Updated: Aug 17th, 2024

Self-Scheduling Protocol to Increase Nurse Retention Essay

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Table of Contents

Problem Statement
Practice Change, Quality Improvement, or Innovation
Rationale
Evidence Summary
Recommendation
References

Nurse retention is a priority to most hospitals in light of the persistent problem of nursing shortages. The goal is to retain sufficient staffing levels to deliver quality and safe patient care and avoid overstraining current RNs with work that may increase their intent to leave the organization. On the economic front, the turnover costs can hurt the fiscal health of a facility; loss of experienced bedside nurses can interrupt service delivery and affect quality. Thus, low staff retention is a major concern for healthcare practitioners.

Among the root causes of turnover is job dissatisfaction due to multiple environmental factors. The work environment itself can affect nurse retention, especially in conditions of overloads or inflexible shift schedules that deter RNs from attending to family or social engagements (Rizany et al., 2019). Additionally, mandatory overtime hours and long shifts may lead to burnout and the inability to achieve a work-life balance. RNs are working on a 12-hour shift, 40 hours weekly, are likely to become dissatisfied with their role and quit (Wynendaele et al., 2020). Therefore, reasonable workloads are a crucial consideration in nurse retention.

Limited empowerment is another critical factor affecting satisfaction among practicing nurses. Excluding RNs from key decisions about workloads is likely to elicit feelings of unfair treatment and low morale. On the contrary, including RNs in shared governance groups or policy committees can lead to a perception of support by the leadership, increasing their job satisfaction (Rizany et al., 2019). Limited control over working hours may have adverse effects on morale and retention. Flexible schedules may moderate the undesirable impact of shifts on work-life balance and general wellbeing. The implementation of a self-scheduling protocol may foster empowerment and greater involvement of RNs and create a better work-life balance that would reduce job dissatisfaction underlying low nurse retention at Abbott MidWestern Hospital (ABH).

Problem Statement

The issue requiring a practice change is nurse retention at ABH orthopedic unit. A new evidence-based self-scheduling protocol is developed to support greater autonomy in creating work schedules without affecting the acuity needs of the unit. ABH’s turnover rate is relatively high, at about 20%, making nurse retention an urgent issue (Wright et al., 2017). Maintaining work-life balance is challenging due to expectations of 24-hour service and long undesired shifts. At ABH, nurses intimate that they are sometimes overwhelmed with responsibilities that are demanding both physically and mentally. As the major acute care facility in Minneapolis, ABH attends to diverse patient populations with critical care needs, including those with COVID-19 symptoms. Therefore, the units are overstretched, and nurses are prone to burnout and job stress due to long shifts – a scenario that may account for the low retention rate.

Inappropriate staffing and scheduling that does not consider workloads are bound to affect staff morale and impact the quality of care. Inflexible schedules, work pressure, long shifts, and undesired shifts cause job dissatisfaction with significant ramifications for the organization’s financial health (Wynendaele et al., 2020). Increasing staff to ease workload pressure is a gradual process and may not be feasible given the nursing shortages. As a result, RNs at busy units, such as orthopedics, are forced to work harder (resulting in burnout) or reduce the time spent caring for a patient, which leads to a decline in quality.

The existing model in most ABH units is centralized scheduling; the nurse manager prepares and communicates weekly shifts to RNs. Staff input and shift preferences are rarely considered in this process. Additionally, the work hours are fixed, limiting the exchange of shifts between nurses based on need. As Son and Ham (2018) note, inflexible scheduling is a key predictor of low staff morale and job satisfaction. Thus, the failure to address RN’s need for flexibility and work-life balance is a significant factor contributing to low nurse retention at the facility.

Practice Change, Quality Improvement, or Innovation

The practice change proposed entails implementing self-scheduling to address job dissatisfaction and low morale among nurses at ABH’s orthopedic unit in order to reduce their intent to leave the facility. The unit manager will send a blank list (a self-scheduling software or web scheduler) to staff nurses and request each individual to sign up for preferred shift dates at least a month in advance. He or she will then review the draft schedule to ensure fairness and consistency with pre-established guidelines about weekends, holidays, and evening/night rotations.

