Running Head: Clinical Guideline and Implementation Plan CLC-EBP Develop Clinical Guideline and Implementation Plan NURS 504: HealthCare Research...

CLC-EBP Develop Clinical Guideline and Implementation Plan

NURS 504: HealthCare Research Analysis and Utilization

Grand Canyon University, Phoenix Arizona

Professor Karen Hartje

Patricia M Brubaker RN BSN

Alicia Valentin RN BSN

Edith Iheanacho RN BSN

Winnebelle Gamor RN BSN

May 29, 2017

Problem Statement

With baby boomers becoming older and being a large portion of the population, we will be facing a nursing shortage to care for this population. Nurses are a part of this population. In 2015, approximately fifty percent of registered nurses in the United States were 50 years or older. Older nurses have skills and a wealth of knowledge to share and train younger nurses. Is it more important to work on retention of older nurses or to work on the recruitment of younger nurses? Is it important for acute care hospitals to work on team work attitudes, flexible hours, provide assistive devices to help with the physical demands in nursing, and respect for older nurses by administration and organizations to maintain these skilled nurses? Should this be done to provide social and mental support because of stressors older nurses are facing at home; for example, if they are caring for an elderly parent at home?

Acute care hospitals can partner with nursing schools to make recruitment of new graduate nurses an easier transition. Or is working on organizing preceptor programs for new graduates that support learning and addresses the needs of differences in learning with new graduates more important? Some forms of support are through peer discussion forums, offering e-learning modules and active learning sets to practice skills. One way to recruit new graduates is to support nurses throughout their career at acute care hospitals. Better support system must be organized because new graduates are vulnerable and formulate their intent to commit during the first year of their nursing career.

Evidence Based Practice Question

Is it more important to work on retention of older nurses or to work on the recruitment of younger nurses?

Literature Review

Article 1

Citation:

Author-Evans, J.D.

Title-Factors Influencing Recruitment and Retention of Nurse Educators

Reported by Current Nurse Faculty

Journal-Journal of Professional Nursing

Year-2013 Volume-29 Issue-1 Pages-11-20

Abstract/Purpose:

The abstract does clearly summarize the main features of the report. It talks about the need to increase the number of nurse’s graduates. The need for nurse educators to teach nurses. The study was nationwide and included all levels of education. The study identified strategies for retention, recruitment and recommended further study.

Research/Study:

Descriptive study design was used in this article.

Methods:

Questionnaire was the method used. They had three nursing program deans and

administrators critique the questionnaire with open-ended questions.

Settings/Subject:

All surveys were accessed and completed by participants via internet at a

computer of the participant’s choice. There was a cover letter to inform participants of the questionnaire content and voluntary nature. The surveys were anonymously done.

Findings/Results:

The survey was sent to every region and fifty-one percent of respondents agreed on six of fourteen questions. Flexibility of hours and job was a big point of interest. Presenting a positive image of nursing education was the next thing that was important. Another big point, was fostering collegial work relationships.

Variables

Independent Variable:

Flexible hours, flexibility at the job, positive image of nurse educator, loans, scholarships, and work environment are the independent variables.

Dependent Variable:

The dependent variables were retention and recruitment of nurse

educators.

Implications for Practice:

This study has pointed out factors that also pertain to our EBP study. Flexible hours, flexible jobs, positive image of older nurses for retention of older nurses. For recruitment of younger nurse’s scholarships and loans. Work environments that foster team relationships will help retain older and younger nurses.

Article 2

Citation:

Ryan, C., Bergin, M., Wells, J.S, Valuable yet Vulnerable—A

review of the challenges encountered by older nurses in the workplace. International

Journal of Nursing Studies http://dx.doi.org/10.1016/j.ijnurstu.2017.04.006

Abstract/Purpose:

As the global nursing workforce ages, developing a comprehensive understanding of the experiences, needs and values specific to older nurses is increasingly significant. This paper reviews the evidence regarding the specific challenges encountered by older nurses in the workplace.

