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This paper proposes to discuss, analyze, and evaluate possible innovative solutions to the growing tendency of nurses to leave their jobs in the hospital setting after only a short period of work. The issue of the high turnover and turnover intent rates among new graduate nurses is becoming a growing concern among health care administrators and policymakers because of its adverse impact on the delivery of health care to patients.
Turnover, in and of itself, is a crucial problem in organizational studies (Dalton and Mesch, 1990). Turnover is usually defined as who voluntarily leave or transfer to another unit within the hospital (Duffield, et al., 2009). In the health care setting and especially in hospitals, there is always a need for a good number of adequately-skilled and experienced nursing staff to assist in the delivery of quality health care service, so staffing levels should always remain positive.
However, the current trend is that new recruits, particularly fresh graduates of nursing, do not last long in their jobs. This is more than just an isolated case of mismanagement or poor administration in a number of health care institutions, as the problem is becoming more rampant in different settings across the globe. In fact, in some countries like Canada, health care officials and scholars are already anticipating a nationwide nursing shortage, which is estimated to be at 78,000 by the year 2011 (Smith, 2008).
The high financial cost to the hospital management of rapid turnover of the nursing staff is also a driving force behind the need to effectively retain new nurses. If it were only such, less scholarly and administrative attention would be given to the matter. But consistently low staffing levels force hospitals to recruit and hire non-permanent workers, part-time employees and even travelers with working visas just to populate their wards and units with enough working people, costing them more than a regular and stable staff (Duffield, et al., 2009).
It is estimated that majority of the new hires in hospitals would be fresh graduates of nursing (Smith, 2008). At the same time, nursing economists predict that the aging of the current workforce as well as the fact that fewer young people are entering the health care field will make training and retaining new nursing graduates more important than ever (Halfer and Graf, 2006). Moreover, the Baby Boomer generation is also rapidly aging, which means that the demand for new health care staffs to take care of their medical needs (Halfer, Graf and Sullivan, 2008).
Most importantly, however, the lack of a regular and well-trained pool of nurses would impact negatively on the health care team's ability to deliver quality health care to patients (Halfer, Graf, and Sullivan, 2008). As new graduate nurses come and go, hospitals not only have to deal with recurring training and expenses, but also with possible medical errors as inexperienced nurses try to work in special areas such as the critical care unit and the operating room. When nurse staffing is not at a desirable number and level of competency, unfavorable clinical outcomes usually come about as a result of the situation (Beecroft, Dorey and Wenten, 2007).
If a regular and stable nursing staff is maintained, tasks can be carried out efficiently and with minimal supervision. The nurses are also able to familiarize themselves with the skills, strengths, and weaknesses of their co-workers, which can contribute to teamwork and positive working dynamics (Duffield, et al., 2009).
The intent to leave a job has a reverse relationship with job satisfaction. The more satisfied an individual is with his or her job, the less the tendency for turnover. In a study by Robert, Jones, and Lynn (2004, as cited in Halfer and Graf, 2006), it was seen that resident nurses who wanted to stay in their current positions pointed to “their schedule, co-workers, interaction, professional opportunities, recognition, control, and responsibility” as prime motivators for their job. On the other hand, job stress has been found to be a very strong predictor for job satisfaction (Halfer and Graf, 2006) as well as successful socialization within the organization (Smith, 2008).
As such, any attempt to lower turnover rates and improve retention strategies within hospitals will have to be geared towards increasing job satisfaction and socialization while decreasing job stress levels for nurses. One possible solution is adopting a flexible working schedule and staffing policies, which will allow to accommodate non-work responsibilities and other opportunities for career development such as further studies and workshop training (Dalton and Mesch, 1990; Laporta, Burns and Doig, 2005). Another intervention proposed in earlier studies suggested the implementation of mentoring programs that are geared towards helping new nurses adjust to their jobs and giving older staff members a chance to de-stress from work.
Review of related literature
Several studies have already found that offering nurses (especially the new graduates) a flexible working schedule will allow them to feel more relaxed in their integration process, and opportunities for further education are especially helpful in giving their careers a boost. There is also evidence that new graduate nurse mentoring programs reduce turnover rates at as much as 6-13% during the first year of practice (Halfer, Graf, and Sullivan, 2008).
Laporta, Burns and Doig (2005) point out that good working relationships can improve retention rates in hospitals. Adequate levels of peer support have been noted as important for new graduate nurses to feel affirmation in their work and to feel that they fit in and make significant connections with their co-workers (Smith, 2008). At the same time, offering them opportunities for career development and further education can prove to important motivators for them to stay in their current positions. Thus, the proposed intervention will be a composite of (1) flexible work schedule and (2) 1-year internship/mentoring program for the new graduate nurses.
