Nurse Retention & Mentorship: Translational Research Research Paper

Identifying a Current Practice that Needs Change

Practice Description

At the hospital I work for, there is a problem of high nursing turnover. The hospital’s authorities do their best to reduce turnover and increase retention. The most common ways of promoting employees’ desire to stay with the facility are monetary awards, such as bonuses and differential pay. Another approach to promoting nurse retention is offering summers off and winters off programs to the staff. Finally, there is a special offer for newly-hired nurses that is represented by a longer orientation period upon request or based on the chief nurse’s decision. However, despite all these efforts, the rates of retention are still rather high at the hospital where I am employed.

Hence, the current nursing practice that requires change can be identified with the help of a PICO model. The problem is nursing retention, the intervention is a mentorship program, the comparison is no mentorship, and the expected outcome is the increased retention rate. The issues of retention and turnover are closely interrelated both in practice and research. Scholars emphasize the negative aspects of the nursing profession, which lead to high turnover. Nei, Snyder, and Litwiller (2015) report that turnover can increase due to such factors as personal characteristics, working environment, the leader’s treatment of staff, and attitudes of colleagues. The authors note the significance of arranging a positive working environment and maintaining good relationships with the team of healthcare employees in gaining high retention, which holds true for my workplace.

My hospital strives to raise retention levels by creating a healthy work environment, arranging conditions for nurses’ professional development, and recognizing the role of nurses in the process of giving care to patients. However, it appears that the measures taken by my healthcare institution to decrease turnover are not sufficient. Thus, the issue of nurse retention requires thorough consideration and demands change. Subsequent parts of the report aim at establishing how the suggested change will simplify a nurse’s job.

Why the Practice Needs Change

Despite a variety of ways of promoting retention that are practiced by my hospital, the problem of nurse turnover is still significant. Most commonly, this issue refers to newly hired nurses, who do not last through the three-month probation period offered in the medical-surgical unit. Former students cannot cope with a number of challenges they meet upon starting their practice. First of all, they suffer from constant stress and psychological discomfort due to finding themselves in an entirely new environment where they have to work at high speed. Secondly, many new nurses find it physically difficult to work long shirts or be responsible for many patients at the same time. Thirdly, newly-hired specialists may lack experience in the field but feel too embarrassed to ask their senior colleagues for advice. All of these reasons lead to the increased turnover rate, which causes trouble both to nurses and the hospital.

Although financial losses related to turnover are significant, human factors are not less crucial. A nurse’s job is rather stressful, demanding, exhausting, and responsible (Scammell, 2016). If these specialists receive appropriate attention and support from management, they can cope with their important duties despite difficulties. However, each additional stressor adds up to the desire to leave the job, thereby raising turnover rates. What is more, burnout and job dissatisfaction experienced by nurses can be reflected in patients’ care and their satisfaction with the services provided (White, Aiken, & McHugh, 2019). Taking into consideration the detrimental effects of nurse turnover and the variety of approaches to dealing with it, the suggested change is to introduce mentorship programs for improving retention rates (Horner, 2017; Schroyer, Zellers, & Abraham, 2016). The need for change in the current practice is evident, so it is vital to analyze the most beneficial approach to managing the problem.

The Key Stakeholders

The main stakeholders in the process of change are nurses, managers, hospital leaders, mentors, and patients. The reason why nurses constitute one of the key stakeholder groups is evident. The focus of the whole change program is made on these specialists since their retention affects not only themselves but also hospitals where they work and patients about whom they care. Nurses’ reasons for quitting a workplace are significant for various stages of the healthcare process, so it is logical that nurses constitute the first stakeholder group. The second stakeholder community is comprised of managers who are the closest to nurses in the hierarchy chain and who can observe difficulties associated with nurses’ professional duties and pressure on a daily basis. Hospital managers are the most influential representatives of the facility’s authorities in each medical unit. Hence, their importance in the process of change cannot be overestimated.

The next stakeholder group is hospital leaders, who manage the whole organization. Leaders have many responsibilities and functions, so they need the help of managers to understand the working environment at different units. Without hospital leaders, no change could ever be promoted or implemented since every final decision is made by them. The fourth stakeholder group is represented by mentors, who play a crucial function in the suggested change process. Finally, patients, who are the main recipients of nurses’ services, constitute the fifth stakeholder group. The roles of each stakeholder will be identified in the next subsection of the report.