Research/Study:

A systematic descriptive research study was utilized in this article.

Methods:

A scoping review of the published literature was conducted using the electronic databases Medline, CINAHL, PsycINFO, Science Direct and Google Scholar was undertaken.

Keywords including “older” or “ageing” nurses were searched. Studies published from the

year 2000 to 2016 only were retrieved.

Settings/Subject”

A total of 20 papers were included in this review, most of which were qualitative (n=14). Three quantitative studies were identified (including one study which combined a physical exam with survey methods) as well as three mixed method studies.

Findings/Results:

The challenges faced by older nurses in their practice are synthesized across three primary domains: Nursing and the ageing body; Recognition and support of the older nurse and Demands associated with middle-age. Conclusion: As older nurses form a substantial proportion of the healthcare workforce in many countries, the development and implementation of strategies to address these challenges is of utmost importance.

Variables:

Work stress, older nurses, aging nurses, aging workforce, challenges, job satisfaction.

Independent Variable:

Work Stress, Job satisfaction.

Dependent Variable:

Older nurses. Aging nurses, Aging workforce.

Implications for Practice:

The following sections as indicated by the article creates the evidence in relation to each of these domains. Nursing and the ageing body, recognition and support of the older nurse and demands associated with middle-age. Nurses who experience chronic stress or burnout in the workplace are more likely to leave the profession, move to a less demanding position or retire due to ill-health. Heiden et al. (2013) suggest that the prevalence and impact of musculoskeletal injury among older nurses may be underestimated as those most severely affected may have left the workforce early. As such, older nurses currently in practice may represent a particularly stress-tolerant cohort of the workforce, due perhaps to developing more effective coping strategies or possessing more resilient personality traits. This may account for the fact that whilst turnover and intention to leave the profession is quite high in nursing compared to other occupations, and higher still among younger nurses it is less so amongst older nurses. However, it should be borne in mind that nursing is a global profession and so older nurses may experience differing levels of occupational stress and satisfaction depending on the individual workplaces, organization, cultural, economic or political context in which they work.

Article 3

Citation:

Upenieks, V. (2003). Recruitment and Retention Strategies: A Magnet Hospital Prevention Model. Medscape, 1-9.

Abstract/Purpose:

The abstract for this article clearly defines its main purpose. Our National Health Care system is facing yet another significant nursing shortage. Acute care facilities will be hit harder than other departments, because of the increase of the aging population and the retirement of lifelong nurses reaching the end of their career.

Research/Study:

This study was drafted using an objective / pilot study method by including

several hospitals that were identified across the country that were successful in recruiting and retaining nurses.

Methods:

American Academy of Nursing conducted an extensive research project and nominated 6-10 hospitals from with the United States, there was a set of three questions that were asked to these hospitals to consider them into this specific study. Questions were as follows: 1. Did the nurses consider the hospital a good place to practice nursing? 2. Did the hospital have the ability to recruit and retain nurses? 3. Was the hospital located in the area, within a city, considered to be in a competitive marketplace?

Settings/Subject:

A total of 10 hospitals were included in this review to conduct the specific study. The hospitals were predominantly private, non-profit institutions, most of which had approximately 300-400 beds.

Findings/Results:

The American Academy of Nursing included 41 hospitals that were their focal points and surveyed and interviewed each facility. These facilities were known as “Magnet Hospitals”. The findings included that the turnover rate in these magnet hospitals was approximately 9%. Where the acute hospitals had a turnover rate of about 18%. It was also noted that magnet hospitals provided autonomy, recognition and recognized nurse value through systems that supported nursing practice. These magnet hospitals demonstrated stronger support of professional nursing practice by the number of registered nurses in the workforce that showed autonomy, and shared governance.

Variables:

Independent Variable:

Job satisfaction outcomes, lower reported turnover, and vacancy rates, and higher job satisfaction levels.

