Nurses are the backbone of the healthcare system. Thanks to the roles that nurse play, medical institutions are unable to deliver care. Given the importance of nurses, it is little wonder that hospitals grappling with nurse shortages are unable to deliver quality and affordable care. It has been observed that the US is facing a crippling shortage of nurses (Ferrer et al., 2014). This problem has hampered the capacity of US hospitals to attend to the needs of patients. In an effort to ensure that they are able to fulfill their mandate, hospitals are resorting to some measures that are rather desperate. Ashford General Hospital serves as a perfect case study for illustrating the damaging effects of nurse shortage. As a result of its limited staff, this facility is incurring higher costs and has been unable to ensure patient satisfaction. To solve its nursing shortage crisis, Ashford General Hospital should turn to some of the facilities in the US which have been successful in solving the problem of nurse shortage, for inspiration.
Solutions Implemented in other Hospitals
As noted above, the key to addressing the staffing shortage that Ashford General Hospital faces can be found in other hospitals which have encountered a similar challenge. In the following discussion, an overview of the various strategies and measures that five of these hospitals have implemented is offered. The purpose of the discussion is to make it clear that the challenge that Ashford General Hospital faces is not unique and that there are numerous viable solutions that the facility could adopt.
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Erlanger Health System in Chattanooga, TN
Erlanger Health System is among the facilities whose success serves as proof that it is indeed possible to tackle the nurse shortage problem. Apart from a nursing shortage, this institution also had instructors who were too few to adequately train nursing students. As part of its efforts to solve these challenges, this facility implemented a number of initiatives. One, it established a residency program (Wrinn, 2010). This program has been developed in collaboration with the University Of Tennessee Chattanooga School Of Nursing. Through the program, Erlanger Health System hopes to increase the number of highly trained nursing practitioners who will go on to fix the shortage problem. Two, this healthcare provider is leveraging the expertise of its professionals and registered nurses to enhance clinical education (Wrinn, 2010). The leaders at this facility clearly understood that to solve the nurse shortage problem, greater investment in nursing education was needed. In a demonstration of this understanding, the facility worked with its professionals and registered nurses to train nursing students in various areas of clinical practice. As a result of the efforts of these practitioners, the institution expects to expand its nursing workforce.
The initiatives that Erlanger Health System has implemented are mainly concerned with nurse education and training. In addition to the initiatives discussed above, this facility has also joined forces with such educational institutions as the University of Tennessee Chattanooga School Of Nursing (Wrinn, 2010). The primary purpose of this partnership is to equip nursing students with the skills, attitudes and knowledge that they need to become effective practitioners who will help hospitals to address nursing shortage. Increased investment in education and encouraging students in public schools to pursue nursing are other measures that the Erlanger Health System has implemented. Using school career fairs as platforms for engagement with students, this facility is seeking to challenge them to desire to work in the nursing profession. It would be interesting to determine if the various strategies that Erlanger Health System has adopted are effective. Various studies have established that thanks investment in education, an increase in nurse satisfaction and retention levels has been witnessed (Wrinn, 2010). Furthermore, it has been shown that by investing in education, facilities are able to recruit qualified and competent nurses (Feldman et al., 2015). Since there is evidence that the strategies implemented by Erlanger Health System have yielded positive outcomes, Ashford General Hospital should consider implementing similar programs.
CHI Memorial Hospital in Chattanooga, TN
CHI Memorial Hospital joined Erlanger in demonstrating that by taking practical steps, hospitals can address the shortage of nurse practitioners. As is the case with Erlanger Health System, CHI Memorial Hospital also established a residency program for its nurses (Johnson, 2016). The main purpose of this program is to expose nurses to a wide range of practice areas and to enable the nurses to select the nursing functions that are most in line with their strengths and desires. By rotating the nurses in different departments through the residency program, CHI Memorial Hospital empowers nurses and allows them to select practice areas that they find to be most suitable. Financial incentives are another initiative that the hospital has implemented as part of its campaign to increase nurse retention and satisfaction levels. When they sign on to work at the facility, nurse practitioners are offered a bonus (Johnson, 2016). In exchange for the bonus, the nurses are required to commit to work for the facility for at least two years. This measure is clearly designed to increase retention and satisfaction. Evidence shows that by offering nurse practitioners competitive and fair compensation, healthcare providers are able to minimize turnover while enhancing nurse satisfaction. The fact that CHI Memorial has been able to retain 90% of its first-year nurses shows that the measures it has implemented are working. The sign-on bonus was accompanied by an increase in the wage that the facility offered its nurses. It is not surprising that the financial incentives had the effect of motivating the nurses at CHI Memorial Hospital.
