NUR5094 Module 6 executive project report and reflection example

Hearing Them Before They Resign: A Report to the Nursing Executive Team on Stay Interviews for Early-Career Nurses, With Three Requests and a Reflection on the Nurse Leader Role

Student Name

American College of Education

NUR5094: Capstone Practicum Experience for Role of the Nurse Administrator

Module 6 Assignment

Instructor Name

April 24, 2029

Summary for the Executive Team

Last year nearly a quarter of the medical service line's registered nurses left, well above the hospital's 15%, at an estimated cost of 1.9 million dollars. Early-career and night-shift nurses left at the highest rates, most often citing scheduling, their relationship with their manager and workload. Over twelve weeks, the service line's three nurse managers held structured stay interviews with 46 of 49 nurses in their first three years, acted on what they heard and changed three practices: a single schedule request policy, regular manager contact with night-shift nurses and monthly recognition. Early-career nurses planning to remain for at least a year went from 57% to 76%. Direct costs were under 2,500 dollars, plus 7,200 dollars a year for certification support. The team is asked to approve three recommendations, set out at the end of this report.

The Problem and What Was Done

The research on nurse turnover treats it as expensive for hospitals, hard on the nurses left behind and a risk to patients, and it names the way units are managed, staffed and scheduled among the causes organizations can address (Hayes et al., 2012). On the medical units, exit interviews showed that most departures were for reasons the service line could influence, while managers, each responsible for more than 40 nurses, had no routine conversation with staff about staying and often learned of dissatisfaction only from a resignation letter.

The project introduced stay interviews: short, planned conversations in which a manager asks a nurse why they stay and what could make them go. Recent reports describe the method as a practical way for nurse leaders to learn what would keep individual nurses, and in one hospital the interviews showed that culture, colleagues and schedules anchored nurses while pay, development and travel contracts drew them away (Snyder et al., 2023). The managers were prepared in a two-hour session, held the interviews in five weeks, including before and after night shifts, recorded commitments to each nurse and reported back on most of them. Themes from the interviews led to the three practice changes, and to the director's decision to fund certification review courses and fees.

Results and Costs

Process targets were met: 94% of eligible nurses were interviewed and 82% of commitments were reported back on. Among early-career nurses, planned retention for another year climbed 19 points, to 76%, and night-shift nurses reporting regular contact with a manager went from about one in eight to more than half. Departures in the first twelve weeks fell to three, from eight in the matching weeks a year earlier, though a quarter-year says little about annual turnover, which is why the turnover target runs to twelve months. The early signs are good; the result that matters to the budget will be known next spring.

Direct costs were about 2,450 dollars in the first semester. Each registered nurse who leaves costs the hospital roughly 61,000 dollars by the finance department's reckoning, so the project, including a year of certification support, would pay for itself several times over if it prevented even one or two departures. The estimates of turnover cost used a method for updating earlier cost studies to current prices (Jones, 2008).

What the Managers Said

The three nurse managers were asked, in the final managers' meeting, what they would tell other managers about the project, and their answers are worth reporting to the executive team because the recommendations depend on managers elsewhere adopting the practice. The manager of the general medical unit said the interviews took less time than the resignations they had previously spent managing, and that the most useful question was the one about what frustrated nurses, because it produced problems she could fix the same week, such as a broken supply cart that had irritated the night shift for months. The manager of the renal and endocrine unit said the hardest interview was the one in which a nurse criticized her directly, and that the director's support afterward made her willing to keep asking the question. The manager of the medical-oncology unit, whose turnover was already the lowest of the three, said the interviews confirmed what was working and gave her a way to thank specific nurses for specific things, which she had rarely done. All three said they would not return to managing without the interviews, and all three asked that the division's other managers receive the same preparation session rather than a written guide, because the practice conversations in the session were what made the first interviews possible. Their views support the first request below, and they have offered to co-lead the preparation for the surgical units' managers.

Requests

The executive team is asked, first, to endorse stay interviews at the first and second work anniversaries of every registered nurse on the medical units as a standard part of the nurse manager role, and to include them in manager orientation across the division. Second, to approve extending the schedule request policy to the four surgical units, where managers have already requested it, with a staff working session on each unit to adapt it. Third, to fund a small evaluation: a twelve-month trial of stay interviews on a single surgical unit, matched against a similar unit that continues as it is, measuring turnover and intent to stay, so that the hospital has stronger evidence before adopting the practice system-wide. These requests involve little new spending and use capacity the division already has. The chief nursing officer has asked for the item to be placed on the next division leadership agenda.

Reflection on the Nurse Leader Role

When the practicum began, the author rated their own performance against the nurse executive competencies (American Organization of Nurse Executives [AONE], 2015) showed confidence in communication with patients and staff and weakness in business skills, understanding the healthcare environment beyond the unit and leading peers who outrank a charge nurse. The end-of-practicum self-assessment shows the largest growth in business skills: the author can now read a service line budget, explain a variance, estimate the cost of a problem and argue for a modest expense by comparing it with a larger one. The second largest growth is in leadership. Leading three experienced managers through a change they had not asked for required listening to their objections, adapting the plan to their workload and letting them own the decisions, an approach consistent with the review by Cummings et al. (2018), in which people-focused leadership went with better results for nurses.

The hardest lesson concerned the limits of a leader's authority. Nurses asked for things the managers could not give, particularly pay, and the most useful thing leadership could do was to say so honestly and send the information to the people who could act on it. The author also learned how much of a nurse administrator's work happens in meetings about time, money and priorities rather than at the bedside, and that the bedside remains the reason for all of it. The author has applied for an assistant nurse manager position on the renal and endocrine unit and intends to hold stay interviews there from the first month.

References

American Organization of Nurse Executives. (2015). AONE nurse executive competencies.

Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P. M., & Chatterjee, G. E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 85, 19-60. https://doi.org/10.1016/j.ijnurstu.2018.04.016

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

Snyder, A., Whiteman, K., DiCuccio, M., Swanson-Biearman, B., & Stephens, K. (2023). Why they stay and why they leave: Stay interviews with registered nurses to hear what matters the most. Journal of Nursing Administration, 53(3), 154-160. https://doi.org/10.1097/NNA.0000000000001261