Hi Lili Annotated Bibliography

According to Suzanne Gordon “ whether young or old, nurses are disillusioned because they believe that health care systems guided by bottom-line concerns simply don’t recognize the specificity of their work” (234). Nursing is more demanding than many other professions or occupations, due to the combination of difficult patients, exhausting schedules and arduous physical work (Gordon 235). It can take a significant emotional toll on many, hence the higher levels of burnout. Job dissatisfaction as a result of increased workloads and unreasonable demands, such as inappropriate nurse staffing levels, was cited as the number one reason that drives many experienced nurses to leave the profession (Sanford 38+). Studies have shown that such working conditions also affected the retention of new graduate nurses by leaving their first hospital jobs within two years of graduating (Sanford 38+).

There are many challenges facing today’s nursing leaders and managers. From staffing and scheduling, to budget cuts and reduced reimbursements, today’s nursing leaders must evolve to meet the ever changing health care environment. Constance Schmidt, Chief Nursing Officer at Cheyenne Regional Medical Center (CRMC), identified retaining experienced registered nurses (RN) as one of the biggest problems she faces as a nursing leader. She went on to state “Nationally, most hospitals have more than 60% of their nurses with at least 5 years of experience. At CRMC, it’s the reverse. We have more than 60% of our nurses with less than 5 years of experience” (personal communication, March 28, 2014). The two largest factors affecting those numbers are the nursing shortage and nursing retention. The first, the nursing shortage, was identified years ago and has been researched countless times. Some projections indicate the number representing the gap between available registered nurses, and the positions needing to be filled, could be over a million before the end of the current decade. The latter, retention of nurses, is a problem in every health care facility in the nation. Nursing turnover results in both a significant financial cost to hospitals, and a significant impact on the community through its effects on patient outcome.

Staff satisfaction is empirical in retention of nurses in any healthcare setting. Although a slight turnover is necessary to maintain the diversity of ideas, too much of it causes instability that might affect patient and employee satisfaction negatively (Marquis & Huston, 2015). The planned change is to be executed at a small, private hospital (SPH) in Los Angeles with a 200-bed capacity, which offers emergency and medical-surgical services for adults. After a six-week hospital orientation, only 20% of new RNs hired at SPH in 2015 rated their confidence levels at >70% (Appendix A). Out of 32 new hires, 7 left during orientation, and 12 left before reaching 1 year- leading to 41% retention or a 59% turnover (Appendix B). The RN turnover of SPH is thrice the

The cost to train new nurses becomes so enormous for hospitals it would be much smarter to figure out why new nurses are leaving and provide tools to assist new nurses with their transition. Looking at reasons NGRN leave their new chosen profession seems simple enough find out what it is that decreases job satisfaction and fix it. One study looked at burnout in new nurses and possible causes, they looked at workplace environment, workplace incivility and empowerment.(Spence Laschinger et al., 2009) They found

A positive force for change centers on the nurse’s strong desire to change current practices. The combination of the turnover rate, low morale, and higher percentage of new nurses, is the driving

The main purpose of this article is to examine various research on the etiology of stuttering. The experimental research explored various brain circuitries involved, specifically the the basal ganglia. Furthermore, the meta-analysis discussed neuroimaging, lesion, pharmacological, and genetic studies on the neural circuitries connected to persistent developmental stuttering and acquired neurogenic stuttering.

The nursing shortage in healthcare has been a highlighted issue for many years. With the ever-growing health care system, hospitals and healthcare facilities often find themselves searching for ways to acquire new nurses and retain their very own. Throughout the years, the number one solution to this problem remains the same: decreasing nurse turnover, and increasing nurse retention. This paper discusses the causes of high nurse turnover rate, the negative effects on health care, and ways to improve the turnover rate.