Before implementation, a unit meeting will be held to explain the scheduling rules and prepare nurses for the transition. Flexibility will help accommodate changing acuity needs of the unit. The system will be linked to the Google calendar app to enable nurses to receive reminders or update the schedule after shift exchanges. The web scheduler will allow staff to view and post requests for a shift change. Any agreement to exchange work hours by staff nurses must be followed by notifying the unit manager to ensure a balanced daily schedule. RNs will be free to work overtime depending on patient acuity needs. An additional component is a Facebook page that will allow nurses to post requests and contact a colleague individually before trading shifts. This aspect will also promote professional communication and interaction among RNs. The self-scheduling protocol is intended to eliminate undesired shifts and reduce workloads that impact staff morale, increasing turnover intent.

Rationale

The self-scheduling concept is not new; hospitals have successfully implemented flexible work arrangements before to boost morale and reduce turnover. Schedule flexibility, which gives nurses autonomy over work hours, can ameliorate the negative impact of workload on work-life balance and burnout (Wynendaele et al., 2020). Therefore, the project will address the structural root causes of job dissatisfaction that account for low nurse retention: limited empowerment, perceived loss of control over personal and professional life, and inflexible schedules.

The project aims to address the strain on RNs by implementing a self-scheduling protocol to cater for flexibility in work hours and achieve greater autonomy and satisfaction. Under this model, RNs can exchange shifts on a voluntary basis provided that they notify the unit manager about the changes for him/her to reorganize the schedules. This project is intended to address this gap so that both unit and coworker needs are accommodated. The nursing staff will feel empowered by introducing an element of flexibility. This scenario is likely to lead to a satisfied workforce because of perceived control over work time, contributing to nursing retention.

