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nurse retention literature review
nurse retention literature review
literature review on nurse retention
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The concept of nurse retention as it relates to employee satisfaction is a critical issue to manage before any nursing theory can be deployed. The problem of nurse retention and staffing can impact the numbers of medication errors, patient mortality, readmissions, a length of stay, falls, pressure ulcers, central line infections, health care related infections as well as costs (Simpson, 2016, p 139). The nursing satisfaction and appropriate staffing have cause and effect results with the ability for a facility to retain the nursing staff in place. Failure to maintain the nursing staff leads to increase training costs, overtime, fatigue with current staff and safety issues when staff falls below par.
Analysis of Concept
Walker and Avant utilize
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This further aggravates the nursing issue as the lack of physicians only drains the over taxed nursing staff into a larger unsatisfied state.
The antecedents of the nurse retention and satisfaction problem may include the days of fewer patients, more staffing and the population of less acute patients. The addition of technology lengthened life spans, and consumer savvy health care may make the issue of nurse retention and satisfaction more prevalent in today’s healthcare market. The Ana, as well as other agencies, promote and mandate reporting of staffing, preventable infections, sentinel events and other issues related to poor patient outcomes that make the issue more transparent (Simpson, 2016).
The consequences are increased patient mortality, increased complications, decreased job satisfaction and nurse burnout with the lack of staffing from poor nurse retention (Jones, 2014). The lack of staffing lead to areas of care that must be omitted to compensate for the lack of staff available which leads to decreased nursing and patient satisfaction (Jones, 2014). This dissatisfaction then leads to a departure to a more adequately staffed safer care environment that only perpetuates the cycle of poor retention and satisfaction. One study reported a six percent increase in the risk of death for patients with staffing shortages (Hairr, Salisbury, Johannsson & Vance,
The level of job satisfaction for a nurse is a vital factor in creating positive outcomes for their patients. California RNs report having much more time to spend with patients. The hospitals are far more likely to have enough RNs on staff to provide quality patient care. In California, where hospitals have better compliance with the staffing limits, RNs report fewer complaints from patients and families and the nurses have more confidence that patients can manage their care upon discharge. California RNs are substantially more likely to stay in their jobs because of the staffing limits, and less likely to report burnout than nurses in any other state. Two years after implementation of the California staffing law which mandates minimum staffing levels by hospital unit, nurse workloads in California were significantly lower than that of any other state. The legislation of the mandated nurse patient ratio has achieved its goals of reducing nurse workloads, improving recruitment and retention of nurses, and having a favorable outcomes on patient
Working in long-term care can be overwhelming. Imagine you are a new graduate nurse putting your new found knowledge and skills to practice for the first time. Your orientation lasted three days which is standard for nurse home orientation compared to hospital orientation that last approximately six to eight weeks for new grads. The shift has just begun and already you have a new admit, new found pressure ulcer to assess, a possible medication reaction, several new orders to take off and eight patients to document on for varying reasons. Feelings of frustration and confusion take over as you are the only nurse on the unit along with a Certified Medication Technician (CMT) and three Certified Nursing Assistants (CNAs) taking care of 47 patients. Ideal nurse-to-patient ratio continues to be a national issue in both the hospital and long-term care setting (LTC). In the LTC setting there is no official nurse-to-patient ratio; there is a suggested staff-to-patient ratio. This issue not only affects the new licensed nurses but the seasoned nurse as well. Recently, there has been controversial debates as to whether heavy workloads are detrimental to patients. The federal, state, and local government regulates many aspects of healthcare. However, it is the physicians, nurses and other healthcare professional that provide care directly to patients. Consequently, does insufficient staffing, heavy workloads, and unsupportive work environment directly contribute to poor patient satisfaction, nurse burnout, high turnover and job dissatisfaction?
