Executive Summary:
The nurse turnover in a hospital can cause disruption in the regular operations and can also result in patient dissatisfaction. This proposal consists of the analysis of two solutions that are presented to the board of Renfrey Memorial hospital by taking into account the cases faced by hospital of similar scale. It analyzes the solutions that these hospitals incorporated in order to overcome the crisis of nurse turnover. Moreover examples of these hospitals are used because the scenario and the extent of the organization are more or less similar to our case. It is better to implement strategically designed changes rather than spending huge amount of money to reduce the crisis or overcome it. The management must incorporated the strategy as a part of the culture of the organization and make it a driving force for the organization. This will not only help the organization in times of crisis but will also act as a sustainable approach towards its development.
Morton Hospital
Morton Hospital is an American based hospital and medical that faced a situation of nurse shortage. The problem which it encountered was that the turnover had started to rise and there was a problem of properly staffing of nurses. The nurses either resigned from the job or retired before their age. After carrying out survey which was aimed at identifying the reason of the turnover, the management came to know that the problem was within the organization and that there was no external factor affecting the shortage. Nurses had complained to the management to increase their salary and review their compensations plan so that they could be revised and the management could come up with something new and beneficial for the employees, which would motivate them to work efficiently and effectively. However the management had been ignoring the request of these employees and had been of the opinion that employee satisfactions and commitment towards the organizational goal is due to the good organizational environment. The management however assessed its ranking of the employee compensation and thoroughly analyzed that the compensation rates of the hospital were relatively low to the standard market offering. The management then came up with a solution to increase salary of the employees but with certain objectives attached to it. These objectives were related to the work requirement. Nurses who had to do overtime jobs due to the shortage of employees at that time were rewarded with extra bonus and recognition. This was aimed at retaining those who were working and then attracting employees. The salary packages were upgraded and a retention strategy was chalked down. This retention strategy was to compensate employees which mainly include nurses to get points for following things like working on night shifts, overtime and reduction in absenteeism. This was a workable option for the hospital. After six months of implementing the strategy, a survey was taken which was to know the opinion of employees working in Morton, 74% of the employees liked the work environment and the compensation plan for them. This also helped in employing of new nurses.
Greater Baltimore Medical Center
Then another hospital in Towson, Maryland was faced with a similar scenario of nurse shortfall. Greater Baltimore Medical Center, a 335-bed hospital was faced with sudden shortage in the nurses. These nurses were registered nurses and the hospital was loss in terms of finance as well human resource. The hospital was incurring financial loss because of the temporary nursing services which it has to take help. This method was much more costly than that of keeping a permanent staff. Approximately $ 5 million was incurred because of this process. The other problem was that due to the lack in number of registered nurses temporary nurses were called, who were not necessarily registered. This was affecting the quality of care of patients and customer services. The solution to this problem was through conducting analysis of the environment in which GBMC did a SWOT analysis of the driving forces. These driving forces were patient profile; capital investments etc. the second step was formulate scenario plans. This was basically to chalk out those situations that are likely in which an organization like GBMC would operate. GBMC came up two possible scenarios for future events and then place the forces into each scenario. Then the organization conducted a detailed registered nurses demand analysis and analyzed the skill needs for future scenarios to come. The human resource department in the organization came up with solutions to reduce turnover and increase supply. This was done by launching nurse training programs in which the member used to offer great support to the new hirer. Moreover mentoring programs were done in which experienced nurses after their shift would have discussion with the new employees and would answer their questions. This caused the decline in the turnover rate of the nurses in the hospital and which added to the finances of the organization by saving costs of $4 million. This workforce planning is now a business driving force at GBMC and has been applauded by various medical and management council.
Ashtabula County Medical Center
Another case relates to a small medical center in Ohio. Ashtabula County Medical Center is 180 beds hospital which operates for 24 hours a day. The hospital was faced with a situation of turnover in attendants and nurses. Management was short on the budget as it was not a big hospital and major portion of the income it generated was from the charity it got through various foundations. The hospital analyzed the problem in a more comprehensive way and came up with two situations it was facing. First was that the nurse turnover was due to the organizational culture that promoted bureaucratic environment. The functions of a nurse were restricted in a manner that they had to get approval from a professional doctor physician. This culture was very unpleasing to the senior staff that had spent years in the hospital and they had developed the skill to take certain decisions and a given scenario. What the staff felt was that the management even though compensating them in the normal way did not respected the senior staff an its decision. This had increased the turnover of registered nurses and second, the hospital was also facing financial constraint because of the increased cost in hiring nurses. Then the nurses who were retained in the hospital had had decreased motivational level and increased absenteeism. This directly affected the impression of the hospital as the shortage of nurses was affecting the patients. The management of the hospital took into account the reaction of the employees and came up with a solution to have a change strategy incorporated in to the organization. The hospital started with a small scale change because of the financial constraints. The management initiated change by keeping sessions which were aimed at instructing doctor on what responsibilities to delegate to the nurses and what level of care should be taken in handing over those responsibilities. Then the importance of the role of nurses was promoted within the organization. This was to increase the motivation of the attendants and the nurses in the hospital. The result was astonishing in a way that the management reduced the turnover rate to a single digit number (6.3%). The nurses were started to be perceived as an important part of the organization and the satisfaction level of the employees had increased over a period of time.
