Diffusion In Nursing

First, we must ask who the stakeholders are when it comes to any nursing program. This is a wide universe, for the stakeholders are many. First, of course, we have instructors at the university level, most of whom have been or are practicing professionals. Then there are the administrators of the program who must continually search out money and grants to keep the program going. We then move into the public sector: patients, families, physicians, support staff at healthcare facilities, healthcare administration, HMOs, private insurers, and governmental agencies (Colvin, et.al., 2008). Each has a role to play within the evaluation process.

Current literature continues to reiterate the indicators of a major shortage of registered nurses (RNs) in the United States. The total RN population has been increasing since 1980, which means that we have more RNs in this country than ever before (Nursing Shortage). Even though the RN population is increasing, it is growing at a much slower rate then when compared to the rate of growth of the U.S. population (Nursing Shortage). We are seeing less skilled nurses “at a time of an increasingly aging population with complex care

Healthcare systems and the way safe, quality health care is delivered are continually changing to better serve patients and communities. Professional nursing practice is a large component in the healthcare system today. Back in the 1960s, professional nursing leaders tried to adopt the bachelor degree programs as the only educational track to become a registered nurse (Creasia & Friberg, 2011). Due to nursing shortages and demands this motive did not hold fast. Individuals entering the nursing profession today must first decide which educational pathway to take to become a Registered Nurse (RN).

There are many challenges facing today’s nursing leaders and managers. From staffing and scheduling, to budget cuts and reduced reimbursements, today’s nursing leaders must evolve to meet the ever changing health care environment. Constance Schmidt, Chief Nursing Officer at Cheyenne Regional Medical Center (CRMC), identified retaining experienced registered nurses (RN) as one of the biggest problems she faces as a nursing leader. She went on to state “Nationally, most hospitals have more than 60% of their nurses with at least 5 years of experience. At CRMC, it’s the reverse. We have more than 60% of our nurses with less than 5 years of experience” (personal communication, March 28, 2014). The two largest factors affecting those numbers are the nursing shortage and nursing retention. The first, the nursing shortage, was identified years ago and has been researched countless times. Some projections indicate the number representing the gap between available registered nurses, and the positions needing to be filled, could be over a million before the end of the current decade. The latter, retention of nurses, is a problem in every health care facility in the nation. Nursing turnover results in both a significant financial cost to hospitals, and a significant impact on the community through its effects on patient outcome.

Registered nurses are an integral part of the healthcare system, and make up the largest number of healthcare professionals. According to the Bureau of Labor Statistics (2015) “The employment rate for registered nurses is expected to grow by 16% between 2014 and 2024”. This is more than double the average rate of growth for a profession. The rapid growth rate can be attributed in part to better management of chronic diseases and the baby boomer generation. The growth in the nursing profession is paramount, however the demographics of the nursing population does not mirror the demographics of the population served.

The publication from the institute of medicine has garnered much interest since its publication in 2010 focusing on the future of nursing and the implementation of this with in the nursing community. The nursing profession has over 3 million members and is the largest segment of the nation’s health care workforce. Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives set forth in the 2010 IOM (Institute of Medicine). One of the recommendations is that of a nurse residency program for new nurses or nurses transitioning into new clinical practice areas. The area I work in is home health and this is a growth area the need for a residency program cannot be over stated home

With an ever-increasing body of knowledge in the field of nursing, more education is being required to enter the field of nursing. Many healthcare institutions are raising the educational requirements in order to become employed or maintain employment in their facilities. Healthcare organizations are transitioning to hiring registered nurses (RN) who have a higher level of education, such as, a graduate from a Baccalaureate Degree Nursing (BSN) program. The goal of these institutions is to have nurses with a broader array of skills that can meet the growing demands of our patient population. BSN prepared nurses are recognized for their well-rounded skills in critical thinking, management, case management and health promotion versus Associate Degree nurses (ADN)/Diploma nurses that focus on direct patient care.