Stakeholders’ Roles

Nurses

There are several roles nurses will play in the suggested process of change. First of all, these stakeholders will need to participate in the discussion of the current state of the issue. Nurses will be inquired to fill out surveys and questionnaires the aim of which is to find out the level of job satisfaction and the likelihood of turnover. Secondly, nurses will have to cooperate with mentors and keep notes on their progress both in the professional dimension and in personal experiences. Specifically, nurses may be asked to keep a journal where they reflect their feelings and attitudes toward the mentorship program. Additionally, they may need to compare their attitude toward the working environment at regular intervals so that the researcher could trace some tendencies at the end of the change implementation process.

Hospital leaders

The function of this stakeholder group is to arrange the most beneficial conditions for the change to be enforced. Thus, hospital leaders will need to arrange meetings with managers to find out the general atmosphere of staff. Also, leaders might need to contact other facilities to discuss how they deal with the turnover issue. Next, hospital leaders will have to create beneficial conditions for the mentorship program and find the necessary financial and human resources o make the implementation of change possible. Finally, they will evaluate the change together with mentors and managers in the end.

Managers

In the process of change, managers will play the intermediary function between hospital leaders, mentors, nurses, and patients. At first, managers will cooperate with leaders to create a plan of change. Next, it will be the managers’ duty to design a schedule that will enable mentors and nurses to collaborate. Finally, managers will be responsible for supervising nurses’ work and collecting feedback from nurses, mentors, and patients regarding the quality of services and patient and nurse satisfaction.

Mentors

The role of these specialists is the most important in the process of change. Mentors will bear the responsibility of offering sufficient professional and psychological support to newly hired nurses who are usually at a high risk of leaving the workplace within their first year. Mentors will have to analyze the strengths and weaknesses of their mentees and create an individual plan for each of the mentees. Mentors will also report to managers on the flow of the change process.

Patients

This stakeholder group’s role is somewhat passive but still rather important. Patients will not have any specific role designated during the change, but they will be asked to share their impressions on the success of the project. Patients may be requested to complete questionnaires at the beginning and at the end of the program. Another way of collecting feedback from these stakeholders might be a daily conversation with the manager during which patients will share their experiences.

Evidence Critique Table

Evidence Summary

Research by Lengerich et al. (2017) aimed at generating and trying out the Baptist Health Nurse Retention Questionnaire (BHNRQ), with the help of which scholars investigated nurse retention determinants. Such aspects as flexible scheduling, management’s competence, support, and engagement, a sufficient number of employees, a positive environment, and others were included in the questionnaire. Data were obtained from 279 bedside nurses working at a community hospital. Lengerich et al. (2017) performed a principal component analysis to establish the subscale structure of the BHNRQ. The authors found that the BHNRQ had sufficient validity and reliability and could be used to measure the determinants of nurse retention. The article relates to the practice change since it investigates the factors of nurse retention.

The study by Bugajski et al.’s (2017) is the continuation of Lengerich et al.’s (2017) research. The purpose of the article was to analyze the significance of factors associated with nurse retention. The authors investigated the responses of 279 nurses to the BHNRQ consisting of twelve questions to identify how the specialists understood retention factors. Additionally, Bugajski et al. (2017) differentiated between the results of the groups of nurses varying by generation, the type of unit, degree, and years of experience. The results of the study indicate that various aspects of work related to nursing practice, staffing, and management have moderate to high significance for nursing specialists. The article supports the practice change recommendation in that it singles out the factors associated with nurse retention.

Research by Horner (2017) investigated mentoring as a positive effect on nursing retention. The aim of the study was to check the correlation between nurses’ job satisfaction and mentoring grounded in Jean Watson’s Caring model. The study had a non-experimental and mixed-method design, which employed an online survey conducted through Qualtrics (Horner, 2017). The author found that mentoring experience had the potential to create a positive environment, which could raise job satisfaction. Consequently, an increased level of job satisfaction would lead to decreased turnover and increased retention. The study supports the selected practice change since it contains suggestions on increasing nurse retention.

Schroyer et al. (2016) focused their research on the analysis of the correlation between mentorship programs and nurse retention. The authors aimed at investigating whether the use of mentors had the potential to increase retention rates of new graduate nurses, re-entry specialists, and nurses who are new to a specific professional area. Schroyer et al. (2016) employed a descriptive, quasi-experimental, quantitative method of research. The findings indicated that the retention level of nurses involved in a mentorship program was 25% higher than of those not mentored. The article endorses the selected practice change since it investigates a viable approach to increasing nurse retention.

The purpose of the study by Trybou, De Pourcq, Paeshuyse, and Gemmel (2014) was to evaluate the effect of leader-member exchange, perceived organizational support, and psychological contract breach on nurse retention. Scholars emphasized that one of the main reasons for high nurse turnover was the unsatisfactory working environment. Hence, Trybou et al. (2014) employed a cross-sectional survey to investigate whether the mentioned factors were related to job satisfaction and retention. The authors found that turnover was closely associated with the social exchange. The article supports the practice change recommendation because it involves the analysis of crucial factors influencing nurse retention.

