The chapter will focus on providing a summary of the entire project and significant conclusions regarding the study topic presented. Additionally, the chapter will outline important recommendations that are necessary for a bid to enhance a similar study in future and recommendations that would be necessary for addressing the problem identified within the study. The summary of the project will help in providing an understanding of the critical aspects addressed within the project by outlining various processes and strategies used in the completion of the project. The summary will provide insights into the chapters included in the project, which will help in outlining the key elements discussed within the given chapters. The chapter will capitalize on summaries of the findings and conclusions that were obtained during the data collection stage. The findings play an essential role in defining the outcome of given research based on the information obtained from various sources.
Another important aspect concerning the chapter entails the discussion of the implications of the study, focusing on the theoretical, practical, and future implications of the study. In this chapter, the researcher will engage in an in-depth discussion that will provide the implications of this project focusing on the findings and conclusions obtained in the course of undertaking the given project. The final bit of the chapter will capitalize on the provision of recommendations that relate to undertaking the study process. The first part of the recommendations will include recommendations for future projects, which is a section that will help in providing crucial information to the researcher that out to undertake similar projects. The second part will include recommendations for practice, which is an important part that helps in addressing issues relating to the research problem. The recommendations help in summing up a project by providing strategies that would be necessary for solving research problems in the future.
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Summary of the Project
The project focused on the issue of a nursing shortage, which is an aspect that resulted from the inability of the healthcare providers to maintain nurses, thus resulting in factors such as increased costs, high turnover, and loss in productivity. According to Wright & Bretthauer (2010), the nursing shortage is a significant problem within the healthcare industry that influences the delivery of quality care to the patients affecting the public health. The project focused on finding solutions to the issue of nursing shortage experienced in a West Texas hospital. The first aspect of the project involved stating the problem of the project and defining the purpose of undertaking the project. The identification of assumption, limitations, and delimitations of the projects was an important aspect that helped in providing a proper avenue to undertake a useful study concerning the research topic. Additionally, the researcher focused on defining the significance of the project within the health sector in the West Texas Hospital that experienced increased cases associated with the nursing shortage.
The second section of the project involved the literature review, which focused on different aspects concerning the nursing shortage in the healthcare industry. The researcher engaged in a review of literature that sought to provide crucial information regarding ways to deal with the issue of increased nursing turnover. The goal of this section was to provide adequate information based on past and present studies that focused on strategies and measures that would be relevant in addressing the issue within the healthcare industry. The researcher used different information on how the healthcare industry engages in strategies and measures to reduce nursing turnover focusing on the theoretical perspectives that are applicable within the industry. According to Bavier (2017) , organizational policies within any given industry may play an essential role in defining the rates of employee turnover, which is also an aspect that influences the healthcare industry with regards to the nursing shortage.
The section on methodology focused on the analysis of various research methods applied in the project to obtain vital information that concerns the issue of the nursing shortage. The researcher capitalized on the use of quantitative methods and non-experimental descriptive designs to obtain information concerning factors that contribute to the increase in the nursing shortage in the healthcare industry and the implication of the issue in the overall running of the industry. The project engaged in the development of survey questionnaires and behavioral observations to obtain relevant information that was required for the practical completion of the project. According to Buerhaus, Donelan, Ulrich, Norman, DesRoches, & Dittus (2007) , engaging in proper data collection methods helps in increasing reliability of information collected considering that the participants are in a position to undertake the process effectively. The section mentioned the number of participants that would engage in the behavioral observations to ensure adequate completion of the study.
The section on data analysis and results focused on analyzing the information obtained from the research to make proper conclusions regarding the issue of the nursing shortage. Data analysis helps in ensuring that the information collected is reliable to be used within a given project based on its relevance ( MacLean, Hassmiller, Shaffer, Rohrbaugh, Collier, & Fairman, 2014 ). In this section, the researcher capitalized on the use of effective strategies to analyze the information obtained with the aim of ensuring that the participants provided accurate information concerning various issues that contribute to the nursing shortage. During the analysis process, the researcher engaged in the use of SPSS statistical software that helped in creating a proper description of the results.