Author(s)(Formatted as in-text citation)	Database(CINAHL, EBSCO, Cochrane, Pro-Quest) WGU Library	Peer-Reviewed(Yes/No)	Applicability (Yes/No)	Evidence Grade(Strength/ Hierarchy)	Appraisal(Brief summary of findings; how findings inform your project?)	Inclusion(Yes/No)
Alfonsi et al. (2021)	WGU Library	Yes	Yes	1/integrative review	Night shift RNs experience sleep problems that impact their cognitive functioning and job satisfaction, which leads to attrition. My project focuses on implementing a self-scheduling protocol to increase retention through a better work-life balance.	Yes
Al-Hinai et al. (2018)	WGU Library	Yes	Yes	7/Case Study	A nurse-scheduling tool helps achieve a balanced workload, preferred shifts, and day-offs that lead to workforce satisfaction. My project implements a self-scheduling protocol to optimize fairness and satisfaction that predict RN retention.	Yes
Allah et al. (2020)	WGU Library	Yes	Yes	4/Descriptive Study	Nurse managers consider strategies to manage nursing stress and workloads as key to reducing absenteeism and turnover. My project implements a self-scheduling tool to motivate RNs and increase retention.	Yes
American Nurse (2018)	WGU Library	Yes	Yes	7/Expert Opinion	An electronic scheduling system permits input from all RNs, enhancing their satisfaction and optimizing skill sets. My project focuses on implementing a self-scheduling protocol to enhance unit-level RN retention.	Yes
Al Sabei et al. (2020)	WGU Library	Yes	Yes	4/Cross-sectional	Involvement in hospital affairs apparently enhances job satisfaction and reduces turnover intention. My project seeks to empower nurses by supporting their participation in schedule preparation to increase retention.	Yes
Baek et al. (2019)	WGU Library	Yes	Yes	4/Cross-sectional	Young staff nurses working in units headed by authentic leaders are more satisfied and dedicated to their role. My project aims to improve working conditions through self-scheduling to increase satisfaction that would increase retention.	Yes
Cao et al. (2020)	WGU Library	Yes	Yes	4/Cross-sectional	Perceived organizational justice increases work commitment and quality and reduces the intent to leave among newly licensed RNs. My project implements a targeted measure (self-scheduling) to foster perceptions of fairness and decrease turnover.	Yes
Dede and McCreary (2020)	WGU Library	Yes	Yes	7/QI project	Role autonomy and control are key predictors of job satisfaction among home care nurses that potentially lowers turnover. My project aims to foster greater control over scheduling by RNs to improve morale and retention.	Yes
D’Souza et al. (2021)	WGU Library	Yes	Yes	4/Descriptive study	An automated nurse scheduling system (ROTA) that supported shift swapping enhanced managerial control and reduced time spent scheduling. My project focuses on implementing an online self-scheduling tool to support unit-level schedule flexibility.	Yes
El Adoly et al. (2018)	WGU Library	Yes	Yes	7/Case study	A nurse-scheduling model was associated with fair scheduling and balanced RN preferences, resulting in higher satisfaction levels. The self-scheduling protocol implemented in my project will balance preferred shifts and day-offs to enhance perceived fairness and satisfaction.	Yes
Gander et al. (2019)	WGU Library	Yes	Yes	4/Cross-sectional	Night shifts and extensions were associated with fatigue-related outcomes, such as medical errors. My project implements a self-scheduling protocol to minimize workloads and fatigue that potentially reduce retention.	Yes
Garde et al. (2019)	WGU Library	Yes	Yes	4/Descriptive study	Operational hours for nurses are comparable between countries but work schedules are different and reflect turnover rates. My project will implement an optimal shift system (self-scheduling) to lower the intent to leave among RNs.	Yes
Gifkins et al. (2017)	WGU Library	Yes	Yes	7/Case study	Flexible shifts are mitigated the effects of shiftwork on work-life balance and promoted social support for RNs. My project will implement an autonomous scheduling protocol to foster connections with social networks and enhance job satisfaction.	Yes
Hunt (2018)	WGU Library	Yes	Yes	7/Expert Opinion	Computing full-time equivalents is critical in optimal scheduling to meet unit acuity needs. My project will implement a self-scheduling system that caters for preferred shifts without compromising optimal skill-mix and patient-RN ratio based on patient acuity.	Yes
Jung et al. (2017)	WGU Library	Yes	Yes	4/Descriptive Study	Flexible work schedules are associated with improved work-life balance and nurse health. My project will implement self-scheduling to increase RN job satisfaction and retention.	Yes
Lee and Kang (2018)	WGU Library	Yes	Yes	1/Systematic Review	Role conflict and limited work-life balance are among the factors contributing to a high turnover among hospital nurses. My project will address work-home conflict through self-scheduling to increase retention.	Yes
Li et al. (2020)	WGU Library	Yes	Yes	4/Cross-sectional	Perceived organizational support, autonomy, and staff satisfaction have a direct impact on RN’s intention to stay, and thus, unit managers can increase retention by improving work characteristics. My project focuses on self-scheduling as a way to enhance job control and morale among nurses to reduce turnover.	Yes
Lobo et al. (2018)	WGU Library	Yes	Yes	4/Descriptive Study	Exhaustion and fatigue prevent nurses from working overtime. Additionally, unpredictable shift notices contribute to low job satisfaction. The self-scheduling protocol implemented in my project will allow shift swapping to promote work-life balance.	Yes
Maass et al. (2017)	WGU Library	Yes	Yes	7/Case study	High nurse-staff ratios achieved through a staffing decision algorithm is associated with increased quality and RN satisfaction. My project will focus on a flexible scheduling system that considers unit acuity needs in scheduling.	Yes
Mischek and Musliu (2019).	WGU Library	Yes	Yes	7/Expert Opinion	An effective self-scheduling system must balance preferred shifts requests and ensure optimal RN skill set at the unit. In my project, the unit manager will manage the scheduling to ensure balanced shifts.	Yes
OʼConnor and Dugan (2017)	WGU Library	Yes	Yes	7/Expert Opinion	Floating RNs in familiar clinical environments can reduce the need for long shift hours or overtime work. My project aims to decrease workloads and shift frequency and duration through self-scheduling.	Yes
Rerkjirattikal et al. (2020)	WGU Library	Yes	Yes	7/Case study	Optimal schedules implemented using a scheduling optimization tool improves perceived organizational justice and satisfaction among RNs. My project aims to achieve workload fairness and balance preferred shifts that would make nurses more satisfied and less likely to leave.	Yes
Rizany et al. (2019)	WGU Library	Yes	Yes	4/Cross-sectional	Optimized management of nurse schedules, including how they are organized and controlled, is positively correlated with RN job satisfaction. My project will aim to achieve optimal schedules through a self-scheduling protocol for nurses.	Yes
Sagherian et al. (2017)	WGU Library	Yes	Yes	4/Descriptive Cross-sectional	Working during off-days and consecutive night shifts are associated with acute fatigue because of limited recovery time. My project aims to reduce burnout in RNs through flexible work arrangements that allow shift swapping.	Yes
Son and Ham (2018)	–	Yes	Yes	4/Descriptive Study	Nurses engaged in shiftwork experience a high work-family conflict, increasing their turnover intentions. My project proposes a self-scheduling tool to enhance work-life balance in order to increase retention.	Yes
Sundari and Mardiyati (2017)	WGU Library	Yes	Yes	7/Non-evidence-based Practice Guidelines	The best self-scheduling tool is the one that maximizes job satisfaction factors and accommodates fluctuating patient volumes. My project will ensure optimal staffing levels based on patient acuity needs of the unit.	Yes
Uekata et al. (2019)	WGU Library	Yes	Yes	4/Cross-sectional	Rotating work schedules can address shift-related demands that impact the health of RNs, leading to burnout and sleep disorders. My project implements a self-scheduling tool that supports flexible work arrangements at the unit level.	Yes
Vedaa et al. (2017)	WGU Library	Yes	Yes	4/Prospective Study	A short inter-shift rest is linked to absenteeism and turnover intent. My project will aim to enhance work-life balance to increase retention.	Yes
Wright et al. (2017)	WGU Library	Yes	Yes	7/QI Project	Inflexible shift arrangements affect morale, which is a key predictor of RN retention besides professional development opportunity and autonomy. My project will enhance flexibility in scheduling to increase nurse job satisfaction and retention.	Yes
Wynendaele et al. (2020)	WGU Library	Yes	Yes	1/Systematic Review	RNs are working on a 12-hour shift, 40 hours weekly, are likely to become dissatisfied with their role and quit. My project focuses on flexible work arrangements that include RN shift preferences to boost morale and increase retention.	Yes

