Executive Summary
Many factors are responsible for understaffing and financial constraints encountered by hospitals. The Renfrey Memorial Hospital is an example of such health care organizations that is facing both staffing and fiscal challenges. Several strategies can be used to address these issues; these can be short-term strategies such as pay rise and temporary staff. On the other hand, long-term strategies may include improving working environment and nurse education. However, analysis and the context of Renfrey memorial Hospital shows that Improved working environment will be a viable solution to the hospital’s current woes.
Similar Cases from Other Hospitals
Similar to the problem of Renfrey Memorial Hospital is the case study of Beth Israel Hospital in Boston represented through Code Green. It reveals the financial constraints that Beth Israel Hospital was plunged into, as well as how it attempted to resolve this through merging with another hospital and carrying out restructuring. This was reported to have had a lot of impact on nursing. Beth Israel being a magnet hospital graduated from being a gold standard model for the nursing professional to a health provider where it was difficult to fill nursing vacancies. Lack of a working environment that is healthy and positive is one of the major causes of staffing problems in nursing.
A working environment that attracts and retains nurses is known to be found at magnet hospitals. Strategic goals should be put in place by all hospitals to ensure that the type of standards required to be met by magnet hospitals are also met by them. National standards for developing and sustaining healthy work environments have been published by the American Association of Critical – Care of Nurses. Looking into the future makes hospitals make a realization of having a shortage of nurses and all other workers in the future. Since there is likely to be great competition for this scarce resource, hospitals are supposed to become employers of choice (Cowen and Moorhead, 2006, p. 335). However, to become an employer of choice, Renfrey Memorial Hospital should provide a working environment that is positive.
Secondly, most Community based health care hospitals are adopting the use of staffing in any context to show a relationship with required patient outcomes. Monitoring of clinical indicators and outcomes should be enhanced by using several strategies based on the performance improvement model. Performance indicators are measured by use of the performance based model. This is achieved with measurable product characteristics such as services, processes, and mechanisms that can be utilized in not only tracking of performance, but also in improving it. A dashboard is one of the tools used in this model.
It encompasses a benchmark that is performance – based, the actual performance, the marker, and marker value, source of data, comments, and trends. Collection and reporting of information takes place on a quarterly basis. A nutritional care system that is evidence based using a number of tools such as data, measures, and procedures that are validated on which performance and management can be based (Edelstein, 2010, p. 347). Therefore, the performance-based model can be used to ensure that members of staff perform in accordance to patient expectations.
It is important to measure staff satisfaction since doing so may bring out more information regarding other underlying issues that ought to be addressed as well. If there a low ratings with respect to staff satisfaction, it may be needful to hold further discussions with the staff group as an attempt to take note of potential problems and their remedies. In some cases, the problem may be lack of coordination and support among staff members.
In addition, the real problem could be flaws in the organizational process or ineffective leadership. Most hospitals in some states have resorted to the use of staffing legislation to solve staffing inadequacies. Regulatory issues differ with regard to the regulatory body. Most of the regulatory issues stress on the significance of sufficient members of staff to undertake the given piece of work, procedures and policies that reveal how a shift-by-shift basis is used to address nursing assignments and sufficiency of nurse staffing (Dunham-Taylor and Pinczuk, 2009, p. 216).
Data from round five of the Community Trucking Study reveals the both long term and short-term strategies employed by hospitals to address staffing problems. In using short-term strategies, temporary staff was reported to have been used by about 75% of hospitals under study. Both per diem and traveling nurses were signed short-term contracts to fill vacancies that had arisen from staff vacations and health leaves. Due to cost and quality concerns, many hospitals were reducing their dependence on temporary staff. Out of the twenty-four hospitals that had implemented the use of temporary staff, about fourteen reported plans to minimize their use. However, the use of temporary staff continued to be in place in the Orange County, Phoenix and California (May, Bazolli and Gerland, 2006).
During the study, ten other hospitals reported to have dealt with short term staffing needs by use of internal staffing agencies or staff pool. This strategy encourages hospitals to save costs since it is cheaper compared to use internal staffing in comparison to external staffing agencies. Internal pools also encourage quality staffing care because this strategy makes use of nurses who are currently on staff but seeking extra working shifts or formerly employed nurses who are in need of both flexibility and less working hours. Other hospitals have agencies that make use of per diem nurses who are external but may require either specialized training or a certain degree of experience (May, Bazolli and Garland, 2006).
