Introduction
The global healthcare system is gradually receiving substantial international concern, with the need to improve services to meet human healthcare demands augmenting.
Despite having great developments in its current healthcare provision, challenges facing the systems have become eminent with the public becoming heavily concerned with issues affecting these systems.
Service improvement has always depended on several factors, including the levels of expertise in the healthcare system, the financial stability of the respective systems as well as the human resources related factors, among others.
Precisely, human resource factors have always formed a larger accountability of performance in organizations. In this context, recruitment and retention of healthcare providers, including both doctors and nurses are part of the critical worries for health care providers.
Over the past three decades, concern has risen about the overwhelming aspects in the recruitment and retention of the healthcare workers with researchers identifying gradual shortage of the labor force in healthcares.
Therefore, for this rationale, this essay seeks to provide a comprehensive plan for recruitment and retention of nursing staff.
Background to the problem (Global perspective)
The global focus on the imperativeness of the healthcare sector at the height of human health needs remains a hotly contested issue across the world, both in developed and developing nations.
For three consecutive decades, research has invested heavily on issues affecting the recruitment and retention of healthcare workers, with several challenges established in this context.
According to Scanlon (2001), medical experts and providers in the healthcare are reporting significant facts on the contemporary shortage of nurses, with increasingly complex of patients’ care needs across the globe.
Based on this report, “while comprehensive data are lacking on the nature and extent of the shortage, research expect the situation to become more serious in the future as the aging of the population substantially increases the demand for nurses” (Scanlon, 2001, p. 2).
The problem has extended from the past three decades and is currently stretching in all parts of the globe, regardless of the geographical positioning, the status of the economy or environment of a given state or nation.
Situation in developed economies
Focusing on the developed economies, the situation of recruitment and retention of healthcare workers, especially the nurses who are core to caring services in the healthcare, remains a contention in leading economies of the world.
A current empirical evidence drawn from investigative studies undertaken in several parts of the United States of America have revealed considerable realities over the challenges facing recruitment and retention of healthcare employees.
For instance, for the next twenty years, estimates reveal that the healthcare sector in the United States of America might have a shortage of about 400,000 Registered Nurses (RNs) below the required number (Perrine, 2009).
Recent research, conducted in the USA in 2004, revealed that human-resource-related factors, including lack of motivation were eminently the most outstanding reasons associated with nurse understaffing.
Others included nurse burnouts, low salaries/remunerations, lack of ample time with patients as well as other demographic characteristics. Primary demographics in the USA include gender, marital status and childlessness.
The USA government has noticed this issue as among the most severe problems affecting the welfare and development of the nursing sector, with efforts in improving the healthcare systems and calls from different healthcare organizations calling for more sobriety and sanity in these sectors.
A similar situation is eminent in the United Kingdom, Germany, China, and other parts of Europe with developed and developing economies suffering this menace.
In Europe, employee recruitment and retention have augmented in the past two decades and the nursing sectors have felt the worst effect of this mayhem.
Considerable empirical evidence has portrayed extensive correlation between nurse staffing and levels of performance in the healthcare system, especially nursing in the USA.
Furthermore, “a recent Health Care Financing Administration (HCFA) report to Congress found a direct relationship between nurse staffing levels in nursing homes and the quality of resident care” (Scanlon, 2001, p. 5). This aspect forms a complete background to ascertain the contemporary issues affecting the entire globe.
Substantial empirical evidence is continuously reflecting on the augmenting shortage of healthcare employees in the USA for the past two decades and the problem might further surge depending on the predetermined conditions.
Empirical studies, undertaken by several researchers pertaining to this problem around the USA in a decade ago, reveal considerable and reliable evidence on the prevailing situation.
According to Hasmiller and Cozine (2006), throughout a number of decades, hospitals in the entire U.S. have consistently faced cyclical shortages of nurses especially in the year 2000 when an estimated number of 126,000 hospital nursing positions remained vacant.
Subsequently, the trend commenced in 2004, when the hospitals witnessed approximately 4% drop in the number of nurses working in hospital from the initial 59% in the year 2000.
Hasmiller and Cozine (2006) assert, “A broad set of factors related to recruitment and retention among them, fewer workers, an aging workforce, and unsatisfying work environments” (p. 268) are renowned contributive factors in this mayhem.
Situation in developing nations
The issues of recruitment and retention of healthcare employees, especially the nurses, remains a global controversy with its ramifications felt throughout the continuum of global healthcare stretching from developed to developing nations.
