Renfrey Memorial Hospital Board of Directors - Essay Example

?Renfrey Memorial Hospital Board of Directors Executive Summary The report analyses the problems faced by hospitals with respect to the nursing staffand looks at the various strategies they use to counter those problems. Based on the research done on the various hospitals, two possible long term solutions for RMH are short listed and analyzed. Based on the analysis it is concluded that in the long run, achieving magnate status can help the hospital cope with the problems it is facing today. Impact of nurse shortage on Hospitals Shortage of nursing staff has major detrimental impact on quality of service of the hospital which directly impacts its reputation as well as on the hospital’s overall capacity to service (Buerhaus et al, 2007). Quality of service is impacted because the nurse response time to patients increases. The patients also feel that they are not being cared for appropriately. With reduced nursing staff, the workload of the physicians increases further. The hospital’s capacity is impacted because with reduced nursing staff, there is delay is discharge of patients leading to reduction in number of beds available. Many patient care programs also need to be closed down (Buerhaus et.al, 2007). Hospital’s response to nursing staff shortages Most of the hospitals have been implementing two types of solutions for nursing staff shortages – long term and short term solutions. Short-term solutions include increasing their salaries, increasing the bonuses of the nursing staff or filling the vacant positions with temporary staff (May, Bazzoli and Gerland, 2006). Long-term strategies of hospitals include creating favorable working environment and providing opportunities for them to enhance their skills (May, Bazzoli and Gerland, 2006). We will discuss both these strategies used by hospitals in greater detail in the ensuing sections. Short-term strategies These include using temporary staffing which involves recruiting nurses on a per day basis on short contracts. These also include using nurses on the move to cover a particular shift (May, Bazzoli and Gerland, 2006). The major problem with these types of recruiting solutions is that they turn out to be very expensive. It also encourages the normal staff to take up more assignments of this type rather than for the permanent job as the former pays better. Another problem with this kind of recruitment practice is the lack of staff quality. This kind of temporary staff cannot be relied for good service quality. Using “Internal staffing” or “float pool” is another way of fulfilling temporary staffing needs (May, Bazzoli and Gerland, 2006). Internal staffing solutions are less expensive than staffing through external agencies despite the fact that some premium needs to be paid even for recruitment through internal channels. However, this premium is far less than what needs to be paid to external agencies for recruitment. Spartanburg Regional Medical Centre in South Carolina has utilized internal staffing channel very effectively (May, Bazzoli and Gerland, 2006). They allow the internal nursing staff who wish to apply for vacant shifts (to increase their earnings) to apply online at bid rates that are set below the external agency rates but at a premium to the general rates prevailing within the hospital. This helps them to utilize staff that is willing to work extra without compromising on quality as they are all trained and tested employees. At the same time the hospital does not have to force the employees to work extra and then deal with repercussions of overstressed staff. Technology is used very effectively to create an online internet based platform where the employees can apply and get immediate response. Another short term strategy for fulfilling temporary staffing is by providing higher salaries. This is done not only for the new workforce but also for all previous employees by providing competent increment at all current levels. This has a retaining impact in the short run as external employers may not immediately adjust their salaries accordingly. However, in the long run it may not be of much help as other employers can also adjust their salary structure accordingly. Ultimately this race to attract talent through monetary compensation may lead to highly inflated salaries which would make it impossible to motivate staff through this channel as any further increases would have detrimental financial impact on bottom lines. Cleveland Clinic thought of another innovative way of retaining employees. They have offered nurses with “parent shifts”. These are two hour shifts which allow nurses to balance between their obligations at home and work. This has proved to be a very fruitful technique as the hospital has been able to attract nurses who were earlier not able to work because of family obligations back home. Self scheduling by nurses has also been implemented in the hospital. This allows nurses to schedule their shifts on their own through on-line systems based on the shifts available. This helps them take up working hours according to their convenience and reduces the extra work of re-scheduling on demands of change of shifts. This also helps the hospital in having a supply of motivated and satisfied staff rather than a disgruntled one who is being forced to work in a shift against his/her will. The hospital has also been very inventive in providing its staff with a wide variety of shift options. Thus, the staff can choose from shifts that are most convenient to them (May, Bazzoli and Gerland, 2006). Long-term strategies So, far we have looked at some of the strategies that help hospitals cope with the staffing issues in the immediate future. However, staffing shortage impacts the hospitals in the long run by affecting their quality of service. So, many hospitals resort to creating a pool of well trained nurses by investing in improving