CHI Memorial Hospital must have understood that financial incentives and the residency program would not be enough to solve its nursing shortage. In addition to these measures, this facility also sought to ensure that its nursing workforce reflected the culturally diversity of the community that it served. This facility developed a culturally-diverse workforce. Apart from addressing the nurse shortage, the recruitment of culturally-diverse nurses appears to have been aimed at enhancing the hospital’s cultural competence. Nurses from different cultural backgrounds are better placed to attend to the needs of a culturally-diverse patient population. Another initiative that CHI Memorial implemented was the adoption of a new and revamped patient charting system. Before introducing this system, the facility had observed that most of its nurses complained of burnout resulting from heavy workloads. The new charting system is designed to reduce the amount of work that the nurses at the facility perform. Research shows that lighter workloads result in low stress and burnout levels (Hart & Warren, 2013). Therefore, it can be expected that the new charting system will allow the nurses at CHI Memorial Hospital to feel more satisfied with their jobs.
Piedmont Hospital in Atlanta, GA
Nurse shortage is a problem that Piedmont Hospital in Atlanta is all too familiar with. This facility understood that if it failed to address this problem, its employees and patients would suffer. To protect these stakeholders against harm, the hospital implemented various measures. Among these measures was expanding the capacity of its nursing residency program. The facility recognized that many nursing educational institutions refuse to accept students because they lack capacity. In order to increase the number of students undertaking nursing programs, Piedmont Hospital accepted an unprecedented number of applicants who wished to participate in its residency program. Offering tuition reimbursements is another strategy that the hospital implemented. This strategy was intended to ensure that no student with a burning desire to become a nurse is kept from school owing to an inability to pay for tuition. There is no question that Piedmont Hospital acknowledges that the healthcare industry needs to take the lead in tackling shortage. The providers in the industry cannot continue to look to the government for interventions.
In a clear demonstration of its commitment to nursing education and training, Piedmont Hospital went beyond offering tuition reimbursements. This facility also forgave student loans. In the US, many people are struggling with financial difficulties as they try to settle student loans. Piedmont Hospital is among the few institutions which recognize that students should not carry the burden of acquiring education alone. Offering retention bonuses is yet another approach that the hospital adopted in the hope of tackling nursing shortage. Through these bonuses, the facility aimed to offer its nurses reason to stay and continue to deliver care to patients. Moreover, by offering bonuses, it can be argued that the facility is seeking to attract nurses whose philosophies resonate with the financial incentives that the hospital offers. The various initiatives that Piedmont Hospital has implemented are undoubtedly well-designed. It can therefore be expected that the hospital will find success in its quest to increase the size of its nursing workforce.
Vanderbilt University Medical Center in Nashville, TN
The discussion above has identified some of the strategies that three hospitals have implemented as they seek to protect patients against the adverse impacts of nurse shortage. The fact that there are other hospitals whose strategies need to be explored demonstrates how widespread the problem of staff shortages in US hospitals is. Vanderbilt University Medical Center is yet another healthcare provider that has been prompted to act by nurse shortage. In July 2017, the nurse retention rates at this facility stood at a meager 79.5% (Batcheldor, 2018). Following the implementation of a raft of measures, this figure had risen to an impressive 83.4% by April 2018. The increase in nurse retention is the result of such initiatives as enhanced recruitment and increasing the number of residency positions for nurses. Vanderbilt University Medical Center also streamlined the job transfer process, increased the number of start dates, and challenging resident nurses to commit to work at the facility for at least two years (Batcheldor, 2018). This facility also identified greater investment in the education and training of nurses as among the most promising initiatives. To facilitate education and encourage nurses to remain committed to their roles, the medical center implemented a loan forgiveness program and offered scholarships to nursing students pursuing certain programs. Furthermore, the hospital introduced retention bonuses with the aim of encouraging nurse practitioners to stay (Batcheldor, 2018). When one considers the range and extent of measures that Vanderbilt University Medical Center implemented, they are able to understand why this facility was able to increase the nurse retention rate.