Dependent Variable:

Nursing shortage, aging nursing workforce, and diminishing pipeline of new students.

Implications for Practice:

This study has reflected numerous areas that magnet hospitals use to retain nurses, not only older nurses, but new graduates as well. The employer allows for nurses to use autonomy and when they do they receive positive recognition for their accomplishments. These hospitals repeatedly show stronger support for their nursing departments and always have availability for advancement within the company, including continuing education. The high impact of nursing shortage in the United States has come to face a major dilemma, with high patient acuity and short staffed, we are facing major consequences if all hospitals are unable to retain their current nursing staff and incorporate new practices to attract new nurses out in the current market seeking employment with highly reputable companies.

Article 4

(Making tradeoffs between reasons to leave and reasons to stay employed in long-term care homes: Perspectives of licensed nursing staff).

Citation:

MacGilton K.S, Boscart,V.M., Brown, M., Bowers, B. (2013). Making tradeoffs between the reasons to leave and reasons to stay employed in long term care homes: Perspectives of licensed nursing staff. International Journal Studies, 51, (917-926), http://dx.doi.org/10.1016/j.ijnurstu.2013.10.015

Abstract/Purpose:

The abstract clearly defined and summarized the entire research study. The main purpose of the study is to “understand factors that influence nurses’ retention to remain employed at their current job” (MacGilton, Boscart, Brown, Bowers, 2013). The authors were interested in this topic due to the high turnover of licensed nursing staff in long-term care (LTC). Previous studies have focused on direct care workers such as nurses’ aid but little research have been conducted on issues concerning licensed nursing staff working in LTC. Hence, the authors seek to understand the various factors that influence nurses’ retention and turnover (MacGilton et al., 2013).

Research/Study:

The research was conducted using a qualitative descriptive study. The researchers used focused groups in each LTC. The authors designed a set of semi-structured and open-ended questions to encourage nurses to describe their motivation for staying employed at their current job (MacGilton et al., 2013).

Methods:

The researchers used focus groups, semi-structured open-ended questions to facilitate the research. The researchers also used follow up questions for greater depth of understanding. The researchers gathered and analyzed data using content analysis (MacGilton et al., 2013). Information obtained was transcribed verbatim by a professional transcriptionist (MacGilton et al., 2013).

Settings/Subject:

The study was conducted across LTC facilities in Ontario, Canada. The sample included seven LTC facilities: three large urban-area facilities, two medium homes in rural locations, two small homes in remote settings (MacGilton et al., 2013). The participants were licensed nursing staff such as registered nurses (RN) and licensed practical nurse (LPN). The sample consisted of 17 RN’s and 24 LPN’s.

Findings/Results:

The researchers found that factors affecting nurses to stay at their current workplace consists of both positive and negative workplace conditions. They include: building a meaningful relationship with the residents as well as their colleagues, opportunities for learning, the impact of regulations on role flexibility and professional judgment, perception of an underfunded system, lack of supportive leadership (MacGilton et al., 2013).

Variables

Independent Variable:

The independent variables identified in the study are relationship with residents and coworkers, creating opportunities for learning, absence of supportive leadership, underfunded LTC system, regulations on role flexibility, external personal and life circumstances

Dependent Variable:

The dependent variable identified in the study is retention of licensed nurses in LTC facilities

Implications for Practice:

The study suggests that LTC facilities need to make changes to work environments in order to retain licensed nurses. Relating this to practice; nurses working in facilities with unfavorable work conditions are more likely to leave the job than those with favorable work conditions. Thus, it is essential for facilities to respond to the needs of their nurses to help with retention and decrease attrition. This strategy can be applied to the group’s EPB project of nurse retention.

Article 5

Citation:

Authors-Kirschling, J.M., Colgan, C. & Andrews, B.

