Abstract
The most significant problem in the healthcare system is the shortage of nurses; this substantially impacts the recruitment and retention of nurses in hospitals and other healthcare facilities (Oulton, 2006). Nurses are vital healthcare professionals because they provide hospital direct patient care services. Therefore, healthcare quality in hospitals depends on nurses’ performance. When there is a shortage of nurses, the available nurses are overwhelmed, affecting their performance and leading to poor health care service delivery. This research will significantly focus on improving the health care work environment to attract and retain high-quality nurses in hospitals with the prime objective of improving healthcare outcomes.
Introduction
Currently, the healthcare industry faces a nursing shortage, which impacts nurse availability and patient care. There is a shortage of nurses when the demand for nurses exceeds the available supply of nurses. On the other hand, nursing turnover is when nurses voluntarily move or shift from one healthcare facility to another for better personal opportunities. As a result of high retention, some nurses leaving the field altogether, and a shortage of nurses, research has shown that the number of nurses within hospitals is gradually declining. This report is to address the possible causes of nurse shortages and retention. It also provides clear guidelines on how our nursing leaders and managers should address this problem. The report also tackles my point of view regarding this issue based on my professional and personal philosophy. To provide excellent patient care, healthcare organizations need fully involved, regular, and highly efficient staff. Nursing shortage and nurse retention have been an increasing and serious issue across the United States and the world. They are not expected to end soon, which has affected the performance and influence of patient outcomes.
Applied Business Research and Organizational Theory
In applied business research, high-quality research methodologies and tools are used to evaluate business problems, facilitate change, and provide valuable feedback to organization members (Gomes & Martins, 2016). Organizational issues that can be addressed with applied business research include performance issues, improvements in processes, gaps in education, and efficiency in the workplace. Research of this type is typically conducted by external consultants or internal members of the organization, and it requires diverse skills and strengths from the researchers (Payne & Leiter, 2013).
The study of organizational theory focuses on the effects of social relationships within an organization and the actions of its members. In addition, it examines the impact of a company’s internal and external environment, such as its political, legal, and cultural practices (Deem et al., 2015). Groups of individuals work together for a common purpose, performing tasks to accomplish the stated goal. As an organization, we apply the concept of synergy, which means that a team can accomplish more than any individual can. The research project I have chosen is based on the recent issues with staffing and, more specifically, nurses.
There was a significant shortage of nurses in the healthcare industry before COVID, but since COVID, it has exacerbated. For ABC Hospital, the patient-to-nurse ratio significantly affects the quality of care. In many cases, the high nurse-to-patient ratio impedes medical care delivery, and, in some cases, they may leave the hospital in worse shape than when they arrived. The organizational theory that closely aligns with the research choice is organizational support theory, one of the management theory (Baran et., 2012).
According to Organizational Support Theory, employees generally perceive the extent to which an organization values their contributions and cares about their well-being through their social and emotional needs (Baran et al., 2012). When employees perceive organizational support (POS), they feel compelled to help the organization achieve its objectives, feel committed to the organization, and expect improved performance will be rewarded. Performance outcomes of POS would include increased in-role and extra-role efforts and decreased stress and withdrawal behaviors, such as absenteeism and turnover.
Organizational Analytical Description Sources
The sources that I will use are the website for ABC Hospital, internal reports, annual reports, and the nurses.
Ethical Perspective
It is common for organizations to implement specific ethical codes that guide their operations and how those processes affect stakeholders overall. In the face of challenges and different day-to-day circumstances, these ethics may assist organizations in maintaining specific standards of accountability, responsibility, professionalism, and more (Iltis, 2001). Organizations that maintain these guidelines in their work often experience a variety of significant benefits which can enhance the lives of their employees, customers, leaders, and the public. While gathering information for this research, I will ensure that its integrity is consistently maintained according to Psalms 25:21 ” May integrity and uprightness protect me, because my hope is in you.”
