Framework to Resolve Nursing Staffing

Introduction

In healthcare practice, job satisfaction has been an issue that affect the quality of care provided to the patients. The nursing practitioners have been noted to be largely affected by job overload that leads to frustration and job dissatisfaction. Job dissatisfaction in return leads to high turn-over rate and thereby leading to inadequate staff. The effects of this issues trickle down to the organization as the remaining nurses are overworked with extra task. The measures of nurses’ workload are categorized into unit level, patient level, and situation level. Studies have revealed a relationship between working conditions for nurses, job dissatisfaction and high workload. It has been established that job dissatisfaction causes low morale, the poor job performance, high rates of absenteeism thereby negatively affecting the level of patient of quality care and the attainment of the long-term objectives of the organization (Harrington et al. 2015).

Nurse staffing is a critical issue facing many healthcare organizations. Healthcare facility have been noted to be struggling to maintain the recommended a nurse-to-patient ratios. Health care facility administrators have been known use reduction of staff as the most cost-effective measure. A study carried out in 2002 indicated that the nurse understaffing was among the largest threats to patient safety in the United States (Harrington et al. 2015). This prompted the American Nurse Association to give proposals for development of laws and regulations. California was noted to be among the first states to officially establish laws requiring a minimum registered nurse to patient ratio in healthcare facilities. 

The issue of nursing staff has mainly been associated with the issue on financial conditions and uncertainty. The financial uncertainty has been linked with factors such as low reimbursements from payers, higher acuity patient, and stiff competition. The nurse’s wages being among the largest cost centers, most hospital tends to minimize the number nurses and as a strategy to cut down on costs and increase profitability. The issue on nurse staffing has been linked on patient outcomes such as rescue, mortality, and hospital falls. Nurses engaged in healthcare facilities with excess workloads have been noted to experience burnout and dissatisfaction. 

An analysis into the state of California reveal the success story of having establishing laws in nurse-to-patient rations. It has been reported increments in the satisfaction of nurses within the states. The outcomes for nurses and patients were noted to have improved. Facilities located in California have experience a reduction in job dissatisfaction and nurse burnout. It can therefore be established that there need to develop and implement a solution to deal with the strategic issue. 

Identification and Selection of Strategic Management Approach

To address the issue of nursing staffing, it is important to consider both the supply and demand side of the issue. The issues that need to be addressed on the supply issue include enhancing the recruitment process, retention and return-getting, and managing the relative scarce nurse. Research has indicated that nurses are attracted to work in and remain in facilitates that offer a path to professional development, attain autonomy, be engaged in the decision-making process, and getting fair remuneration (Buchan & Calman, 2006). The nurses are influenced by factors related with the work environment especially on the need for a decentralized style of management, flexible employment opportunities, and access to chances for professional development and these lead to improvement of retention of nursing staff and patient care. An approach that may be taken to increase the recruitment scope entails widening recruitment base through accessing a broader range of recruits who may be comprised of: mature entrants, entrants from ethnic minorities, recruits with vocational qualifications or work-based experience. Another aspect of the recruitment process that may be considered in expanding the supply of workers is on international recruitment (Buchan, & Aiken, 2008). This has seen the developed countries exploit the push factors where nurses from developing countries are found to be willing to cross national borders. This is trends is facilitated by factors such as low pay, poor career growth plans, lack of opportunities for professional development, and in some areas, threat of violence (Buchan, & Aiken, 2008).  

Another issue that is important in this case is on the demand challenges. This seeks to recognize that healthcare facilities are labor intensive thereby calling for the need of utilizing the available nursing resources effectively. The issue of nursing staffing is not just focused on the shortage numbers but entails the means by which health system functions can enable the nurses to utilize their skills effectively. This requires the healthcare facilities to align their workforce planning capacity across occupations and disciplines to ensure that they can identify skills and roles that will be sufficient to fulfill the identified service needs. This calls for the need to enhance the daily routine matching of the nurse staffing workload. The healthcare facilities need to ensure that there is flexibility to ensure working patterns that are efficient and allows the nurses an opportunity to strike a balance between work and personal life (Buchan, & Aiken, 2008). 