Title-Predictors of Registered Nurses Willingness to Remain in Nursing

Journal-Nursing Economics

Year-2011 Volume-29 Issue-3

Abstract/Purpose:

Retaining members of the current nursing workforce and increasing the number of new graduates are major strategies being addressed across the health care industry and higher education. Beyond focusing on retaining older RNs, it is important that employers initiate strategies to retain RNs who are approaching their 40s. Data in this survey showed that, as RNs enter their 4th decade, there is a strong tendency to shift employment into non-acute care settings. Strategies should be developed and tested that encourage retention in direct patient-care positions in acute care environments.

Research/Study:

The study was a quantitative research, collecting data from well over 8,000 nurses across the country. The data set included numerous questions including categories of age, gender, highest education in nursing, and primary role in nursing. Also included in the study is whether the nurse plans in working in the field in the next five years. And how many hours do they work in a typical week.

Methods:

The research was conducted by the use of surveys. This was accomplished by the state incorporating a two page survey with all license renewal applications. The time frame for the research started September 1, 2002 and was concluded on August 31, 2004. The results data was referred to as the Maine Minimum Data Sheet. This data sheet focused on several aspects such as education, work status, work hours, employment setting, position, demographic information, just to name a few.

Settings/Subject:

The research study was conducted in Maine and consisted of 8,038 nurses to include registered nurses (RN) and licensed practical nurses (LPN). Maine was selected because the state had been able to maintain its registered nursing workforce although it is not expected to continue. Participation was voluntarily for all nurses renewing their licenses.

Findings/Results:

The findings in this study included nurse managers and nurse educators, and how important it is to include an attractive work schedule that focuses primarily on what the nurse’s want and need. Will there be a rotation of weekends, holidays etc. Allowing the nurses to adjust slowly to the change of values will also allow for decrease in vacancies.

Variables:

Independent Variable:

Strategies to retain RNs, impact of flexible scheduling.

Dependent Variable:

Older RNs, workforce.

Implications for Practice:

To see what issues the survey identified that can be worked on for the retention of nurses and the recruitment of new graduates to hospitals.

Article 6

Citation:

Dawson, A. J., Stasa, H., Roche, M.A., Homer, C.S.E., Duffield, C.

Title: Nursing churn and turnover in Australian hospitals: nurses’ perceptions and suggestions for supportive strategies.

Articles in BMC journals,

Reported by BMC Nursing 2014, 13:11 doi:10.1186/1472-6955-13-11

Year April 2014

Title:

Nursing churn and turnover in Australian hospitals: nurses’ perceptions and suggestions for supportive strategies

Abstract/Purpose:

This study aimed to reveal nurses’ experiences and perceptions of turnover in Australian hospitals and identify strategies to improve retention, performance and job satisfaction.

Research/Study:

A descriptive research study was made use of in this article.

Methods:

A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories.

Settings/Subject:

Participants were part of a broader study, which examined the relationship between nurse turnover and patient, organizational and staff outcomes. Patient, nurse and costing data were collected on 62 medical and surgical nursing units in 11 public hospitals across two states and one territory of Australia. Nurses’ experiences and needs about nursing turnover were sought at the end of the survey where an open question followed by a blank A4 page was given for participants to write their responses.

Findings/Results:

Key factors affecting nursing turnover were limited career opportunities; poor support; a lack of recognition; and negative staff attitudes. The nursing working environment is characterized by inappropriate skill-mix and inadequate patient-staff ratios; a lack of overseas qualified nurses with appropriate skills; low involvement in decision-making processes; and increased patient demands. These issues impacted upon heavy workloads and stress levels with nurses feeling undervalued and disempowered. Nurses described supportive strategies: improving performance appraisals, responsive preceptorship and flexible employment options

Variables:

Independent Variable:

Distributive justice, workload, resource adequacy, supervisory/kinship support.

Dependent Variable:

Behavior of the “average nurse”, generational membership and age, years of experience, job satisfaction.