Best Practices

Based on the literature review, if implemented correctly, self-scheduling can increase job satisfaction, which is a key factor in improving nurse retention. Various strategies for self-scheduling exist that maximize RNs’ shift, a day off, and vacation preferences without compromising unit acuity needs and patient volume fluctuations. In general, the process is organized into distinct phases completed manually or with the help of IT tools. First, scheduling guidelines are established for staff to use when inputting preferred shift dates, day-offs, and vacation days (Wynendaele et al., 2020). In this stage, other RNs cannot see a colleague’s schedule; hence, a nurse is free to consider individual choices. Second, individual schedules sent to the unit manager are integrated to determine shortages or surpluses and balance workloads based on projected staffing needs (Mischek & Musliu, 2019). A core component of this process is the negotiation between coworkers in exchanging shifts. If there is no consensus, a shared governance committee can sit and make adjustments (Rizany et al., 2019). The unit manager who acts as the facilitator in self-scheduling then approves the final schedule for use.

Evidence Summary

The studies reviewed to emphasize the link between self-scheduling and job satisfaction – a positive staff-related outcome (Rizany et al., 2019; Wynendaele et al., 2020). Thus, self-scheduling could be an effective intervention for retaining nurses. It ameliorates the effects of heavy workloads on work-life balance, nurse wellbeing, and stress (Lee & Kang, 2018). Self-scheduling also facilitates flexibility, greater control over work hours, and autonomy, aspects that are associated with increased job satisfaction and low turnover intent (Gifkins et al., 2017). The process also enhances a nurse’s influence on shift duration and date, which may not be possible under fixed scheduling (Son & Ham, 2018). Self-scheduling also fosters recovery from fatigue before it can become acute and increases access to exercise and family support that ameliorate work-related stress (Giftkins et al., 2020). All these aspects suggest that implementing self-scheduling could improve retention because of its effect on satisfaction and wellbeing. However, to achieve these benefits, shift, holiday, and day off preferences must be balanced manually or using algorithms to promote fair assignment (Rerkjirattikal et al., 2020). The approach will also ensure that unit needs are accommodated in the plans without overwhelming current staff.