A key framework recommended to deal with the strategic issue on nursing staff is the leadership adopted in various healthcare facilities. This remedial action is effective since it has more direct effects to the nurses extending to areas that policies on nurse-patient ratio cannot influence. Leadership is noted to be essential for nurses at all levels. Leadership is defined as a multifaceted process aimed at identifying a goal, motivating people to act accordingly, offer support and motivation to achieve mutually agreed goals. Leadership differs from management functions that involves doing things right as opposed to leadership that involves doing the right things. Management is concerned about tasks whereas leadership is concerned with perception, judgement, skill, and philosophy. In nursing, leadership is concerned with coordinating the operations of the nurse in various shifts, and supporting the staff while on duty. 

To deal with the issue of the nursing staff the people entrusted with the leadership position are required to exhibit characteristics of an effective leaders. Leaders are in most cases described as a visionary, equipped with strategies, and with a plan and urge to direct their teams to offers services to attain a future goal (Frankel, 2018). Effective leaders are expected to use problem-solving processes, maintain group effectiveness, and acquire group identification. The leaders should be flexible, full of passion, and with motivational influence on others. The nurses in leadership position are required to apply these characteristics in carrying out their duties. This facilitates them to gain the respect and trust of the team members and guide the development of the clinical practice (Frankel, 2018). Nurse leaders who are able to demonstrate effective leadership styles are in a position to influence the successful development of the nursing staff, are able to make sure that there is adherence to professional standards as well as achieve the stable growth of competent nurse practitioners. Leaders have been described as driving forces of those that they leader, are a source of inspiration, and act as role models to the nurse staff. The nurses in leadership position are tasked with primarily roles of; making decisions, delegation of duties and distribution of workload, dealing with arising conflict, and promoting integrity. Effective nurse leaders are involved in the process of nurturing other nurses and supporting them emotionally. These functions are deemed to be important to connect the leadership with effective development of the nurse staff (Frankel, 2018). The leader is able to achieve this through mentoring and coaching of the nurses. The mentorship roles facilitate learning opportunities for the nurses and as well as support the framework for supervision and assessment of nursing staff in staffing practice. leader who satisfy these roles are described as teacher, supporter, coach, facilitator, assessor, role model, and supervisor (Frankel, 2018). An effective leadership is able to demonstrate in the action the phrase that states, “Don’t just tell me-show me” Such leader is able to facilitate the provision of instructions to the team. The nurse staff get support from their leaders in understanding how to deal with tasks. such a culture based on continual learning is noted to be a best practice that empowers and motivate the staff. This improve the job satisfaction of the nurses hence minimizing the rate of nursing staff turnover (Frankel, 2018). In such a case, the healthcare facilities are able to maintain an ample workforce that satisfies the nurse-patient ratio. A leadership model that fits the description of the leadership model described above is transformational leadership.

Transformational Leadership Model 

Effective nursing leadership is a key tool in provision of healthcare. Traditionally, nurses have indicated to be over-managed and inadequately led which has been a main cause of unprecedented challenges and opportunities. The healthcare organizations are increase becoming dynamic and thereby demanding the need of adaptive flexible leadership. Transformational leadership fits as the perfect leadership theory that can help deal with the issue of nursing staffing. Transformational leaders are described as a leadership model that focuses on the process to motivate followers through appealing to higher perspectives moral positions where the leader has a strong sense of internal values and ideas thereby motivating the followers to act in a manner yields to greater good as opposed to attaining their own interest (Doody, & Doody, 2012). It is observed that transformational leaders operate in such a manner that it makes it safe for staff to operate, think beyond the boundaries, enhance process of energy, creativity, innovation. The transformational leadership model is considered as effective model that allow it to identify the need of offering reward and ensuring that it provides a room of attainment of higher needs of the follower by engaging into the nurses emotionally and intellectually. Transformational leadership model is comprised of four major components; idealized influence, inspirational motivation, intellectual stimulation, and individual consideration (Doody, & Doody, 2012). 