Implications for Practice:

The handwritten responses were entered Excel and then imported into NVivo, a qualitative data analysis software tool. These were analyzed thematically [34] using an inductive process to categories, tabulate and recombine the evidence, in line with the aim of the study reported in this paper.

Article 7

Focus on Retention: Identifying Barriers to Nurse Faculty Satisfaction

Citation:

Bittner, N. P., & O’Connor, M. (2012).Focus on retention: Identifying barriers to nurse faculty satisfaction. Nursing Education Perspectives,33(4). https://www.readbyqxmd.com/read/22916629/focus-on-retention-identifying-barriers-to-nurse-faculty-satisfaction

Abstract/Purpose:

The abstract describes the issue of nursing shortage in the country. It summarizes the article to include the aim of the study, method, as well as the findings. The abstract gives a brief description of the various components mentioned above. The aim of the study was to “determine factors nurse faculty report as barriers to job satisfaction” (Bittner & O’Connor, 2012)

Research/Study:

The researchers used a descriptive qualitative study to identify barriers to job satisfaction for nursing faculty (Bittner & O’Connor, 2012)

Methods:

The research was conducted using surveys. A 32-item survey was used with questions related to nursing job such as workload, satisfaction, and identified barriers to satisfaction. It included eleven demographic questions, nine workload questions, and eleven questions on satisfaction or intent to leave, plus one question regarding barriers to satisfaction. A five-point Likert scale was used with scores ranging from very satisfied to very dissatisfied (Bittner & O’Connor, 2012).

Settings/Subject:

The study was conducted in Massachusetts and Rhone Island. This was part of the strategic plan for the Massachusetts/Rhode Island League for Nursing to explore issues related to and affecting nurse educators. The study consisted of 226 nurse faculty. Of these, 97 percent of respondents were women, and their mean age was 53. The majority of respondents (82 percent) were full-time faculty (Bittner & O’Connor, 2012).

Findings/Results:

The finding of the study support existing research on nurse faculty satisfaction. Factors essential to nurse faculty satisfaction include workload and work environment. Majority of the participants reported having two or more jobs and about (20 percent) reported having three jobs or more. This is consistent with nurse faculty being dissatisfied with their salary (Bittner & O’Connor, 2012).

Variables:

Independent Variable:

The independent variables identified for this study are faculty workload, working hours, technology, retirement, barriers to job satisfaction, faculty salaries, and life-work balance (Bittner & O’Connor, 2012).

Dependent Variable:

The dependent variable for the study was nurse faculty recruitment and retention (Bittner & O’Connor, 2012).

Implications for Practice:

Implications for the study findings include the need for attention to the complexity of the academic work environment, specifically in nursing education. Some factors such as retirement as unavoidable but creating a pleasant work environment for these nurses will help with nurse retention. This can be directly applied to the group’s EBP of nurse retention.

Article 8

Citation:

Author-Manion, J.

Title-Nurture a Culture of Retention

Journal-Nurse Management

Year-2004 Volume-35 Issue-4 Pages-28-39

Abstract/Purpose:

The abstract does summarize clearly and concisely the main features of the report. It points out how at present acute care hospitals may not be facing shortages of nurses at present. But with baby boomers getting old there will be a shortage and who will be there to care for all these patients. The articles also states that nurse manger have a big role in retention. Nurse’s mangers are the major forces that create positive work environments and so sow a culture of

retention.

Research/Study:

Categorical-content analysis which is that the categories and themes emerged from the participant’s words and stories. More than twenty factors were identified and the researcher sorted them into five major themes.

Methods:

Interview was the method used, the researcher asked managers nationwide from different departments. The researcher also interviewed three focus groups that included managers and employees.

Setting/Subject:

The study interviewed nurse managers from around the country that included different departments and clinical settings.

Findings/Results:

The article points out that nurse leaders do not need to do extravagant or difficult things to recruit and retain nurses. They need to do simple thin with authentic caring that creates an environment where people want to be at and work.

