Quality Improvement in Healthcare: Nursing Shortage Solution Plan

This report addresses the critical issue of nursing shortages in healthcare environments, specifically within a hospital setting. The author identifies the imbalance between nursing demand and supply, citing factors such as aging workforce, high turnover, and increased patient complexity as contributing causes. The problem is recognized through feedback from nurses and patients, highlighting increased workloads, burnout, and missed care. The goal is to improve nurse retention and recruitment. Metrics for success include reduced turnover, increased new nurse hires, improved patient and job satisfaction. The report proposes strategies like recruiting permanent staff, training, academic-practice partnerships, and effective feedback mechanisms. Key stakeholders, including hospital managers, nursing leaders, and researchers, are identified to implement and support the proposed solutions. The report emphasizes the urgency of addressing the shortage to maintain quality of care.

Running head: QUALITY IMPROVEMENT IN HEALTHCARE 1
Quality improvement in Healthcare
Name
Institutional Affiliation

QUALITY IMPROVEMENT IN HEALTHCARE 2
The Problem
The problem I wish to improve in my healthcare environment is nursing shortage.
Nursing shortage refers to an overarching imbalance in the demand and supply of nursing
wrkforce, which can be attributed to willingness to work, availability, demographics and
qualifications. A nursing shortage occurs when there are an inadequate number of nurses to meet
the demand of the healthcare environment (Mudihanselage & Chamaru, 2015). Nursing shortage
has been a major problem in the United States. The increase in the nursing shortage can be
attributed to the increased turnover resulting from the aging baby-boomers generation (Cox,
Willis, & Coustasse, 2014). Other causes of nursing shortages include high turnover, inadequacy
of potential educators, and unequal distribution of workforce (Haddad & Toney-Butler, 2019).
Additionally, the growth in the aging population has significantly resulted in increased medical
problems and complexity of healthcare needs. This problem has significantly been experienced
at the hospital where I work. In the last one year, the number of registered nurses has continued
to decrease while the patient population increases. This challenge has impacted the quality of
healthcare delivery to the hospital, and warrants urgent action.
Identification of the Problem
The problem of nursing shortage has increasingly been identified through feedback from
nurses and patients and observations in medical units. Most of the nursing staff complains of
increased workloads, burnout, dissatisfaction, failure-to-rescue rates, work-family conflicts and
high patent-nurse rations. Additionally, nurses have been forced to work for longer shifts and
more days to compensate for the shortage. Nurses have also complained that they lack
opportunities for trainings and education, which are essential in advancement of their careers.

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Due to the increased pressure, the turnover rate and intention at the hospital has increased as
nurses leave the hospital to work in other organizations.
Nursing shortage is also demonstrated by increased reports of missed care by the patients
such as increased neglect of important aspects of care such as informed consent, comforting and
talking to the patients, and missed medications. Additionally, there have been challenges in
addressing the growing number of patients who are forced to wait for long hours or leave the
hospital unattended. The hospital units and understaffed and the available nurses are busy; hence
patients experience challenges interacting with them. The nursing shortage has negatively
affected nurse-patient relationships.
The Goal Outcome
Addressing the nursing shortage is achievable through:
1. Retention of nursing workforce by creating a positive work environment
2. Improving the recruitment strategies to equip nurses with skills on how to handle
challenges in the healthcare environment while adhering to nursing standards, and
recruiting more nursing professionals
Metrics That Will Inform the Goal Has Been Reached
The metrics that will be used to measure the achievement of the goal include:
Reduction of nurses’ turnover: Turnover refers to voluntary or involuntary leaving
employment. According to Kurnat-Thoma, Ganger, Peterson, and Channell (2017) employee
turnover is a critical metric in assessing the operational effectiveness of a healthcare
organization. The factors that determine turnover intention and burnout include work overload,
work-family conflict, frequent night shifts, tensed nurse-patients interactions (Chen et al., 2018).

