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Online Submission Assignment Part B - No.1:


Predicament of specific nursing units: High nursing turnover
Student Name: Lara Pabandero-de Lasan
Student No.: N00180321
Date Submitted: Friday, February 12, 2016
NURS250: Practical Nursing Leadership
Professor:
Humber College ITAL

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Predicament of specific nursing units: High nursing turnover


High nurse turnover (HNT) has long been a predicament in hospitals, numerous research
studies can attest to this ongoing global problem that indicate a job dissatisfaction of more than
40% of hospital nurses in the United States (Gilmartin, 2012). This is indeed an eye opener
considering that 4/10 nurses are unhappy with their job. As an almost graduate nurse, it is
imperative to comprehend literature regarding this issue so that when it is time to join the
workforce, there are no surprises, and maybe even implement some solutions to help with the
situation. In Canada the nurse turnover rate is as high as 20% (OBrien-Pallas, Murphy, Shamian,
Li & Hayes, 2010). The purpose of this assignment is to identify the problem of HNT, generate
alternatives of action to help this dilemma increase the nursing staff satisfactory by 1) starting
from the very beginning, having a very thorough selection process with each potential nurse to be
hired or 2) having a system for staffing and scheduling and an open communication with
management or leaders of the unit; and of course relaxation or de-stressing vacation time to avoid
burnout then utilize an evaluation tool to assess the success of the action.
According to Gilmartin (2012), the HNT phenomenon has a tremendous effect on hospital
costs such as decline on productivity, drops in efficiency leading to errors, and lesser funding for
adequate number of nurses per unit because the cost of replacing a nurse could add up to $60,000.
Every time a nurse voluntarily leaves, not only the cost is affected, the valuable expertise of the
one going also leaves the unit. Practical skills and knowledge are taught at school and in labs, and
competency is tested during the registration exam, however experience and expertise can only be
obtained with time and practice in the unit. Not only the financial aspect is affected, or the
indispensable skill and knowledge of each nurse departing will handicap the unit, but most of all
the patients are the ones most affected because of the discontinuity of care, this is coming from a
humble observation of a nursing student in her hospital placement and Wallis (2016) also observed

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that in his clinical placement as a second year nursing student. The skill mix of the seasoned and
the new graduate nurses create a very good teaching and learning atmosphere, where new nurses
can learn from the more experienced staff and vice versa. (Trinkoff, Han, Storr, Lerner, Johantgen,
& Gartrell, 2013). Having new, young and excited blood in the mix can sometimes rejuvenate the
staff as well. It is also very evident in a national study by Trinkoff et al. (2013) of nursing homes
in the US that there was significantly higher probability of pressure ulcers, pain and urinary tract
infections when there is a HNT and mended once the nursing staff was sustained.
The route of doing a thorough selection process during hiring and having a screening
method for applicant nurses can help with the HNT. OBrien-Pallas et al. (2010) found that the
nurses who had a higher mental status was able to cope better in the critical and acute care and
retained their job and position for a longer period of time. There was a very significant correlation
with HNT and the degree of the mental status of the nursing staff where there was the tendency of
higher possibility of deterioration. One method to help screen applicants for this process is to have
a situational questionnaire to help with the interview questions. Also have a psychologist or a
behaviour expert also in the room to assess the candidate if they were fit to work in that specific
unit.
The alternative that will be focused on is having a scheduling system and an open
communication with staff and leader management. In a five-country nursing study, it was evident
that four main determinants influence HNT: intrinsic values of motivation, work load, unit size,
and leadership that ultimately affect the quality of nursing care given (Sellgren, Kajermo, Ekvall
& Tomson, 2008, p.3181). Looking at all four factors, the ultimate goal is to maintain the HNT
low and uphold a continuity of care for patients and the nurses happy in the workplace. This will
result in the ripple effect. If the nurses are motivated to work, they are happy coming in to their
shift, available and aspire to help each other despite the complex workload, able to communicate

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with management in a positive and encouraging environment between the workers and the higherups.
Sandlin (2001), states that giving autonomy to her nurses in the unit, having an open
communication and a system to scheduling is what keeps her HNT to 0%. Nurses are well
educated individuals who are in the profession to do good. When given the opportunity to work as
a team and autonomously without being commanded to do orders creates a better working
environment for everybody. As a result there would be less stress than there needs to be on all
parties involved. In the unit that I am doing my placement, there is a scheduling issue that is
coming up to a boil. The problem is that the nurses were given a stiff schedule to choose from,
posted on the fridge in the lunch room and all the nurses were to put their names on the desired
leg of 3 choices. However, seniority comes into effect where if a senior nurse wants a newer
nurse schedule, she can take it without question and this is what the nurses were all quarreling
about. It also does not help that the unit manager is not a very popular guy because 99% of what
the nurses say about him are negative traits, they are not happy with his rudeness (which I was a
witness to several times) and the difficulty to bring up an issue with him, through e-mail because if
they were to speak to him, he would either forget about it or not do anything altogether. The
method of having a system where schedules were all inputted, vacations, sick leave, designations
(RN/RPN), and degree of critical care needed in each appointed room can choose and preselect the
schedule. If there was a glitch in the system, the charge nurse would still be there to fix the
discrepancy. The long term scheduling would be an easier task if done on a system, such as 3
months in advance and if any changes would need to be done such as appointments could be done
on an individual basis with the nurse in charge.
I have not seen this to be implemented yet however, Sandlin (2001) had the alternative of
implementing the nurses to take charge of their own schedules given some parameters such as the