Developing nations, including the entire Sub-Saharan Africa and other parts of the Asian continent have suffered from nurse staffing issues with the majority of them migrating from their countries in search of better labor remunerations.
Arguments embedded in the research undertaken in developing nations indicate a considerable shift of carrier in healthcare sectors as well as complete migration from one country to another to explore better job opportunities.
With the augmenting scarcity of healthcare workers, especially nurses, coupled with at least better remunerations in developed countries, job transfers are increasing from developed to developing nations.
Anxiety is rising on how the two economies will manage the trend and as NGOs and government struggle to improve healthcare conditions in Africa and Asia, questions are rising on how they will curb the augmenting migration aspect.
Research has cited nurse related factors as the reason behind poor healthcare provision in all economies, though developing economies are facing considerably more significant impact.
A considerable amount of mortality and morbidity issues are directly relating to employment and retention of nurses with job satisfaction issues like wages, remunerations and salaries, as well as other underlying job factors in healthcare.
Fatalities in the developing nations have sometimes associated with poor nursing practices attributed to factors relating to recruitment and retention of nurses.
Hasmiller and Cozine (2006) stress, “Nurses are the largest group of health care professionals providing direct patient care in hospitals and the quality of care for hospital patients strongly links to the performance of nursing staff “(p. 268).
In fact, healthcare is an essential component in human life determining the quality of life, which no one should defy. The prevailing condition in developing nations seems to be gradually elevating depending on underlying economic conditions in each nation.
Regional perspective (area of study)
Regionally, the issue of nurse staffing, including the recruitment and retention of such professionals, remains compromised. The nursing staffing menace has and is increasingly becoming a mind seizing matter with its ramifications stretching from international paradigm to local and regional states in the U.S.
Nurse recruitment and retention in the state of Tennessee in America has recently become a regionally debated issue with significant stakeholders in the healthcare sector, struggling to find possible remedies to avert the situation.
Despite substantial efforts by the board of nursing and other dependent associations around the entire U.S. inclusive of the Tennessee to improve the state of healthcare systems through education, practice and licensure much remain anticipated.
Since the emergence of the board of nurses in the early 1911, reforms and transformations undertaken have hardly managed to overcome the most vital issue of employment and retention of workers in the healthcare system.
Healthcare system in the State of Tennessee suffers mostly from unprecedented nurse-patient ratio with the situation augmenting from each consecutive year, posing significant health hazards.
Latest reports of the last two years documented by the incumbent board of nursing of State of Tennessee have revealed significant evidence on the underway problem, citing an increasing shortage of nursing staffs and escalating patient numbers as major healthcare concerns.
The problem seems to have existed and augmenting each successive year for the past one decade as other researchers acknowledged the issue since before.
Scanlon (2001) postulates, “an important factor in the current shortage is the higher proportion of patients having more complex care needs, which increases the demand for nurses with training for specialty areas such as critical care and emergency departments” (p. 3).
There is an influx in the populace the State of Tennessee in the past two decades with some of the available medical centers facing congestion from the demanding health care.
Statistics indicate that the number of patients attended to by nurses is increasing with a ratio greater than the nurse population can manage to handle.
Background of the Organization (AI medical Center)
This study focused on drawing empirical evidence from a single organization to represent other organizations operating in the U.S.
As reflected in the background, the study’s interest in the research problem is typically in the U.S. A1 Medical Center is the case of this study, which is essential to provide empirical evidence to the prevailing research problem.
A1 Medical Center is a 188-bed medical and surgical center, which serves more than 52,000 emergency cases per year. It is renowned for its quality of emergency care, cardiac services, oncology services, orthopedic surgery, diabetic management, and obstetric services.
The staff commits to a service culture of “I serve…with pleasure” with values of integrity, selflessness, exceptional patient-centered care quality, respect, visionary care, and overall excellence. The medical center focuses on hiring quality staff.
Bound to this objectivity, nurses are always obligated to perform their duties diligently to ensure they meet the standards required to address the increasingly complex care needs.
Currently, the high patient turnover in A1 Medical Center is threatening the ability of nurses to provide the quality care needed within the hospital. Nurses are forced to work extra hard with the number of overtime working increasing consecutively.
Problem Description
As with many other medical centers, a key problem is the hiring and retention of medical staff and especially nurses. It is challenging to find nurses of the appropriate quality and quantity needed to provide patients with the level of care indicated by the company culture.
