According to the Bureau of Labor and Statistics report of 2012, analysts projected an employment surge of approximately 26% by the year 2020 (Jeffreys, 2012). Much of this occurrence may be attributed to the fact that there has been a notable rise in the baby boomer population where most are turning 65 years at the rate of nearly 10,000 individuals in a single day (Van den Heede et al., 2012). Accordingly, it has become apparent that there is the dire need of registered nurses (RNs) to facilitate the burgeoning numbers of the aging population who demand unique healthcare needs. Moreover, studies conducted by the American Health Care Association (AHCA) indicated that one in six of registered nursing position had been declared vacant, but there was a shortage of skilled candidates with the proficiencies of filling the positions satisfactorily. There is also the anticipated growth of vacant positions which will create numerous vacancies resulting in a shortage of RNs. Consequently, this study focuses on the challenges experienced in hiring and retention strategies of Carolinas Medical Center (CMC). Moreover, the study accords keen attention to streamlining the nurse retention approaches in particular as a cost-effective measure that would ensure optimised functionality of the organization.
Turnover refers to the movement of employees from the process of hiring up to when they abandon their current professional positions, and it has been an emerging subject of interest in contemporary RN staffing (Chan et al., 2015). Several factors have been identified as the causative agents that propagate the lack of skilled workers and prevalence of nursing turnover. According to Hussain et al., (2012), some of these factors include demographic alterations in patients, job dissatisfaction, RN age increases, supervisor control and inadequacies in staffing. These occurrences culminate in unnecessary expenses which ultimately drain the financial assets of a given health organization as a result of the existence of job vacancies. Researchers project that nearly 80% of the total expenses emanate from lost productivity of healthcare organizations while covering the duties of a missing employee.
A survey conducted by Decker, J. L., & Shellenbarger (2012) interviews involving individuals who had voluntarily left healthcare organizations, illustrated that the work content of nursing was extremely demanding, and the practice environment was not suitable in regards to the shift hours and nurse-patient ratios. On the other hand Klopper et al. (2012), attributes a nurses career burnout to the fatigue of not being able to provide the nursing care as they would have preferred. This problem was compounded by the internal conflict regarding the ethical consideration that is associated with the inability to deliver patient-centered care. As a result, being unable to provide optimised results and the incapacitation on influencing the working condition culminated in the contravention of the talents and ambitions portrayed by new graduates. Findings from Feldman et al. (2015), illustrated that new graduates are expected to reproduce cultural images and stereotypes that mimic the responsibilities of a nurse. Hence, nurses are supposed to be altruistic, nurturing and always ready and willing to serve, and the absence of such qualities may have contributed significantly to abandoning the nursing profession According to Currie & Hill (2012), the greatest sense of motivation for leaving the healthcare workforce is that the individuals felt that they were being underpaid since the nursing profession is pervaded with emotionally and physically draining tasks as evidenced by Figure 1 below. Moreover, Twigg, & McCullough (2014) argue that nurses are also required to sacrifice their holidays and family events due to their prolonged and ever-changing job schedule. On their days-off, nurses prefer picking up extra shifts in a bid to earn extra since they feel that they are not well compensated and such factors are likely contributors to early career burnouts.
Earnings for Nurses
Currie & Hill (2010). Figure 1: Graph illustrating stagnant wages for RNs.
The study focuses on highlighting mechanisms of addressing the challenge associated with hiring and retaining nursing staff at CMC. Some of the factors that have inspired the need for retention may be attributed to the fact that high employee turnovers culminated in augmented costs to a healthcare organization and coupled with a waste of resources such as time and finance. Following the research on what has worked versus what has not work regarding the hiring and retention of staff at CMC, this study aims at proposing an approach that would aid in augmenting the retention capacity of the health organization. The parameters to be utilized in measuring the outcome of the research includes a comparison of the number of employees leaving the organization against the total number of current employees. Information pertinent to the study will be collected through organizational statistics and surveys on employees with the objective of distinguishing the hiring practices and incentives which are working from those which are ineffective. In addition to this, the study aims at uncovering the reasons behind the lack of retention and the factors to be analyzed include retirement; voluntary or involuntary removal; whether individuals are leaving into promoted roles or laterally into other roles; differences in tenure stages and the levels of employment. Other factors include hard to fill roles, individuals who are critical to the success of the organization, relationship with co-workers, the boss and the interaction with the work environment and the organizational culture.