Nursing satisfaction has criteria for change; as documented in the Future of Nursing’s report, by the Institute of Medicine in cooperation with the Robert Wood Johnson Foundations’, Campaign for Action. (IOM, 2010) (RWFF, 2010) Both reports lay the groundwork that influences NC current nursing shortage. At the same time; to make health care more affordable, the Affordable Care Act was entered into law (ACA, 2010). Additionally, hospitals and other health care facilities are applying for, and meeting criteria for accreditation and is very clear about implementing a mandatory, entry level, BSN

There are many major challenges facing the nursing shortage environment today. One of those challenges includes the facility recruitment of registered nurses and then the facility retention of the registered nurses that they have recruited. Factors to consider would be as to why a registered nurse chose to accept a particular job and will they choose to stay at the facility after being given an employment opportunity. A facility’s reputation, union status, autonomy and salary are among some of the factors that influence recruitment. Factors that influence retention includes the inclusion in decision making, practice

A1. The nursing profession has evolved significantly over the decades. One of the factors that have greatly influenced these changes has been the involvement of nurses in the development of theories and data base needed to support the advancement of our profession. In the last half of the twentieth century, nurse researchers (1950s) and nurse theorists (1960s and 1970s) greatly contributed to the expanding body of nursing knowledge with their studies of nursing practice and the development of nursing models and theories (American Nurses Association, 2010, p. 16). Like in any other research activity, a special set of

Nursing shortage and nursing turn-over cannot be addressed through a single intervention because there are multiple reasons for the shortage and turn-over. Nurse managers and leaders play a major role in solving this problem by different approaches. Many different strategies are available to address these issues and they are described as follows.

In the early 1980s it came to light that while the supply of nurses had reached a record high, only 80% of hospitals nationwide had adequate nurse staffing levels (American Nurse Credentialing Center, 2011, p. 8). To address this issue a taskforce was formed within the American Academy of Nursing (AAN). Through an initial study of 165 hospitals, the AAN determined the characteristics of healthcare organizations that were magnetically attracting and retaining nurses as employees (American Nurse Credentialing Center, p. 9). In this study the AAN found “Forces of Magnetism” that contributed to the high level of job satisfaction amongst nurses, superior quality of care, low job turnover, and high level of nurse involvement in leadership, decision-making, and research. In the early 1990s, catapulted by the findings of this initial study, the American Nurses Credentialing Center (ANCC) developed the Magnet Recognition Program. The intention of the ANCC’s Magnet Recognition Program was threefold: To reward hospitals that demonstrated “excellence in the delivery of nursing services to patients;” to encourage quality in the nursing work environment to support practicing professional nurses; and to guide navigation for the dissemination of evidenced-based clinical nursing practice (American Nurse Credentialing Center, 2011, p. 14).

With the ongoing changes in the healthcare field, nursing workforce retention presents itself as one of the greatest challenges facing healthcare systems today. According to the American Nursing Association, nursing turnover is a multi-faceted issue which impacts the financial stability of the facility, the quality of patient care and has a direct affect on the other members of the nursing staff (ANA, 2014). The cost to replace a nurse in a healthcare facility ranges between $62,100 to $67,100 (ANA, 2014). The rising problem with nursing retention will intensify the nursing shortage, which has been projected to affect the entire nation, not just isolated areas of the country, gradually increasing in its scope from 2009 to 2030 (Rosseter,

“Throughout the last decade, policymakers and practice leaders have recognized that education makes a difference” (Impact of Education, n.d.). Hospitals are also trending towards preferred hiring of bachelors prepared nurses for their workforce. Even national organizations are jumping on the bandwagon requiring “all nurse managers and nurse leaders to hold a baccalaureate or graduate degree in nursing by 2013” (Impact of Education, n.d.), likewise the Institute of Medicine has also recommended that all hospitals have at least 80% of their nursing staff with a BSN or higher by the year 2020 (Impact of Education, n.d.).

In the early 1980s there was a significant nursing shortage and high turnover at hospitals. Research by the American Academy of Nursing recognized forty-one hospitals that attracted nurses to work at their location because of their more collaborative and supportive work environments. These hospitals were more effective with filling nursing job vacancies compared with similar hospitals. The American Nurse’s Credentialing Center (ANCC), an organization of American Nurses Association developed a voluntary recognition program to formally credential Magnet hospitals, and the first Magnet hospital was credentialed in 1994 (Kelly, 2011). ANCC review certain criteria that are design to measure the quality and strength of nursing practice at the hospital. Nurses who work at these Magnet hospitals have higher job satisfaction and reports that they have better communication between the nurses and other healthcare team. Most importantly, Magnet hospitals have high quality nursing care, better patient outcomes, and high patient satisfaction.