There are three types of qualitative research that are most suitable for DBA research, namely, case study method, grounded theory, and phenomenology. Their use has become very widespread for different reasons. For instance, grounded theory is an approach that enables a researcher to formulate a hypothesis on the basis of observations, interviews, or surveys (Creswell, 2007, p. 62).
The main advantage of this approach is that it ensures that data are not misinterpreted in order to fit the theory. The theory itself has to be grounded on relevant facts and observations. In turn, phenomenology enables to understand the perceptions of a person (Creswell, 2007, p. 57).
This method helps the scholars examine the experiences of individuals and their views. Finally, case study method provides good opportunities for studying rare forms of organizational behavior or innovative methods of management (Creswell, 2007, p. 75).
Overall, these three types of researches are beneficial because they enable researchers to understand the connection between individual behavior and organizational strategies. Secondly, they can explain how people view organizations and what kind of problems they face. With their help one can formulate a hypothesis that can later be tasted in an empirical way.
There are other types of qualitative research, namely narrative research or biography and ethnography. Yet, there are less suitable for DBA research. In this prospectus, an analysis of qualitative and case study research will be done. A thesis for the analysis chosen has employed interpretive penology. Thereafter, a qualitative research technique has been done.
Designing a Qualitative Study and Approach
The thesis chosen for evaluation is “titled understanding the lived experience of novice nurses in a northern Ontario critical care setting through interpretive phenomenology” (Piper, 2009). The data collection method that was employed in this case was interpretive phenomenology.
Phenomenology enables the researcher to understand the perceptions of a person (Creswell, 2007, p. 57). This method helps scholars examine the experiences of individuals and their views. The research design was consistent with the methods chosen.
Involved were five personnel that subsumed Heidegger (1962), Benner (1984), Benner, Tanner and Chesla (1992, 1996) and van Manen (1984, 1990, and 1994) and they guided the interpretive hermeneutic phenomenology. Semi-structured interviews conducted with a purposive sample of five informants led to the discovery of themes until a constitutive pattern arose.
The author could have included case study method as part of the data collection strategy. Given that the setting of the research is based in northern Ontario critical care, it cannot be said that it is interpretive phenomenology alone that was used to gather data for the study.
The data for this research could have been collected using all the three methods that are suitable for DAB research and include a case study method, grounded theory and phenomenology. An integration of these three methods is suitable because they enable researchers to understand the connection between individual behavior and organizational strategies. Secondly, they can explain how people view organizations and what kind of problems they face.
Focusing the Qualitative Study and Collecting Data
Small-Scale Qualitative Research Project—the Interview
Q: What is your job position and how long have you been working at this hospital?
A: I am the nurse manger in charge of the surgical floor (pause). I joined this place in 1988 as soon as I left the college. You (smiles) you can guess the number of years I have been in this nursing field.
Q: definitely! And they add up to 24 years. How has your career ladder been?
A: I served a nurse for five years, before leaving for six months for further studies. When I returned, I was made the word, where I served for two years before taking another six months education leave to Advance in my education. When I returned, I was made an assistant manager for two years (pause). I was then made the nurse manager to date.
Q: I can see your advancement has depended on education; is there another way of career advancement?
A: In nursing there is albeit theoretically (pause). Nurses in the surgical floor if not transferred to other units remain in their professional roles unless they break for further studies. However, when some get opportunity, they move out.
Q: can you be able to describe the eve of your first day as a nurse?
A: I recall well, I was just a naĂŻve clumsy girl. I had been dreaming to be a nurse since I was young. I was eagerly waiting to earn a lot of money of my own, to treat patients, to love the patients and be loved too, to co-work with other nurse for the better of the patients, and to have a glamorous career.
Q: it seems you had a great anticipation for your work…
A: yes! I had very high anticipation for my work.
Q: did it turn out to be so?
A: Not really. I found it hard to mingle with the old nurse and the work was too much.
Q: does it means you were not taught and trained to co-work with other nurse?
A: the training we received was mostly medically oriented. Other things such as, how to live with one another, was supposed to come by experience.
Q: I am truly sorry that your expectation did not come to be. Did you feel like quitting the place?
A: yes. And more than that because half of the nurses we came with left before the sixth month. By the time I was finishing my fifth year as a nurse, I had witnessed myriads of nurse come and go as a result of lack of understanding.
Q: In your first five years as a nurse at the general surgical floor, were you transferred to any section apart from the surgical floor?
