Effectiveness of Rotation Programs: Registered Nurses in Hong Kong - Essay Example

Proposal on how to handle shortage of nurses by ensuring staff rotation Insert Insert Insert Insert supervisor name Insert date. Table of Contents AIMS/OBJECTIVES 3 RESEARCH QUESTIONS 3 INTRODUCTION 3 Statement of the problem 3 Scope and sampling 4 BACKGROUND LITERATURE REVIEW 4 DESIGN-METHODOLOGY-METHODS-ANALYSIS 6 ETHICAL CONSIDERATIONS 8 TIMEFRAME 9 Detailed timeline 9 Detailed timetable 10 BUDGET 12 DISSEMINATION 13 Expected results 13 Dissemination plan 14 CONCLUSION 15 REFERENCES 17 APPENDICES 19 AIMS/OBJECTIVES This project aims at establishing a workable plan for ensuring that management team in nursing applies strategic management to mitigate the issues of shortage of nurses dabbed as “Nursing storm”. The main objective of this project is to analyze the effectiveness of rotation programs on registered nurses (RN) in Hong Kong in the nursing profession based on the knowledge that there is global shortage of nurses. RESEARCH QUESTIONS The primary questions for this project will be: 1. Based on the global nurse’s shortage, can RN rotation help in establishing continued nursing care to patients? 2. Does nurses’ experience perception and views of an ideal nursing program affect nurses’ effectiveness in delivering health care? INTRODUCTION Statement of the problem The nursing system in Hong Kong is managed by the Nursing Council. The council is mandated to ensure the quality of nursing care meets the continued changing needs of nursing care in the Hong Kong society. The council does so by ensuring that the registration system of nurse is not compromised as well as necessary guidance and intervention in the nursing discipline. However, this is on the technical bit. Availability of personnel will be the prerequisite for the application and the effectiveness of this council’s effort in meeting their mandate. But availability is the main problem in the whole nursing profession in the globe. This raises the need for a workable plan that Nursing Council of Hong Kong can apply to ensure that the available RN is well utilized and is able to meet the raising need for health care in Hong Kong society. Scope and sampling The scope of this research project is to develop a nursing program that will be implemented through Nursing Council of Hong Kong. Therefore, all the registered nurses as well as upcoming nurses form the scope of this project. The nurses to be interviewed and the focus group discussion groups will be developed from the already existing list of registered nurses in Nursing Council’s database and nursing students emails in the universities data base. Among the issues to be considered when sampling will be nursing experience level of the respondents, cost and time constraints as well as accountability and program orientations. BACKGROUND LITERATURE REVIEW Nursing is the main pillar of any health system in the world (Jamison, 2006, p.1). The nature of training and the kind of work done by nurses’ makes the core of patient’s healing and recovery. Nurses remain with the patient long after the doctors have left to ensure that the patients are comfortable as well as are able to take medication prescribed by the doctors. Healthcare thus needs more nurses than any other healthcare practitioner. Hong Kong nursing workforce is majorly dominated by female (Chan, 2012, p. 15). These nurses are required by law to be enrolled and registered for practice. However, the levels of nurses’ registration in Hong Kong vary across authorities (Baumann, 2006, p. 1). These levels are general and psychiatrics. With advanced education level, a nurse gets to specialize in midwifery which is highly paying than the first two (Christiansen, Vermon, & Jinks, 2012, p. 1176). In Hong Kong, a nurse is either registered or enrolled. This mean that both the practicing and the students planning to start practicing. The disparities in registration levels have exposed practicing and student nurses to a number of challenges and issues. Among many challenges has been leadership in nursing, education and practice, and workforce size (Thompson, 2006, p. 160). However, this problem is shared by many other countries since it is a global issue. By 2006, it was estimated that there was a shortage of at least 4.3 million health care workers (Chan, 2012, p. 3). The few who are well educated are not available since they often migrate to high-income countries where higher pay will be guaranteed. With higher pay comes job satisfaction, expanded career opportunities and leadership processes (Townsend & Anderson, 2013, p. 2). With increased pressure to work under the best conditions that the profession can offer, occupational stress