Recommendation

A successful implementation of self-scheduling is dependent on unit-level demand or staffing needs, which is often difficult to predict. Therefore, the protocol should be implemented in small wards that do not involve complex acuity challenges. Additionally, fairness or justice must be achieved through adjustments to the schedules submitted by nurses to balance between highly demanded and less popular shift days. The system must be perceived as fair and impartial; therefore, equal distribution of work hours, off-days, and vacations is recommended for this project. A training to build communication skills is also suggested to help RNs negotiate shift exchanges and understand the scheduling problem. The self-scheduling guidelines should also be made available, and a shared governance committee involved in implementation to manage staff attitudes. An assessment of unit needs and workload is also recommended before transitioning into self-scheduling to cater to acuity needs.

References

Alfonsi, V., Scarpelli, S., Gorgoni, M., Pazzaglia, M., Giannini, A. M., & Gennaro, L. D. (2021). Sleep-related problems in night shift nurses: Towards an individualized interventional practice.Frontiers in Human Neuroscience, 15(644570), 1-16. Web.

Al-Hinai, N., Al-Yazidy, N., Al-Hooti, A., & Al-Shereiqi, E. (2018). A goal programming model for nurse scheduling at emergency department.Proceedings of the International Conference on Industrial Engineering and Operations Management, 99-103. Web.

Allah, A. R. G., Elshrief, A. H., & Ageiz, M. H. (2020). Developing strategy: A guide for nurse managers to manage nursing staff’s work-related problems.Asian Nursing Research, 14(3), 178-187. Web.

American Nurse. (2018). The imperative for an electronic nurse scheduling system: Case study: West Hospital VCU Health. Web.

Al Sabei, S. D., Labrague, L. J., & Ross, A. M., Karkada, S., Albashavreh, A., Al Masroori, F., & Al Hashmi, N. (2020). Nursing work environment, turnover intention, job burnout, and quality of care: The moderating role of job satisfaction.Journal of Nursing Scholarship, 52(1), 95-104, 2020. Web.

Baek, H., Han, K., & Ryu, E. (2019). Authentic leadership, job satisfaction and organizational commitment: The moderating effect of nurse tenure.Journal of Nursing Management, 27(8), 1655-1663. Web.

Cao T., Huang, X., Wang L., Li, B., Dong, X., Lu, H., Wan, Q., & Shang, S. (2020). Effects of organisational justice, work engagement and nurses’ perception of care quality on turnover intention among newly licensed registered nurses: A structural equation modelling approach.Journal of Clinical Nursing, 29(13-14), 1-12. Web.

Dede D., & McCreary, J. (2020). Home health nursing job satisfaction and retention.Nursing Clinics of North America, 55(1), 121-132. Web.

D’Souza, B., Rao, S. S., Muthana, C. G., Bhageerathy, R., Apuri, N., Chandrasekaran, V., Prabhavathi, D., & Renukaradhya, S. (2021). ROTA: A system for automated scheduling of nursing duties in a tertiary teaching hospital in south India.Health Informatics Journal,00(0), 1-12. Web.

El Adoly, A. A., Gheith, M., & Fors, N. M. (2018). A new formulation and solution for the nurse scheduling problem: A case study in Egypt.Alexandria Engineering Journal, 57(4), 2289-2298. Web.

Gander, P., O’Keeffe, K., Santos-Fernandez, E., Huntington, A., Walker, L., & Willis J. (2019). Fatigue and nurses’ work patterns: An online questionnaire survey.International Journal of Nursing Studies, 98, 67-74. Web.

