Renfrey Memorial Hospital Board Project Proposal

Executive Summary

Job discontentment is accepted to be very high in the nursing profession. Apart from countless other issues, nurses express their unhappiness which relates to some major concerns, that involves staffing, deference and appreciation, and earnings, and this disappointment is to a large extent is taking a toll on their decision to be employed in the nursing profession. Factors that influenced the retention of nurses at a particular facility were identified as friendliness and support of co-workers, effective management policies, job environment and equipment provided by the facility, satisfaction, and enjoyment at the workplace, employment terms, and development procedure offered by the facility, job scheduling, and timings, and the distance of the facility from the nurse’s residence. (Lawler, 15-31)

Thus keeping in mind these preferences, a comprehensive strategy has to be designed in order to attract and retain quality nursing professionals. In order to do so the most important aspects in this context have to be identified. This proposal identifies the promotion of a congenial work environment by the hospital administration and staff development as two of the most effective and viable solutions to the nurse retention problem. Furthermore, it goes on to make some practical recommendations about effective leadership and staff involvement to the Renfrey Memorial Hospital Board which could be beneficial in addressing the current issues the hospital faces.


In the course of the research, five hospitals, spread across the United States of America, which were facing similar nursing staff retention problems, were identified. The issues faced by them were analyzed at their approach towards the subject was also studied. The identified hospitals were Abbot Northwestern Hospital in Minneapolis, Baylor Jack and Jane Hamilton Heart and Vascular Hospital in Dallas, Boone Hospital Center in Columbia, Jersey City Medical Center in Jersey City, and Saint Joseph’s Hospital in Atlanta. (Mathews, 175-183)

From this research, it has been found that job discontent is acknowledged to be very high in the nursing profession. Nurses express their unhappiness which relates to several different issues, that involves staffing, deference and appreciation, and earnings, and this disappointment is to a large extent is taking a toll on their decision to be employed in the nursing profession. In addition, the nursing staff is aging, and lesser numbers of new nurses are coming into this line of work to take up the positions of those who are retiring or parting ways from nursing.

Discontentment with the job might play a major role in both existing and upcoming staffing and retention issues. Insufficient staffing, intense workloads, and the exploitation of overtime to deal with staffing scarcity have been found to be key aspects of job dissatisfaction amongst nurses. According to a survey conducted, of those nurses responding, who had reflected on parting from the patient-care arena due to causes save for retirement, 56 percent revealed that they desired a less demanding and physically challenging occupation and 22 percent divulged that they were worried about schedules and working hours.11 The same survey discovered that 55 percent of individuals currently working as nurses were either only to some extent or completely dissatisfied by their institution’s conscription levels, whereas 43 percent of nurses surveyed said that better staffing levels would perk up the quality of their job. (Lawler, 15)

Executives of associations for nurses revealed that the topic of staffing and overtime have been gaining a lot of significance for their nursing affiliates during current negotiations. State representatives have also pointed toward this concern—in the early stages of 2001, legislation crafted to restrict mandatory overtime procedures or protect the rights of nurses who are not willing to work in added shifts have been established across 10 states. (Ramlall, 64)

Nurses also allude to the little reverence and appreciation given to their work, together with their seeming lack of authority, as some aspects of their disappointment. In the survey conducted, 48 percent of nurses assessed who had worked as patient-care professionals for over one year revealed that they were extremely or to some extent unhappy with the acknowledgment they receive, whilst 35 percent were discontented with their degree of participation of the nurses in the process of decision-making. The survey found that nurses were in varying degrees unhappy with the amount of support they received from the facility’s management.

While investigations conclude that improved earnings might prompt nursing professionals to retain their jobs, wages are not at all times reported to be the main rationale underlying job dissatisfaction. According to the study of those nurses responding to survey questionnaires, the ones who had thought about departing from the patient-care profession for on grounds save for retirement, 18 percent sought after increased earnings, whereas a majority of 56 percent were apprehensive about the pressures and physical stress of the occupation. However, conclusions of studies carried out the point that only 27 percent of nurses responding cited increased pay scales or enhanced health care reimbursements as a means of improving the quality of their job.

Research also indicates that nurses express displeasure in relation to a decline in the number of support workforce that is made available to them. Contemporary nursing workforce concerns are an element of a bigger health care staff scarcity picture that takes account of a dearth of nursing aides as well. Nurse aides provide backing for nurses and help outpatients with day-to-day activities for example dressing, nourishing, and bathing.