on practicing nurses has been on the rise. Nurses turnover rate have been on the rise as many face job dissatisfaction (Howley, 1992, p. 212; Cooper, 1986, p.326 ). As nurses undertake managerial position in taking care of junior staff and the patients placed under them, they often lack people to take care of their emotional needs. The demands of the profession coupled with the need for a place to unwind expose nurses to stress that at times lead to psychological problems. The result have been many nurses will opt to exit from practicing way in advance or migrate to countries where there will be a great pay for the same pressure. With increased migration of health workers, there is an increased financial loss that makes it hard for the government to cater for its population healthcare needs. Such effects were the cause for World Health Organization establishing global code of practice on international recruitment. The code aimed at establishing a balanced health worker distribution as well as takes care of health care worker’s interests having the source country in mind (Gebremariam, 2010, p. 6). This is the basis behind work force planning in many countries labor force management. Demand for nurses and other health professional have been increasing in countries where professional health care is depended on abroad training. This aspect have made it easy for any high income country to be able to porch health workers from countries like Hong Kong thus leaving such countries exposed to shortages that only strategic planning can solve. Hong Kong and other low income countries in the world thus need a strategic plan that determines the sufficiency of the available nurses based on their education levels and availability to serve the population of the Hong Kong people with health care needs. DESIGN-METHODOLOGY-METHODS-ANALYSIS This project aims at taking a multi-layer approach where the evaluation of the existing nursing program will be combined with the validation of the newly proposed nursing program. Using survey research design, the project will describe the nature of individuals in the nursing profession based on their academic and experience settings. Survey research design was adopted due to its versatility, efficiency, and general approach to data collection from samples (Hancock, 2002, p. 7). This research design has been used in investigating various areas of nursing care, experiences in the different nursing cares, and leadership in nursing profession (Taylor, 2010, p.1). Its versatility enhances understanding of just any issues in nursing. This means that many variables can be measured without a need to increase cost or time regardless of the number of participants (Kelley, Clark, Brown, & Sitzia, 2003, p. 262). Besides being versatile, survey research design is capable of using results from a sample population to generalize to the whole population (Labaree & Scimeca, 2013, p. 45). The sample is taken as a representation of the characteristics and attitude of the whole population and thus the research responses will be taken to reflect how the whole population will be reacting to the research problem at hand (Smith & Albaum, 2012, p. 5). This thus makes survey research design the most appropriate tool to be used in the research of such a diverse and yet important component of health care system. The project will utilize both qualitative and quantitative research methodologies. The research approach will be participatory since it contributes to program ownership significantly (White & Pettit, 2004, p.4). The whole program will endeavor to produce timely and constructive results through participative facilitation. The approach of this project will be bottom up approach that will emphasize on the nurse’s experience, perception and views of an ideal nursing program. The nurse’s experience and perceptions will thus be interrogated with expert perspective to evaluate their effectiveness in adopting the new nursing program. A combination of qualitative and quantitative research methods have been identified as appropriate for this project due to its prowess in handling a wide rage of issues in nursing subjectively and expressively (Kinn, 2005, p. 320; Ostlund, Kidd, Wengstrom, & Dewar, 2011, p. 371) . While qualitative research methods respond to questions concerned with unequivocal reality, quantitative research method measure the objective of the study in one singular numerate reality (Paley, 2000, p. 147; Remshardt & Flowers, 2007, p. 20). Therefore, the combination of both qualitative and quantitative methods creates a wide dimension through which the topic on shortage of nurses can be handled comprehensively. The methodology will work to gather subjective responses as