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Nurses’ retention: It is a critical measure of the overall operational health of an
organization (Kurnat-Thoma et al., 2017)
Increase in the number of new nurses: New nursing employments reflect an increase in
nursing workforce.
Increase in the level of reported patient satisfaction: The patient feedback will
determine the sufficiency and efficiency of nursing care in various hospital units.
Increase in the level of reported job satisfaction: Employee feedback is essential in
determining the level of satisfaction and the nature of the work environment.
Processes to Improve the Problem
Various processes will b essential in addressing the nursing shortage. They include:
The hospital will focus on recruiting permanent employees as opposed to temporary
workforce. According to Seo and Spetz (2013), due to the problem of nursing shortages, hospital
managers often experience difficulties retaining and recruiting. Therefore, they often seek nurses
for temporary employment agencies to fill the vacancies. However, in most cases, these nurses
are not experienced enough to handle the nursing environments that are left unattended.
Emphasis will be placed on training and education of new nursing staff during recruitment.
Chen, Li, Li, Lyu and Zhang (2018) explained that younger nurses are less experienced, and lack
essential skills such as effective communication and handling complex clinical situations; hence
they experience greater stress. According to Mudihanselage and Chamaru (2015), leadership in
healthcare settings should focus on recruitment and retentions strategies that focus on training
nurses on how to deal with complex situations in the workplace and emotional management.
Trossman (2016) explained that retention of qualified staff is achievable by ensuring effective
assimilation of new employees into the organizational culture during hiring. Employees who

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participate in a well-structured on-boarding process after recruitment have a higher (58%)
likelihood of remaining in the employment for 3 years after recruitment (Kurnat-Thoma et al.,
2017).
Academic-practice partnership is also essential in addressing the challenge of workforce
shortage in the healthcare sector (Wyte-Lake, Tran, Bowman, Needleman, & Dobalian, 2013).
The partnership will ensure that the hospital supports students during their nursing practices and
offers them employment on completion of their courses. Consequently, the nurses will be
familiar with their potential work environments early enough, and the hospital will have
adequate junior staff to support nurses in their work.
Effective feedback gathering is essential in improving the work environment. It can be
achieved through effective communication. According to Kurnat-Thoma et al. (2017), explained
that understanding the factors that determine employee turnover helps hospital management to
create a positive work environment and achieve better employee outcomes, improved retention
and reduced turnover. A positive work environment will foster better employee outcomes.
Stakeholders Involved
The stakeholders that will be involved in addressing the problem include hospital
managers, human resource leaders, nursing leaders, researchers, nurses, patients and
academicians. The managers will approve and provide funding for the strategies and steps
involved in addressing the nursing shortage. Nursing leaders will provide advice on the areas that
need improvement. The patients and nurses will provide essential feedback for measuring
progress. The researchers will help in analyzing feedback from the stakeholders and the
academicians will help in the establishment of effective academic-practice partnerships.

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References
Chen, H., Li, G., Li, M., Lyu, L., & Zhang, T. (2018). A cross-sectional study on nurse turnover
intention and influencing factors in Jiangsu Province, China. International Journal of
Nursing Sciences, 5(4), 396-402.
Cox, P., Willis, W. K., & Coustasse, A. (2014). The American epidemic: The US nursing
shortage and turnover problem. Retrieved from
https://pdfs.semanticscholar.org/21d8/3d77233481b31852283688a9088c904b1158.pdf
Haddad, L. M., & Toney-Butler, T. J. (2019). Nursing shortage. In StatPearls [Internet].
StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK493175/
Kurnat-Thoma, E., Ganger, M., Peterson, K., & Channell, L. (2017). Reducing annual hospital
and registered nurse staff turnover—A 10-element onboarding program
intervention. SAGE Open Nursing, 3, 1-13. doi:10.1177%2F2377960817697712
Mudihanselage, H. S. S. S., & Chamaru, A. A. A. (2015). The nursing shortage impact on job
outcome (the case in Sri Lanka). Journal of Competitiveness, 7(3), 75-94. doi:
10.7441/joc.2015.03.06
Seo, S., & Spetz, J. (2013). Demand for temporary agency nurses and nursing
shortages. INQUIRY: The Journal of Health Care Organization, Provision, and
Financing, 50(3), 216-228. doi:10.1177%2F0046958013516583
Trossman, S. (2016). Stepping into a culture of safety onboarding programs help retain nurses,
strengthen patient care. The American Nurse, 48(6), 1-6.
Wyte-Lake, T., Tran, K., Bowman, C. C., Needleman, J., & Dobalian, A. (2013). A systematic
review of strategies to address the clinical nursing faculty shortage. Journal of Nursing
Education, 52(5), 245-252.