Nurse Turnover/Retention in the ED
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Nurse Turnover/Retention in the ED
Most health care establishments are experiencing nurse shortages. Like other healthcare organizations, the retention and staffing of nurses is a primary concern in emergency departments. Nurse turnover intent in emergency departments has adverse effects on patient health outcomes and staff morale. Additionally, nurse turnover lowers the quality of patient care and the productivity of the organization; thus, it is costly. Usually, health care organizations need more money for every nurse turnover. Hence, emergency departments use different strategies to retain and attract more nurses. Still, a few of the departments have successfully attained nurse retention through the various application of retention interventions. Most of the nurse retention strategies highlight on reducing nurse burnout through self- administered resilience programs.
Background
Numerous aspects affect job satisfaction of nurses, which in turn impacts the levels of nurse retention and turnover. Studies have demonstrated that elements such as flexibility and autonomy in scheduling emergency health care, workplace violence, and having fewer years of work experience are interconnected with job satisfaction. Job satisfaction is a vital forecaster of nurse turnover retention. Generally, high job dissatisfaction and low job satisfaction are the primary predictors of nurse retention. As most emergency departments strive to address the factors on nurse turnover intent, studies illustrate that nurses’ job satisfaction is projected by interactions with workplace violence and justice. Years of experience was an additional variable that impacted nurse turnover intent (Bruyneel et al., 2017). Since the demand for nurses will increase in emergency departments, job satisfaction should be a primary priority to lower intention to leave. For optimal job satisfaction, individual levels of resilience had significant benefits in improving patient outcomes and nurse retention rates.
Clinical problem statement
Healthcare organizations in the United States and worldwide experience difficulties in meeting quality objectives because of suboptimal nurse retention and high turnover. Since the need for
more ED nurses grow due to the ever-increasing number of emergency patients, the resilience of nurses, and nurse staffing becomes a primary concern. The turnover of nurses in emergency departments is the highest among all nurses, and this likely highlights the increased stress and potentially the nurses. Most emergency department nurses undergo high levels of stress; hence, these issues reflect the significance of nurse resilience as a potential intervention to increase intention and reduce nurse turnover (Bruyneel et al., 2017). Nurse turnover is interrelated to job satisfaction, the resilient aspects of nurses, and the features of the workplace setting. Moreover, the low turnover of nurses directly contributes to high-quality patient care. Higher levels of job satisfaction, in combination with decreased nurse turnover, have been correlated as a vital variable that predicts best patient outcomes, patient satisfaction, and quality care. Increased nursing turnover and nursing shortages that result from turnover are significant as the situation is associated with disruption to the highest quality of patient care. These factors elaborate the significance of nurse resilience as a prospective intervention to reduce nurse turnover and increase intention, with particular impacts in relation to the nursing needs of patients in the ED when nurse to patient ratios are suboptimal.
Purpose of Change Proposal in Relation to Changing Healthcare Health System
The Capstone project’s purpose was to focus on an intervention to support the resilience of nurses, with the potential to lead to better organization work settings, nurse job satisfaction, lower turnover with higher retention rates, and better patient outcomes. The critical purpose of this project was to implement and assess self- administered resilience programs to improve the experience of workplace settings and job satisfaction.
PICOT Question
For emergency department nurses (P), is an interactive but self-delivered resilience support program (I) effective in comparison to the pre-intervention status (C) when delivered as an interactive online program over a five-week period (T) as indicated by a significant improvement in the measured resilience level (O)?
To identify some of the issues affecting nurses who work in the ED the following PICOT Question was
Population: Nurses who work in the emergency department
Intervention: Program to identify levels of resilience among nurses
Comparison: Measuring resilience before the intervention and after the intervention
Outcome: Resilience in nurses will increase in response to the intervention method
Time: Five weeks
Literature Search Strategy Employed
A literature search strategy was employed through the PICOT question. The designated population of interest was nurses working in the emergency departments. These nurses have a goal of providing high-quality patient care; however, the capacity to achieve this is dependent on having a sufficient number of nurses who are engaged with their work and satisfied with their jobs. The turnover intention of nurses in the ED is the highest in all areas of nursing. Factors identified in the research literature that can increase the intention to leave of nurses include workplace violence, a lack of perceived fairness and justice in the workplace environment, and having fewer years of experience (Bruyneel et al., 2017). What these factors have in common is that they are disruptive to individual wellness and job satisfaction for nurses. Nurse resilience strategies could contribute to reduced nurse turnover, an improved workplace environment, increased nurse satisfaction, and the components needed for the delivery of quality patient care.