well as expressions of the nurses on experience, perception, and desire for a better nursing program. The main instruments of this project will be questionnaires to be used in interviewing nurses and focus groups during the discussions. The project will take an exploratory and descriptive approach in that the whole project will be contextualized to be within a nursing care institution. The perspectives of the sub stakeholders in the institutions will be reviewed as key information to the success of the project and its implementation. Questionnaire interviews will be conducted to both experienced registered nurses and start up nurses who do not have necessarily to be registered but venturing into nursing care. The data collected form these two types of nurses will be used as part of the triangulation process. Descriptive statistics will be used to analyze information on each quantitative research question in the study. The main descriptive will be checking their means, standard deviation, range, mode, median, skewness, and kurtosis. Descriptive statistics is normally appropriate when sample characteristics are the main interest of the analysis (Larson, 2006, p. 1). Qualitative questions will be analyzed using content analysis. Any other data analysis method will be necessitated by the need for further analysis which is not specified at this point of the proposal. ETHICAL CONSIDERATIONS For this research design, the following will be the main ethical considerations to be observed. 1. Sought conceit from the participants Normally, potential survey respondent have the right to decline an offer to participate in a survey since participation should be voluntary (Singer, 2008, p. 1). To ensure this is adhered with, a cover letter/introductory statement explaining the motive of the study, the sponsors, and assurance on confidentiality will be served to eligible participant before the survey questionnaire is administered. 2. Confidentiality The survey will be designed in a way that individual participants will have to share their individual experiences in the nursing profession. This and any other sensitive information might be damaging to the participants especially when disclosed. This research design thus will observe confidentiality by ensuring that the survey tools does not ask for the name of the respondent as well as only the research personnel access the data (Kaiser, 2009, p. 1633). Numbers will be used to identify the research subjects. TIMEFRAME Detailed timeline The project will take approximately 165 days in total. The description below outlines a detailed program for the development of the new nursing program. Consent will be sought from nurses in Nursing Council and university nursing student’s databases. The email will give details of what the project is all about, the scope and what it aims to achieve. Individuals who will respond to the email will be considered for the interview. Direct assessment and in-person interviews will involve performing direct assessments and participants interviews. Direct assessment will entail evaluating nursing experience based on number of years in practice as well as areas where one has been deployed in their career. The nurse’s perception of the current nursing program and the suggestion of what an ideal nursing program will be based on the current nurse’s shortage will also be evaluated. The last stage will involve triangulation of data, data analysis and reporting. Detailed timetable Key Steps/Timelines Main Activities Expected Results Time/Days Stage 1: Preparatory 1. Send emails to experienced and student nurses 2. Make follow up after 2 weeks to the non-response mails. 1. A good number of nurses will respond to emails. 2. The follow-up mail will increase the number of nurses willing to participate in the survey 30 days Stage 2: Primary data tools development 1. Finalize on detailed data collection program plus develop tools and materials. 1. Facilitation program, tools and or materials developed 15 days Stage 3: Actual study/ primary data collection 1. Actual primary data collection - facilitate study per the methodologies, selected 2. Triangulation of data from all sources 1. Primary data collected during field work from different respondents per the agreed program. 90 days Stage 4: Data entry and Analysis 1. Analysis of the data/information. 