Nurses Shortage: ABC Hospital, Texas
Analytical Description
Description
The organization chosen for the analysis is the ABC Center, located in Houston, Texas. The organization provides medical services in cancer treatment by conducting advanced scientific research in this field. During the last decade, the Center has been famous as one of the most progressive cancer-related organizations. The ABC Center was opened in 1941 as part of the University of Texas and centered on advancing clinical research and experimental treatment in the sphere of cancer (ABC center Alkek expansion, n.d.). The shortage of registered nurses is a problem caused by low salaries, the high workload, nursing taking travel positions, and professional responsibilities.
Milestones
The Center strives to provide high-quality treatment and research, expanding its possibilities and coverage. For example, the expansion program to Madrid, Spain, can be mentioned. Today, it is one of 41 cancer research centers listed by the National Cancer Institute. The ABC Center has 22,000 employees; 108 thousand patients registered per year (ABC cancer center Alkek expansion, n.d.). The organization continues to advance research and clinical practices in cancer treatment. There are many new up-and-coming projects on the horizon.
Stakeholders
The primary resources allocated for creating the Center were the fund created by Anderson and Clayton. The primary stakeholders of the Center are the funds such as Anderson’s and others. Moreover, a significant part of the budget was provided by the Texas State government. The relationships with stakeholders support the organization’s vision of providing governmental support for further research.
Problem Statement
The major problem that can be identified within the organization’s scope in relation to the nurses’ shortage issue is the significant layoffs and retention. This situation is caused by ABC’s decision to staff cutting by 1000 to avoid affecting the doctors (Ackerman, 2018). Such actions show the lack of reasonable HR practices in the sphere of nursing. The primary theory which can be the basis for the efficient analysis of the issue is structural empowerment in patient care (Idrees et al., 2018). It states that the nurses’ empowerment, motivation, and efficient leadership improve the quality of patient care (Idrees et al., 2018). The problem is essential because of the lack of high-quality and evolved nursing, causing the shortages to result in decreased quality of patient care. The problem was caused by the hospital’s position striving to preserve money for future research in cancer. At first, the stakeholders inside and outside the organization were against such limitations being afraid of the decreases in quality (Ackerman, 2018). The main issue is the shortage of nurses as well as being able to retain nurses.
Ethical Perspective
Such an attitude of the authorities undermines the role of nursing personnel as a mediator between patients and clinicians. The money-saving can be done in the more operational sphere, where the quality of care should not be limited. This issue affects the organization as a whole. The universal Retention and Success framework states that the nurse shortage caused by the lack of HR management and empowerment causes significant problems in patient care from a long-
time perspective (Jeffreys, 2020). Therefore, this problem must be addressed to formulate a respectful attitude toward the profession and minimize the shortage and retention problems.
Key Concepts for Literature Review
In light of the nursing positions in various health faculties, shortage and nursing retention are significant problems. Many relevant resources offer credible insights to explain the lack of nurses in most health institutions. These academic sources try to get the background information that leads to these shortages. In addition, these reviewed articles also offer some credible information regarding ways hospitals can maneuver around ensuring that nurses are retained, mainly concerning obtaining graduates (Ackerson & Stiles, 2018). Having the nurses would only create one major problem for the hospitals: adding another workforce to curb the shortage. The presence of depreciated human resource management can serve as one of the significant factors that lead to the nursing shortage. It is worth noting that this literature review focuses on the key concepts leading to the qualified nursing shortage. The key concepts include employee retention, aspects of apt conflict resolution, proper workflow, the hospital’s management system, and the entire organizational policies.
Literature Review
Employee Retention
Retaining the current nurse workforce proves to be a challenge in most hospitals. The idea of prospects such as better pay continuously drives most nurses in public hospitals to end up at private institutions. Therefore, public hospitals have less workforce to handle the patients. According to the various reviews, several attempts to retain the nursing workforce involve solving the issue from the top of the food chain. The idea that nurses are undervalued suggests that most governments do not see the importance of nurses in the healthcare delivery system (Hairr et al., 2014). Since most nurses know the idea of being undervalued, they leave their jobs for either better ones or a change in the course they engage in for better pay. Human resource management should be crucial in ensuring the nursing workforce is retained. The human resource’s sole duty is to provide a healthy relationship between the nurses and the entire organization. They should be in charge of noting the various issues of concern that the nurses try to raise before they get out of hand and decide to go for other jobs.