Gwinnett Medical Center in Lawrenceville, GA
The fifth hospital which set out to increase nurse retention rates is Gwinnett Medical Center. Joining forces with the Atlanta Veteran Affairs (VA) is among the strategies that this facility pursued. The introduction of a new charting system for patients and offering nurses competitive wages are other strategies that this facility adopted. While it is yet to be established whether these strategies are working, Gwinnett Medical Center can expect to experience higher nurse retention and satisfaction rates. This hospital has also introduced flexible work schedules for its nurses. These schedules enable nurses to pursue personal endeavors while still performing their duties as required. Investment in education adds to the list of programs that Gwinnett Medical Center is pursuing. The facility is offering scholarships to students. In supporting nursing students, this hospital shows that it is not sitting idly by and waiting for other stakeholders to intervene. Instead, it is demonstrating initiative by addressing the root causes of the nurse shortage problem.
Most Viable Solutions for Ashford General Hospital
The discussion above has identified numerous effective strategies that Ashford General Hospital could adopt in its quest for higher nurse retention rates. However, since nearly all of the strategies require huge capital investments, the hospital will be unable to adopt them all. A careful selection should be conducted to identify the measures that are most cost-effective and holds the greatest promise of solving the challenge that Ashford General Hospital faces. It is suggested that the hospital should invest in education and provide financial incentives to its nurses. The investment in education should involve establishing a nurse residency program. Through the program, the hospital will be able to educate nursing students from whom it will select nurses to practice at its facility. Moreover, as part of its investment in nursing education, Ashford General Hospital needs to offer scholarships to nursing students who demonstrate excellent academic performance. Higher wages for nurses and sign-on bonuses are the key financial incentives that the hospital should introduce. The financial incentives coupled with investment in nursing education promise to drive the hospital’s performance. A number of factors informed the decision to recommend these two measures. One of the factors is the fact that nearly all the hospitals discussed above have adopted these measures. As a result of the implementation of these measures, the hospitals have registered marked improvement in nurse retention and satisfaction. Therefore, as it implements the same measures, Ashford General Hospital can expect to enjoy similar improvements. Another reason why the two strategies have been recommended is that research has established that they are effective. Being provided with opportunities for training and continued education has particularly been shown to have significant impacts on nurse retention and satisfaction (Yeager & Wisniewski, 2017). Financial incentives also have the effect of inspiring nurses to become more committed. Therefore, since there is scientific support for the two initiatives, Ashford General Hospital should consider them.
Stakeholder Analysis
Before implementing strategies, healthcare providers need to evaluate how the strategies will affect different stakeholders. In the following discussion, the impacts of the two strategies recommended above on various parties are examined.
Investment in Education
Patients
Enhanced patient outcomes are the key impact that investment in education by Ashford General Hospital will have on patients. Scholarly studies have shown that by investing in nursing education, healthcare providers experience improvements in such patient outcomes as safety and general wellbeing (NIH, 2014). Through such investments as the establishment of a residency program, Ashford General Hospital will increase the number of competent and committed nurses. These nurses will be in a better position to attend to every need that patients present. An initial increase in the cost of care is one of the negative impacts that the investment in education may present for patients. Establishing residency programs and offering scholarships are costly undertakings. Ashford General Hospital is facing a cash crunch that has impaired its capacity to deliver care. As it invests in nursing education, the financial challenges will only worsen. This facility may be forced to pass the added cost on to patients in the form of increased fees. Therefore, the patients should anticipate to pay more for care. However, with time, the cost is likely to come down since most of the costs that the hospital incurs as it invests in nursing education are one-off.