Summary of Findings and Conclusion
From the research conducted on the West Texas Hospital, it is clear that some of the findings can be gathered as part of trying to examine the general expectations of the study. The study noted that lack of a balance between work-related expectations and knowledge in the workplace acts as the main issue contributing to reduced satisfaction levels among nurses. Abhicharttibutra, Kunaviktikul, Turale, Wichaikhum, & Srisuphan (2017) point out that work-related expectations act as ultimate objectives that nurses are expected to achieve while in their respective work environments. In the case, the nurses within the West Texas Hospital face a significant challenge in trying to balance these expectations with their knowledge and abilities. Ultimately, it meant that it would be challenging for them to deliver the set goals and expectations from the management.
The researchers noted that job satisfaction is a crucial issue of focus on determining nursing retention levels. Job satisfaction creates a situation where nurses tend to find themselves shifting their focus towards their work environments to determine whether or not they can deliver on their expected objectives ( Monahan, 2015 ). While focusing on the element of job satisfaction, it is expected that management within healthcare facilities ought to focus their attention on critical factors that may impact nurses' satisfaction levels negatively. Identification of these factors means that the management would be in a better position from which they would create that productive environment for nurses depending on overall expectations. The research recognizes it as one of the critical expectations towards boosting an overall shift in perception among nurses towards their respective roles and responsibilities.
Another key finding to note is that rewards offered to nurses tend to pave the way for satisfaction taking into account that they determine the extent to which nurses can deliver on their respective expectations. By offering rewards, management within healthcare facilities tends to reflect on creating that proactive approach from which they can define the need for nurses to change the way that they offer their services ( McDermid, Peters, Jackson, & Daly, 2012 ). In other words, it means that it becomes much more comfortable for nurses to work out a useful platform from which they shift their focus towards advancing the quality of care offered. The long-term effect will help towards promoting satisfaction among nurses. The impact of satisfaction among the nurses help in ensuring that changes are made within the health facilities in order to deliver the set goals and expectations.
The main conclusion from the findings is that health facilities ought to focus on active interventions touching on engagement, motivation, job satisfaction, and practice environment. Duvall & Andrews (2011) highlight the need for having to focus on interventions that seek to safeguard the position of the nurses with the focus being towards changing the way management approaches the issue nursing shortage. These interventions will seek to ensure that nurses do not only have the motivation allowing them to deliver on the set out goals but also seek to ensure that they remain satisfied with their respective workplace environments. Additionally, motivation will also help towards creating interaction among nurses concerning their respective roles as part of the healthcare service delivery platform. The intervention will help in solidifying strategic efforts aimed at promoting efficiency as part of service delivery with the focus being towards limiting the possibility of nurse turnover.
Implications
The following is an analysis of the theoretical, practical, and future implications that this study is expected to have in dealing with the problem identified.
Theoretical Implications
From a theoretical perspective, the study is expected to influence stakeholders in the health sector towards finding alternate approaches in their bid for dealing with the issue of the nursing shortage. The study exposes the fact that indeed nursing shortage is a severe issue of concern in health care today as it creates a situation where it has become challenging for health facilities to deliver on some of their set out goals and expectations. Thus, the issue highlights the need for having to focus on alternative approaches that would seek to meet some of the strategic expectations regarding reducing exposure of health facilities to the nursing shortage.
Alternatively, the study's theoretical implication will reflect on the possibility of having to recognize some of the key factors contributing to loyalty among nurses in a bid to advance the retention levels. The study examines some of the key aspects that define loyalty among nurses considering that these are some of the critical factors to consider in determining the extent to which health facilities can retain nurses. The study will play a vital role in the development of fundamental theories that seek to change the approaches used in dealing with nurses as part of their health service delivery efforts. Using the findings and conclusions from this study, stakeholders and leaders in the health sector would be in a better position to advance such factors to establishing a framework from which to promote loyalty.
Practical Implications
On the other hand, the study will change the dynamics of leadership in a majority of healthcare facilities as one of the practical implications with the focus being towards ensuring that nurses are accorded an environment that will boost their loyalty levels. The leadership within healthcare facilities ought to recognize the role of nurses as essential in health care service delivery. The study expounds on the principle that nurses act as a critical conduit in ensuring that indeed health facilities can meet their prospective expectations regarding delivering health services matching patient objectives. Using that approach, the study’s implication can be seen from the perspective of leadership considering that it is expected to change significant dynamics as a way of ensuring that the leaders can promote loyalty among nurses working in health settings.