Apt Conflict Resolution
Most organizations can survive and last due to extraordinary measures of handling conflicts. Both locally and globally, organizations have conflicts that arise either between members of the workers and their employers. The nursing shortage can be linked to the fact that most hospitals do not have proper systems and ways to deal with disputes (Marć et al., 2018). Conflicts that might arise in the working environment include issues with a pay rise, patient-related quality standards in the type of treatment, or even the operating hours. These are just a few potential cases that might lead to conflicts within the organization. Most hospitals lack the proper ways to deal with these problems, which makes nurses need to look for better working environments (Wan, 2018). Retaining nurses becomes a significant problem, culminating in an increased workforce shortage.
Proper Workflow
Hospitals must always have a detailed schedule for taking care of the patients, which necessitates proper workflow. Patients stream the hospital at random times during the night and the day. Both doctors and nurses are always present to ensure that the patients receive the best health care in an emergency. The nursing shortage is attributed to the fact that most nurses get overworked in these hospital setups (Marć et al., 2018). The nurses work extensively and past their stipulated working hours, disrupting the workflow (Wan, 2018). Shortage of the nurses would mean that the nurses would be working when they are supposed to be taking a rest from their shifts. The primary concern is that they work extra shifts without any pay rise, making them leave their jobs for places that value proper workflow and provide better pay.
Hospital’s Management System
Another major cause leading to the nursing shortage is poor hospital management. A flawed management system would mean that issues regarding the nurses’ welfare are not discussed. Poor hospital management remains a global issue that is the primary factor behind the nursing shortage in most hospitals (Drennan & Ross, 2019). An organization that does not support the entire workforce is always subject to losing most of the crew (Keith et al., 2021). The nurses end up leaving this kind of hospital to go work for other employers who are willing to look after their needs. Neglecting their rights and demeaning them is a significant way most hospitals suffer from a nursing shortage.
Organizational Policies
Poor policies within an organization primarily drive the employees away. Lack of defined organizational policies that stipulate how an organization runs most definitely leads to nurses leaving for other serious institutions. Policies dictate compensations, relations, working environment, and different case scenarios that create a better and more conducive working environment (Keith et al., 2021). Poor strategies such as lack of compensation or even frequent recognition of highly performing nurses lead to losing the workforce to other institutions offering these privileges. Better policies hence attract the nurses to other institutions while at the same time creating a problem in shortage of the nursing workforce where they have left.
Synthesis of Reviewed Literature
In an attempt to review various literature concerning the shortage and retention of nurses, several articles provide perfect examples of the significant causes. In addition, these articles also give different credible remedies to each case involving a shortcoming that might lead to the shortage. The presence of a better hospital management system would mean that there would be better policies. Better policies, however, would mean better pay, and the workflow is distributed to the nurses according to shifts to give room for resting. In this manner, the hospital will retain the nurses and attract new staff (Gorman, 2019). Existing research denotes the various problems which are accurate in most hospitals. To create change, these health institutions must ensure that they meet all the criteria that will allow nursing workforce retention but not drive them away.
Ethical Perspective
The nurses are morally obligated to ensure that patients receive the utmost care that can be delivered. They must ensure that they uphold the safety of the patients and their co-workers. As much as the nurses work to better the patients’ lives, they also need the care to make this happen. There should be no doubt in catering to the needs of the nurses. In this manner, most nurses would feel their importance in a healthcare institution, leading to nursing retention and no nursing shortage (Gan, 2020). Hence in matters dealing with ethics, one must see just beyond the patients as they must also cater to the needs of the nurses. Nursing retention in most hospitals remains one of the challenges due to the various problems that lead to its occurrence (Niskala et al., 2020). Downgrading them and not respecting their views only create problems in the relationship between their employers and them. In the long run, healthcare institutions lack the proper workforce to care for patients in hospital institutions.
Methodology and Analysis of Data
Methodology
Applying an adequate methodology allows for conducting a credible study based on a sound framework and involving the necessary variables to analyze. This section will describe the key data collection algorithms utilized in the research project. Two types of information are used: secondary data, which are taken from good academic sources that raise the topic of nursing shortage and retention, and primary data obtained through interaction with real people. Data limitations will also be presented to represent the key deterrents in the data collection process.