As it invests in nursing education, Ashford General Hospital should be wary of various ethical and legal risk factors. Under the Obama administration, various law and policies were adopted with the goal of making medical care cost effective. For example, the enactment of the Affordable Care Act introduced a new dispensation where providers would need to identify measures to keep costs down and make healthcare affordable (Agrawal & Venkatesh, 2015). As noted above, as it invests in education, Ashford General Hospital will incur huge costs, part of which will be borne by patients. The facility should understand that charging patients higher fees could place it on a collision path with the government.
Executive Leadership
For the successful implementation of healthcare reforms to be realized, full and committed engagement of the top leadership of healthcare providers is needed. The executive leadership at Ashford General Hospital should understand that increased investment in nursing education and the provision of financial incentives will affect them in a number of ways. Being required to redefine change processes is among the impacts. Currently, Ashford General Hospital lacks proper structures and processes that allow for the smooth implementation of reforms. The hospital focuses on short-term solutions instead of implementing strategies that secure long-term growth. For example, the hospital has hired temporary nurses. While the hiring of these nurses has offered a temporary fix for the shortage, it does little to address the fundamental issues. If they truly desire to see the hospital become fully-staffed, the top leaders need to transform the hospital’s policy. Focus should be placed on finding and implementing long-term solutions. The top leadership should also expect to incur significant costs. As noted above, the implementation of the recommended strategies is a cost-intensive undertaking. The managers will need to appeal to sponsors and partners to fund the implementation process. In many cases, hospitals are unable to implement changes because of inadequate funding (Kishore et al., 2015). To ensure that the implementation of the proposed strategies is not derailed by inadequate finances, the top leaders should reach out to the hospital’s partners for financial support.
As noted earlier, as it increases its investment in nursing education, Ashford General Hospital will encounter ethical and legal questions. Ensuring cultural diversity is among the questions that the top leadership will need to answer. It is understood that a culturally-diverse student population helps nursing students to develop cultural competence (Smith, 2017). The top leadership of Ashford General Hospital will need to take steps to ensure that the student population of its residency program and those who receive scholarships reflects the cultural diversity of the US. It has been observed that minorities are under-represented in nursing education (Carthon et al., 2015). Ashford General Hospital should join other healthcare providers in ensuring equity in nursing education by prioritizing minority students.
Nurses
Nurses are perhaps the stakeholders who will witness the greatest impact when Ashford General Hospital prioritizes nurse education. At present, the nurses are overwhelmed owing to shortages. Increased satisfaction and lighter workloads are some of the impacts that the nurses should expect to experience. Nursing education increases the number of nurses who are adequately trained to attend to patient needs (Tshiamo et al., 2015). The more nurses attending to patients, the less the work that individual nurses are required to perform. Career advancement is another effect that investment in education will have on the nurses. In addition to improving nurse competence, education also allows nurses to access career opportunities. Therefore, as Ashford General Hospital offers scholarships and develops its residency program, it will be making it possible for its nurses to enhance their career growth.
It has been stated that the implementation of the proposed solutions will require Ashford General Hospital to introduce change processes. The hospital’s nurses will need to lead in the introduction of these processes. When a facility is introducing changes, hiccups are usually experienced. The nurses at Ashford should expect such hiccups. For example, the class schedules may conflict with the roles of the nurses at the facility. Working with the top leadership, the nurses need to streamline the schedules to ensure that nurses are able to pursue education and training without abandoning their obligations.
Ashford General Hospital
The larger Ashford General Hospital is another stakeholder whose operations will be affected by the implementation of a robust nursing education program. Higher levels of operational efficiencies are among the primary benefits that the hospital will witness upon the establishment of nursing residency and scholarship programs. Nursing education has been shown to help medical providers to minimize errors (Tshiamo et al., 2015). As a result of the reduced frequency and gravity of errors, the providers are able to enhance the wellbeing of patients. Ashford General Hospital will also address the nurse shortage problem with which it is grappling. As already stated, the education programs will supply the hospital with competent and dedicated nurses who will help to drive organizational performance and growth. With regard to ethics and the law, the entire Ashford General Hospital fraternity will need to work together to promote cultural diversity and minimize the extra costs that patients will be required to bear.