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hours per nurse, the number of different nurses (RN/RPN) per shift and other than that they were
free to make their own schedules, taking into consideration all the nurse needs and present it to
Sandlin (2001). This autonomous system has worked very well with her nursing staff, and she is
very humble to say that if there was a problem or a shortage then she herself would work a shift as
one of the nurses which she states that is very refreshing. It is only imaginable the headache the
nurses went through to persevere as a team but the article makes it seem like the nurses were more
motivated to work on the schedule that they produced rather than just being given a premade
schedule. As observed, from an outsider, scheduling might be a small aspect of the job however,
nursing is already a very stressful profession and little things can and will push an individual to the
edge when all the little things escalate into one compact problem.
The scheduling team can be compromised of all the nurses involved. A dedicated time and
place to implement a desired schedule that all the nurses will be satisfied with is a process that will
help the nursing staff work as a team and unified for a cause. Compromise will be needed to make
the group work, and with open communication, anything can be resolved, it may not be
instantaneously but with guidance from the right personnel such as the unit manager positive
results are bound to happen (Sandlin 2001). Sandlin 2001 also talks about treating her nurses like
she wanted to be treated is a very wise philosophy, and in turn the nurses have a very high respect
for her. The common courtesy of giving weeks or one month advance of changes to the already
made schedule, or not giving restrictions to changes of the shifts as long as there is accountability
taken by both nurses doing the changes shows that the nurses are independent and are responsible
for their actions, and the nurturing and communicative environment instituted are all very
important aspects of a happy workplace and 0% HNT (Sandlin 2001).
One other aspect that Sandlin (2001) talks about is giving encouragement where it is due.
It is a source of power and energy especially when an individual worked very hard during a critical

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shift, any kind of recognition and support will be blissful and promotes a happy working
environment. Making the unit like home because most nurses spend at least 40 hours a week
there, taking into consideration infection control such as posting pictures of beloved pets at home
nurtures and helps in the healing process of patients as well as making a familiar environment for
everyone that is there. And the last point is to spread out the assignments, giving each nurse equal
amount of critical case to avoid exhaustion and burnout. In the surgical unit, the nurses are rotated
so that each one will have a turn for admission and not end up having one nurse with all her patient
assignments new admission and the others none to keep equality and have fair assignments.
To utilize the action that has been chosen, a survey will be the best evaluation tool. The
nurses will fill out a questionnaire of how satisfied they were of their current job position and
environment for the yearend report. If the nurses are staying in their current position, there must
be a reason why, it may be because of the current staff pool, the competitive wages, the unit itself,
the workload, the schedule they have, the leadership that is integrated or the environment. Hoping
that all factors would be accounted for, in the survey, those aspects can all be individually
evaluated by the nurses taking the questionnaire. There is also the option of giving a discharge
survey to patients and any comments they want addressed for the oncoming patients. All these
evaluation tools can be implemented and should be taken seriously by the management.
It is vital to keep workers happy, because it radiates to the patient experience. A good
healthcare team relationship will impact the nurse-client relationship because in spite of policies
and legalities, the openness of communication will be of benefit to all. Lowering the HNT is
indeed a notable intervention to keep a hospital or a care facility up and running.

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References
Gilmartin, M. J. (2013). Thirty years of nursing turnover research: Looking back to move forward.
Medical Care Research and Review, 70(1), 3-28. Retrieved January 31, 2016 from Humber
College Library Database
http://mcr.sagepub.com.eztest.ocls.ca/content/70/1/3.full.pdf+html
O'brienPallas, L., Murphy, G. T., Shamian, J., Li, X., & Hayes, L. J. (2010). Impact and
determinants of nurse turnover: A panCanadian study. Journal of Nursing Management,
18(8), 1073-1086. doi:10.1111/j.1365-2834.2010.01167.x. Retrieved January 31, 2016
from Humber College Library Database
http://web.b.ebscohost.com.eztest.ocls.ca/ehost/pdfviewer/pdfviewer?sid=fa8dd344-d4064c7b-8b4f-a342ab4af1e5%40sessionmgr111&vid=1&hid=116
Sandlin, D. (2001). Take a bite out of high employee turnover. Journal of PeriAnesthesia Nursing,
16(2), 109-111. doi:10.1053/jpan.2001.22597. Retrieved January 31, 2016 from Humber
College Library Database
http://www.sciencedirect.com.eztest.ocls.ca/science/article/pii/S1089947201654121
Sellgren, S. F., Kajermo, K. N., Ekvall, G., & Tomson, G. (2009). Nursing staff turnover at a
swedish university hospital: An exploratory study. Journal of Clinical Nursing, 18(22),
3181-3189. doi:10.1111/j.1365-2702.2008.02770.x Retrieved January 31, 2016 from
Humber College Library Database
http://web.b.ebscohost.com.eztest.ocls.ca/ehost/pdfviewer/pdfviewer?sid=3e7f6131-662644e2-8171-054fefb38bf5%40sessionmgr114&vid=1&hid=116
Trinkoff, A. M., Han, K., Storr, C. L., Lerner, N., Johantgen, M., & Gartrell, K. (2013). Turnover,
staffing, skill mix, and resident outcomes in a national sample of US nursing homes.
JONA: The Journal of Nursing Administration, 43(12), 630-636.

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doi:10.1097/NNA.0000000000000004 Retrieved January 31, 2016 from Humber College


Library Database
Wallis, M. (2015). Starting out - A familiar face can be reassuring in a ward with high staff
turnover. Nursing Standard (Royal College of Nursing (Great Britain) : 1987), 30(11), 27.
Retrieved January 31, 2016 from Humber College Library Database
http://journals.rcni.com.eztest.ocls.ca/doi/pdfplus/10.7748/ns.30.11.27.s29

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