Sources of Data
Secondary Data. Data was used from the website of my organization as well as internal reports. The academic research revealed the relevant trends and principles of workflow organization. Systems for forming team practices were considered through working environments (Patzold, 2013). Maintaining a stable organizational regime in the hospital was described through the organism’s unique framework and metaphor (Mathias, 1998). The specific setting was analyzed by using reports on the methods of organizing teamwork in different healthcare institutions.
Primary Data. Three 20-minute interviews were conducted remotely using Zoom as a primary data collection tool. Different employees were involved in the communication process, which made it possible to obtain distinctive views on specific aspects of the nursing shortage, particularly retention features. A specific question was put to the respondents, which helped receive and analyze unambiguous answers and review the positions concerning the stated issue. The employees both interacted with each other and solved problems individually. Most of them used smartphones for calls and correspondence on skype and teams. Managers set tasks for the staff. Teams of nurses, midlevel’s and doctors acted together in the workrooms. The doctors, Midlevel’s, and nurses discussed urgent tasks to be performed, which indicated a successful collaboration.
Data Limitations
One of the main limitations was the poor engagement with the respondents involved due to the current COVID-19 pandemic. The inability to conduct conversations in person distorted the participants’ actual positions on the stated issue. Another limitation was the inability to organize group meetings, which would have been helpful for complete coverage of the topic raised. Finally, time constraints in data collection were a barrier to an efficient research process.
Analysis of Data
The information obtained from observations and interviews was compiled and coded to analyze the available qualitative data. Appropriate interpretation approaches were drawn from the academic literature, such as the Collaboration Quality Scoring Scheme proposed by Balser, Grabau, Kniess, and Page (2017). Developing a comprehensive understanding of the issue raised, the triangulation method was designed to apply adequate mechanisms for interpreting the information collected based on the chosen approach, particularly the qualitative method. Table 1 summarizes the key findings concerning the topics identified, divided into data from observations and interviews. Making associations between reported variables is a convenient way to evaluate collaboration practices promoted in the given institution and assess employee choices regarding organizational behaviors (Srivastava & Banaji, 2011).
Table 1: Thematical Data Analysis
Ethical Perspective
The participants agreed to the interviews voluntarily and were informed that their positions would be disclosed. No personal information was provided to maintain confidentiality during the research process. The principles of business ethics were observed to prevent the distortion of the collected information and not to force the respondents to withhold the necessary data deliberately. Each interviewee was advised that their responses would be interpreted and compiled to provide an overall picture of the issues under consideration.
Study Analysis: Discussion and Recommendations
Discussion of Findings
The study explored recent staffing issues among nurses in ABC Center in Houston, Texas. The selected organization focuses on cancer treatment and research and has been perceived as one of the most prominent cancer-related establishments. Nonetheless, data gathered upon assessing the Center suggests that the institution lacks adequate human resources practices, which has resulted in a shortage of registered nurses in addition, to a high patient-nurse ratio, a high negative impact on patient care, and a lack of employee motivation by way of proper reward. Accordingly, the research’s key findings are that the Center’s problem is interconnected with employee retention, workflow and workload, and collaboration. The listed findings can be regarded as concepts and correspond with some terms from the study’s literature review but should be discussed more to explain the topic better.
Retention
Employee retention is a significant challenge for various organizations, including healthcare systems. Nurse retention refers to the extent to which nurses remain in their positions and is associated with motivation and intention (Efendi et al., 2019). The concept is essential because nurse retention affects individual specialists, healthcare establishments, patients, and various communities (Efendi et al., 2019). Nonetheless, as discussed in the study’s literature review, nurses are often undervalued, especially by the management of public hospitals (Hairr et al., 2014). Notably, as mentioned in the dialog forum posts from Week 3, many staff members at the study hospital understand the importance of retention, which indicates that the ABC center has opportunities for improvement.