Idealized influence assists in building of confidence, admiration, respect, and trust (Bass et al. 2003). This tends to provide the employees with a sense of mission. To achieve this, the nurse leaders need to act as role models for the nursing staff working under them. This component of the model requires that leader be the first reference point by adhering the saying the actions speaks louder than words. Transformational leader is able to garner respect of the nursing staff and thereby unlikely to face resistance. Such leaders are in able to excel at managing of staff and dealing with staff issues that may be affecting the issue of nurse staffing. 

The other component of the transformational leadership model is on inspiration motivation. Inspirational motivation is aimed at encouraging others to achieve their goals and aspiration of the organization while attaining their own goals. Transformational leaders are able communicate high expectations to the employees and inspire them to hold the vision of the organization (Northouse, 2010). Transformational leaders are able to enhance a spirit of teamwork and commitment. Leaders applying the transformational leadership model are able to clarify the vision, mission, and strategic goals of the organization hence develop a strong sense of followers (Renjith, Renu & George, 2015).

The other component of the transformational leadership theory is the intellectual stimulation. Intellectual motivation involves encouraging staff innovation, and challenging the preposition of the staff. The leader encourages and appreciates the staff to offer their innovative and creative ideas. It involves not placing a blame to any staff or avoiding publicly criticizing the staff for their act. The application of intellectual model helps the leaders stimulate the staff’s critical thinking ability. In a health care facility, there nurse leader intellectually stimulates the nurse staff to the think rationally and act in a manner that adheres to evidence based practice (Renjith, Renu & George, 2015). 

 The other component on individualized consideration attributed transformational leaders is that they operate with compassion. The leaders in this case act, as mentors and require their followers to follow their lead. The staff’s creativity and innovation are rewarded. A transformation has excellent communication skills and possess excellent interpersonal skills. Under this model, the followers have their needs addressed and nurtured according to their talent (Renjith, Renu & George, 2015). The staff under this model are empowered to undertake decisions and are offered enough resources to implement those decisions. Leaders within firms are required to take care of the staff and act in a supportive role. The leaders using the transformational leadership have a duty of care to their staff. 

Critical Argument for Transformational Leadership in Nursing Staff

The Institute of Medicine have reported that the quality of care is largely affected by the nursing leadership. Nurse leaders tasked in supervisory and management have been noted to experience high stress causing burnout and turnover. The resulting turnover of these manager is costly to an organization in terms of training cost and replacing the individuals in these positions. It is noted that the loss of a nurse can cost a healthcare facility more than $80000 and for every 1% increase in overall nursing turnover, there is an increment of $300000 cost to the hospital annual costs. This highlights the need for healthcare facilities to deal with issue of nurse leader shortage (Denker, 2014).

The transformation leadership theory has been noted to enhance the job satisfaction of the nursing staff. Transformation leaders are generally able to transform the values, desires, aspirations, and priorities of the staff and motivate the staff to exceed the expectations. It has been asserted that actions of transformational leadership enhance job satisfaction of the employee through the perceptions of the transformational leaders. Transformational leaders have been noted to increase the staff expectations and recognition of the contribution of the staff. The actions of transformational leaders that increases the job satisfaction include offering individual attention, intellectual stimulation, and motivation. Transformational leadership approach of participative decision making offers the staff a sense of involvement. With higher levels of job satisfaction, the staff feel valued and appreciated are able to reciprocate with better job outcomes (Choi, Goh, Adam, & Tan, 2016). This in turn leads to reduction in turnover rate which is a major issue in the affecting nurse staffing. 

