NUR5094 Module 2 organizational assessment example

Thirty-One Departures, Nineteen Before Year Three: An Organizational Assessment of Registered Nurse Turnover on Three Medical Units and the Leadership Problem Behind It

Student Name

American College of Education

NUR5094: Capstone Practicum Experience for Role of the Nurse Administrator

Module 2 Assignment

Instructor Name

January 30, 2029

The Question and the Sources

The practicum plan identified registered nurse turnover on the medical service line as a possible project focus: 24% over twelve months, against 15% for the hospital. This assessment asks where the turnover is concentrated, what it costs and what the service line's leaders can influence. Four sources were used with the mentor's approval and the nursing research council's determination that the work was an internal operational assessment: the human resources turnover report for the past twelve months, in aggregate by unit, tenure, shift and exit reason; the finance department's estimate of turnover and replacement costs; the most recent practice environment survey results for the three units; and structured interviews by the author with the three nurse managers and the mentor.

Where the Turnover Is

Thirty-one registered nurses left the three units in twelve months, from an average staff of 128. By unit, turnover was 30% on the renal and endocrine unit, 26% on the general medical unit and 16% on the medical-oncology unit. By tenure, 19 of the 31 had less than three years on their unit, although only 38% of the units' nurses fall in that group, so early-tenure nurses left at about twice the rate of their share of the staff. By shift, 21 of the 31 worked mainly nights. Of the 31, 23 left the hospital entirely; eight transferred to other departments, most often to outpatient areas with daytime hours.

Exit interview reasons, coded by human resources from free text, were scheduling and work-life conflict in 11 cases, relationship with the manager or leadership in 8, workload and staffing in 7, relocation or personal reasons in 5. The first three categories account for 26 of 31 departures and are, at least in part, within the service line's influence. Most of the reasons nurses gave for leaving were about how the units are run, not about where they wanted to live.

What It Costs

Turnover cost includes advertising and recruiting, vacancy coverage with overtime and agency staff, orientation and training, reduced productivity of new nurses and termination processing. Jones (2008) set out a way to bring older turnover cost estimates up to date using the consumer price index, so that nurse executives can calculate current costs and potential savings from retention without a new primary study. Using a version of that method with local salary and agency rates, the hospital's finance department estimates the cost of each registered nurse departure at about 61,000 dollars. For 31 departures, the service line's annual turnover cost is therefore about 1.9 million dollars, a figure that closely matches its 1.9 million dollar travel nurse spending, much of which exists to cover vacancies turnover creates. Reducing turnover on the three units from 24% to the hospital average of 15% would mean about 12 fewer departures a year, saving roughly 730,000 dollars.

The Practice Environment and the Managers' View

The hospital measures the practice environment every two years with Lake's practice environment scale, a shortened form of the older Nursing Work Index and a validated instrument with five subscales covering nurses' voice in hospital affairs, the foundations of quality care, the manager's ability and support, whether staffing and resources are adequate, and relations between nurses and physicians (Lake, 2002). On the most recent survey, the three medical units scored below the hospital mean on two subscales, nurse manager ability, leadership and support, and staffing and resource adequacy, and at or above the mean on the others. The lowest item on the manager subscale was the one asking whether the manager praises and recognizes a job well done.

The three managers, interviewed separately, described spending most of their time on staffing, filling open shifts and recruiting. Each supervises between 42 and 47 registered nurses plus assistants across all shifts. Each said they rarely had a planned one-to-one conversation with a staff nurse unless there was a problem, and none had held a conversation with a nurse specifically about whether they intended to stay. Two said they learned a nurse was unhappy only when the resignation letter arrived. All three said they would welcome a structured way to have retention conversations if it did not add hours to their week. The mentor noted that the managers' span of control and the absence of assistant managers on nights were long-standing issues outside the scope of a one-semester project.

What the Data Do Not Explain

The assessment also has gaps, and naming them shapes what the project can claim. Exit interview reasons are coded from short free-text answers by a human resources generalist, and nurses leaving on good terms may soften their reasons; a nurse who writes scheduling may mean a manager who approves schedule requests unevenly. The data say nothing about the nurses who stayed but are thinking of leaving, the group a retention project most needs to reach. The practice environment survey is two years old, and one of the three managers has changed since it was collected. And the higher turnover on the renal and endocrine unit coincided with a new dialysis procedure that increased workload, which may explain part of that unit's rate independently of anything managers do. For these reasons, the project should gather current information directly from the nurses who remain, rather than rely only on why others left, and its evaluation should track intent to stay, which changes faster than turnover, as well as departures themselves. The mentor agreed that a one-semester project cannot be judged on annual turnover alone and asked that the evaluation plan say so explicitly.

Problem Statement and Requirements

The sources converge. Turnover is concentrated among nurses in their first three years and on night shift; the leading reasons are scheduling, relationships with managers and workload; the units score lowest on manager support and recognition; and managers have no routine way to learn what would keep a nurse before the nurse decides to leave. Research on nurse turnover supports the relevance of these findings; a comprehensive review identified leadership and management style, workload and scheduling among the organizational factors associated with nurses' intentions to leave (Hayes et al., 2012).

Problem statement: On the medical service line, registered nurses in their first three years leave at about twice their share of the staff, citing scheduling, manager relationships and workload, while nurse managers have no structured, routine conversation with staff about retention and learn of dissatisfaction only at resignation, contributing to turnover costs of about 1.9 million dollars a year.

A solution must therefore give managers a structured way to learn, early and individually, what keeps each nurse and what might cause them to leave; lead to specific actions that managers can take within their authority, particularly on scheduling and recognition; fit within managers' existing time; reach night-shift nurses; and be measurable against turnover, intent to stay and the manager support subscale. The proposal in Module 3 is built to these requirements.

References

Hayes, L. J., O'Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., Spence Laschinger, H. K., & North, N. (2012). Nurse turnover: A literature review: An update. International Journal of Nursing Studies, 49(7), 887-905. https://doi.org/10.1016/j.ijnurstu.2011.10.001

Jones, C. B. (2008). Revisiting nurse turnover costs: Adjusting for inflation. Journal of Nursing Administration, 38(1), 11-18. https://doi.org/10.1097/01.NNA.0000295636.03216.6f

Lake, E. T. (2002). Development of the practice environment scale of the Nursing Work Index. Research in Nursing & Health, 25(3), 176-188. https://doi.org/10.1002/nur.10032