Workflow and Workload
One of the concepts explored in the study’s literature review is the workflow. It is based on a detailed schedule for all employees and is disrupted when nurses are pushed to perform extensively and past their stipulated hours (Wan et al., 2018). The idea of workflow is closely related to workload, as the former can impact the latter through such unpredictable events as patient emergencies and examinations (Ivziku et al., 2021). The phenomenon refers to the quantity of time and cares that nursing specialists devote to patients, colleagues, and personal professional development (Ivziku et al., 2021). Consequently, a high workload and unstable workflow are interconnected and represent staffing issues in healthcare organizations.
Collaboration
A valuable concept identified in the study and discussed in dialog forum posts is collaboration. The term is essential for healthcare professionals because it creates synergy and facilitates efficient, safe, and high-quality patient care (Wei et al., 2019). As noted in a discussion post from week 4, collaboration is closely connected to trust, and together they can generate a culture of caring and promote better patient outcomes (Wei et al., 2019). Collaboration is one of the primary findings of the present research, which reflects the relationships between nurses, middle-level employees, and doctors in the Center.
Recommendations
Recommendations for Organization
Several recommendations can be applied to the organization’s leaders reviewed in the study. Moreover, it concerns similar institutions alongside organizational teams and individuals. It is vital to regularly assess internal operations and the effectiveness of human resources practices. It helps to detect any issues that may affect employees, patients, or customers. The executives should be mindful when making decisions that concern the number of staff members required to accomplish specific tasks because inadequate resolutions may cause a high workload and low performance. Top managers should implement policies that would facilitate employee collaboration to ensure that workers continually interact with each other toward satisfactory patient outcomes. Team members and individuals, such as physicians and nursing supervisors, should be encouraged to detect and voice problems that may impact the quality of work to make timely interventions and prevent significant issues. The suggestions are meant to remind organizations that they should be aware of and prepared to overcome challenges resulting from faulty decisions.
Recommendations for Business Researchers
Business researchers should consider the following recommendations when exploring institutions and matters related to the healthcare system and human resources. Organizational scholars should examine enough literature on their subject to ensure that they have a basis for understanding their topics. Researchers should think critically and explore more than one side of a case because each involved party will likely have a distinct perspective. Business scholars should provide clear conclusions based on analyzing obtained information to suggest how their findings can be utilized in resolving certain matters or broadening specific discussions. Organizational researchers should collaborate with peers to assess the final papers and evaluate chosen methods and insights to detect missteps or prevent conflicts. By following the proposed recommendations, business scholars can potentially improve the quality of their work. This can be done by assuring that their studies have theoretical backgrounds, consider several aspects of a matter, and offer ways to apply results, thereby making theoretically sound and meaningful contributions to the knowledge base.
Ethical Perspective
All organizations, including those in the healthcare system, should strive to satisfy their customers and patients and meet their employees’ needs. Whether in lower- or higher-ranking positions, staff members should not be viewed as a mere means to an end. Executives must behave ethically and understand that all workers are essential in accomplishing goals and achieving satisfactory performance. Consequently, nurses’ contributions should not be compared to or undermined by other specialists within the scope of the medical field.
Conclusion
In conclusion, the current nursing shortage at ABC Hospital in the U.S. and worldwide is of grave concern and a significant stressor in the healthcare industry. With the nursing shortages that the nation faces, the retention of nurses is essential. The nursing shortage is real and is also considerably known to have gotten worse. There is no single strategy for curing such a crisis. The nursing shortage is a multifaceted issue that requires a multiple-pronged approach. As healthcare needs continue rising with a growing population and deteriorating lifestyles, interventions must address current and future shortages. Nurses are migrating from one state or country to another because of population expansion, a desire for a better wage, and involvement in a better working environment, resulting in a rise in the demand for attracting and retaining nurses in every hospital (Gan, 2020). It is, therefore, the mandate of the healthcare system to implement the solutions and come up with a better plan to accommodate all nurses happily.
References
Ackerman, T. (2018). MD Anderson cutting staff by 1,000 workers via layoff, retirement. Chron. Web.
Ackerson, K., & Stiles, K. A. (2018). Value of nurse residency programs in retaining new graduate nurses and their potential effect on the nursing shortage. The Journal of Continuing Education in Nursing, 49(6), 282–288. Web.
Balser, T. J., Grabau, A. A., Kniess, D., & Page, L. A. (2017). Collaboration and communication. New Directions for Institutional Research, 2017(175), 65-79.