The Best Practice

Based on the evidence summary developed in the previous section, the best practice recommended for a successful change of the problem is the implementation of mentorship programs for newly hired nurses. Two out of the five articles included in the evidence critique table dwell on the importance of mentorship. The study by Horner (2017) has the 4^th level of evidence strength, and the article by Schroyer et al. (2016) has the 3^rd level. Both of these researches emphasize the need for increasing nurses’ job satisfaction to enhance retention rates. Schroyer et al. (2016) note that the leaders of healthcare facilities should engage in workplace development programs since the creation of favorable conditions can decrease turnover and promote retention. As such, scholars suggest that a mentorship program for nurses has the potential to present nurses with the opportunities of professional growth and eliminate negative factors, such as stress and burnout. In Horner’s (2017) study, similar postulates are defended, as well as the association between decreased turnover and a better healthcare system. The scholar remarks that patient outcomes and nurse satisfaction increase significantly with the implementation of mentoring programs.

The suggested change incorporates the process of translating knowledge from more experienced staff to novices. Research findings indicate that this approach can lead to considerable growth in retention rates. Specifically, Schroyer et al. (2016) report a 25% higher retention rate among nurses who have participated in a mentorship program versus those who have not been enrolled in such a program. All the participants of Horner’s (2017) study acknowledged the positive effect of mentorship on their job satisfaction. Therefore, the introduction of a mentorship program for newly hired nurses may be considered as the best practice to be employed with the aim of eliminating the retention problem.

A Practice Change Model

The selected change model to be used in the present project is Kotter’s eight-stage model of change. Out of the variety of change frameworks, this one is rather popular in healthcare settings due to the clear distinction between phases and high efficacy that develops because of such a distinction. Kotter’s model contains eight independent steps necessary for creating a significant change. The stages included in Kotter’s change model are as follows:

1. Generating a sense of urgency: it is necessary to make it clear that the change is critical and that the organization will suffer without it.
2. Forming a powerful coalition: one person, no matter how eager he or she is, cannot guide the whole change process, so it is crucial to create a team that will work on the process.
3. Creating a strategy and vision: this step will help the change initiator to explain the premise of change to all staff units and will eliminate misunderstandings.
4. Communicating the vision: to promote people’s understanding of the change, it is important not only to create a vision but also make it clear to everyone.
5. Empowering the change: at this point, the most crucial thing is to remove the barriers to change and eliminate the activities undermining the effort.
6. Creating short-term wins: with the help of these, it will be easier to manifest the positive role of change and motivate staff to continue dedicating their efforts to the project.
7. Reinforcing gains and generating more change: it is necessary to cement every new achievement and not relax when the first gains become apparent.
8. Anchoring the change in corporate culture: rather than generating one successful change, the hospital should make it a part of the organization and gain a lasting effect (Pollack & Pollack, 2014).

The Rationale for Choosing Kotter’s Model

The reason for selecting Kotter’s model is that this approach is highly useful for the suggested change. By analyzing each stage of the change process separately, it will be possible to generate a well-developed plan of action. By viewing the model as a single unit, it will be easy to create a sense of connection between each phase, as well as between stakeholders. Kotter’s change model allows not only identifying the problem but also explaining its urgency to every staff member. Additionally, this approach promotes a sense of success through creating short-term goals and keeping track of their achievement. What is more, with the help of Kotter’s model, leaders do not have to generate all ideas and put them in action by themselves. All they have to do is form a powerful coalition whose mutual efforts will promote the success of the process.

Another asset of Kotter’s model is that it promotes the removal of obstacles in the process of change. Creating a vision and strategy and following them also serve as beneficial aspects of the model. With the help of cementing every small gain, it will be easier to reinforce the staff’s belief in the positive resolution of the problem. Finally, when the change becomes anchored in the facility’s corporate culture, it will be possible not only to fix the result in this aspect but also generate positive outcomes in other spheres.

