Introduction
Nurse turnover is a far-reaching challenge that disturbs hospital services, managerial processes, staffing processes, patients’ experience, and revenue. Therefore, the high nurse turnover in our hospital must be tackled with apt urgency by implementing a multifaceted approach to improving nurse retention. The multifaceted approach will tap into shared governance programs, effective communication, flexible nursing work schedule, staffing ratios, work environment, and inspiring onboarding. Ensuring that the project framework is fit for purpose will require a well-planned change process. The ADKAR Model of change is a successful tool for implementing change from the human perspective. A multifaceted approach to tackling nursing turnover implemented using the ADKAR Model of change will improve the hospitals’ retention rate for newly hired nurses for a minimum of three years.
Strengths and Opportunities of the Proposed Plan
Implementing the multifaceted approach to improving worker retention will grant the hospital multiple strengths and opportunities. Effective nurse retention can reduce costs, improve patient care, influence high admission rates, and increase hospital revenues. Improved efficiency and cooperation across all management levels through shared governance, nursing development, and improved communication create opportunities for nursing development and innovation (McKenna & Jeske, 2021). The proposed changes will accord the facility various strengths, including enhanced reputation, competitiveness, ability to attract high-talent employees, and improved cohesive and cooperative hospital staff.
Weaknesses and Treats of Failing to Implement the Plan
Alternatively, failure to implement changes to curtail the high turnover will allow weaknesses within the hospital, making it vulnerable to threats. Nurse turnover implicates staffing and leads to the loss of trained nurses, increasing workload and stress on other staff while negatively affecting the hospitals’ ability to deliver high-standard patient care (McKenna & Jeske, 2021). Statistics indicate a steady increase in new nurses resigning, creating an imbalanced composition of new and experienced nurses. Finally, in default of the proposed plan, the hospital faces the risk of losses, poor admission rates, and extreme competition.
The ADKAR Model of Change
The ADKAR Model of change will ensure the successful implementation of the multi-component plan to mitigate nursing turnover to achieve a measurable goal of retaining newly hired nurses for a minimum of three years. ADKAR stands for Awareness, Desire, Knowledge, Ability, and Reinforcement, creating the framework for managing change (Kachian et al., 2018). The framework for the ADKAR model is simple for everyone involved in the change to understand and follow through. Moreover, ADKAR is elemental in implementing changes at individual levels.
Steps and Processes
Awareness is the first step in ADKAR theory that acknowledges stakeholders on the nature of change and why the change is necessary through effective communication and leadership. The desired element will enhance the recruited nurses’ willingness to continue working in the facility by leveraging the working environment. The knowledge step will feature improving recruit nurses’ technical skills through the training and development programs. The ability stage of ADKAR will evaluate the changes in turnover and nurses’ performance against expected outcomes. Reinforcement through effective communication and shared governance program will strengthen the change.
Communication Plan
Implemented changes will be communicated to all stakeholders in the hospital through the integration of the Dyadic Interpersonal Communication Model and written communication. Training, onboarding, and nurse development strategy will utilize the Dyadic model to provide deep insights and allow adaptive communication and simulated experience. The feedback system in the hospital will also be enhanced in the facility through the use of drop boxes and performance appraisals for new nurses.
Participative Leadership Style
The participative leadership style is the most authentic for the potent implementation of the proposed changes. The new nurses will be more involved in decision-making while utilizing participative leadership, improving communication, and highlighting challenges contributing to the high turnover. Additionally, participative leadership is compatible with the shared governance plan that will encourage nurses’ feedback, promote collaboration and increase team morale (Gilson & Agyepong, 2018). More involvement of new nurses through participative leadership will facilitate collaboration and a free flow of ideas.
Management Functions
The changes will affect the scheduling, control, and staffing management functions. A flexible working schedule will allow nurses to have control of the hours they work to reduce work-related stress and job dissatisfaction. A flexible schedule enhances the working environment since nurses practice during their most productive and comfortable hours. The control function will assess progress in implementing the change and seek planned goals. The hospital will have to monitor the staffing levels to ensure the nurse-to-patient ratio is constantly convenient to avoid overworking nurses and a toxic work environment.
Budget Requirement and Implications
The total budget for the recommended change is $100,000. Of the budget, $15,000 will be committed to altering systems and making necessary management preparations, including the shared governance program, setting the ground for implementing the changes. The remaining $85,000 will finance the necessary ingredients for organizational change and operating expenses accruing from communication, training, development, appropriate staffing, inspiring onboarding, and flexible scheduling. However, implementing the change is expected to reduce the recruitment budget by at least half.
Steps to Assure Staff Compliance
Measures to ensure compliance by the staff will include; creating sufficient awareness, improving feedback, proper oversight, and documentation of the changes. Creating sufficient awareness is the first step to ensuring compliance by acknowledging all personnel on the change and its relevance. Allowing feedback creates inclusivity, and the nursing staff can express their contributions and objections to the changes hence regulating non-compliance. Proper oversight utilizing policies and initiatives will ensure strategic objectives are achieved on time, and committee members are held accountable. The hospital will conduct an inventory to document the change and make necessary amendments to the implicated procedural documents, policies, and processes.
Evaluation
Evaluation will provide a uniform yet structured means of determining the impact of change relating to expected outcomes. Monitoring the changes help determines what works well and what ought to be improved. The rate of newly-hired nurse turnover will be the key evaluation metric for the efficiency of the implemented change. Expected outcome after implementing the change includes mitigating the turnover rate and retaining newly hired nurses for a minimum of three years, subjective to quantitate evaluation. Feedback from the staff and patients regarding the change will provide data for qualitative assessment.
Conclusion
The decision-making process used in the plan included five steps: identifying the challenge, gathering relevant information, evaluating alternatives, considering the alternatives, and choosing among the alternatives. Participative leadership style and shared governance effectively accommodated all the proposed changes to improve nurse retention. The blend of Dyadic and written communication was elemental in ensuring awareness of the change. However, maintaining stable staffing levels while implementing a flexible scheduling policy was impossible due to variations and significant overlaps in time schedules. Drawing from the data collected, it would be recommendable to scrap flexible scheduling to maintain sustainable staffing ratios. Overall the ADKAR model of change realized the expected outcomes.
References
Gilson, L., & Agyepong, I. A. (2018). Strengthening health system leadership for better governance: what does it take?. Health Policy and Planning, 33(suppl_2), ii1-ii4.
McKenna, J., & Jeske, D. (2021). Ethical leadership and decision authority effects on nurses’ engagement, exhaustion, and turnover intention. Journal of advanced nursing, 77(1), 198-206.
Kachian, A., Elyasi, S., & Haghani, H. (2018). ADKAR model and nurses’ readiness for change. Journal of Client-Centered Nursing Care, 4(4), 203-212. Web.