A: that is common in this place. Whenever there was an acute nurse shortage, we could be called to help in ICU and CCU sections. Some ended up remaining there.
Q: have you ever come into conflict with the management?
A: Yes. And in several occasions (pause)
Q: why?
A: It happened mostly in my first year at work. I had not known that the hospital required me to take care of the patients’ friends and family members. In most cases, I ignored majority of their prepositions. I thought that they will ruin the patients. In the end, I was summoned and almost lost my job.
Q: Did any of your colleague fall victim of the same?
A: Yes. Almost everybody got into conflict with the management for misinterpreting the requirements of the company. Some were even sucked in the process.
Q: I am sorry for this. I hope they got another job.
Q: What have been the secrets behind your success?
A: Resilience! Only that can help you through and it has been the key to many nurses.
Analyzing Qualitative and Case Study Evidence—Part One
The research questions for the interview were varied but directed at finding answers to the questions and meeting research objectives. The research question was: what are the factors that lead to the high turnover of nurse in the surgical floor? Could it be the nursing profession is understaffed? Are nurses satisfied with their work?
The codes developed for the same were: unrealistic workload to the nurse, the understaffing has led to Job Burnout, there was no job satisfaction and thus high turnover, nurses feel powerless and inadequate in their capacity yet they are sacked and therefore leading to high turnover. The coding system resulted from intensive review of the interview result with the research questions. All questions were tailored at finding the reasons for the high turnover of nurse in the surgical floor. The in-text coding system was therefore applied.
Analyzing Qualitative and Case Study Evidence—Part Two
Data Analysis Evaluation of Dissertation
For the dissertation selected, interpretive hermeneutic phenomenology technique was used. Semi-structured interviews conducted with a purposive sample of five informants led to the discovery of themes until a constitutive pattern arose. The methodology relied on the experience of person so as to ascertain the result. The results from the same were gotten by interview process. This method is good though the researcher has to guard on three issues that are social desirability, self-fulfilling prophecy, and social interaction processes.
Evaluating Qualitative Research
Evaluating a Dissertation
From the research evaluated, there are several methods that have been used for establishing quality. The first one is clarity. The researcher states clearly what was involved in the research. The researchers, the place, description of their occupation, and the answers they gave. Another method is contribution. The researcher is contributing to the solution that has been have been found out by many researcher.
The issue of high turnover of burse is not new and many researchers have come on the scene to establish the cause. Therefore this research is contributing to the solution to this problem. There is also communicative resonance. The problems described are from firsthand experience and the reader can feel the real situation on the ground (Finlay, 2006).
Writing and Reporting Qualitative Research
Based on qualitative research technique, this section will apply the same
High Turnover of Nurses on General Surgical Floor
Nursing is the backbone of hospital activities. Nurses are essential to this institution as they perform essential services to restore the health of the patients. However, if the supply of nurses is disrupted, the activities of hospitals will be affected. This implies that their supply should be maintained in the optimum number. Using a Qualitative research technique, a research on the high turnover of nurses on general surgical floor will be investigated.
Introduction
New nurses are often hired to fill vacancies in stressful and challenging workplaces such surgical floor in northern and rural environments. In these contexts, many nurses leave within the first year, while others leave the profession altogether.
This study attempts to understand the reasons why there is a high turnover of nurses in the general surgical floor.
Problem Statement
Health is an essential need for human beings. A healthy nation is a prosperous nation. However, maladies sometimes struck in the least expected hour. In such conditions, hospitals are the only sure way of restoring the health of victims to have the healthy nation visa avis the prosperous nation. The general surgical floor in hospitals is the most flooded areas in the terms of number of patients.
According to the reports by The Joint Commission on Accreditation of Health (n.d), general surgical floor is normally buzzed in activities since most patients are referred to this section. The report further says that nurses are normally willing to see to see that the patients brought on this floor get well. The nurse therefore embark on activities of including, dressing the wounds, giving injections, feeding, prescribing drugs, charting, among many other activities.
However, the workload for every nurse in the general surgical floor normally goes beyond the limits nurse can bear. According to Linda (2004), nurses encounter a stressful situation at the places of work due to too much workload forcing them to leave the employment in those areas. As a result, the management counters such problems by employing other nurses, who eventually leave again after a short period of time.
High turnover of nurses is detrimental to hospital management and equally to patients and the general public. According to the reports by The Joint Commission on Accreditation of Health (n.d), the high turnover of nurse in the United States has lead to high cost of medical care since the cost of replacing nurses is passed to the patients. The report further indicates that the high mortality rate in hospitals is as a result of high turnover of nurse.