2. Distillation of emerging / cross cutting issues 3. Identification of major findings, lessons learned, recommendations, and conclusions 1. Data organization and cleaning undertaken 2. Qualitative (and quantitative data, where applicable) analysis done 15 days Stage 5: Report writing 1. Validation & Learning Session 2. Develop final report with recommendations 1. Final report developed and shared 15 days BUDGET This project is estimated to cost approximately $154,000. Majority of the funds will be on personnel expenses for the essential collection of interviews data. The total personnel cost is estimated to be $ 120,000. This includes compensation for the investigators to conduct the interviews, support for the investigators and subcontractors for the interviews, coding and analysis of the data collected and validation and reporting. The estimated direct expenses will be $15,000 and will include cost of supplies and interview transcription. Travel cost will take $9,000. This will facilitate travelling to the nursing stations and campuses for direct interviews. The rest of the money will go to miscellaneous expenses that the researchers are not certain of at this stage of the project being proposed. Budget Item Amount Sub-Total 1 Personnel Expenses Support for investigators and sub-contracted interviewers (approximately 100 interviewers @ receiving approximately $350. Stipend and expenses for investigators and sub-contracted interviewers. Coding and analysis Validation and reporting $35,000 $53,000 $27,000 $5,000 Total Personnel expenses $ 120,000 2 Direct expenses Cost of supplies and interview transcription $15,000 Total Direct expenses $15,000 3 Travel Cost Travelling to the university campuses for direct interviews $9,000 Total Travel Cost $9,000 4 Miscellaneous expenses Any other expenses that might arise along the survey $6,000 Total Miscellaneous expenses $6,000 TOTAL EXPENSES $150,000 DISSEMINATION Expected results This project upon completion is expected to change the nursing program in Hong Kong by giving nurses an opportunity to work under rotation. Nurses will be able to choose schedules that will work for them as much as they work to provide human resource at all times in the nursing profession. This way, nurses including nursing students looking forward to practice nursing care will feel part of the system since they will all be involved in the survey. The new program will not only provide a solution to the current human resources shortage but will also encourage nurses to be involved in fully in the nursing career since convenient working hours and availability of nurses has been the main impediment to the growth in health care. This project also expects to expose the nursing experience that has been the main drive to the perception taken by both the patients and the nurses. While patients feel neglected, nurses have had experiences of being overworked, demotivated and despised hence their reaction towards patients. Implementation of the project will ensure that both the patient and the nurse embrace each other since the nurse will be able to apply good nursing practice with the patient in mind. The Nursing Council will benefit by knowing the status of their registered nurses as well as plan on how to attract more nurses to register. This is because; the nurses will be able to enjoy what they advised as the program that works for them. Dissemination plan To achieve the expected results, the project will be disseminated in the following plan Target Audience(s) All individual in health care Nursing Council policy makers Objectives Expand knowledge on the current nursing program. Advice Nursing Council on the new nursing program. Dissemination method(s) Direct communication to Nursing Council personnel on the research findings. Through nursing council, indirect communication of the research findings to the stakeholders. Indirect communication to nurses and nursing students. Upon Nursing Council approval, publications on Internet and print media. Radio and television broadcasts. Social networks like twitter, blogs, and linked. Formal research report Resources and funding available No resources available for dissemination Resources and funding needed $20,000 Timeline 6 months Assignment of tasks Project team will present project report in the first 2 weeks after project completion. Nursing council will be mandated to review the report and give feedback. Project team together with Nursing Council will be mandated to establish the plan of implementation. Nurses will be tasked to implement the research finding in their nursing practice. CONCLUSION Nursing program in Hong Kong is faced with the challenge on workforce planning. This affects both the practicing nurses and nursing students looking forward to be integrated in the system. Apart from practicing nurses who are already in the system, nursing students join the profession with higher expectations that the system will work for them. However, disappointment checks in hence forcing them to opt for working in other countries where job satisfaction, higher pay, and good leadership will be