For hospitals that have removed external agency staff, this strategy has proved to work for them. For example, at Spartanburg Regional medical center in South Carolina, the internal agency of the hospital allows members of staff interested in extra shifts to bid for costs that higher than those of staff nurses but lower than external agency rates. This takes place by use of an online shift auction for nursing (May, Bazolli and Gerland, 2006).
The second short term strategy to employed was use of salary and financial benefits. A high demand environment causes hospitals to use competitive salaries for recruiting and retaining nurses. The approach targets an increment that is allocated to all nurses and not just those who have been newly recruited. In cases where other hospitals in the market are not quick enough to respond to salary increment in response, the effects of wage increase may be short term.
On the other hand, if more people are attracted to the nursing profession, the approach may have effects that are long term. This strategy was reported to be the second mostly used short-term approach. Thirdly, financial strategies that were employed by about 44% of the hospitals include use of sign-on, retention, or referral bonuses or a blend of all these. In addition, fiscal incentives were applied with majority of the hospitals reporting that the work environment could also contribute a lot to retaining nurses and that money alone was not sufficient. In addition to this, most hospitals have started making use of flexible schedules due to the need for nurses to strike a balance between their home duties and jobs (May, Bazolli and Garland, 2006).
The study also revealed the use of long-term strategies by some hospitals. First, one hospital reported to have employed the use of nurse education. The educational approach that was mainly used was nurse training. Most of the hospitals reported to have embraced this approach said that they were either enlarging the capacity for training or opening extra schools for the same. Through the approach, hospitals are able to nurture their own nurses, by running schools for nursing, paying for the learners’ education as they get work commitment in return, or ensuring that the current ancillary nurses acquire degrees by providing them with both training and flexible schedules.
For example, there are student shadow nurses who receive tuition reimbursement at St Joseph’s Hospital and Medical Center at Phoenix. Almost all these students are employed at the hospital. Some nurses are trained for environmental services at St Joseph Health System in Orange County. This enables them to become nurse assistants that are certified after which they can pursue a degree in nursing.
The second most common educational approach to be used was orientation of nurses. Most of the hospitals using this strategy reported that their orientation sessions were lengthened or restructured to ensure that nurses were retained and satisfied. Some hospitals could carry out their orientation programmes for a period of between twelve to twenty weeks. During the period, new nurses could be excluded from their normal hospital routine or find the best fit by rotating through various units. Use of formal nursing preceptor programs was reported by four hospitals. This programme ensured the pairing of new nurses one with another with the experienced ones during orientation. Other hospitals have also begun offering trai8ning that is specialized in certain clinical areas.
A number of other fringe benefits and approaches focusing on nurse education were reported by some hospitals. This entails collaboration with nursing schools, acting as a place for clinical rotations and giving benefits related to education such as offering specialized career tracks, paying for advanced education, and giving of certificates. However, limited nursing capacity was reported to be the main stumbling block to nursing education. This coincides with studies at the national level, which indicate that despite increase in enrollment at the nursing schools, inadequate nursing facilities are causing many qualified applicants to be turned away.
Due to insufficient financial resources by most nursing schools to provide salaries, nurse faculty salaries have been subsidized by nine hospitals. The hospitals have paid their own nurses full salaries after loaning them to serve as faculty and have helped local nursing schools to obtain faculty. Union contracts and some hospitals that prohibit increasing pay for a single support group could hinder hospital’s investment to financially support a faculty at external nursing schools.
The other long-term strategy is improving the working environment for nurses. Most hospitals have also realized that making changes to the hospital’s environment could help in the recruitment and retention of nurses. These changes can have a great impact if the hospitals cultivate a reputation as a good working place.
However, long-term effects can emanate from being committed to invest in the improvement of the working place. Twenty-eight hospitals reported having made at least one adjustment to the nurses’ working environment. Changes affecting nursing staff levels were the most common. Despite these changes leading to better patient care and lead to a reduction in the workload of nurses, they do not result to major changes as far as care delivery is concerned.
A few hospitals reported having made some changes to the duties of nurses that could have led to greater changes to nurse satisfaction and care delivery. An example of these attempts is arranged teams of clinicians to attend to patients during situations that are critical, support nurses that ensure that the personal needs of patients are met, and recruitment of older nurses to take care of administrative chores and paperwork.