their skill set. They do this either by expanding their current capacity or by opening up new schools (May, Bazzoli and Gerland, 2006). St. Joseph’s Hospital and Medical Center in Phoenix allows students to shadow their nurses. By doing this they not only help in providing training to students but also provide an environment for the students to familiarize themselves with the environment of the hospital which encourages them to join the hospital after completion of their training as they feel more comfortable working in an environment which they already know. Another long term strategy used by St. Joseph Health System in Orange County is to train their non-nursing staff (mostly housekeeping or maintenance staff) to become “certified nurse assistants (CNAs)” (May, Bazzoli and Gerland, 2006). These assistants can then get enrolled in nursing degree programs to eventually become fully trained nurses. The hospital helps them by providing sponsorships and flexible working hours in return for long term work commitments. This strategy helps them in gaining commitment as well as loyalty from employees. Another training approached used is to provide a very specialized orientation program for new nurse employees. The program can run from 12 to 20 weeks and helps nurses get training on specialized cases. During this orientation program they are not assigned to any shift and have full time for improving their technical skills. They are also rotated through various departments to help them find the best fit environment. Many hospitals have adopted the policy of providing better working environment to their nursing staff. This is a very important retaining approach in the long run. They have changed the workstations of nurses and made them more user-friendly. One of the hospitals in Birmingham, AL named Alacare Home Health and Hospice has equipped its nurses with laptops (healthcaretechnologyonline.com, n.d). These laptops help them access any information about a patient at any time. This helps them concentrate more on patients rather than waste time in searching for information. This technique is very useful in utilizing staff in the most efficient manner and hence reduces the requirement of more nurses leading to lesser shortages. St. Luke’s Hospital and Health Network in South Bethlehem, Pennsylvania, used a very innovative Human resource assessment instrument called Myers-Briggs Type Indicator (MBTI) to understand its employees as well as the patients so as to create an environment which motivates the staff so that they can provide better service to the patients. The instrument helped the hospital create well-functioning teams which experience complete job satisfaction and helped in their retention. A major problem seen at any hospital environment is that the job pressure there is so high that communication between nurses among themselves as well as the doctors is under tremendous stress. Women’s health centre at St. Luke’s Hospital used MBTI to improve team work by understanding each other’s working style. Each nurse at the center keeps physician’s type chart to understand their working style. This helps them adjust their own style according to the physician type. This helps in improving communication and better work environment (cpp.com, n.d). Some hospitals have taken the initiative to become “magnate hospitals” to ensure employee satisfaction for long term retention (Barker Sullivan and Emery, 2006). These hospitals achieve this by creating high quality of nursing leadership. These leaders are storehouses of knowledge and pillars that supported the other staff. The hospitals also create a flat organizational structure with decentralized nursing departments. The nurses have a strong representation at the organizational committee levels. Nurses are allowed to participate in the leadership roles. They are given responsibility for their tasks and are accountable for their own actions. They are made responsible for the quality of care. Autonomy is given to the nurses (within their professional jurisdiction) and they are expected to make independent judgments (Barker Sullivan and Emery, 2006). The hospitals also get involved in a number of community programs which help them to improve their image as strong and positive organizations which have a strong value base (Barker Sullivan and Emery, 2006). Nurses are also used as teachers which gives them immense job satisfaction. The nursing profession is recognized as an intrinsic part of the organization and is respected for its contribution to patient satisfaction. They are given full opportunities and support to improve their technical skills for future growth (Barker Sullivan and Emery, 2006). Miami Children’s Hospital is one such hospital which found major savings by reduced turnover after achieving the “magnet” status (Finkler and McHugh, 2008). Feasible solutions for Renfrey Memorial Hospital (RMH) Looking at the various strategies that the hospitals have applied to counter nursing shortages, long term strategies should be used by RMH. Two major long-term strategies which can provide immense financial benefits in the long run from staffing turnover reduction perspective are – Achieving magnet status – This has been done by Miami Children’s Hospital in our discussion above. Magnate status has helped hospitals deal with all current issues, especially nurse shortages (Mason, Leavitt and Chaffee, 2007). Achieving this requires developing policies on shared governance model (Mason, Leavitt and Chaffee, 2007). As seen in Miami Children’s Hospital case, nurses will require to be given full autonomy and representation in the hospital committees and hence will need to be part of the policy making process. Hence RMH would require to first initiate the change process at leadership level to create the adequate governance model for implementation of the nurse participation. The leadership team would require propagating an environment