the guaranteed. With dissatisfaction, worker demotivation and high patients’ turnover has been the characteristic feature of nursing care in Hong Kong. Nursing Council have tried to mitigate such occurrences by enduring that one is either a registered nurse or an enrolled nurse. However, pay differences based on nursing level have raised more issues than was initially anticipated. The result has been nurses turn over have been on the rise even with the already experienced shortage of workforce in the field. Besides poor pay, profession pressure have been the main contributor to worker migration as well as taking the option of practicing other fields even with nursing training in Hong Kong. Many Nurses who have had the experience of psychological illness, or rather know of a nurse who suffered may be afraid of falling into the same problem. The option is change of career or change of working station which includes migration. To be able to handle such issues, nursing rotation will be more efficient in establishing the area where a nurse will be able to be more efficient in the nursing profession. This program will be implemented with the help of Nursing Council of Hong Kong. REFERENCES Baumann, S. L. (2006). Nursing issues in Hong Kong. Study mode. < http://www.studymode.com/essays/Nursing-Issues-In-Hong-Kong-854361.html>. Accessed 15 December 2014. Chan, E. (2012). Hong Kong perspective on nursing workforce planning, development and education. < http://www.ha.org.hk/haconvention/hac2012/proceedings/downloads/S8.3.pdf> . Accessed 15December 2014. Christiansen, A., Vermon, V., & Jinks, A. (2012). Perceptions of the benefits and challenges of the role of advanced practice nurses in nurse-led out-of-hours care in Hong Kong: A questionnaire study. Journal of clinical Nursing, 22(7-8), 1173-1181. Cooper, C. L. (1986). Job distress: A recent research and the emerging role of the clinical occupational psychologist. Bulletin of the British Psychological Society, 39, 325-331. Gebremariam, M. K. (2010). Health workers migration: What can be done? Oslo University College. < https://oda.hio.no/jspui/bitstream/10642/361/2/Gebremariam_Mekdes.pdf>. Accessed 15 December 2014. Hancock, B. (2002). Trent Focus for research and development in primary health care: An introduction to qualitative research. Trent Focus, 1998. Howley, M. P. (1992). Sources of stress for emergency nurses in four urban Canadian emergency departments. Journal of emergency Nursing, 18(3), 211-216. Jamison, D. T. (2006). Pillars of the health system-Priorities in Health. Bethsaida: National Library of Medicine. Kaiser, K. (2010). Protecting respondent confidentiality in qualitative research. Qualitative health research, 19(11), 1632-1641. Kelley, K., Clark, B., Brown, V., & Sitzia, J. (2003). Good practice in the conduct and reporting of survey research. International Journal for Quality in Health Care, 10(1093), 261-266. Kinn, S. (2005). Integrating qualitative and quantitative research methods. Journal of Research in Nursing, 10(3), 317-336. Labaree, R. V., & Scimeca, R. (2013). Research methodology and design. Unisa Institutional repository (UnisalR).< http://libguides.usc.edu/content.php?pid=83009&sid=818072> Accessed on 15 December 2014. Larson, M. G. (2006). Statistical primer for cardiovascular research: Descriptive statistics and graphical displays. Circulation. < http://circ.ahajournals.org/content/114/1/76.full> Accessed 15 December 2014. Ostlund, U., Kidd, L., Wengstrom, Y., & Dewar, R. N. (2011). Combining qualitative and quantitative research within mixed method research designs: A methodological review. International Journal of Nursing Studies, 48(3), 369-383. Paley, J. (2000). Paradigms and presuppositions: The difference between qualitative and quantitative research. School of International Nursing Practices, 14(2), 143-155. Remshardt, M. A., & Flowers, D. L. (2007). Understanding qualitative research. Practice matters, 2(9), 20-22. Singer, E. (2008). Do incentives exert undue influence on survey participation? Experimental evidence. Journal empirical research human resources ethics, 3(3), 49-56. Smith, S. M., & Albaum, G. S. (2012). Basic marketing research: Volume 1. Provo, Utah: Qualtrics Labs, Inc. Taylor, E. M. (2010). 2010 Survey of design research in healthcare settings: The use and impact of evidence-based design. The Center for health design, 2010. Thompson, D. R. (2006). Nursing in Hong Kong: Issues and challenges. Nursing Science, 19(2), 158-162. Townsend, T., & Anderson, P. (2013). Are extended working hours worth the risk? American Nurse Today, 8(5), 1-9. White, S., & Pettit, J. (2004). Participatory approaches and the measurement of human well-being. Bath: UNU-WIDER. APPENDICES Read More