Two general principles show the effectivity of flexible working hours as a means of decreasing employee turnover. First, such as scheduling method would give employees a chance to maintain desired work-life balance, reducing the need to be absent in order to attend to these non-work responsibilities. Second, flexible scheduling would cultivate work autonomy and responsibility, increasing the employee's commitment to his or her job and workplace.
Flexible working policies would allow new graduate nurses to be exposed to other units or wards within the hospital, facilitating both their organizational integration and their knowledge and skills in other areas of clinical practice. They can also be assigned rotational activities within their parent unit, giving them a chance to familiarize themselves with the holistic functions and technologies being used in that unit.
When new graduate nurses are given enough free time to pursue other activities, they may now be more open to grab opportunities for further learning. The nursing internship program currently being used in Canada today is a good example of a balanced and attractive retention system for new graduate nurses. The 12-week program features internships in medicine and surgery (the usual throughput units for specialty programs) and in mental health, where potential retirement rate is projected to be at 30% in the next few years. Through participation in the program, new graduate nurses are expected to gain better confidence in knowledge and assessment skills, better clinical skills, and improved decision-making, prioritizing and problem-solving (Smith, 2008).
According to Halfer, Graf, and Sullivan (2008), measuring the effects of “internship and residency programs on new graduate nurse job satisfaction and retention determines the value of these programs for health care organizations.” This can be done by assessing the job satisfaction levels using the McCloskey-Mueller Satisfaction Scale and assessing both the mentees' and the mentors' experiences from the mentoring program and flexible work schedule through an evaluation sheet that will be administered at the end of the program. The evaluation sheet will measure parameters such as checking frequency attendance and appropriateness of the lessons to assist them in transition (Persaud, 2008).
Graduate nurse programs are already an established way of handling turnover rates in both private and public health care settings (Victorian Government Department of Human Services, 2002). Such an intervention method is deemed most practical and effective because of the positive results that it can offer both parties at the end of the implementation. In fact, higher education—which can only be available to nurses if they have enough time to spare—is a crucial factor in preparing graduates to work at an acceptable competency level.
The literature also suggests that decreasing the number of nurses leaving hospitals also means is a positive contribution towards decreasing the number of nurses who are leaving the profession and keeping up the levels of the nursing population (Smith, 2008). This means that more competent and highly trained nurses are available to take care of the health of the community.
- Beecroft, Pauline, Dorey, Frederick and Wenten, Madé. (2007). Turnover intention in new graduate nurses: a multivariate analysis. Journal of Advanced Nursing, 62(1), pp. 41-52.
- Dalton, Dan and Mesch, Debra. (1990). The Impact of Flexible Scheduling on Employee Attendance and Turnover. Administrative Science Quarterly, 35, pp. 370+.
- Duffield, Christine et al. (2009). The implications of staff 'churn' for nurse managers, staff, and patients. Nursing Economics. Retrieved 24 November 2009 from http://findarticles.com/p/articles/mi_m0FSW/is_2_27/ai_n31642741/pg_2/?tag=content;col1.
- Halfer, Diana and Graf, Elaine. (2006). Graduate nurse perceptions of the work experience. Nursing Economics. Retrieved 24 November 2009 from http://findarticles.com/p/articles/mi_m0FSW/is_3_24/ai_n17213677/pg_5/?tag=content;col1.
- Halfer, Diana, Graf, Elaine and Sullivan, Christine. (2008). The organizational impact of a new graduate pediatric nurse mentoring program. Nursing Economics. Retrieved 24 November 2009 from http://findarticles.com/p/articles/mi_m0FSW/is_4_26/ai_n28012059/.
- Laporta, Denny, Burns, Jenny and Doig, Chip. (2005). Bench-to-bedside review: Dealing with increased intensive care unit staff turnover: a leadership challenge. Critical Care, 9(5), pp. 454-458.
- Persaud, Debra. (2008). Mentoring the new graduate perioperative nurse: a valuable retention strategy. Association of Perioperative Registered Nurses. Retrieved 24 November 2009 from http://findarticles.com/p/articles/mi_m0FSL/is_6_87/ai_n27498038/.
- Smith, Cheryl. (2008). Implementing a nursing internship program. Healthcare Quarterly 11 (2), pp. 76-79.