The most applicable nursing theory to proposed changes is the modeling and role-modeling theory. It utilizes Maslow’s hierarchy of needs, with the assumption if basic physiological and safety needs are met, nurses are more likely to seek social belongingness, self-esteem, and self-actualization, in turn increasing job satisfaction, professionalism, and retention rates. Without appropriate wages, nurses are unable to provide shelter, clothing, food, and other necessities for themselves and their families to ensure that physiological needs are met. Staff also needs to have the fundamental aspects of safety at work such as the necessary training, adequate supply, and precautions to protect against any biological threats as well as social ones such as workplace discrimination, stress, or harassment (Clark, 2009).
The modeling and role-modeling theory suggests once these needs are achieved, staff began to have a sense of belonging and work well in a team. Once that is reached, the stage of self-esteem set in where staff seek to achieve the best outcomes, gain recognition, and be competent at their performance. Eventually nurses will seek self-actualization, seeking opportunities for advancement and transcendence where their level of self-actualization allows to mentor other staff (Clark, 2009). The proposed changes closely match this theory and Maslow’s hierarchy of needs, but if such an environment is achieved and needs are met, nursing shortage will be resolved as it would create a positive cycle of retention.
The implementation of intervention measures focused on meeting the needs of nurses is aimed at increasing retention and provide the optimal nurse-to-patient ratios and comfortable working hours to staff. The implementation plan is multifaceted, focusing on education, increase of salaries, and reduction of burnout via organizational and scheduling changes. Reducing burnout is key to maintaining retention and will be done via a range of policy implementations including set nurse-to-patient ratios, support programs for staff, reduction of non-clinical staff, and training of nursing leaders and management in addressing burnout (de Oliveira et al., 2019). The outcome measure is to ensure that less than 10% of nurses at evaluation classify themselves as burnt-out due to work factors and decrease turnover due to these factors.
Based off the policy changes, the HR department will begin to implement changes in staffing to meet criteria in staffing and ratios including hiring new staff and begin a gradual increase of salaries according to agreements with nursing staff and management. The outcome measure is to meet all staffing needs within a year. Finally, a mandatory education program is proposed to enhance quality of care and nursing competency, consisting of a mixture of self-education via online courses and practical in-person sessions. The key outcome is for all staff to complete the education program within a year and increase their qualifications.
The primary outcome of the change intervention is to increase nurse retention. A longitudinal evaluation for a year and potentially 5-year period is viable using convenience sampling. To evaluate the effect of the implementation on stabilization of staffing and hiring patterns, it is necessary to calculate the number of nurses needed, historical patterns of turnover, and recruiting quota for new staff. Therefore, a key statistic that should be impacted with an effective implementation of the intervention include decreasing turnover rate in comparison to historical rates at the specific facility as well as dropping below national averages for the type and size of the healthcare organization.
It is also necessary to increase retention, calculated through the number of days nurses are employed as well as maintaining a healthy rate of hiring to maintain adequate nurse-to-patient ratios (Kester et al., 2019). Other factors to consider are objective evaluations of a cost-benefit analysis in terms of implementing the changes alongside subjective evaluation of the effectiveness of education and satisfaction of nurses with the new changes.
Barriers to Implementation
Despite the changes being relatively straightforward, the process of implementation may be inherently complex, largely due to organizational parameters. The primary barrier is cost, due to the expenses of implementing additional training and education programs, raising salaries, and hiring new nursing staff. While government and local reimbursements and funding to focus on the initiative can be secured, the initial financial impact would be significant and can impact solvency. Another barrier is resistance to change, stemming from a variety of stakeholders. These can range from hospital management to any sponsors or investors to even the staff themselves.
Despite the changes directly benefiting staff, many may not welcome the mandatory education and training initiatives on such scale. Finally, there are organizational factors that may serve as barriers to change, including the sheer complexity of the change, requiring multiple changes to staffing, organizational, and financial structures in a healthcare facility. Along with the structural changes, to achieve retention there will have to be a cultural shift as well that takes time as well as dependent on strong leadership which can lead the complex change implementation (Tappen et al., 2018).
These barriers are overwhelming but can be addressed. Costs can potentially be mitigated through a range of cost-saving measures in other areas, resource allocation, and attracting finances via loans and contributions by labeling the initiative as beneficial for long-term community health provision and public health. Resistance to change can be met with a series of steps such as communication, staff engagement, and competent leadership. Finally, the complexity of change is addressed by careful planning, risk mitigation, and utilization of tools and management at all levels of the organization which can drive effective change.
Clark, C. C. (2009). Creative nursing leadership and management. Jones & Bartlett Learning.
de Oliveira, S. M., de Alcantara Sousa, L. V., Vieira Gadelha, M. do S., & do Nascimento, V. B. (2019). Prevention actions of burnout syndrome in nurses: An integrating literature review. Clinical Practice & Epidemiology in Mental Health, 15(1), 64–73. Web.
Kester, K. M., Lindsay, M., & Granger, B. (2020). Development and evaluation of a prospective staffing model to improve retention. Journal of Nursing Management, 28(2), 425–432. Web.
Tappen, R. M., Wolf, D. G., Rahemi, Z., Engstrom, G., Rojido, C., Shutes, J. M., & Ouslander, J. G. (2017). Barriers and facilitators to implementing a change initiative in long-term care using the INTERACT® quality improvement program. The Health Care Manager, 36(3), 219–230. Web.