Applying Kotter’s Model to the Proposed Practice Change

• Step 1. At the initial stage of the change model, managers will collect data on nurse retention and inform hospital leaders about the detrimental effects of high turnover. To complete this phase successfully, managers can employ both the data available at their units and research findings based on scholars’ analyses of the problem. Additionally, the financial analysis of the past year or two, indicating losses from high turnover, could encourage the leaders to enact change.
• Step 2. At this point, hospital leaders will work on creating a powerful coalition that will work jointly on the change. There are several purposes that the newly assembled coalition will pursue. First of all, it will help the leader to understand the problem from different angles due to the diversity of knowledge and experiences. Secondly, it will become possible to delegate responsibilities and share information throughout the facility. Lastly, the coalition will enable the prompt fulfillment of each phase of the suggested project.
• Step 3. This phase will be used to generate a vision encapsulating the overall purpose of change. With the vision, it will become easy to explain the core aim of the change process to all stakeholders. The vision will serve as a rationale for each staff member involved in the change process. When creating the vision, one should bear in mind that it should be simple but inspirational at the same time.
• Step 4. Hospital leaders and managers should realize that the creation of the vision is not enough to make the project successful. Therefore, they will need to communicate the vision to each stakeholder group in order to make it clear to all the participants. At this phase, the coalition formed during phase one will be of service since it will enable leaders to divide responsibilities related to communicating the vision.
• Step 5. While the previous steps are crucial for bolstering the initiative, the fifth stage is important to look forward and identify the potential barriers to the change process. Managers and mentors will play the most crucial role at this phase since they will communicate with nurses and patients directly, thus being able to single out problematic issues. If the potential obstacles become known, it will be easier to oppose them.
• Step 6. Creating short-term wins will lead to enhanced motivation and increased activity of stakeholders. In the current project, a short-term goal may be a slight decrease in turnover, which can be measured over the first several months of the change. Also, it may be useful to measure the levels of workplace stress and anxiety of newly hired nurses within the same period and announce positive changes to the stakeholders.
• Step 7. When the first positive results are recorded, the managers should not slow down the pace of the program. On the contrary, it will be necessary to implement mentorship for each novice without waiting for the risk of a person’s quitting. The analysis of gains will be performed by managers and leaders, and potential improvements will be generated. This phase will prepare the hospital for the last and most important one.
• Step 8. Finally, the facility should make sure that the change is ingrained in its corporate culture. At this point, hospital leaders might think about some reward system for mentors under whose guidance novices’ acclimatization has been the smoothest. Also, nurses who demonstrate the best professional achievement under mentors’ guidance might be rewarded. By doing so, hospital leaders will promote a positive attitude to the current and future changes among the staff.

Possible Barriers to Implementation

Any change involves the risk of some barriers to its successful implementation. Within the healthcare settings, such potential obstacles are related to the attitude of various stakeholders to the proposed change. First of all, hospital leaders might find it irrelevant and unnecessary to introduce a mentorship program that would entangle additional financial and human resources. Secondly, some novices may be opposed to the program due to considering it as a personal insult and accuse of professional incompetence. Thirdly, patients may feel concerned about the need for their nurses to be trained. This stakeholder group is the most vulnerable in terms of health care, so patients may feel alarmed about nurses being taught by senior personnel right upon graduation. Also, some patients may not want to fill out the questionnaires even if they accept the idea in general.

Ethical Implications

During the planning and implementation stages of the proposed change, some ethical implications may arise. For instance, some nurses may feel that they do not adhere to the second provision of the Code of Ethics. This provision states that the primary commitment nurses make should be to patients and not to their own professional development (American Nurses Association, 2016). If such a problem occurs, the mentor and manager should help the nurse realize that by increasing their professional scope, they will be able to give more care to their patients. This aspect is included in provision 5, declaring that nurses should “continue personal and professional growth” (American Nurses Association, 2016, p. 2). The ANA Code of Ethics has a number of provisions that support the suggested practice change. Provision 4 states that nurses should promote patients’ health, provision 6 requires the enhancement of the working environment, and provision 7 demands professional advancement. Provision 8 advocates collaboration with other specialists, and provision 9 emphasizes the articulation of nursing values (American Nurses Association, 2016). Hence, the Code of Ethics promotes the suggested change initiative in several ways.

References

American Nurses Association. (2016). Code of ethics for nurses. Web.

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Horner, D. K. (2017). Mentoring: Positively influencing job satisfaction and retention of new hire nurse practitioners. Plastic Surgical Nursing, 37(1), 7–22. Web.

Lengerich, A., Bugajski, A., Marchese, M., Hall, B., Yackzan, S., Davies, C., & Brockopp, D. (2017). The Baptist Health Nurse Retention Questionnaire: A methodological study, part 1. JONA: The Journal of Nursing Administration, 47(5), 289–293. Web.v

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Trybou, J., De Pourcq, K., Paeshuyse, M., & Gemmel, P. (2014). The importance of social exchange to nurses and nurse assistants: Impact on retention factors. Journal of Nursing Management, 22(5), 563–571. Web.

White, E. M., Aiken, L. H., & McHugh, M. D. (2019). Registered nurse burnout, job dissatisfaction, and missed care in nursing homes. Journal of the American Geriatrics Society, 67(10), 2065–2071. Web.