Another practical implication reflects on the position that the study seeks to define nurses' perception explicitly focusing on quality nursing care. Understanding the perception held by nurses is essential as it will help towards creating a new approach on how to engage with the nurses as a way of advancing their overall satisfaction levels ( Fox & Abrahamson, 2009 ). The primary challenge that the study seeks to examine is how health facilities would be able to minimize the challenges that nurses are experiencing with the focus being towards providing them with a quality workplace environment (Snavely, 2016). In that view, it is clear that indeed this study will be of great value towards creating new dynamics on what to expect in building or creating an overall shift regarding enhanced service delivery efforts from the part of the nurses.
Future Implications
The study will also have important implications for future research studies focusing on nursing retention as a way of dealing with the nursing shortage issue. The first future implication is that it defines the need for researchers to examine the issue as a systemic problem rather than considering the issue from one perspective. The study reflects on the issue of nursing shortage from the perspective that this is a problem that has been created due to failing systems within the healthcare sector. Thus, this means that it has created a leeway through which researchers would be able to develop that broad understanding on the impacts that this issue has on the health service delivery system. Researchers may use this study as a log to determine the areas on which to examine in their bid to advance validity and viability of their research studies.
The second future implication is that this study seeks to highlight the importance of ensuring that researchers work towards connecting their studies on nursing shortage and the implication on the health sector. As the study seeks to examine some of the approaches that would be expected of it in decreasing nursing shortage and reducing nursing turnover, it exposes critical issues on the impacts. The main impact noted is that this issue has resulted in reducing the quality of patient care considering that it has become challenging for health facilities to deliver quality care while remaining understaffed. Lack of quality delivering quality care exposes a gap for future research focusing on ensuring that indeed researchers can explore the impacts further in a bid to find viable solutions.
Recommendations
The following are recommendations for future projects, as well as for the nursing practice depending on the findings of the study.
Recommendations for Future Projects
Nurse Managers’ Powers . The first major recommendation for future projects reflects on the need to examine the relationship between nurse managers’ powers and the overall levels of satisfaction among nurses. Nurse managers act as critical links between nurses and the management within health facilities, thus highlighting the importance of having to determine their influence on enhanced service delivery ( Pelayo, 2013 ). Evaluation of this relationship will be necessary towards defining the style of leadership that is expected when dealing with nursing environments with the focus being towards defining overall possibilities of success in promoting nursing retention. Future projects ought to examine the role that nurse managers play towards ensuring that nurses achieve the expected levels of satisfaction in a bid to advance their loyalty. The projects will help determine the changes that would be expected in creating that proactive environment to promote nursing retention.
Burnout and Fatigue . The second primary recommendation is on ensuring that researchers work towards providing an evidence-based approach in dealing with the issue of burnout and fatigue among nurses. Burnout and fatigue remain the key factors contributing to high turnover rates among nurses considering that these two factors contribute to compassion fatigue, which affects their ability to deliver in an effective manner ( Cherry & Jacob, 2016 ). As part of future projects, researchers ought to come up with strategic approaches that would allow them to advance general expectations in dealing with burnout and fatigue. The general outcome of the approach will help build that proactive platform to deal with the issue of the nursing shortage in health facilities.
Motivation Strategy . The third recommendation for future projects is for researchers, involved in these projects, to focus much of their attention towards understanding some of the critical motivation strategies that they ought to adopt in a bid to promote efficiency regarding nursing retention. Lack of motivation among nurses creates a situation where the majority of the nurses find themselves in situations where it becomes difficult or challenging for them to deliver on their set expectations ( Igbo, Straker, Landson, Symes, Bernard, Hughes, & Carroll, 2011 ). Thus, lack of motivation highlights the need for researchers to focus their attention on trying to find the most effective motivation strategy that would work in motivating nurses towards their respective positions.