Several investigations in this matter report nurse aide conscription and retention as a difficulty for many health care service providers. The scarcity of nursing aide professionals may be associated with complicated work settings in addition to disappointment with earnings and remunerations. Further, other aspects that affect turnover comprise work pressures and staffing levels, deference from administrators, organizational appreciation, and involvement in the decision-making process which are all very analogous to aspects of disappointment identified by nursing professionals. (Summers, 16)

The studied healthcare organizations identified the rationales underlying the choices of workplace made by nurses and motivations behind retaining their positions at a particular facility to find a solution to the aforementioned problems relating to nurse staffing. Findings revealed that the most important factors that influence nurses to opt for a particular facility are: the distance of the facility from the nurse’s residence, job scheduling and timings, the reputation of the institution, job environment, and equipment provided by the facility, program influence, employment terms, and development procedure offered by the facility.

Factors that influenced the retention of nurses at a particular facility were identified as friendliness and support of co-workers, effective management policies, job environment and equipment provided by the facility, satisfaction, and enjoyment at the workplace, employment terms, and development procedure offered by the facility, job scheduling, and timings, and the distance of the facility from the nurse’s residence. Thus, it was evident that there is a considerable degree of likeness among the causes that were behind drawing nurses to a facility for employment and those encouraging them to continue their service at that facility.

Factors underlying both choosing and continuing at a health care facility overlapped, with at least five frequently reported aspects being identical in both cases. Thus it was obvious that some key inducements in selection carry on motivating in retention mentality. Thus, it was important to recognize that the closely related factors appeared to underpin the significance of recruitment information precisely revealing the employment status quo. There were various measures taken by the five different studied institutes. Amongst those, we look at the most significant aspects of their restructuring program. (Ramlall, 51-64)

Perhaps the most significant amongst the steps taken by the institutes was the initiative to provide a safe working environment for the nurses. Health care settings using evidence-based plans were established to foster better patient outcomes and thus exerted less pressure to some extent on nurses. Personal hygiene was made a priority of those nurses who were in contact with patients. It was ensured that the facilities are latex-free, mercury-free, and free of other toxic materials that caused illness.

Organizational policies to safeguard and support nurses were instantiated. Hospitals ensured that a safe needles system was pursued. A zero-tolerance stance was adopted for abuse of practices and procedures. A grave incident anxiety debriefing mechanism was put in place that was recommended to all workers who undergo physically or sexually abusive experiences in any form. Processes were drafted to protect other rights of the nurses. It was ensured that hospital policies effectively addressed the fatigue issue for the nurses.

The recruitment procedure of new nursing managers underwent some major changes. It was made mandatory for nursing managers to have some considerable management training. A master’s degree in nursing was made the minimum eligibility for the chief nursing officeholder to improve the quality of supervision. A major structural change was that new nursing manager applicants were interviewed by the very nursing staff they would administer.

In case of staffing issues, authorized nurses were allowed to position the staffing levels on their respective floors based on the demand of nurses and workload and an apposite blend of nurses based experience and proficiency. Basic minimum nurse-to-patient ratios were standardized and were set accordingly. Nurse-to-patient ratios were positioned very noticeably for visitors to make out on every division and the list was renewed after each shift. (Kesler, 26-37)

Employee benefits and development were paid significant attention as it was a key motivator for job retention. Nurses received full-tuition recompense for edification that made it possible for them to pursue their career in nursing or patient care. The hospitals funded at least 15 hours of ongoing learning units for every nurse every year. The entire nursing workforce, counting part-time members of the nursing staff, was offered retirement benefits and health indemnity for themselves as well as their families.

Finally, a healthy collaboration of healthcare professionals was stressed. The healthcare personnel was provided with recurrent guidance on how to operate as a team. Physicians were expected to request nursing contributions on patient rounds and morbidity and mortality rounds. Doctors and medical apprentices were asked to observe nurses at work for a minimum of 12 hours each year so that they could appreciate the worth of nursing.

Such measures helped nurses feel more involved and connected to the system and thus improved the quality of nursing and had a positive impact on the turnover rates in the nursing domain for the studied hospitals.

Two Solutions

Several factors reported as encouraging nurses to retain their job at their respective hospitals involve interpersonal associations, and leadership, and administrative approach and action. It may also be noted that efforts to enhance job satisfaction and to produce prospects for staff development are eventually the duty of the administrative unit in an organization. Consequently, it may be feasible for Renfrey Memorial Hospital to draw and retain nurses by fostering a healthy work environment with strong interpersonal connections and through efficient leadership and strategic organizational skills within the hospital. Another important aspect to be considered to increase nursing staff retention rates is the issue of staff benefits and development. (Jamrog, 51-63)


Enhancement of the work environment

Retention rates are typically superior in cases where nurses feel more connected to the system and supported by colleagues because job contentment is improved. Positive support from administrators and co-workers at work reduces absenteeism to a greater degree. The reformation of the psychosocial environment of the workplace is a means of dropping the number of sick leaves taken by nurses. This fact also has positive implications for the retention of nursing staff. The congenial work environment has a connotation of a community feeling where the workforce experiences a sense of belonging to a team.