The expense of losing an experienced nurse can be costly to the hospital. Not to mention the nursing knowledge and skills. Estimates of the actual dollar amount incurred by nurse turnover range from 10 to 20 thousand dollars per nurse to as much as well over the nurse’s yearly salary. According to Anderson (2004), Nurse Executives estimate that “…visible costs represent only 24 percent of total costs for medical/surgical nurses and only 18 percent for specialty nurses. A true total cost of $42,000 per medical/ surgical RN and $64,000 per specialty nurse is more close to reality.” Turnover costs, average approximately $47,403 per medical/surgical RN and $85,197 for specialty RNs. “A 400-nurse hospital with a 20 percent turnover rate is replacing 80 nurses per year. The direct costs might average $800,000 per year, but

“High rates of staff turnover in nursing homes is not a recent phenomenon. As far back as the mid-1970s studies have documented average turnover rates for registered nurses (RNs), licensed vocational nurses (LVNs) and certified nurse’s aides (CNAs) ranging between 55% and 75%” (Mor,V., Mukamel, D.B., & Spector,W. D. 2009, 1). Long term care facilities (LTC) have staffing issues related to the high turnover of licensed staff. The effect can have a heavy financial burden and also affect the care given to residents. Many ask the question why is it hard to attract and keep nurses at a long term facility. The International

Willcox, C. and Willcox, B., 2009, ‘FOXO3A Genotype and Human Longevity: The New APOE?’ Japanese Journal of Anti-Aging Medicine, vol 5, no.6, pp.804-809.

Retaining a stable and sufficient supply of nurses is an important hospital and nationwide concern. Numerous factors affecting retention of registered nurses comprises of practice autonomy, managerial respect, workload, and inclusion in decision making, flexible schedules, education, and pay (“Recruitment”, 2013). Hospitals not capable of retaining qualified registered nurses may result in the loss of experienced and knowledgeable staff. Additionally this will lower hospital productivity during this transition. High turnover rates for registered nursing staff may also impact job fulfillment and nursing moral altogether. Retaining qualified registered nurses will enhance patient care quality and satisfaction.

The broad research problem leading to this study is the belief that nursing shortage in facilities leads to patient safety issues. The review of available literature on this topic shows strong evidence that lower nurse staffing levels in hospitals are associated with worse patient outcomes. Some of these outcomes include very high patient to nurse ratio, fatigue for nurses leading to costly medical mistakes, social environment, nursing staff attrition from the most affected facilities. The study specifically attempts to find a way to understand how nurse

With the ongoing changes in the healthcare field, nursing workforce retention presents itself as one of the greatest challenges facing healthcare systems today. According to the American Nursing Association, nursing turnover is a multi-faceted issue which impacts the financial stability of the facility, the quality of patient care and has a direct affect on the other members of the nursing staff (ANA, 2014). The cost to replace a nurse in a healthcare facility ranges between $62,100 to $67,100 (ANA, 2014). The rising problem with nursing retention will intensify the nursing shortage, which has been projected to affect the entire nation, not just isolated areas of the country, gradually increasing in its scope from 2009 to 2030 (Rosseter,

Hospitals nationwide are experiencing nurse shortage and increased workloads because of shorter hospital stays, fewer support resources and higher acuity in patients (Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D., 2004). Higher nurse workloads are directly associated with job burnout and job dissatisfaction which in turn causes more voluntary nurse turnover and relates to the increased nursing shortage. According to the Missouri Hospital Association the turnover rate of nurses has increased by fourteen percent in the last five years (Browning M., 2012). Nursing shortage is a real threat to the patient population. According to the Quality Health Outcomes Model by the American Academy of Nursing by Donabedian, effects of the healthcare interventions are characterized by the environment the staff works in (Vahey et al., 2004). Donabedian describes that quality metrics can be divided into three broad categories, structural, process, and clinical.

Nurse turnover is defined as “the number of nurses changing jobs within an organization or leaving an organization within a given year” (Baumann 2010). Retaining nurses is one of the most important issues in health care as its effects range from challenges in human resource planning, to high costs in financial and organizational productivity (Beecroft et al, 2008), to workgroup processes and morale, to patient safety and quality of care (i.e. patient satisfaction, length of patient stay, patient falls, and medication errors) (Bae et al, 2010). Nursing Solutions Inc (NSI) reported the national average turnover rate for hospitals increased from 13.5% in 2012 to 14.7% last year. Nurses working in Med/Surg had more turnover