Sturdy Memorial Hospital
Sturdy Memorial Hospital in Massachusetts is a state-run hospital which is operational 24 hours. The hospital one of the oldest hospital in the state and has extensive medical facilities available. It also provides off hours specialist services to patient. In 2007, the hospital faced employee turnover problem which was affecting the operation of the hospital. Management started taking services of temporary nurses in order to maintain smoothness in the operations, but things started to get out of control. Patient complaints started to increase and this showed signs of dissatisfaction. Not to mention the method of hiring temporary services was not very cost effective. But the management was more focused on the reasons of patient dissatisfaction. The hospital took the service of a human resource consultant. During the first step of the recovery process, the scenario and its reasons were chalked down. The primary reason of the turnover was the strict roster and time scheduling of the nurses. Most of the senior staff was married women who had children. For them to work during night shift was a difficult task as they had to take care of the daily chores and their children. Then the salary problem was also faced by the employees. Nurses showed dissatisfaction in term of the compensation plan of the organization. For them to work within a strict schedule and for a lesser salary was not worth the effort. The human resource consultant then planned the whole employee retention strategy and lined down the methods. First was the program to reschedule the work shifts of all the nurses and this was done with the help of consensus of the staff. Flexible work timing were implemented in which if the employee had to work after the work shift the he/she would be compensated for the extra hours in the form of overtime payment. This helped in two ways. First it motivated the staff who started to perceive the management as employee friendly. Secondly, it eliminated the hassle of calling temporary nurses who were not necessarily registered. This was extremely beneficial to the hospital as this activity was then treated as a competitive advantage for the hospital.
Ephraim McDowell Regional Medical Center
Ephraim McDowell Regional Medical Center is a hospital located in Kentucky. The hospital was made in the 70s as a part of a community work to cater to the medical need in the neighborhood. Now it is a 450 bed hospital which not only provides medical facility in the community but is also recognized as one of the major hospital in the city. The hospital was under a management that now had left and a new management had taken over. Under the previous management, the hospital was faced with a crisis. The crisis was in terms of the human resource problem that the organization was facing. This problem was interconnected with the financial and the operational problems. The hospital was facing a major problem of nurse staff shortage. The reasoned as quoted by the management was the employee conflict in the daily operations of the organization. This was affecting the patients and more compliant were been observed. The reason of the conflict was due to the lack of workgroup cohesion. Doctors working in the hospital did not treat the nurses and the subordinate staff in a polite manner. This decreased the level of motivation in the nurses and their performance was reflected in the patient-care and other operations. Then there was a problem in tasking identification. The nurses were not properly administered and decrease level of employee efficiency was observed in that the nurses didn’t know what was required of in a certain situation. The whole operation was haphazard and due to that the whole work force efficiency was getting affected. When the hospital was taken over by a new management, the culture of the organization went through change and more decentralized administration system was implemented. The scenario was more structure in a manner that task identification of employees was done in a manner in which the scheduling of nurses was incorporated. Time flexibility for the employees was taken into account and job tasks were structured. This helped in reducing the conflict between the doctors and the nurses and reduced stress among the nurse staff. The employees were more focused in their working and the operation began to go smoothly.
Solutions that should be implemented by Renfrey Memorial Hospital:
The strategy that should be implemented by Renfrey Memorial hospital must be designed in accordance with the scenario faced by the hospital. First, due to the employee turnover scheduling problem has occurred and the staff that is currently working is facing a tough schedule. This is the reason that there is increasing workload that the employees are facing. Then the turnover is due to the senior nurses who are nearing retirement. This situation was inevitable and turnover for such staff is anticipated after a period of time. This is because hospital usually hire on a need basis. And the need for nurses is generated when the working lot either retires or the staff either leaves the place.
In order to tackle the crisis, the management must decide on what objectives to achieve in the long run. This will derive their strategy for the implementation of the method to cope up with this crisis. Then the hospital even though suffering from the human resource crisis will have to incur a cost of hiring the new staff and then training the fresh employees. The first method which will be viable for the hospital will be to reschedule the working hours of the nurses. The impact of rescheduling on the organization is discussed.
Impact on the Nursing Staff:
The rescheduling of the roster is one of the components that design the workload on the employees in an organization. It is also a measure of the motivational level of the employees. The nursing staff that is already retained in the hospital will have a positive impact because of the reason that suitable work schedule will ensure work time flexibility. This flexibility will not only affect the nurses by reducing their work time, so that they may have time for other things. It will also help the organization because the employees will be more efficient during the work hours. The proper rescheduling will also reduce the amount of stress faced by the employees. This will reduce the chances of getting sick for an employee, thereby reducing absenteeism.