Under such a pretext, employees believe that they are incorporated and know one another, and thus can concentrate on the action with a humanitarian face. Fun should be promoted, all echelons and organizational positions should be valued and staff should be advised to interact with each other and respect and recognize each other’s zeal. (Ulrich, 12-22) Support is widened when positive associations are constructed. This denotes that mutual reverence, faith, and integrity must be created and upheld. The employees need to be taken care of as distinctive individuals who are capable of making exclusive contributions, and valuable interpersonal relationships should be promoted.

Conflict management plays an important role in such a situation and proper procedures need to be in place. From a negative point of view, certain factors for example work stress, lack of administrative support, poor solidity, and independence can influence withdrawal actions (turnover and absenteeism) amongst nurses both overtly and circuitously. Poor morale is one of the primary causes resulting in amplification of absence in mental health nurses.

Various researches reveal that positive support from the administration reduced the number of sick leave and dropped absenteeism rates. This has an additional effect of escalating the retention rates in the longer term. Nurses do not undergo as much anxiety and stress due to intense work pressures if the job is satisfying and if they obtain positive responses and support for their actions. By creating a supportive atmosphere for nurses, the retention rate can increase dramatically.

Supportive and efficient management practices are often reported as encouraging aspects in nurse retention issues at a hospital. The characters of supportive and efficient management practices include executing new schemes, efficiently working together with nurses, involving them in the process of decision-making, and transparent problem-solving methods. Decentralized decision-making processes and shared authority enhances the nurses’ command over their work atmosphere as it fosters self-sufficiency and collective decision-making and also develops positive relationships. This ensures a more connected feeling on the part of the nurses with the entire system and brings in a sense of belonging. Issues like empowerment and the opening to operate independently enhance job satisfaction and thus increase retention rates.

Apart from leadership and management issues, other tangible considerations have a significant implication for a congenial work environment for the nurses. Hygiene and cleanliness need to be promoted for the safety of both patients and nurses and other people in the vicinity of patient-care activities. Work environments using evidence-based designs need to be implemented to cultivate better patient outcomes. This would consequentially exert lesser pressure on the nurses. It has to be ensured that the patient care facilities are latex-free, mercury-free, and free of other toxic materials that caused illness. In addition, the hospitals have to make sure that a safe needles system is pursued. (Elsdon, 45-47)

Organizational policies to safeguard and support nurses have to be efficiently put in place. A zero-tolerance stance needs to be adopted for abuse of practices and procedures. A grievance handling mechanism has to be established. Processes to protect other rights of the nurses also need to be instantiated. Furthermore, hospital policies have to effectively address the fatigue issue for the nurses.

Staff Development

Improved openings, information, and assets make the staff more resourceful, productive, and powerful. This has been shown to foster enhanced job satisfaction in the nursing workforce. The most excellent places to work are facilities where the workforce is endowed with the required training that is needed to be successful in the competitive market arena and where there are strategies to fabricate capacity. Growth and development are promoted by doing stimulating and pioneering work and by constantly scrutinizing and reforming the old methods of working. Various researches show that the new age nursing workforce prefers to be trained and thus grow in the process.

Thus the hospital administration needs to ensure that the staff is challenged and stretched, but at the same time, it should be kept in mind that this should be done within their potentials. One of the primary causes underlying employees leaving their workplace is a supposed dearth of career development opportunities. Baby boomers frequently work with an organization for a prolonged period because of their loyalty to the institute. However, members of new age nursing workforce cite prospects for skill development and erudition as significant motivators in the judgment to continue or to part ways with an organization, revealing their apparent dedication to long-term development and erudition. Thus, efforts such as mentoring initiatives and training and development courses may be a valuable rejoinder to these requirements.

Prospect for new-fangled challenges and added experiences in the course of skill diversity and task implication are key motivating aspects for nursing workforce attraction and retention at the hospital. Countless researches conclude that nurses are attracted by the verity that the workplace presented a career pathway instead of a plain straight-lined job. Presenting training opportunities and development initiatives equips the employees to handle change in a better way.