About 50% of the study hospitals indicated having adjusting the physical environment such as a redesign in nurse workstations and decentralization of pharmacies. There were also some technological changes such as implementing electronic medical records, use of automation. In addition, some hospitals reported to have introduced changes ion the working environment that lead to an improvement in quality of care. Due to these changes, most of the hospitals reported to have either attained ‘nurse magnet’ status or were in the process of getting it. Attaining this status will enable the hospitals recruit more experienced nurses and hence protect themselves from the looming cases of nurse shortages.
Two Solutions that are Viable for Renfrey memorial Hospital
First, Renfrey Memorial ought to introduce nurse education. This can be done through several ways. First, it should be through nurse training. The hospital should invest in starting new schools to provide nursing education. By doing this, the hospital will be in a position to grow its own nurses. This should be achieved by paying for the education of the students as they work for the hospital or allowing the ancillary nurses to train so as to attain degrees. They can be given this opportunity through being given a flexible working schedule.
Secondly, the hospital should introduce an orientation program. The orientation program should be long enough to improve patient care and in the process lead to retention and satisfaction among nurses. As the new nurses go through this, they should be exempted from the hospital tasks. New nurses should also be paired with the old experienced ones during the orientation process. To ensure that there is no hindrance to the operation of the nursing schools, the hospital can either subsidize the fees of its students or loan them while still paying them.
The second approach that the Renfrey Memorial Hospital should use is to improve the working environment of nurses. This can have effects that are both immediate and long-term. This should mainly entail planning changes among ancillary staff and nurses though it should mainly center on increasing staffing levels. This will go a long way to not only reduce the workload of nurses, but also to improve patient care. There can also be changes in the duties of nurses, which can result to nurse satisfaction, for instance, letting older nurses to take care of paper work and administrative work while the younger nurses carry on with other patient care needs. These strategies can be carried out in two years with the changes in work environment being done in the first year and nurse education being implemented in the second year.
Analysis of the two solutions
First, the nurse education strategy will ensure that both new and ancillary nurses undergoing it increase their knowledge and hence their competence. This will in turn lead to the increase in the quality of care accorded to the patients. The lengthened orientation program will not only improve the care for patients, but will also lead to contentment among nurses. To carry out effective training, the hospital’s human resource department will be required to enroll new nurse students for the same. They will also be responsible for organizing good training material and availing training personnel.
On the other hand, the hospital administration will also be required to market the strategy in several places where students can respond to come and enroll with it. In addition, the accounting department will be required to chip in and ensure that the trainers have been paid apart from loaning and providing the nurse trainees with pay as a way of motivating and retaining them. This is important since policies in health care go hand in hand with financial incentives (Dochterman and Grace, 2001). Given that Renfrey Memorial Hospital is encountering financial constraints, being able to effectively carry out these costly strategy will require the commitment of a third party such as a donor, the government, local leaders, or the community support.
Secondly, to lead to an improvement in the work environment, the hospital administration will be required to be involved in raising staff levels. They should also introduce changes to nurse responsibilities. This will ensure that patients are given quality care while at the same time providing the nurses with a working environment that is conducive and one that encourage them to be retained for long. Making physical changes to the hospital units will require support from the accounting department. Use of new technology such as automation and electronic records will reduce the workload of the nurses and enable them to embark on giving quality care to the patients. This will also make them reduce fatigue that can at times hinder proper decision making in medical care (Westert, 2006, p. 263).
Recommendation of the best solution for Renfrey Memorial Hospital
The best way to increase retention and recruitment of nurses for the hospital will be to adopt the strategy of improving work environment. Research shows that what drives most nurses away from their jobs is the much tediousness and stress that the working environment provides (Byers and White, 2004, p. 218). The reason why this strategy should be implemented over the other one for nurse education is that the latter may be more expensive and may take long to be effected.
Moreover, changing of staffing roles such as using support nurses to attend to the personal patient needs and letting older nurses to work on light duties may not really involve the hospital financially since older nurses will continue to be paid their usual salaries. This will cause them to have sufficient time for their families and reduce job fatigue especially if decentralized designs have been used to reduce time taken by nurses in moving from one place to another to collect supplies needed for patient care (Porter-O’Grandy and Malloch, 2009, p. 272).
In addition, the administration can improve the working environment by introducing soft music in the nurse offices. This helps to relieve stress and increase staff motivation (Miller, 2006, p. 10). A survey that was conducted at Delnor-Community Hospital at Chicago showed that most nurses appreciated improvement in their working environment and this showed a statistically important cultural shift (Pillow and Smith, 2007, p. 77). Thus in view of these considerations, improved working environment is the most feasible strategy to be implemented by Renfrey Memorial Hospital.
References
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