The risk for patient health has been increasing while the nurse staffing levels are decreasing, throughout the world patient care is at risk due to the shortage of staffing in the nursing industry. Many, including the nurses who are being greatly impacted by this situation believe that changes need to be made to increase nurse staffing levels to better the lives of every individual involved in such a massive problem that can affect many innocent lives. Although, some might argue against finding a solution to the problem and bettering the staffing levels by stating that the nursing field doesn’t have a low employment rate and is projected to grow in the near future, however, the situation remains to be impacting nurses and patients in negative
Recent literature reports that there is a nursing shortage and it is continually increasing. Data released by the American Association of Colleges of Nursing (2011) projects that the shortage, would increase to 260,000 by the year 2025. AACN (2011) also reported that 13% of newly registered nurses changed jobs and 37% were ready to change within a year. A study conducted reports that there is a correlation between higher nursing workloads and nurse burnout, retention rates, job dissatisfaction and adverse patient outcomes (Vahey & Aiken, 2004). Among the nurses surveyed in the study, over 40% stated that they were suffering from burnout while 1 in 5 nurses intended
One of the most serious issues in nursing, that can affect a nurses career is nursing burn- out. According to the article “Where have all the nurses gone”, current nurses that are practicing, report high rates of job dissatisfaction (which is part of burn out) and 1 of 5 nurses may quit nursing in the next 5 years (Dworkin, 2002). Burnout is associated with nurses not coming in to work, not feeling satisfied when doing their job, high turnover rates and a lack of commitment to the work (Katisfaraki, 2013). If a nurse becomes burned- out, they may not take care of their patients as well and could make mistakes with medication administration. A study performed in the United States by Dr. Jeannie Cimiottti, shows that hospitals with high burn-out rates among nurses have higher levels UTI’s, and surgical infections (World, 2012). Nursing burnout not only affects the nurse, but it also affects the patient, the nurses’ colleagues, and the nurses’ family; nursing burn out often leads to emotional exhaustion and depression, that can effect relations and communication between the nurse effected and the person they are communicating with. This paper will cover what burn-out is, who is susceptible to burn out, and treatment and prevent nursing burn out.
The stakeholders that are affected by the nursing shortage and nurse retention are the patients, the nurses themselves, the organization, and the payer. Nursing shortage and nurse retention has the biggest impact on the patients and their health. Knudson (2013) states that there is a correlation between nurse staffing and patient outcomes, failure to rescue, and patient mortality rates. Quality of patient care that the nurses offer their patients suffer as an effect of these issues. Patient suffer from lack of care, bed sores, falls, and medication errors when nurses are overwhelmed and stressed due to the nurse patient ratio being so high.
The nurse to patient ratio is unrealistic in many hospitals. In most cases it is almost impossible to give each patient the true amount of detailed care they really need. This is seen in most cases where there is one nurse assigned to 16 patients and each patient requires a different level of attention. Nurses are pressed for time, forcing them to cut corners, resulting in an increase in nosocomial infections and patient deaths. “The past decade has been a unsettled time for many US hospitals and practicing nu...
Several other causes have been attributed to the nursing shortage. An increase in the number of nurses is needed. Sadly, there is little increase in compensation for nurses. In addition to no growth in pay, the level of stress, responsibility, and demand nurses is increasing. Unfortunately, patients are the ones who suffer. When a hospital does not have the proper nursing staff to care for patients, it results in poor patient safety and patient outcomes (Buerhaus, Donelan, Ulrich, Norman, DesRoches, & Dittus, 2007). Nursing salaries compared to other professions has remained stagnant. For example, a registered
The number of patients assigned per nurse has been directly linked to nurse job satisfaction and patient outcomes; with a ratio of four patients to one nurse being the ideal ratio (7). Research has shown that the addition of just one patient per nurse has been associated with a higher risk of death for patients and an increase in nurse job dissatisfaction and burnout (2). This is significant because nurses wish to provide the best quality of care for patients and with increased patient to nurse ratios, nurses are unable to maintain their ideal quality of care; which leads to job dissatisfaction and nurse burnout. Originally, after the passage of the California nurse staffing act, which set mandated nurse-patient rations, overall job satisfaction appeared to increase (1). However, several longitudinal studies have suggested that direct care nurses are still dissatisfied despite increased nurse to patient ratios (1). From the results of these longitudinal studies, it has been found that there is still some shortcomings with staffing systems based solely on nurse-patient ratios. Therefore, even though the ratios staffing system accounts for appropriate patient care, it does not take into consideration different patient complexities and needs for nursing care (10). Staffing by acuity is the third and final staffing system that is considered when looking at nurse burnout and job