Evaluation of the Literature
Nurses who work in emergency departments (EDs) face significant obstacles and challenges with their patients that may contribute to high rates of turnover and require greater strength and courage among nurses. Studies have reported that resilience is essential for nurses to alleviate stress and to minimize some of the risks related to traumas that require emergency care. The purpose of this discussion was to engage nurse leaders regarding the importance of interventions to increase resilience and maintain high-quality care for patients in the emergency department work environment. From the evaluation of the studies, each article had strengths in addressing some of the critical issues affecting nurses in emergency departments and how they responded to adversity and developed resilience. Still, the studies from the literature evaluation were limited due to a small number of participants and the potential for outcomes that are not widely applicable (Schmidt & Haglund, 2017. Future studies that address the adversities that ED nurses face should include an expanded discussion of resilience and the effects on nurses working in high-stress environments. Nurses should be provided with interventions that will effectively address their complex needs and will encourage them to take the steps required to improve their wellbeing.
Applicable Change or Nursing Theory Utilized
Areas of stress and the risk of burnout are likely very high among ED nurses. Therefore, they require significant support and guidance from leaders and colleagues to address areas of strength and weakness while facilitating workplace environment changes that will strengthen their resilience. Also, this increases their willingness to expand their roles to accommodate patients requiring high-quality treatment and care (Delgado et al., 2017). Nurse leaders create the conditions for nursing interventions since there is a relationship to nurse leadership, education, and quality improvement at the secondary level. Hence, an intervention to support resilience is likely to include a nursing education component and further the intention of nurse turnover reduction to create the conditions for the highest quality patient care quality.
Proposed Implementation Plans with Outcome Measures
The program was implemented through the use of Mindfulness-Based Cognitive Therapy since it is a form of cognitive therapy that underscores mindfulness practices such as meditation and breathing exercises. With the MBTC design, nurses would be taught how to break away from negative thought patterns and fight depression. This design was to be implemented once per week, two-hour sessions, and conducted from eight weeks. Additionally, to facilitate patient care and ensure that appropriate interventions are utilized in the provision of care services, nurse engagements were improved. For example, when the ED department focuses on improving nurse engagement, clinicians in the unit will provide effective care to the patient; thus, leading to the achievement of positive healthcare outcomes (Conley, 2018). This is the case because engaged nurses in the ED would inspire and help them create better patient outcomes and improved perception toward care practices.
How Evidence-Based Practice was used in Creating an Intervention Plan
When work interferes with individual nurse wellness and job satisfaction, this manifests as higher levels of turnover (Li et al., 2019). A crucial mediating factor in the intention to leave of nurses has been identified in the research as including a personal level of resilience. Intervention opportunities with promising results have included change initiatives that focus on culture, emotional labor, and leadership as essential variables to support nurse retention through job satisfaction and wellness in clinical environments. A primary mediating factor in the intention to leave of nurses has been identified in the research as including a personal level of resilience. Aspects of resilience include less risk of nurse burnout, a higher level of engagement, and greater wellness. Hence, it was a promising strategy as an implementation plan with positive impacts for nurses, patients, and quality care delivery.
Plan for Evaluating the Proposed Nursing Intervention
A self-administered resilience program was to be conducted to improve the depressive states of the ED nurses. The nurses will be exposed to learning mediation techniques, and the basic principles of cognition—including the relationship between how an individual thinks and how they feel. Additionally, they will further be provided with the opportunity to learn about their depressive condition and questioned on their states. Also, Mindful meditation would be introduced with breathing exercises to help the nurses break away from negative thought patterns that could spiral into depression.
Identification of potential barriers to plan implementation and how these could be
The implementation plan had several barriers. While Mindful Based Cognitive Therapy has proven efficiency, some challenges with the setting include session timing, homework assignments, and travel issues. About session timing, respective nurses have preferences on the best time for implementing the program. Equally, homework assignments are part of MBCT; however, concerns have been reported about shift lengths, consecutive shifts, and physical fatigue after shifts.
References
Bruyneel, L., Thoelen, T., Adriaenssens, J., & Sermeus, W. (2017). Emergency room nurses’ pathway to turnover intention: A moderated serial mediation analysis. Journal of Advanced Nursing, 73(4), pp. 930-942. https://doi.org/10.1111/jan.13188
Conley, Karen A. “Nurse Manager Engagement: Strategies to Enhance and Maintain Engagement.” The Journal of Nursing Administration, vol. 47, no. 9, 2017, pp. 454-7.
Delgado, C., Upton, D., Ranse, K., Furness, T., & Foster, K. (2017). Nurses’ resilience and
The emotional labor of nursing work: An integrative review of the empirical literature. International Journal of Nursing Studies, 70, 71-88.
Li, N., Zhang, L., Xiao, G., Chen, J., & Lu, Q. (2019). The relationship between workplace violence, job satisfaction, and turnover intention in emergency nurses. International emergency nursing, 45, pp. 50-55. https://doi.org/10.1016/j.ienj.2019.02.001
Schmidt, M., & Haglund, K. (2017). Debrief in emergency departments to improve compassion fatigue and promote resiliency. Journal of Trauma Nursing, 24(5), 317-322.