A review of organizational statistics indicates that the 2016 Annualized turnover by the department, showed that a total of 7134 graduates had transferred into the Cardiac Department while 7016 had transferred out during the year of 2016. Currently, the half-year Annualized turnover for 2017 was capped at 3572 for the total transfers in and 3546 for transfers out in Carolinas Healthcare System. In regards to engagement survey, the year 2016 saw CMC outperform the industry average in Leadership Access and Responsiveness and Autonomy as the. Additionally, there was noted improvement in ANCC nursing themes such as fundamentals of quality nursing care and inter-professional relationships. Nonetheless, a comparison of performance between the year 2015 and 2016 illustrated a decline in areas such as RN to RN collaboration, fundamentals of quality nursing, inter-professional, adequacy of nursing and resources and professional development stratagems for team members. These areas were also cited as possible avenues for improvement in CMCs approach towards innovative hiring and retention structures.
Following the conduction of extensive interviews with the individuals who had voluntarily left the organization, many cited that the work content of nursing was extremely demanding, and the practice environment was not suitable in regards to the shift hours and nurse-patient ratios. Moreover, the nurses career burnout was attributed to the fatigue of not being able to provide the nursing care as they would have preferred. This problem was compounded by the internal conflict regarding the ethical consideration that is associated with the inability to deliver patient-centered care. As a result, being unable to provide optimised results and the incapacitation on influencing the working condition culminated in the contravention of the talents and ambitions portrayed by new graduates. Conventionally, new graduates are expected to reproduce cultural images and stereotypes that mimic the responsibilities of a nurse. Hence, nurses are supposed to be altruistic, nurturing and always ready and willing to serve, and the absence of such qualities may have contributed significantly to abandoning the nursing profession. Perhaps the greatest sense of motivation for leaving the CMC team was that the individuals felt that they were being underpaid since the nursing profession is pervaded with emotionally and physically draining tasks (Currie & Hill, 2012). Moreover, nurses are also required to sacrifice their holidays and family events due to their prolonged and ever-changing job schedule. On their days-off, nurses prefer picking up extra shifts in a bid to earn extra since they feel that they are not well compensated and such factors are likely contributors to early career burnouts.
Hiring at CMC
The looming crisis of the anticipated nursing shortage has spurred the application of innovative stratagems of hiring new health professionals. At the CMC, the primary target comprises of students who at high school level where the organization conducts extensive recruitment fairs. During such presentations, students are informed on the promising future that the nursing career entails including highlighting the numerous benefits that are associated with interaction with healthcare in a professional capacity. For the newly recruited nurses who meet the criteria of the organization, a welcome party is held in their honor as they are familiarised with the leadership structure and the various roles within CMC. Additionally, the health facility provides scheduled breakfast meetings with the Assistant Vice President, Cindy Brenton whose responsibility is to offer guidance to team leaders on the best practices to adopt regarding the hiring and recruiting of new graduates. Upon admittance into the institutions, the new nurses at CMC are subjected to a 16-week long orientation process. Nonetheless, research conducted on the population of newly accepted nurses indicated that nearly 20% of those admitted leave the health organization within the two weeks of orientation. Most candidates abandon the nursing profession entirely and opt to pursue a different degree to a heightened sense of anxiety and stress (Sharma & Dhar, 2016). Consequently, CMC has attempted to curb this worrying trend by formulating a policy whereby when a new nurse is hired; their manager has the mandate to work with them on 30-60 days open door policy. During this phase, the team leader keeps in check their psychological well-being by making inquiries on the progress of students and how they are adapting to the system. Furthermore, the nurse manager employs the use of active listening skills and empathy which fosters the culture of an open and honest communication channel. The expectations of both the team members and that of the organization are discussed, and it is by these two paradigms that the performance outcomes are evaluated. Further, the CMC has also adopted innovative strategies in its hiring approaches where the eXtras franchise presents an exclusive affinity program that offers discounts from local regional and national vendors. Some of these products under the program include but are not limited to scrubs, real estate services, child care assistance, Tickets@Work, and cellphone services. Moreover, the nurse manager employs the use of other resources that complement the needs of new graduates. For instance, CMC utilizes travel nurses who are outsourcing from other states, and the organization willingly pays for their relocation fees. Moreover, every day Monday Matters is an inspirational program that influences teammates to conform to the notion of ordinary individuals achieving extraordinary deeds. The above mantra is synonymous with CMCs organizational culture that unites the team members at the health facility. All these serve the purpose of being incentives towards fostering enviable hiring practices for new employees.
Comprehensive Retention Plan for CMC
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