Another important effect of the transformation leadership is on employee empowerment. Empowerment has been noted to be among the approached taken to promote employee development which is a component of the organization’s long-term goal. Transformational leaders are indicated to be persuasive and are in position to offer positive organizational perception of the staff members. The charisma characteristic is noted to be a main determinant causing empowerment. Charismatic leaders are known to encourage employees to continuously engage in decision-making process which is a route for developing their skills and knowledge (Choi, Goh, Adam, & Tan, 2016). The employees in such an organization gain a sense of responsibility, self-confidence and job -specific technical skills. The transformational leader is able to empower the staff members which has been indicated to the essential in the reduction of high turnover rate that cases issues with nursing staff in most health care facilities. 

Studies have established relationships between effective leadership style and staff nurse retention. Transformational leadership are able to articulate a shared vision of the future of the organization and encourage the staff to undertake creative problem-solving approaches. Research has attributed transformational leadership to a low staff turnover less than 10%. The leadership traits associated with transformational leadership have been noted to directly influence retention of nursing staff (Kleinman, 2004). Nursing leader are expected to take into account the budgeting requirement and maintaining interpersonal leadership.

Conclusion

Nurse staffing is a critical issue facing many healthcare organizations. The nursing practitioners have been noted to be largely affected by job overload that leads to frustration and job dissatisfaction. Studies have revealed a relationship between working conditions for nurses, job dissatisfaction and high workload. The issue of nursing staff has mainly been associated with the issue on financial conditions and uncertainty. The issue on nurse staffing has been linked on patient outcomes such as rescue, mortality, and hospital falls. Research has indicated that nurses are attracted to work in and remain in facilitates that offer a path to professional development, attain autonomy, be engaged in the decision-making process, and getting fair remuneration. The issue of nursing staffing is not just focused on the shortage numbers but entails the means by which health system functions can enable the nurses to utilize their skills effectively. 

A key framework recommended to deal with the strategic issue on nursing staff is the leadership adopted in various healthcare facilities. To deal with the issue of the nursing staff the people entrusted with the leadership position are required to exhibit characteristics of an effective leaders. Effective leaders are expected to use problem-solving processes, maintain group effectiveness, and acquire group identification. Transformational leadership fits as the perfect leadership theory that can help deal with the issue of nursing staffing. Transformational leadership model is comprised of four major components; idealized influence, inspirational motivation, intellectual stimulation, and individual consideration. The transformation leadership theory has been noted to enhance the job satisfaction of the nursing staff. The transformational leader is able to empower the staff members which has been indicated to the essential in the reduction of high turnover rate. Studies have established relationships between effective leadership style and staff nurse retention.

References

Bass, B. M., Avolio, B. J., Jung, D. I., & Berson, Y. (2003). Predicting unit performance by assessing transformational and transactional leadership. Journal of applied psychology88(2), 207.

Buchan J, Calman L. The Global Shortage of Registered Nurses: An Overview of Issues and Actions. Geneva: International Council of Nurses; 2006

Buchan, J., & Aiken, L. (2008). Solving nursing shortages: a common priority. Journal of clinical nursing17(24), 3262-3268.

Choi, S. L., Goh, C. F., Adam, M. B. H., & Tan, O. K. (2016). Transformational leadership, empowerment, and job satisfaction: the mediating role of employee empowerment. Human resources for health14(1), 73.

Denker, A. G. (2014). Transformational leadership in nursing: A pilot nurse leader development program.

Doody, O., & Doody, C. M. (2012). Transformational leadership in nursing practice. British Journal of Nursing21(20), 1212-1218.

Frankel, A., & PGCMS, R. (2018). What leadership styles should senior nurses develop?. Practice10, 18.

Harrington, C., Carrillo, H., & Garfield, R. (2015). Nursing facilities, staffing, residents and

facility deficiencies, 2009 Through 2014. Menlo Park: The Henry J. Kaiser Family

Foundation.

Kleinman, C. S. (2004). Leadership: A key strategy in staff nurse retention. The Journal of Continuing Education in Nursing35(3), 128-132.

Northouse, PG (2010) Leadership: Theory and Practice. 5th edn. Sage Publications, London

Renjith, V., Renu, G., & George, A. (2015). Transformational leadership in nursing. International Journal of Scientific Research and Management Studies2(2), 112-118.

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