Independent Variable:

The five major themes are the independent variables, which are put staff first, forge authentic connections, coach for-and expect-competence, focus on results, and partner with staff.

Dependent Variable:

The dependent variable is retention and recruitment of nurses.

Implication for Practice:

This article is very specific and has identified many things under each of the five themes that are of value to our EBP project. Some of the points are caring about staff and being authentic in feelings, meeting staff needs, getting to know your staff, setting high standards and expectations, problem solving, and visibility of manager to name a few.

Article 9

Citation:

Kathleen B. LaSala, P. R. (2000). Nursing Workforce Issues in Rural and Urban Settings: Looking at the Difference in Recruitment, Retention and Distribution. Online Jounral of Rural Nursing and Health Care, 8-17.

Abstract/Purpose:

The abstract of this article clearly explains the workforce issues and concerns that are currently trending in our nursing workforce. Rural Settings are facing more difficulties at this time of desperate need of help. The nursing personnel workforce issues in rural and urban areas are a major challenge, which result in recruitment of travel/agency nurses.

Research/Study:

This study was a self-administered, mailed questionnaire survey. It included demographic as well as descriptive items. Both descriptive analysis and inferential techniques were used to analyze the data.

Methods:

The survey that was mailed was sent to all rural hospitals that had less than 80 beds.

Settings/Subject:

The study interviewed nurse administrators as they shared their perception to the causes of the nurses shortages, and also what they did to help recruit new and established nurses.

Findings/Results:

The findings in this article stated that nurse administrators worked closely with schools of nursing education to improve recruitment and retention of nurses. The family like atmosphere helped decrease the amount of vacancies. The nurse rural administrators also stated that increasing nurse salaries has also helped improve drawing nurses to the rural area.

Variables:

Independent Variable:

Workforce, resignation

Dependent Variable:

Retention of nurses, and recruitment of new nurses

Implications for Practice:

This article stated very specific data on how the nurse administrators worked hard towards retaining nurses. Not only by allowing the environment to work as if they were all family, but also offering higher salaries to promote positive attitudes, and decrease the resignation of nurses to other facilities. The nurse’s administrators worked side by side with the college instructors so upon graduation they would try to do interim for new graduates and take the time to train and invest the proper training to increase nurses in the area.

Article 10

Citation:

Kathleen B. LaSala, P. R. (2000). Nursing Workforce Issues in Rural and Urban Settings: Looking at the Difference in Recruitment, Retention and Distribution. Online Jounral of Rural Nursing and Health Care, 8-17.

Abstract/Purpose:

The abstract of this particular article explains how the Australian Workforce predicts a shortage of nurses by the year 2025. Also states why nurses resign from rural hospitals and explains during what time of employment they decide to resign.

Research/Study:

A qualitative study using grounded theory method was conducted to research the data for this study.

Methods:

The method used was the collection of data from 12 different nurses whom had resigned from rural hospitals. These nurses did not resign because of retirement, maternity leave, or relocation.

Settings/Subject:

Rural NSW hospitals in Australia.

Findings/Results:

The findings in this study resulted in the reason for nurses resigning in rural hospitals is due to a conflict of values, managers not collecting meaningful data to inform retention strategies. Communication during the window period was not utilized and nurses were not being trained properly.

Variables:

Independent Variable:

Resignation, retention

Dependent Variable:

Rural nurse, workforce

Implications for Practice:

The nurse managers have learned during this study that the main reason for resignation from nurses is because of conflict of values between the nurses and the hospitals. When hospital values change nurses are unable to realign their values to the facilities and find it difficult to make change. Non-Traditional nurses have values that are set in their ways and it is hard to make change and allow themselves to carry out new values. Nurses that participated in the study stated that the organization did not engage with them and try to resolve this particular issues.

Research Synthesis

Clinical Protocol

Implementation Plan