The shortage of the nursing personnel forces the center’s management to ask the available nursing staff to work for long hours, coupled with making use of outside agency nurses to compensate for the shortage.
This observation means that first; staff nurses are over-worked and second, outside agency nurses may not have the same commitment to the organization’s culture and values.
Due to the biting shortage, the available staff and particularly nurses have to deal with an increasing workload in their places of work, which are also not conducive.
Both those situations can have a negative effect on patient care and negatively influences the company’s budgets, since the per-hour cost of agency nurses and overtime nurses is higher than standard pay rates.
Problem Statement
The key problem is to identify a plan that will better the recruitment and retention of nursing staff both to improve overall patient care and to reduce budget costs. The Director of Nursing at A1 Medical Center has requested a plan to address these issues.
The problem addresses three critical functional areas of the organization: management, economics (financial input), and human resources.
In terms of management, the critical approach will be the creation of one or more nursing pools to allow nurses to be cross-trained to float among two or more departments, depending on need.
The leadership portion will be addressed by establishing a process of daily rounds by leaders to inform them of needed resources and to encourage positive work environment and by providing training and support for transitioning to a transformational style of leadership.
The human resources aspect comes into play through active recruitment of quality staff and providing appropriate leadership training to improve overall leadership skills.
Methodological approaches employed
This study was simply an investigated report that followed all necessary approaches to ensure that the information contained does not portray any form of biasness or breach of respective laws governing research.
To provide a comprehensive insight into the prevailing condition in A1 Medical Center, it was essential to acquire primary data to provide empirical evidence to the study. The research sought consent from the respective authorities before undertaking any investigative strategy in the study.
The researcher sought prior permission to interrogate members of the organization, especially acquiescence from the top management officials, including the Chief Executive Officer (CEO) and all the appropriate managers.
The concession involved a permit letter from respective managers before commencing with the study. Being a member of this medical center, which was the case study, I had reliable data to validate the research problem.
I decided to find partners to assist in analyzing the problem and thus no need for questions and interview schedules since it was just direct conversation.
Functional area attributing to the problem
Organization’s management
For one to understand better the confronting issue of recruitment and retention of employees, it is important to identify the functional areas, especially those related to internal matters of the company. Management has itself always affected the general operations of A1 Medical Center.
Management in A1 Medical Center has been a critical issue in the past one year. Management has always been of good rapport with the subordinates and the only management factor that attributes to challenges in recruitment and retention of nurses in A1 Medical Center is policy-based, not leadership based.
The prevailing condition of work in A1 Medical Center and the increasing complexity in the Medicare is hampering the company’s ability to employ more nurses. Managers and directors in the hospital have always practiced good governance but have policy issues in the nursing field.
Recruitment and retention of nurses in A1 Medical Center are suffering from policy-centered strategies that may assist in providing proper employment schedules.
Organizational Economics
The most important factor that affects organizational performance is the idea of how to manage economics. Economics in its broadest term means the science used to analyzes the production, distribution, and consumption of either goods or services.
Services form an integral part in the production and its contribution is measurable in terms of output provided by serving customers. Generally, economics has always been the key functional area in the success and development of all organizations.
However, the most economics aspect affecting the recruitment and retention of nursing staff is the financial input. Financial instability of the A1 Medical Center is hampering its ability to recruit and retain nurses.
The modern nursing generation has become more financially demanding than the traditional nurse professionals who seemed to view work as inherently valuable and thus more dedicated to their organizations.
Perrine (2009) postulate, “A variety of factors, such as changes in social, economic, and public policy and shifts in society-wide attitudes influence the members of different generations” (p. 22).
Recommended solution
The augmenting nurse staffing menace is becoming a hotly contested issue at the helm of international healthcare environment, with a similar situation evident in A1 Medical Center.
The nursing staff in this organization as stated in the problem statement is inadequate and the situation is simultaneously increasing from decade to another, a year to the other.
As aforementioned, the shortage of nurses forces the center’s management to ask the nursing staff to work for long hours, coupled with making use of outside agency nurses to compensate for the shortage.
Subsequently, the working conditions are deteriorating with fear surrounding the management on this overwhelming condition as nurses increasingly become impatient towards the management.
Based on the prevailing condition, this is one of the reports needed by the management to make informed decisions on the recruitment and retention of nurses in A1 Medical Center.
As the analytical review provided an analysis of the three different functional areas, recommendations on this study focused on the Human Resource Management, general organizational leadership and the financial sectors (economics).