Purpose Statement
The purpose of this research is to investigate the reasons behind the high turnover of nurses on general surgical floor as a response to the problem described above. In order to come up with credible findings, qualitative research method has been used. The research design is based on interview of a nurse manager from Vanderbilt University Hospital.
This issue has been selected because it has been discussed in many peer-reviewed journals, books, and even newspapers and thus the result obtained can be compared with the existing literature to so as to come up with credible conclusion. By talking to nursing professionals, one can gain better insights into the nature of this issue. The interview has been done on a nurse manager who has been working for a long time in a surgical unit.
Such a person has a vast experience of working in medical organizations, and he or she knows why nursing professionals may decide to leave. Furthermore, a nurse manager can tell what kind of problems they encounter. Most importantly, such a person can tell why people choose to stay in medical organizations and what factors make their work more rewarding. Such an interview can throw much light on the turnover of nurses. Findings from the same will help in alleviating the situation.
Nature of the Research
In an effort to come up with the data for this study, grounded theory based on interview process has been used. The research also incorporates case study technique since the interview Process takes place in the northern Ontario general hospital, where activities are going on. This method was selected because it enables researchers to understand the connection between individual behavior and organizational strategies. Secondly, they can explain how people view organizations and what kind of problems they face.
A Semi-structured interview was conducted on a nurse manager who had a working experience of 24 years in hospitals. Such a person has a vast experience of working in medical organizations, and he or she knows why nursing professionals may decide to leave. Furthermore, a nurse manager can tell what kind of problems they encounter. Most importantly, such a person can tell why people choose to stay in medical organizations and what factors make their work more rewarding.
Research Question
The research question employed was how to decrease nurse turnover and increase retention in general surgical floor. There were further several questions leading to the identification of the problem. They are attached at the appendix.
Significance of the Study
The study will help in reducing the existing gaps on top of having a positive impact on the society.
Reduction of Gaps
By finding answers to the research question “what are the reasons for the high turnover of nurses in the surgical floor in general hospitals?” the stakeholders in the medical field will use the findings to eradicate the problem of high turnover of nurses in the general surgical floor. In doing so, the cost of medical care will reduce.
Implications for Social Change
Based on the findings from the research, solution into the cause of high turnover of nurse will be found. If this solution is found, healthcare service to the society will improve as nurse will be stocked well. The current cost of medical care will also reduce. The problem of nurse turnover affects the whole society. Conclusive solutions can only be found if a thorough examination of the issues found form the same is considered.
Summary of the Research
The summary of the research is as shown bellow.
Data Collection
A Semi-structured interview was conducted on a nurse manager who had a working experience of 24 years in hospitals. Such a person has a vast experience of working in medical organizations, and he or she knows why nursing professionals may decide to leave. Furthermore, a nurse manager can tell what kind of problems they encounter.
The Interview Process
The interview process was conducted in a favorable atmosphere. Open ended questions were asked in most cases. For effectiveness, the data was recorded while at the same time notes were being taken. The interview lasted for about 18 minutes
Data Analysis
The data from the interview field was carefully red and internalized. During the process of internalizing the data, notes from the same was also taken. The process was also done for the audio data. This is because of the fact that the data gotten from the field was voluminous and thus had to be reduced to a manageable level.
The process was enhanced by highlighting key passages from the raw data and at the same time writing in the margins. The data was then coded. This was achieved through matching the information from the field with the hypothesis suggested.
Results
The fiver themes that emerged and that are integral to the constitutive pattern were as follows: General floor is a Training ground, Lack of understanding of mission & purpose of the organization, No opportunity for professional growth, Search for advancement in education, and lack of teamwork. They are as discussed below.
General floor is a Training ground
General floor is considered a training ground for nurses. According to the information from the interview, most nurses begin their careers from the general floor. Being the busiest place where all sorts of patient cases are admitted, it provides a good training ground for novice nurses.
For the case of the Vanderbilt University Hospital, 80% of nurses in intensive care unit and critical care unit had a small stint in the general floor before being moved to their respective places. In some situation, nurses abruptly whisked from the general floor to attend to a critical situation in ICU, who eventually end up being permanently instituted in the place.
Lack of understanding of mission and purpose of the organization
Every organization has a mission and purpose statement. The same applies to hospitals. For the case of the Vanderbilt University Hospital, its philosophy entails the provision of quality and cheap healthcare to the patients and an extension of care to the patient’s family and friends. The services are tailored to fit the needs of the patient meaning that nurse are supposed to be flexible in their services and be ready to adopt to different situation.
