discussion of actual subjective experiences of nurse managers as related to their interactions with staff nurses and overall job satisfaction. The qualitative research methods have been chosen because they can throw light on the opinions, attitudes, and beliefs of the subjects (Creswell, 2009). The data derived can be used to identify the common challenges faced by nurses. It is suitable in those cases, when it is necessary to examine the common experiences of many people and discuss their perceptions of a certain problem or issue that should be addressed (Creswell, 2009). Therefore, this research will be based on the use of phenomenology approach semi-structured interview as a method of collecting interviews.

Phenomenology enables the researcher to understand the common perceptions and experiences of people (Creswell, 2007). This method helps scholars examine the experiences of individuals and their views through interview process. The advantages of the semi-structured interview are the possibility to establish rapport with the interviewee and the opportunity to monitor the interpretation of questions (unlike questionnaires or experiments). This is also beneficial for research and respondent, especially when discussing sensitive issues. The semi-structured interview has been chosen as a method of data collection because it enables a researcher to specify or modify questions. This is one of its main strengths.

Research Question

The research questions for the interview are varied but directed at finding answers to the questions and meeting research objectives.

Research Questions

What factors contribute to high turnover of surgical nurses at Vanderbilt University Medical Center in Nashville TN?

Sub questions:

  1. Why are nurses not willing to stay in their workplace for longer periods?
  2. What circumstances decrease nurses’ satisfaction with their work?
  3. How can managers make staff willing to stay in the hospital?
  4. What kinds of improvement do nurses expect from hospitals?
  5. Are there any recommendations that nurses can make for the improvement of their work experiences?

Conceptual and Theoretical Framework

In their research article, Coshow, Davis, and Wolosin (2009) argue that medical institutions can improve their retention of nurses by focusing on the following areas: 1) work environment, 2) professional fulfillment, 3) compensation and other befits that can increase medical workers’ satisfaction. Such initiatives can be explained by the principles of the Social Exchange Theory. This model implies that workers are more likely to see other employment opportunities when they see that the benefits do not correspond to the efforts that a person takes (Ferell, James, and Holland 2011, unpaged). Moreover, one should take into account that high turnover of nurses is rather expensive for medical institutions because replacement can cost “1.2 to 1.3 times the annual RN salary” (Ferell, James, and Holland 2011, unpaged). This is why administrators should remember that the perception of the job is shaped by such factors as stress, the degree of emotional exhaustion, as well as stress. Provided that there are no rewards, the employee is more likely to leave.

The researchers identified several factors that increase nurses’ satisfaction with their work; among them one can distinguish perceived autonomy, recognition of their contribution, flexible scheduling, good leadership and peer relationships (Ferell, James, and Holland 2011, unpaged). Provided that these conditions are present, medical workers are more likely to stay. This is why administrators should concentrate on these factors in order to improve the retention of nurses. Moreover, they should bear in mind that there is a gap between current efforts of managers and the requirements that nurses or other medical workers can set. It should be also noted that these professionals sometimes can have different priorities and they should be closely examined by researchers. Overall, one of the strategies is to empower nurses and offer them opportunities for professional development.

The Significance of the Study

This nursing shortage is caused by various demographic and social changes; this is why the previous solutions may not be successful (King, 2008, p. 1). This situation does not resemble other crises faced by medical workers in the United States. To a great extent, this problem can be explained by population and labor trends that lead to massive disruptions in the supply of nurses, while the need for these professionals rises dramatically (King, 2008, p. 1). One should take into consideration that the life expectancy in America has increased significantly and more people can live longer with chronic diseases. Yet, many nurses choose to retire or leave medical profession long before retirement. For example, according to statistical evidence at least 50% of all nurses will reach retirement age within 15 years, but they will be no replacement for them (King, 2008, p. 1).

Researchers believe that policy-makers should pay close attention to such aspects as education of nurses, policies regarding their compensation, and the image of this profession (Erickson, 2001). This problem requires close cooperation of many stakeholders, in particular, one can speak about nursing leaders, governmental officials, healthcare executives, and journalists (Erickson, 2001). This shortage can be mostly attributed to the decreased supply of nurses. As it has been said before, a great number of nursing professionals will retire shortly. Previous solutions like relocation coverage, sign-on bonuses, or new premium packages will have only a limited effect on the situation because they can only redistribute the supply of nurses, but not increase it (Erickson, 2001). Apart from that, nursing executives can also play an instrumental role in the organizational campaign to educate their staff and recruit new employees (Erickson, 2001). This is one of the issues that should be considered.

