Running head: CASE EXCERCISES

Case Exercises: Nursing Shortage Rochelle Betton-Ford Human Resource Management (LDR 625-OA) February 08, 2014

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Case Exercises: Nursing Shortage Grayson County Regional Health Center is a private, not-for-profit, 225-bed acute care hospital located in a rural community in a southeastern state. The hospital provides a broad range of inpatient and outpatient services, including cardiology, obstetrics, gynecology, family medicine, and several additional specialties and services (Fried and Fottler, 2010). The Center offers 24-hour emergency care, and is built on a 96-acre site; its service area includes Grayson County as well as parts of three neighboring rural counties. Gray Countys population is 60,879, with 53 percent African Americans, 42 percent Caucasians, and Hispanics and other groups making up 5 percent. The main industry in the area is Agriculture, with cotton as the major crop. Fifteen percent of the labor force works in manufacturing, although most of the textile industry has moved out of the region due to outsourcing, and the town itself has fallen into disrepair. An increasing proportion of the population -33 percent of children and 22 percent of the elderly lives below the poverty line. The county has a civilian labor force of 27,568 with a 13 percent unemployment rate. Infant mortality rate is 12 percent and 24 percent of the population does not have health insurance. The Center has approximately 85 physicians, representing 29 subspecialties, on staff. The Center is fully certified by the Joint Commission and is certified to participate with CMS programs. The Center currently employs more than 800 employees. The employee turnover rate at the Center is 40 percent. Physician recruitment and retention are also major concerns. Grayson County Regional Health Center has a problem with employee retention. The groups most affected are the nurses where retention rates have ranged from 15 percent to 40 percent (Fried and Fottler, 2010). The Center is unable to pay market rates for nurses and other

CASE EXCERCISES professionals, as a result nursing units are understaffed and nurses have voiced concerns about being underpaid and overworked (Fried and Fottler, 2010). How will you go about identifying the most important reasons for the current shortage? In the text Fried and Fottler (2010 p. 198) states employee retention is tied to the effectiveness of orientation and on-boarding procedures; therefore, we should also focus on

these practices in our efforts to improve retention. There are so many questions and answers that will require an assessment of the organization; administrative, clinical and support staff it is necessary to adequately assess reasons for the current nursing shortage at Grayson County Regional Health Center. By creating a questioner for nurses to determine reasons for dissatisfaction in regards to their job, understanding wages to be the number one reason for poor retention of the nursing staff; I would request staff to list as many reasons as possible. It is important to speak to managers and supervisors for their point of view or reasons for the shortage, in doing so I may discover if there is a communication problem between management and the nurses. I will have to have the total number of nurses employed full time and part time, salaries, patient to nurse ratio, support staff for each nurse. If there is any overtime hours and how many hours and the norm for overtime work. What are the working conditions in the hospital; is it fair or poor, is their ample supplies and equipment and is the equipment in good working condition? Who are the top performers, moderate performers and low performers (nurses)? How many specialty nurses are employed, what are the educational background of the nurses, associate, bachelor and master degreed? What are the ages of the nurses, and if there appears to be a particular group; middle-age, younger, new graduates, gender etc. leaving the Center? How many nurses are in management and administrative? What is the average employment period for their nurses? How many nurses have remained with the hospital for

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1year, 5 years, through 20 years? Is there any room for career advancement, or the culture in the hospital and among staff and nurses? Is the Center promoting candidate from the external environment or utilizing internal applicants to fill vacancies? Are they (hospital) concern with hiring persons who will be the right fit (Fried and Fottler, 2010, p. 211) into their How diversified is the Center and is it prepared to adjust for additional diversification? What methods are used to motivate employees, improve employee morale, and what reward mechanisms are in place, to let the staff know they are appreciate, respect as an individual and professional, and the Center acknowledge the hard work they are doing. There is a possibility of inadequate patient care due to the current shortage, have there been an increase in readmissions or mortality during since the current shortage? I will also look at the cost of recruiting new nurses, and how the new addition may affect salaries, (I am under the impression that the hospital is funding the addition through Hill Burton and other grants, donations, considering the Center primarily relies on Medicaid and Medicare revenue) (Fried and Fottler 2010, p. 231). How will you proceed with developing short-term and long-term strategies? To develop a short-term retention strategy, I would begin with conditions I could change right away. I would start by meeting with management and discuss findings in the surveys and assessment of the organization; I would stress how important it is to change or enhance the relationships with the nurses, improve communication skills, and to help create a culture of caring and empathy with the nurses. Meeting with nurses and then with management and nurses to collaborate on strategies to improve the morale of the nurses. I would prioritize the most important concerns of the nurses and begin to implement programs that would focus on those concerns. Realizing that an increase in salaries may not be possible at this time, however, there are other ways to compensate low pay in other ways. Giving bonus for achieving certain quotas,

CASE EXCERCISES or paid getaway weekends for two, game or concert tickets to celebrate employees birthday, or some other event in their lives, just to say thank you. Offer paid continuing education credits. Identify values and visions of the nurses as a whole and focus on how to attain those objectives. In the text Fried and Fottler (2010) states to structure jobs so that they are more appealing and

satisfying by team members, and by carefully assigning and grouping tasks, and providing nurses with sufficient autonomy, allowing flexible work hours and scheduling. Also create work policies that are respectful of individual needs. Develop opportunities for career growth, review and enhance present career ladders. Seriously consider initiating the Magnet Recognition (Fried and Fottler 2010, p.228) Program to acknowledge and reward healthcare organizations that exhibit and provide excellent nursing care, or implement similar program to acknowledge nurses and staff throughout the hospital and community. By establish staffing rations, providing realistic career ladders, and implementing buddy programs will assist in resolving current retention issues (Fried and Fottler 2010). To achieve long term strategies begins with the interviewing and selection process of potential candidates for employment. The mission, vision, values and leadership of an organization is instrumental on the interview and selection techniques utilized when selecting hires for an organization. Several questions are consider prior to the interviewing process; what is the position, who do we want to fill this position? What skills and qualifications are we looking for? What of their educational background, do we need someone to blend in with the organizations current culture, or someone to enhance the culture which presently exists? Should we hire internally, or might someone externally be proved more qualified? Depending on how well structure the interview process is including job description and background checks of potential candidates; plays a role in attaining and retaining long-term team members. Organizations constantly experiencing high turnover among its workforce places a significant

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financial burden on the company (Fried and Fottler 2010, P. 226). Turnover has an adverse effect on organizational performance and shortages on healthcare quality (p. 226). This is why it is important to scrutinize every applicant, whenever possible forego the urge to hire someone with just the right degree or experience for a particular position, only to have that candidate leave when something better comes along. It is necessary to select the candidate that the company is willing to spend money on for additional training, the time and resources it takes to hire a candidate. Fired and Fottler (2010) list the five effective retention strategies issue by the Healthcare Advisory Board yields five effective retention strategies: (1) Select the right employees; (2) Improving orientation and on-boarding processes by creating a buddy program and other opportunities that help new employees establish professional and personal relationships with colleagues, (3) monitoring turnover to identify specific root causes, including identifying managers whose departments have high turnover rates. (4) Developing and implementing ways to retain valued employees and (5) Systematically attempting to reverse turnover decisions.

CASE EXCERCISES References

Fried, B. J., Fottler, M. D. (Eds.). (2010). Human resources in healthcare: Managing for success. Chicago, Illinois: Health Administration Press.