These initiatives can include training on leadership, administration, time management, and communicative skills. By educating the staff, the hospital can have more faith in decentralized decision-making processes, and this sequentially will provide a great degree of motivation for the workforce. It is very important that inventiveness and originality are encouraged as this would lead to enhanced job satisfaction of the nurses. (Conner, 38-46)


Interpersonal associations, and leadership and administrative approach and overall a supportive congenial work environment is the most important aspect in the issue of nursing workforce retention. Thus, Renfrey Memorial Hospital should foster a healthy work atmosphere with strong interpersonal connections and through efficient leadership and strategic organizational skills within the hospital.

To be successful, nurse managers must play the role of a leader in addition to that of just a manager. There is a comprehensible link and interrelationship among the aspects of leadership and management, and a successful nurse manager has to be capable of integrating both leadership and management in his or her responsibilities. Significantly, the cohorts are inspired to follow the manager.

Effective organizations have influential people who are trusted and revered by their followers. An organizational structure needs to be created wherein the followers must have faith in the fact that that the managers are competent enough to guide the team and the institute into the future. Leaders who appreciate and recognize the offerings of others are more successful. Valuable leadership has a substantial influence on staff authorization and the accomplishment of the objectives in a nursing unit. As each individual and team is distinctive, the exciting and appealing test for the leaders is to adopt the most efficient leadership approach that is to be put into action for each individual, team, and condition. However, one leadership method may not be the best option in every situation and with all adherents.

The leadership manner of a manager has an impact on all the activities in a nursing facility. It is essential to choose and implement the most suitable leadership approach for every situation uniquely. For example, a transactional leader concentrates on everyday features and preparation, and other leadership activities are primarily task-oriented. Nevertheless, when the extent of development i.e., maturity levels of the adherents are singular, the situational leadership model might be a more viable option. In the course of change, transformational leadership is considered to be the most fitting approach.

Hospitals draw in and retain more competent nurses when the nurses are provided with easily accessible communication channels to nursing managers and in cases where the hospitals ensure that there are enough nurse managers at hand. In response, nurses will carry out their responsibilities more productively and at the same time acquire enhanced job satisfaction. (Brown, 20-32)


The research concludes that nurses value a manager who is both eager and capable of working together with the staff and is ready to ‘roll up the sleeves when required. The significance of this is twofold: at the outset, in conjuring a team belonging rather than a conventional manager/staff hierarchal relationship and, secondly, in instituting a connotation amid nurses that their leader recognizes the responsibilities and workload of his/her nurses, who consequently have better reliance in the measures taken by the managers. It is vital that the administrators promote and execute inventive ideas and practices.

Although the staff cannot be drawn in for all decision-making processes every time, it is worthwhile that they are engaged in the issues that will directly have an effect on their mode of operations or in the aspects where they possess considerable knowledge and expertise. The significance of a manager’s personal touch is immense. This can be as small as acknowledging a member of the staff by a simple phone call or card on a special occasion or sending personal good wishes to praise a staff member on a particular accomplishment, or support and enquire about the health of a staff member who is away on sick leave.

Two-way interactions, exchange of views also help the administration to keep its staff educated about on-goings. In the larger picture, involvement, consultation, decentralization, and empowerment are significant features of a supportive work environment.

Works Cited

Brown, K.G. “Designing Management Training and Development for Competitive Advantage: Lessons from the Best”. Human Resource Planning. 21.1(2003): 20-32.

Conner, J. “Human Resource Roles: Creating Value, Not Rhetoric”. Human Resource Planning. 19.3(2002):38-46.

Elsdon, R. “Creating Value and Enhancing Retention through Employee Development: The Sun Microsystems Experience”. Human Resource Planning. 22.2(2004):39-47.

Jamrog, J.J. “Building a Strategic HR Function: Continuing the Evolution”. Human Resource Planning. 27.6(2005):51-63.

Kesler, G.C. “Implementing Major Change in the HR Organization: The Lessons of Five Companies”. Human Resource Planning. 20.4 (2003):26-37.

Lawler, E.E. “HR as a Strategic Partner: What Does It Take to Make It Happen?” Human Resource Planning. 26.2(2006): 15-31.

Mathews, A. “Diversity: A Principle of Human Resource Management”. Public Personnel Management. 27.3(2005): 175-183.

Ramlall, S.J. “Measuring Human Resource Management’s Effectiveness in Improving Performance”. Human Resource Planning. 26(2006):51-64.

Summers, S.B. “Strategic Skills Analysis for Selection and Development”. Human Resource Planning. 20.3(2003): 14-19.

Ulrich, D. “From eBusiness to her”. Human Resource Planning. 23.4(2007):12-22.

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