Baran, B. E., Shanock, L. R., & Miller, L. R. (2012). Advancing organizational support theory into the twenty-first century world of work. Journal of Business and Psychology, 27(2), 123–147.
Deem, J. W., DeLotell, P. J., & Kelly, K. (2015). The relationship of employee status to organizational culture and organizational effectiveness. International Journal of Educational Management, 29(5), 563–581. Web.
Drennan, V. M., & Ross, F. (2019). Global nurse shortages: The facts, the impact and action for change. British Medical Bulletin, 130(1), 25-37. Web.
Efendi, F., Kurniati, A., Bushy, A., & Gunawan, J. (2019). Concept analysis of nurse retention. Nursing & Health Sciences, 21(4), 422-427. Web.
Gan, I. (2020). A scoping review of the nursing workforce’s changing demography: Supporting Baby‐Boomer nurses. Journal of Nursing Management, 28(7), 1473–1480. Web.
Gomes, O., & Martins Hélder Fanha. (2016). Advances in applied business research (Ser. Business economics in a rapidly-changing world). Nova Science Publishers. Web.
Gorman, V. L.-A. (2019). Future emergency nursing workforce: What the evidence is telling us. Journal of Emergency Nursing, 45(2), 132–136. Web.
Hairr, D. C., Salisbury, H., Johannsson, M., & Redfern-Vance, N. (2014). Nurse staffing and the relationship to job satisfaction and retention. Nursing Economics, 32(3), 142-147.
Hairr, D., Redfern-Vance, N., Johannsson, M., & Salisbury, H. (2014). Nurse staffing and the relationship to job satisfaction and retention. Nursing economic$. Web.
Idrees, S., Shah, Z., & Zafar, M. (2018). Magnet model: A strategy to overcome/defeat nursing shortage. International Journal of Scientific & Engineering Research, 9(5), 1844–26. Web.
Iltis, A. S. (2001). Organizational ethics and institutional integrity. Hec Forum: Healthcare Ethics Committee Forum: An Interprofessional Journal on Healthcare Institutions’ Ethical and Legal Issues, 13(4), 317–328. Web.
Ivziku, D., Ferramosca, F. M. P., Filomeno, L., Gualandi, R., De Maria, M., & Tartaglini, D. (2021). Defining nursing workload predictors: A pilot study. Journal of Nursing Management, 30(2), 473-481. Web.
Jeffreys, M. (2020). Nursing universal retention and success (NURS) model: A holistic, discipline-focused framework. Journal of College Student Retention: Research, Theory & Practice, 1–26. Web.
Keith, A. C., Warshawsky, N., & Talbert, S. (2021). Factors That Influence Millennial Generation Nurses’ Intention to Stay. JONA: The Journal of Nursing Administration, 51(4), 220–226. Web.
Mathias, T. A. (1998). Metaphor and organizations. Management and Labour Studies, 23(4), 520-520.
MD Anderson cancer center Alkek expansion. (n.d.). McCarthy. Web.
MD Anderson cancer center. (n.d.). Glassdoor. Web.
Oulton, J. A. (2006). The global nursing shortage: An overview of issues and actions. Policy, Politics, & Nursing Practice, 7(3). Web.
Patzold, H. (2013). Images of the school – Images of the organization. Research on Stein Education, 4(1), 111-122.
Payne, J., & Leiter, J. (2013). Structuring agency: examining healthcare management in the USA and Australia using organizational theory. Journal of Health, Organization and Management, 27(1), 106–126. Web.
Srivastava, S., & Banaji, M. (2011). Culture, cognition, and collaborative networks in organizations. American Sociological Review, 76(2), 207-233.
Wan, Q., Zhou, W., Li, Z., Shang, S., & Yu, F. (2018). Work engagement and its predictors in registered nurses: A cross-sectional design. Nursing & Health Sciences, 20(4), 415–421. Web.
Wei, H., Corbett, R. W., Ray, J., & Wei, T. L. (2019). A culture of caring: The essence of healthcare interprofessional collaboration. Journal of Interprofessional Care, 34(3), 324-331. Web.
Zondervan. (2014). New International Version Reference Bible.