Third Party Payers
The US has adopted a complex system of healthcare payment. There are various parties who are involved in paying for care. In addition to the government and individual patients, insurance companies also pay for care through reimbursement. When Ashford General Hospital invests in education, the third party payers will be affected in a number of ways. One, such payers as the government may need to offer financial incentives to the hospital. The pay-per-performance (value-based) model is gaining popularity in the US. Under this model, healthcare providers receive financial incentives for offering quality care (Caveney, 2016). It has already been stated that the investment in education will allow Ashford General Hospital to minimize errors and offer services of improved quality. If it is part of such insurance schemes as Medicaid and Medicare, Ashford General Hospital will receive higher investment amounts for its commitment to quality and safety.
Financial Incentives
Financial incentives are the second solution that Ashford General Hospital should consider adopting. However, before implementing this proposal, the hospital should examine how it will affect different stakeholders. An overview of how the financial incentives will affect the stakeholders is offered below.
Patients
Financial incentives have been proven to help healthcare providers improve the quality of care (Aninanya et al., 2016). Using these incentives, the providers inspire their practitioners to demonstrate greater productivity and commitment. Patients are set to witness the most benefit as the Ashford Medical Center nurses work harder to earn financial incentives. For example, the patients are likely to wait for shorter lengths of time and have more positive interactions with nurses. Nurses who are poorly paid are usually unable to establish warm and professional relations with patients. While they will witness an improvement in the quality of care that they receive, the patients may also be confronted with higher bills. It was stated in an earlier section that Ashford General Hospital is facing a financial crisis that threatens its future. To afford the financial incentives, the hospital may be forced to charge the patients higher amounts. However, it should be noted that the higher charges will be justified since Ashford will be delivering care services of improved quality.
Executive Leadership and Ashford General Hospital
Ashford’s top leadership has been identified as among the stakeholders whose involvement will determine the successful implementation of the proposed solutions. Among the implications that the financial incentives will present for the executive leadership is that it will force managers and leaders to look inward for solutions to the hospital’s problems. Currently, Ashford has turned to outsiders to fix its shortage of nurses. For example, it is hiring temporary nurses. The strategies that the leaders have implemented have clearly been ineffective since the hospital continues to lose its nurses. As part of the change process, the hospital’s leadership will need to recognize that fixing internal issues holds the key to increasing nurse retention. It could be that the nurses are leaving because they are not being compensated fairly or adequately. The financial incentives will compel the hospital’s leadership to build the capacity of the nurses while ensuring that they are provided with the incentives they need to perform optimally. Ashford’s leadership should consider such values as equity and fairness when implementing the financial incentives. The incentives that a nurse receives should be pegged on performance. When nurses feel that they are being denied incentives despite working hard, they are likely to become resentful and their performance usually suffers (Wilson et al., 2018). If Ashford is to create a culture of collaboration and friendly relations among its nurses, its top leadership must ensure that the incentives are awarded in an equitable fashion. The larger Ashford community needs to work with the top leadership. The need for a collaborative effort lies in the fact that the leaders represent the community and their decisions will affect the operations of the hospital.
Nurses
So far, it is evident that the changes that Ashford implements will have far-reaching impacts on its nurses. For the most part, the effects of the financial incentives on the nurses will be positive. In addition to improving their standards of living, the incentives will also motivate the nurses and allow them to derive greater satisfaction from their jobs. As they enjoy the benefits of the incentives, the nurses should understand that these incentives will come with certain change processes and ethical questions. For example, to qualify for the incentives, the nurses may need to demonstrate hardwork and commitment. They will need to focus all their efforts on ensuring that patients receive the best possible quality of care. The nurses will also need to stay vigilant and pressure the top leadership to award the incentives equally. The distribution of these incentives should be on the basis of the level of commitment and industry that a nurse exhibits.