which is supportive to the growth of skill development of the nursing profession. The next focal point of this model is the patient. Hence, RMH would require developing a patient-centered culture (Mason, Leavitt and Chaffee, 2007). As the nurses will be given decision making roles as well as management responsibilities they also need to be culturally made sensitive to the importance of quality care for the patients. This would require running orientation programs for new recruits to familiarize them with the organization culture of commitment to quality care. Motivational programs to encourage quality service should be run and personnel who exhibit such behavior should be adequately awarded. Team work is another feature that a magnate hospital aims for. Hence, the organizational culture should be changed from that of department oriented functioning to team oriented functioning. Hence, team building programs to enhance communication between the various sets of employees like nurses, physicians and non-nursing staff is enhanced. Teaching faculty of the institute should be setup. This can be done initially by creating a core team of experienced nurses who are unable to work in long shifts due to family commitments or age factor. This can help in developing in-house excellence in particular areas of expertise. At a later stage a marketing team of the hospital can involve in arranging for finances for a full fledged training institute. The trainees of this institute can then be given training in the hospital itself and later given attractive offers to join on completion of training. Marketing team also needs to be actively involved in advertising the organizations values and high service levels to the general public so as to attract more patients as well as better talented employees. The HR team needs to come out with innovative programs for supporting higher education for employees at all levels with the aim of retaining such talent over longer periods of time. All this would require financial resources for running all types of training programs and sponsorships. Contributing to trainings of nurses and providing flexi-shifts – This can be done by either participating in teaching activities like opening up relevant university or creating an in-house training excellence as is being done by St. Joseph Health System. This is a good solution for retaining employees. Any investment in the development of employees will not only develop loyalty in them for the hospital but also create a pool of skilled resources for the organization. With loyalty comes the commitment to provide better service. The hospital would require investment in terms of arranging for temporary staff as well as sponsorships. However, this investment would pay in the long run. Flexi-shifts are a good way of dealing with staff that requires support for education as well as for family matters. Conclusion Achieving magnate status is a better option for RMH as this involves an overall development of the organization for sustainable growth. There will definitely be a huge impetus required to change the organizational culture and major conflicts would occur especially between the current administrators and the change managers for empowering the nurses, however, these are only short term challenges. In the long run as employees will understand the benefits being accrued for the organization and eventually the employees themselves, their will be a mutual acceptance. Research has shown that “magnate hospitals were able to attract and retain nurses even when other hospitals in their local markets were experiencing nurse shortages because of the organizational culture they had developed to support the professional practice of nursing” (Hinshaw and Grady, 2010). There will be huge initial investment in terms of starting of the university. However, there is no major cost involved in setting up in-house training department as it will be utilizing the present staff which is not able to work full time on patient care due to either family engagement of personal health problems. Changing organization culture does not require financial investment and utilizing ageing nursing staff for administrative and training purposes would actually help in increasing resources. Magnate hospitals are also preferred by schools and colleges of nursing for clinical affiliations of students (Huber 2006). Thus we can see that with magnate accreditation, RMH will be a much sought after hospital by both employees and patients. References Barker, A.M, Sullivan, D.T and Emery, M.J. (2006). Leadership competencies for clinical managers: the renaissance of transformational leadership. Jones and Bartlett Learning. Buerhaus, P.I., Donelan,K., Ulrich, B.T., Norman, L., DesRoches, C and Dittus, R. (2007). Impact of the Nurse shortage on hospital patient care: comparative perspective. Health Affairs. 26(3): 853-862 cpp.com. (n. d). Bolstering staff soft skills helps hospital face major challenges – A case study of St. Luke’s Hospital & Healthcare Network. Retrieved on February 14, 2011 https://www.cpp.com/pdfs/St_Lukes.pdf Finkler, S.A and McHugh, M.L (2008). Budgeting concepts for nurse managers. Elsevier Health Sciences. healthcaretechnologyonline.com. (n. d). Alacare Home Health & Hospice. Retrieved on February 12, 2011 from http://www.healthcaretechnologyonline.com/article.mvc/Alacare-Home-Health-Hospice-0002 Hinshaw, A.S and Grady, P.A. (2010). Shaping Health Policy Through Nursing Research. Springer Publishing Company. Huber, D. (2006). Leadership and nursing care management. Elsevier Health Sciences. Mason, D.J., Leavitt, J.K and Chaffee, M.W. (2007). Policy & politics in nursing and health care. Elsevier Health Sciences. May, H.J, Bazzoli, G.J and Gerland, M. (2006). Hospital’s responses to Nurse staffing shortages. Health Affairs. 25 (4): 316-323 http://content.healthaffairs.org/content/25/4/W316.full?ijkey=q4No76aIxVF... Read More