However, upon securing a job, they find that things on the ground are not as they had expected them to be and this results in some of them deciding to leave the profession early. Research shows that turnovers within the nursing fraternity target person below the age of 30 (Erickson & Grove, 2011). The high turnover within the nursing fraternity results in a massive nurse shortage. This means that the nurses who decide to stay have to work for many hours resulting in exhaustion. A significant percent of nurses quitting their job sites exhaustion and discouragement as the reason that contributed to their decision. In one of the studies conducted on the issue of nurse turnover, 50% of the nurses leaving the profession argued that they felt saddened and discouraged by what they were unable to do for their patients (Erickson & Grove, 2011). When a nurse witness his/her patients suffering but cannot do anything because of the prevailing conditions he/she feels as if he/she is not realizing the reason that prompted him/her to join the nursing profession. The higher rate of nursing turnover is also affecting the quality of care nurses provide to
The purpose of this paper is to address the issue of nursing staffing ratios in the healthcare industry. This has always been a primary issue, and it continues to grow as the population rate increases throughout the years. According to Shakelle (2013), in an early study of 232,432 surgical discharges from several Pennsylvania hospitals, 4,535 patients (2%) died within 30 days of hospitalization. Shakelle (2014) also noted that during the study, there was a difference between 4:1 and 8:1 patient to nurse ratios which translates to approximately 1000 deaths for a group of that size. This issue can be significantly affected in a positive manner by increasing the nurse to patient ratio, which would result in more nurses to spread the work load of the nurses more evenly to provide better coverage and in turn result in better care of patients and a decrease in the mortality rates.
The nursing workforce is particularly challenged when it comes to retaining high quality nurses in the profession. This issue is relevant to new and seasoned nurses alike. There are senior nurses experiencing burnout intending to leave the workforce before retirement age and new nurses leaving the profession prematurely, creating too much nurse turnover. When turnover takes place unexpectedly and prior to retirement, the collective effect is financially and socially detrimental to the nursing profession and healthcare institutions. High nurse turnover can influence a healthcare organization’s ability to provide quality patient care and accomplish the best possible patient outcomes (Hayes et al., 2006). Investigating the sources of high nurse turnover rates and the negative impact on healthcare will bring greater understanding to this nursing workforce issue.
Finally, a more obvious and direct cause of nurse turnover is overall dissatisfaction with the current job. This can be for numerous reasons related to pay, benefits, job growth availability, lack of autonomy, or simply feeling unappreciated. According to one source, “a 2014 survey of more than 3,300 nurses found that they were stressed, overworked, underappreciated, and underutilized” (Fischer, 2016). No matter the reason a nurse chooses to leave their job, the negative outcomes remain the same. The most common of these outcomes are that hospitals lose money, it decreases patient quality of care, and it continues the cycle of more turnover in the nursing profession. “It is predicted that there will be a shortage of nearly 1 million nurses in the United States by 2020” (Hunt, 2009). Hospitals are impacted financially by the high nurse turnover rates. “The financial costs of losing a single nurse has been calculated to equal about twice the nurse’s annual salary” (Hunt, 2009). With these numbers in mind, the hospital spending more money to retain nurses could be a smart and beneficial action for them to
Patient’s safety will be compromised because increase of patient to nurse ratio will lead to mistakes in delivering quality care. In 2007, the Agency for Healthcare Research and Quality (AHRQ) conducted a metanalysis and found that “shortage of registered nurses, in combination with increased workload, poses a potential threat to the quality of care… increases in registered nurse staffing was associated with a reduction in hospital-related mortality and failure to rescue as well as reduced length of stay.” Intense workload, stress, and dissatisfaction in one’s profession can lead to health problems. Researchers found that maintaining and improving a healthy work environment will facilitate safety, quality healthcare and promote a desirable professional avenue.
Poor staffing stresses every nurse and makes them despite what they once loved to do. Nurses are overworked and because of that they may not provide adequate patient care.