Third Party Payers
The US government and private providers of medical insurers will undoubtedly be affected when Ashford General Hospital rolls out the financial incentives. However, these third party payers should not be concerned since the hospital will bear most of the costs. However, the payers need to keep a close eye on how the incentives are distributed. It is particularly critical for these stakeholders to impose pressure on the hospital to ensure accountability and fairness. When the hospital introduces the incentives, it may suffer such ills as fraud. To protect the financial incentives against fraudulent saboteurs, the third party payers should demand accountability, particularly from the top leadership.
Recommendation
Investing in nursing education and offering financial incentives to its nurses are both viable strategies that promise to help Ashford General Hospital to address its shortage problem. However, since it may be difficult to implement both strategies, ti is important to identify the solution that holds greatest promise. It is advised that the hospital should implement the financial incentives. The discussion below offers a rationale for this recommendation.
Various scholars have examined the impacts that financial incentives such as higher salaries and bonuses have on the delivery of healthcare. It has been noted that these incentives present benefits for individual nurses, medical institutions and patient communities (Leong, 2014). At the personal level, financial incentives inspire nurse practitioners to commit to their hospitals. Moreover, the incentives enhance job satisfaction while motivating nurses. The image of the nursing profession also improves thanks to the financial incentives.
While individual nurses record the greatest benefits when they are offered financial incentives, medical institutions also witness improvements. The delivery of enhanced care, lower workloads for nurses, lower mortality rates and shorter hospital stays for patients are some of the benefits that the hospitals witness (Leong, 2014). Additionally, financial incentives allow the hospitals to attract and retain talented nurses and other practitioners. The larger society also benefits from financial incentives. Patients receive quality care and are provided with education that they need to secure their wellbeing (Leong, 2014). Enrollment of nurse students from the local communities is another benefit that the financial incentives deliver. Overall, financial incentives have positive impacts on various stakeholders.
It is true that the impacts of the financial incentives are largely positive. However, as it introduces these incentives, Ashford should be wary of certain negative impacts. High costs of sustaining the incentives are among the adverse effects. The hospital may be unable to pay the nurses higher wages and bonuses. Even if it is able to pay these benefits, its long-term financial position may be compromised. That Ashford General Hospital’s financial health may suffer is indeed cause for concern. However, the higher patient numbers that the hospital treats coupled with an improved image should offset the additional costs that the hospital incurs.
The justification of the recommendation that Ashford General Hospital should offer its nurses financial incentives would not be complete without a discussion on cultural shifts occurring in the nursing profession and the need for the hospital to adopt sound management approaches. Resistance is one of the factors that hamper the implementation of change. As part of their efforts to ensure the successful implementation of hospital, organizations need to secure the full support of all stakeholders. When it announces that it will be paying its nurses higher salaries and bonuses, Ashford will be greeted with enthusiasm from nearly all stakeholders. The nurses, patients, top leadership and the community are all likely to support the hospital’s initiative. Moreover, by offering financial incentives, Ashford will be part of the emerging culture of nurse welfare. More are more healthcare providers are investing in the wellbeing of their nurses and other practitioners.
Conclusion
Ashford General Hospital represents the hundreds of medical facilities in the US which are losing nurses. If it continues to lose its nurses, this hospital will find it increasingly difficult to offer care. To solve the shortage problem, the hospital should draw inspiration and lessons from such other facilities as Piedmont Hospital. This and other facilities have taken practical steps to persuade nurses to stay. The measures that the hospitals have instituted range from offering scholarships and expanding nursing residency programs to offering nurses higher pay and partnering with educational institutions. Since these measures have delivered benefits for these hospitals, it is important for Ashford to consider adopting them. However, it may be impractical for Ashford General Hospital to implement all the measures. For the purpose of minimizing cost, the hospital should focus on providing financial incentives. These incentives will go a long way in motivating nurses and increasing the satisfaction and retention levels.
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