Garde, A. H., Harris, A., Vedaa, Ø., Bjorvatn, B., Hansen, J., Hansen, A. M., Kolstad, H. A., Koskinen, A., Pallesen, S., Ropponen, A., & Härmä, M. I. (2019). Working hour characteristics and schedules among nurses in three Nordic countries – a comparative study using payroll data.BMC Nursing, 18(12), 1-12. Web.

Gifkins, J., Loudoun, R., & Johnston, A. (2017). Coping strategies and social support needs of experienced and inexperienced nurses performing shiftwork.Journal of Advanced Nursing, 73(12), 3079-3089. Web.

Hunt, P. (2018). Developing a staffing plan to meet inpatient unit needs.Nursing Management, 49(5), 24-31. Web.

Jung, M. S., Kim, H. L., & Lee, Y. J. (2017). Factors influencing work-life balance in Korean registered nurses.Korean Journal of Occupational Health Nursing, 26(2), 114-123. Web.

Lee, Y. O., & Kang, J. Y. (2018). Related factors of turnover intention among Korea hospital nurses: A systematic review and meta-analysis.Korea Journal of Adults Nursing, 30(1), 1-17. Web.

Li, X., Zhang, Y., Yan, D., Wen, F., & Zhang, Y. (2020). ‘Nurses’ intention to stay: The impact of perceived organizational support, job control and job satisfaction. Journal of Advanced Nursing, 76(5), 1141-1150, 2020. Web.

Lobo, M. V., Ploeg, J., Fisher, A., Peachey, G., & Akhtar-Danesh, N. (2018). Critical care nurses’ reasons for working or not working overtime.Critical Care Nurse, 38(6), 47-57. Web.

Maass, K. L., Liu, B., Daskin M. S., Duck, M., Wang, Z., Mwenesi, R., & Schapiro, H. (2017). Incorporating nurse absenteeism into staffing with demand uncertainty.Health Care Management Science, 20(1), 141-155. Web.

Mischek, F., & Musliu, N. (2019). Integer programming model extensions for a multi-stage nurse rostering problem.Annals of Operations Research, 275, 123-143. Web.

OʼConnor, K., & Dugan, J. L. (2017). Addressing floating and patient safety. Nursing, 47(2), 57-58. Web.

Rizany, I., Hariyati, T. S., Afifah, E., & Rusdiyansyah, P. (2019). The impact of nurse scheduling management on nurses’ job satisfaction in army hospital: A cross-sectional research.SAGE Open, 9(2), 1-9. Web.

Sagherian, K., Clinton, M. E., Huijer, H., A., Geiger-Brown, J. (2017). Fatigue, work schedules, and perceived performance in bedside care nurses.Workplace Health & Safety, 65(7), 304-312. Web.

Son, D. M., & Ham, O. K. (2018). The relationship between work-life conflict and turnover intention among hospital nurses based on shift work.Korean Journal of Occupational Health Nursing, 27(4), 191-202. Web.

Sundari, V. E., & Mardiyati, S. (2017). Solving cyclical nurse scheduling problem using preemptive goal programming.AIP Conference Proceedings, 1862, 1-9. Web.

Uekata, S., Kato, C., Nagaura, Y., Eto, H., & Kondo, H. (2019). The impact of rotating work schedules, chronotype, and restless legs syndrome/Willis-Ekbom disease on sleep quality among female hospital nurses and midwives: A cross-sectional survey.International Journal of Nursing Studies, 95, 103-112. Web.

Vedaa, Ø., Pallesen, S., Waage, S., Bjorvatn, B., Sivertsen, B., Erevik, E., Svensen, E., & Harris, A. (2017). Short rest between shift intervals increases the risk of sick leave: A prospective registry study.Occupational and Environmental Medicine 74(7), 496-501. Web.

Wright, C., McCartt, P., Raines, D., & Oermann, M. H. (2017). Implementation and evaluation of self-scheduling in a hospital system. Journal for Nurses in Professional Development, 31(1), 19-24. Web.

Wynendaele, H., Gemmel, P., Pattyn, E., Myny, D., & Trybou, J. (2020). Systematic review: What is the impact of self-scheduling on the patient, nurse and organization?Journal of Advanced Nursing, 77(1), 47-82. Web.

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