Recommendations on Human Resource Management
Investing in research
Research has been an indispensable component to the improvement of several sectors across the world with organizations realizing an existing problem and seeking possible solutions towards averting such problems.
In the contemporary world, the healthcare system has always relayed on research to examine critical issues affecting the system. Within the State of Tennessee and especially in A1 Medical Center, research has remained underutilized and thus some organizational factors remain unrealized.
The Medical Center needs research to “explore, measure, and better define the relationship between nursing care and patient outcomes; to uncover why newly licensed nurses tend to leave a hospital after only a short time” (Hassmiller & Cozine, 2006, p.271).
Through research, the center will identify viable strategies for addressing nurse shortage.
Providing Professional Training and practice
Desperate situations call for desperate times and enhancing professional training is becoming a way of enhancing efficacy in all forms of organizations.
In the situation where the current organizational financial status cannot accommodate the recurring expenses including wages, salaries and remunerations to improve nurse’s job satisfaction, it is essential for the organization to consider nurses professional training as an option.
In respect to this aspect, professional nursing training and practice aids in improving the work efficiency among healthcare workers, which comes with a sense of job satisfaction as well.
Hasmiller and Cozine (2006) refer to this aspect as transformation of hospital culture and states, “ hospital nurses have difficult, demanding jobs; they need to feel inspired by their work and supported as professionals if optimal patient care is to be achieved” (p. 27).
Professional training is one way of maximizing human resources in the sense that few people are capable of producing substantial outcomes in organization. Professional training and practice have proven significant in enhancing health workers competence in handling complicated conditions.
One of the essential strategies that have proven imperative to improving the status of nurse profession and the organizational development as well is the establishment of training centers within the healthcare centers.
Setting up professional institutions within the healthcare center will allow A1 Medical Center to expand its working capacity and reduce the number of nurses lost during post-studies.
Several ambitious individuals capable of working with healthcare organizations across the State of Tennessee have lacked the opportunity to expend their knowledge due to financial constraints.
“An important factor in the current shortage is the higher proportion of patients having more complex care needs, which increases the demand for nurses with training for specialty areas such as critical care and emergency departments” (Scanlon, 2001, p.17).
To curb the growing shortage of nurses accurately in A1 Medical Center, the management on this organization must invest heavily in training new nurses as well as providing in-service professional training to the incumbent workforce.
Improving wages and benefits
there are diverse elements that propagate the eminent challenges that derail effective hiring process of nurses, including poor remuneration and the accompanying benefits.
In the past, different researchers have pointed to motivational needs, and especially extrinsic motivational elements like material rewards, as the main driving forces behind successful retention of nurses.
Salaries, remunerations, wages and other fringe benefits are core factors that determine the productivity of individual in any given organization. Human resource needs motivations through the well-cared environment as well as satisfactory job conditions that enhance the working morale of individuals in a given environment.
“Low wages, few benefits, and difficult working conditions contribute to recruitment and retention problems for nurse aides” (Scanlon, 2001, p.8).
It is essential for any organization to understand that human capital is an important production aspect with financial resource factors equally contributing to the competency of workforce.
A sustainable amount of physical resources achieved from an employer always acts as the source of hope and ambitiousness in employees and always increases individual competence and performance in the working environment.
For the case of A1, a suitable plan improving employee’s wages and benefits must exist to help avert the nurse shortage that is threatening to subjugate the organization’s commitment in providing quality health care services.
However, improving the wages and benefits of workers in A1 does not necessarily mean abnormal pay raise to the nurses.
According to Hassmiller and Cozine (2006), “the morale of nurses employed directly by the hospital also might suffer when they work alongside agency nurses who earn higher wages and enjoy more flexible scheduling” (p.269).
Therefore, despite the fact that it is apparent that attractive salaries and remunerations are solutions to stabilizing workforce through enhanced recruitment and retention plan, might attract problems within the labor force.
Additional employee supports
It is important for healthcare organizations to understand the imperativeness of supporting their staff in overcoming challenges related to their profession.
In a bid to improve the recruitment and retention of nursing staff in A1 Medical Center, the management should acknowledge the importance of providing workers with additional support including improving the work environments, enhancing their professional skills and providing social support.
For nurses to enhance their professional performance, the management needs to provide such support services as both material possession and social wellbeing of individuals affect their competence and performance.