The credo behavior of the hospital requires nurses to be committed to their colleagues, have a sense of ownership, conduct themselves professionally, communicate effectively, make service their highest priority, and respect the privacy and confidentiality of stakeholders within hospital environs.
According to the information from the interview, nurses coming to the general floor have some preconceived ideas about nursing profession. Although they may be willing to adapt to the changes, they lack conclusive change management to infuse the culture and philosophy of the company. As a result, they act contrary to the expectation of the company and ends up being transferred, interdicted, or even sucked.
Lack of opportunity for professional growth
Nurses in the general surgical floor in Vanderbilt University Hospital are given little opportunity to climb the professional ladder. A nurse remains a nurse and can only be transferred to other sections rather than being promoted.
According to the information from the interview, the nurse manager admitted that she rose to her opportunity through sheer lack because the situation rarely happened unless one undergoes further education. Since nurses have the propensity for growth, some will leave for other places where there is likelihood of growth.
Advancement of education
When nurse are employed at the general surgical floor, they are normally at their elementary positions. Nurses can begin their career as Licensed practical nurses (LPN). At this stage, they provide basic direct care to patients and may be considered as junior in rank. Next in the rank are the registered nurses (RNs).
Their duties are more pronounced than LPN nurses. There is also advanced practical nurses. Their academic levels are higher than LPN. To navigate to these levels, nurses have to further their academic levels.
In the process of furthering their academic levels, they leave there occupation at the general surgical floor, contributing to the number of shortage. According to the information from the interview, the responded narrated on how she had attained advanced her career through further academic program that compelled her to leave her duties.
No team work
New nurse at the surgical floor find it hard to corporate with existing nurses. When new nurses are admitted into the general surgical floor, they become the errant people for that unit. This puts strain on the new nurses, which strains their relationship with the existing nurses. Lack of comprehensive change management in hospitals environment is attributed to this situation.
Conclusion
This research was intended to ascertain the reasons behind the high turnover of nurses in the general surgical floor. In this case, the research was out to find the specific hardships that nurse encounter during their work such that majority of them give up. From the data gotten through the interview questions, five themes emerged from the responses gotten from the field.
They include, General floor is a Training ground, Lack of understanding of mission and purpose of the organization, No opportunity for professional growth, Search for advancement in education, and lack of teamwork. It was also ascertained that the key function to the survival is resilience (Dracup & Bryan-Brown, 2000).
Implication to the Stakeholders in the Health Sector
The findings in this research are being directed to the stakeholders in the health sector. They should come to the terms with the fact that nurse in general ward are leaving their duties as a result of the mentioned factors. Efforts should be made to address the same (Cameron, Armstrong-Stassen & Bergero, 2004).
The problem of high turnover of nurses can be rectified if considerations are given to the issues leading to their turnover. One way of addressing the problem is to focus on change management. Change management aims at integrating employees with the organization and the environment of work.
For a hospital setting, this can be achieved by creating a full-bodied nurse resident program or building a strong relationship with nurse colleges. Through such program, nurses will learn in the hospital environment and will acquaint with procedures, mission, and philosophy of the organization. Also, the extensive orientation with appropriate action on the feedback from the same should be in place.
This research is also directed to those pursuing career in this field. They should be prepared for the hasher conditions. In doing the same, they should be equipped with resilience (Masten, 2009).
References
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Dracup, K. & Bryan-Brown, C. (2000). Diminishing supplies: how will nursing cope? American Journal of Critical Care, 9(6), 370-372.
Finlay, L. (2006). Mapping methodology: Qualitative research for allied health professionals: challenging choices. New York, NY: John Wiley.
Joint Commission On Accreditation of Healthcare Organizations. (n.d). Healthcare at crossroad: Strategies for addresing the evolving nursing crisis. Web.
KCameron, S., Armstrong-Stassen, M., Bergeron, S. & Out, J. (2004). Recruitment and retention of nurses: challenges facing hospital and community employers. Canadian Journal of Nursing Leadership, 17(3), 79-92.
Linda, J. (2004). Shortage of nurses putting patients at risk. Web.
Masten, A. S. (2009). Ordinary magic: lessons from research on resilience in human development. Education Canada, 49(3), 28-32.
Piper, J. A. (2009). Understanding the lived experience of novice nurses in a Northern Ontario critical care setting through interpretive phenomenology. Web.
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