Management in Health Facilities . The last recommendation for future studies is on ensuring that researchers seek to examine some of the critical approaches that management in health facilities may take up as part of their efforts in creating a satisfactory environment for nurses. The ability for nurses to perform their respective duties depends on the environment in which they operate as it determines the satisfaction that they derive out of their respective positions ( Byrne & Martin, 2014 ). Ultimately, lack of satisfaction acts as a clear indication of the fact that indeed management in health facilities ought to take responsibility for their actions in promoting enhanced service delivery efforts. The actions that they take will determine the extent to which nurses would achieve satisfaction within their respective workplace positions. Additionally, the actions will also act as a critical determinant of the general impact that the nurses would have on the quality of health services offered in healthcare facilities.
Recommendations for Practice
Appreciation for Contribution . Nurses contribute significantly to health service delivery within health care facilities as they play a critical role towards ensuring that patients receive the best quality of nursing care services ( Oulton, 2006 ). From that view, one of the key recommendations in dealing with the issue of nurse shortage is to create that strategic effort to appreciate the contributions of each nurse. Appreciating the nurses entails having to recognize their efforts once in a while, as this would boost their capacities to advance the quality of services that they offer in a significant way. Additionally, the recognition will also seek to create the need for nurses to advance their loyalty levels towards given health care settings as a way of ensuring that the health facilities can meet their respective expectations.
Open Channel for Communication . Lack of communication remains one of the most significant factors contributing to high levels of nurse turnover considering that it creates a situation where it becomes difficult for nurses to channel their queries ( Vance, 2011 ). Creating an open platform for communication between the management and nurses ensures that nurses can air their grievances depending on the challenges that they encounter within their respective workplace environments. The outcome of the open communication is that it will in ensuring that the management can take proactive steps in creating a safe workplace environment for the nurses. The open channel of communication ought to also create a provision to ensure that the nurses can ask for help where necessary, especially when handling some of the complex cases.
Leadership Style . Health facilities may opt to adopt differentiated leadership styles depending on what they would expect when dealing with their nursing staff. Balogh-Robinson (2012) points out the need for having to focus on a leadership style that ensures that low-level nurses are included in all decision making platforms that may impact their efforts to deliver quality services. In other words, this means that the management ought to focus on an interactive leadership style that seeks to change the overall outlook regarding nurse engagement. Through such engagements, the decisions made will be of great value for nurses considering that they will take their view into significant consideration. Additionally, the engagements will also seek to create that platform to change the dynamics of excellent service delivery by guaranteeing that nurses are accorded that environment to practice on leadership.
Safety/Security . One of the most significant challenges that nurses tend to have in their respective positions is the guarantee of security. Majority of health facilities tend to find it challenging in their bid to maintaining staffing levels, as these facilities tend to hire and fire nurses depending on the success and challenges that they encounter in their operations ( Shackleton, 2017 ). From that perspective, it is clear that creating that guarantee of security will act as one of the critical determinants of enhanced satisfaction levels among nurses. Additionally, this will also seek to allow nurses to work without the fear of retrenchments, which affects their motivation and morale to perform their duties diligently. Ultimately, guaranteeing security means that health facilities would find themselves in a favorable position to build on the overall capacities to retain nurses as part of their efforts to enhance service delivery.
Support . Nursing is an involving professional attributed to the nature of cases that nurses encounter, which tend to vary significantly regarding the overall expectations ( Clark & Allison-Jones, 2011 ). Thus, this means that nurses are expected to receive a lot of support from different sources in a bid to advance their efforts in enhanced service delivery. That means that for health facilities to be able to maintain expected nursing retention expectations, it will be essential for the management to come up with critical approaches to promote support for the nurses. The support that they receive may focus on areas such as training and development with the focus being towards advancing their efforts in service delivery. The outcome of this is that nurses would have the highest satisfaction levels with their respective positions, thus paving the way for nursing retention as one of the strategic efforts towards meeting set out expectations.
Encourage Career Development . The Majority of nurses argue that the profession creates a significant challenge for them from a career perspective considering that it becomes hard for them to achieve the expected development or advancements ( Dolan, 2011 ). From that view, it is clear that one of the strategic efforts towards promoting nursing retention would be creating prospective avenues from which nurses would be able to build on their careers. Health facilities may focus on providing tuition reimbursements, which would encourage more nurses to advance their studies while building on the understanding that this is one of their expectations in promoting their capacities to deliver quality services.
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