Required Change Processes:
The change process calls for; first, taking the retained skilled nurse staff and planning out the roster. The reason is that the skilled nurses will be able to tell the situation and the plight of the nursing staff and will be able to make a better strategy. However the end decision must not be left on the nursing staff but on the administration. Second, the temporary staff must not be given exposure to the extreme scenarios during the working hours because of them being inexperienced. And that the motivational level of the temporary staff is not much which is reflected on the operation and by the patient dissatisfaction.
Fiscal Impact:
The hospital will be incurring a relatively less financial cost by implementing the solution because it is not bringing something new and the method is not very costly to implement. It just requires the management to take into consideration the condition of the employees and its impact on the turnover rate.
Work time flexibility in organizations is a good motivator as it does not ask much from the employee as well as the organization. It can be done in an easy way and can reduce stress and work load from the employees. This is done so that the work schedule fits well into their lifestyle, family and other external commitments. The flexibility in work time scheduling motivates employees to do their work effectively. And it also helps them to take part in the extra organizational activities. These activities then add up to the skill of the employee and if retained the employee pays off in the long run. More over this may help in getting new employees as a permanent staff because this is also seen as an added benefit in an organization. Then this may also help in a way that many mature nurses who have experience may switch job and come to Renfrey Memorial Hospital because many of them are married women who like to give time to their families and for them this is an added benefit.
The second solution that is viable for the hospital is to take into account the strategies implemented by GBMC. The strategy that must be implemented should be for the employee retention and the attraction skillful permanent employees. The hospital should implement task identification strategies that work in accordance to the cause of the employee. The task must be structured in such a manner that the work of the nursing staff does not become monotonous and new opportunities in the form of providing new task must be provided.
Impact on the nursing staff:
The nursing staff will be more focused on the job that it is required to do. Then structuring the job in which opportunities are given to get exposed to new situations will add up to the skill of the employees and will inculcate work diversification. In this way employees may be motivated to learn something new and will response more actively to a new and changing task as compared to having a monotonous one.
Required Change Processes:
The change will be implemented from the management side. The change process requires structuring the employee’s work in a manner that it does not burden them and hence derived the required effectiveness. The change strategy is a to design job timings so that similar tasks don’t conflict with each other in order to reduce confusion. The management must also focus on changing the monotonous work of the employees which thereby reduces work motivation drainage.
Fiscal Impact:
This will not affect a major portion of the financial budget. However due to the hiring of nurses and their training will incur some cost to the organization. This may be because the strategy might require more employees to fill in the gap that may get created due to the task specification.
Conclusion:
The management has to overcome the crisis by not affecting the organization’s finances and in a way that the strategy works for the hospital in the long run. Since the hospital is not large change in terms of the finances and the capacity. So this is a strong point in a way that the change will be on a small scale basis relative to the organization. Then the solution are optimal for the hospital in a way that the employees are in a way tired of the conventional standpoint of the organization and this may act as a factor that may discourage the work input by the employee.
References:
1. Mathis , Robert L., & Jackson, John H. (2007). Human resource management. Cengage Learning.
2. Bratton, John, & Gold, Jeffery. (2007). Human resource management: theory and practice. Palgrave.
3. Flamholtz, Eric. (2006). Human resources accounting: measuring positional replacement costs. Wiley Periodicals,12(1), Retrieved from http://www3.interscience.wiley.com/journal/113449702/abstract?CRETRY=1&SRETRY=0
4. Schuller, Randall, & Ian C., Macmillan. (2007). Gaining competitive advantage through human resource management practices. Gaining Competitive Advantage through Human Resource Management Practices, 23(3),
5. A Jones, RMN, & , . (2008). An Analysis of case management–the efficient utility of human resources, but to what end?.Journal of Nursing Management, 3(3), Retrieved from http://www3.interscience.wiley.com/journal/119835572/abstract
6. Lavelle, James J, MacMahan, Gary C., & Harris, Christopher M. (2009). Fairness in human resource management, social exchange relationships, and citizenship behavior: testing linkages of the target similarity model among nurses in the united states . The Journal of Human Resource Management, 20(12), Retrieved from http://www.informaworld.com/smpp/content~content=a917463073&db=all
7. Hogan, Pamela, Moxham, Lorna, & Dwyer, Trudy. (2009). Human resource management strategies for the retention of nurses in acute care settings in hospitals. Retrieved from http://www.contemporarynurse.com/archives/vol/24/issue/2/article/2229/human-resource-management-strategies-for-th
8. Wagar, , Terry, H, & , . (2009). Impact of human resource management practices on nursing home performance. Health service management research,
9. Prinns, Peggy D. (2007). Hrm effectiveness in older people’s and nursing homes: the search for best (quality) practices. Nonprofit and Voluntary Sector Quarterly, 36(4), Retrieved from http://nvs.sagepub.com/cgi/content/short/36/4/549
10. Marchington , Mick, & Wilkinson, Adrian. (2005). Human resource management at work: people management and development. Retrieved from http://books.google.com.pk/books?id=k9c-0OPb1MsC&dq=hrm+strategies&source=gbs_navlinks_s