Currently, not much attention is paid to the public image of nurses and the role that they play in society. In turn, individual nurses can increase people’s awareness about the importance of this profession, and in this way, they can motivate many young people to choose nursing as their career (Erickson, 2001). Apart from that, marketing strategies and fiscal innovations can also be of some help. Moreover, administrators should change work environment factors that prevent nurses from staying, for example, excessive workload or lack of flexible schedule. The positive tendency is that nursing remains one of the most respected professions (Erickson, 2001). These are the positive factors that should be taken into account and policy-makers should take advantage of them.

Literature Review

The study conducted by Coshow, Davis, and Wolosin (2009) indicates that policy-makers can manipulate different factors affecting nurses, profession. They should attach much importance to the compensation of these professionals, their vocational development, and their work environment. As it has been said before, this strategy is consistent with the principles of social exchange theory. As a rule, nurses feel more satisfied with their job, if they believe that they are valued by other members of the team. Moreover, the sense of belonging is critical for their successful performance and retention (Ferell, James, and Holland 2011, unpaged).

Some common findings are derived by researchers who study the experiences of nurses during their first year in the organizations. In particular, they often feel underprepared for their core duties (Pellico et al, 2009). In many cases, they lack the most important skills such as the assessment of a patient, administration of drugs, or ability to communicate with other professionals (Pellico et al, 2009). Therefore, one can assume that learning in the workplace is critical for a successful adaptation of a student to the work environment (Pellico et al, 2009). This recommendation is quite consistent with the reports of nurses who express the need for guidance, mentoring, and recognition of their senior colleagues. On the whole, this empirical evidence is critical for the understanding of the nursing shortage that the United States faces. The research that will be carried out can throw new light on the experiences of nursing professionals.

Conclusion

Nursing is the backbone of hospital activities. Nurses are essential to this institution as they perform essential services to restore the health of the patients. However, if the supply of nurses is disrupted, the activities of hospitals will be affected. This implies that their supply should be maintained at the optimum number. The problem of high turnover of nurses can be rectified if considerations are given to the issues leading to their turnover. It is necessary to give importance to the factors that lead to the retention of nurses who work on the general surgical floor. The administrators of medical organizations, who are responsible for developing nursing management policies, can use the findings of this research.

Reference

Chitty, K. K., & Black, B. P. (2011). Professional nursing: Concepts & challenges (6 th ed.). St. Louis, MO: Saunders/Elsevier.

Cho, S., Lee, J., Mark, B. A., & Yun, S. (2012). Turnover of new graduate nurses in their first job using survival analysis. Journal of Nursing Scholarship, 44(1), 63-70.

Coshow, S. M., Davis, P., & Wolosin, R. J. (2009). The big dip: Decrements in RN satisfaction at mid-career. Nursing Economics, 27(1), 15-8.

Creswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five approaches (2nd ed.). Thousand Oaks, CA: Sage.

Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches (3rd ed.). Thousand Oaks, CA: Sage.

Duffield, C., Roche, M., Blay, N., &Stasa, H. (2011). Nursing unit managers, staff retention and the work environment. Journal of Clinical Nursing, 20(2), 23-33.

Erickson, N. (2001), The nursing shortage: solutions for the short and long term. Online Journal of Issues in Nursing, 1 (4), 1-10.

Ferrell, N., James, D. & Holland, C. (2011). The Nursing Shortage: Exploring the Situation and Solutions. Web.

Gormley, D. (2011). Are we on the same page? Staff nurse and manager perceptions of work environment, quality of care and anticipated nurse turnover. Journal of Nursing Management, 19(1), 33-40.

Hauck, A., Quinn Griffin, M. T., Fitzpatrick, J. J. (2011). Structural empowerment and anticipated turnover among critical care nurses. Journal of Nursing Management, 19(2), 269-276.

Hegner, B. R., Acello, B., & Caldwell, E. (2010). Nursing assistant: A nursing process approach. Clifton Park, NY: Delmar/Cengage Learning.

King, C. (2008). Relationships Among Intensity of Stressors, Chronic Stressors, Perceived Autonomy Support, Coping and Nurses’ Affective Commitment to Their Current Jobs. New York: ProQuest.

Pellico, L., Djukic, M., Kovner, C., & Brewer C. (2009). Moving on, up, or out: Changing work needs of new RNs at different stages of their beginning nursing practice. The Online Journal of Issues in Nursing, 15(1).

Wolper, L. F. (2011). Health care administration: Managing organized delivery systems (5th ed.). Sudbury, MA: Jones and Bartlett.