Firstly, A1 Medical Center may provide support in improving the work environment by enhancing the working facilities. Another strategy under the provision of more employee support is to enhance the conventional work knowledge and other support services for nursing staff.
Recommended implementation resources
Physical resources
For the recommended solutions to become effective, several physical resources are essential in the implementation of the recommended plan. Financial stamina of the company will determine if the implementation of the desired plan will finally become fruitful.
The financial position of A1 Medical Center will determine the outcome of the proposed the implementation of the recommended plan in the sense that lack of proper financial capacity to accommodate the program will delay in addressing the nurse shortage.
As postulated before, A1 Medical Center will require investing heavily in establishing a nurse-training facility, including a small institution, where new enrolled nurses can acquire basic knowledge in handling patients.
Finance is a driver for every economic development across the globe and thus, it is imperative for A1 to consider their fiscal strength before carrying out the proposed plan.
It will be appropriate for A1 medical center to find possible partnerships and financial sponsorship as means of providing financial solution to the implementation of the proposed plan.
Human resource
A properly planned plan can fail to work if the human resource available fails to undertake stringent measure to implement the plan skillfully. One of the renowned strategies frequently and successfully employed in the implementation of the proposed plan is setting up implementation committee and respective subcommittees.
The effective implementation of the plan hinges on the commitment of the concerned committees. Any biasness or maliciousness between the implementation committee or in the subcommittees affects the quality of the implementation process.
A1 Medical Center will need to set up a dedicated committee, including professional experts in the implementation of the plan.
It will require the management of the organization to remain focused towards the implementation process to avoid further delays that may result from personal differences among the committee members.
The Medical Center will have to develop a culture in researching as well as research institutes to ascertain issues affecting the organization.
Long-term financial and organizational impact of the recommendation
Future Financial Impact
By A1 opting to address the nursing shortage through the provision of professional training and practice to the incumbent nurses, the organization will reduce the recruitment cost required to increase the labor force.
Typically, it will become more economical for the company to increase the professionalism of workers and incur few salaries or wage costs than to increase the number of workforce with little skills.
It sounds more economical to provide in-service training to workers who will further remain loyal to the organization on realizing the fringe benefits offered than to acquire voluminous workforce from outside the organization at much higher cost.
More importantly, a strategy that involves setting up a nurse training facility seems to be a more appropriate long-term solution for A1 Medical Center.
Training young and energetic workforce will enable the healthcare center to be more human-resource equipped than hiring or recruitment trained nurses. Despite ostensibly being a financial requiring project at its onset, the project will aid in reducing recruitment costs in the future.
Future Organizational Impact
The proposed plan is not a short-term running project and its ramifications might stretch to the foreseen future determination of the Medical Center. Investing in research is among the renowned global strategies that facilitate achievement of long-term organizational goals.
Research in A1 Medical Center will aid in providing an enduring solution in the identification and analysis of problems affecting the medical center and other healthcare organizations as well.
Setting up a research institute will, therefore, enable the organization to have a permanent solution in determining and solving organizational problems. Based on this report, setting up a nurse-training institute is another priority included in this recommendation.
The institute will provide an everlasting solution to the nurse shortage in A1 Medical Center as it will enable the organization to produce its own workforce, thus, proving more competent in future.
The salary and remuneration plan intended to provide a substantial reward scheme will enable the organization avoid miscellaneous expenses related to employees salaries and payment schemes.
Conclusion
Conclusively, the global focus on the imperativeness of the healthcare sector at the height of human health needs remains a hotly contested issue across the world, both in developed and developing nations.
The stakeholders in the healthcare sector point to the diverse and sometimes complex patients’ needs as the factors that are responsible for the ever-increasing nursing shortage. A1 Medical Center is among the healthcare centers suffering from this menace.
In an attempt to help avert this condition, this report recommended that the organization should invest heavily in research, develop a nurse training institution around the organization, and engage in providing nurses with professional training and practice that will eventually assist the organization in reducing the financial cost as well acting as an everlasting recruitment solution.
In a bid to achieve the recommendations, the organization needs to increase their financial strength by either engaging in partnerships and other forms of sponsorships to help raise the needed amount to execute the plan.
Reference List
Hassmiller, S., & Cozine, M. (2006). Addressing the nurse shortage to improve the quality of patient care. Health affairs, 25(1), 268-274.
Perrine, J. (2009). Strategies to boost RN retention. Web.
Scanlon, W.J. (2001). Recruitment and Retention of Nurses and Nurse Aides is a Growing Concern. Web.