The Holy Spirit Northside Private Hospital Nursing Essay

Ulrich et al present persuasive evidence that both new graduate nurses and their organizations benefit from the implementation of a structured, immersion RN residency that includes classroom instruction, guided opportunities to develop hands-on mastery of nursing skills, support, professional guidance, and engagement of stakeholders (Ulrich et al., 2010). Today the "baby boomer" nurses are closer to aging out of the workforce and recently enacted health reform laws are predicted to increase the demand for health care and the opportunities and need for nurses ("American Association of Colleges of Nursing," 2012).

"Unless there is significant progress in expanding the size of the future nursing workforce, realizing the goals of health care reform will be difficult" (Buerhaus et al., 2009, p. w667).

Despite much effort and expense to provide an in-house internship for new graduate nurses, the results at HSN have been disappointing; turnover has been high; 34% of the new graduates hired at HSN leaving in less than a year and 66% within 2 years. The resulting cycle of hire-educate replace has been negatively impacting nursing, moral and patient care, yielding a small percentage of program graduates recruited into fulltime positions, demonstrating a poor return on investment, in turn impacting the allocation of financial resources from the executive team, now placing this program at risk.

Interest and financial support are identified as 2 of the most vital components required for the effective management of human resources in healthcare (Arnold, 2010). The executive team consider the nursing employees to be valuable long term competitive assets but are not sure if funding and resources should be continued at the same level of support in favor of other strategies to secure and manage needed human resources. Upon review of the program and discussions with the stakeholders it can be seen that the program is working and meets the intended goal of providing a channel of competent RN’s available to meet future human resource needs with minimal organizational disruption and maintaining a competitive advantage, but is failing to meet other organizational components.

There are identifiable organizational components that improve the management of human resources in the execution of strategy and the achievement of business critical goals (Arnold, 2010) (Noe, Hollenbeck, Gerhart, & Wright, 2012). Human resource management in conjunction with the education department at HSN have been conducting program reviews conducted through survey and interviews with past and present members and graduates of the graduate program to validate the educational effectiveness of the program. Program effectiveness with regards to organizational strategies and goals had not been assessed. Discussions with HR management identified the following as areas for review for improvement opportunities;

Senior management interest and support

Culture

Healthcare manager human resource expertise

Strategic role for the human resources function

Change expertise

Environmental scanning

Human resource planning

Employee selection decisions

Training and development

Organizational commitment

Senior management interest and financial support

Managing people for high performance requires a significant investment in time and money, and at HSN the CEO and CNO are ultimately responsible for ensuring that the HR strategy is aligned with the business strategy, goals and mission. HSN tries to differentiate itself from competitors in the market by providing quality in its healthcare services, mission and customer service to both the internal (specialist service providers and consultants) and external customer (patients and family) but the reality is that customers are drawn in through referrals and procedures offered by the MD service providers.

The current program has support from management but is without an accountable manager. A critical aspect of the graduate nurse program is to ensure that someone is placed in an accountable position to achieve the goals and has the necessary authority and resources to ensure the program is project managed. Managing regular progress reports, feedback mechanisms and demonstrating returns on the program are in line with projections. Other steps would include evaluation of the results to ascertain if the program goals were; being achieved or evolving, improving organizational performance, capitalizing on the opportunity to increase intangible assets through attracting, developing and retaining these knowledge workers and providing competitive advantage.

Culture

Cultural diversity is an important factor to be considered within healthcare and in particular the nursing fraternity. Today nursing remains a predominantly female dominated profession with a multinational workforce, and differing educational backgrounds. The two forces at play here are the cultures of the individuals that make up the workforce and the internal cultures of the profession. HSN has a culturally diverse workforce and the cultural characteristics in play can impact the functioning of individuals and the specialized teams, they are a part of, within the hospital. Cultures differ strongly on such things as how subordinates expect leaders to lead, how decisions are handled within the team hierarchy, what motivates individuals (Noe et al., 2012, p. 656), and these differences must be managed to maintain workplace harmony.

Another cultural phenomenon found within the nursing fraternity in healthcare is horizontal hostility this has widespread implications impacting retention of new nurses. The effects of horizontal hostility include nurse burnout (Jackson, Clare, & Mannix, 2002), intent to leave (Wilson, Diedrich, Phelps, & Choi, 2011) (Simon, 2008), low self-esteem (Randle, 2003), ill calls (Kivimaki, Elovainio, & Vahtera, 2000), and deterioration of physical and mental health (Yildirim, 2009).

The HR department at HSN is aware of the disruptive powers of culture, and anticipate these forces are impacting upon the nurse graduates. Discussions around the introduction of cultural diversity training, for management, utilizing Hofstede’s cultural dimensions (Hofstede, 1993) and communication skills that increase awareness to cultural differences. Effective cross-cultural training (internal and external) will help ease the graduate nurse in the transition to RN.

Healthcare manager human resource expertise

Health care managers need human resource expertise to effectively manage people to achieve results. How a manager effectively manages at HSN has a direct impact on a graduate nurses’ career, motivation, commitment and performance. The HR department should prepare and train managers in the practices used in reaching conclusions about individual’s performance, and the performance of the team supporting the graduate program. Managers need to be trained in employee selection, appraisal, training, compensation, and employee relations with emphasis on nurturing the graduate nurse into a functioning member of the team, as well as managing and assisting with resources where needed.

Strategic role for the human resources function

The human resource management function is becoming more important at HSN because it is being called to serve as a strategic partner in planning and decision making facilitating strategy formulation and implementation. It is essential that HR develop plans and strategies that take into consideration the needs of the graduate nurse, the managers and the organization.

Change expertise

Affirmative action plans are used in hospitals during times of census drops, wards may be closed, beds may be blocked and various departments may decrease procedure bookings. Key staff are kept available, vacation is encouraged, and staff are offered to voluntarily take days off or avail themselves for other departments. These offerings are well communicated to staff offering a sense of job security during quite times and ensuring the hospital is able to re-ramp up when patient census increases. These actions impact all areas of the hospital and maintain the hospitals competitiveness. When these times occur requiring a temporary restructuring efforts such as downsizing jobs may be combined requiring analysis of requirements and skills. Nurses in the graduate program may require additional training and development to provide better matches to cross functional skill needs of the organization.

Environmental scanning

Environmental scanning with reference to the graduate nurse program would involve scanning the external environment and adapting resource management policies to changes in law economic conditions, technology, demographics, or training regulation. Changes need to be recognized early to allow for adequate lead time for adjustments in policies that impact the program.

Human resource planning

Accurate healthcare demand forecasting is needed to ensure that the new graduate RN is available to transition to a permanent role at times when the hospital anticipates human resource and hiring. This planning will have a positive impact on motivation and commitment as well as enables HSN to maintain a stable well trained workforce. Currently hiring of RN’s is occurring prior to graduation of nurses from the transition program, this is resulting in a lack of positions for the nurses completing the program. With better coordination of staff needs HSN would not lose the well-trained workforce they have just invested in, and would reduce some of the significant cost involved with on-boarding R/N’s from outside the organization. With good planning HSN could effectively compete for the best students through recruitment from the universities (Noe et al., 2012, p. 221) with student attending clinical placements at HSN. Students would have the advantage of firsthand experience with the organization and both parties can make informed evaluations regarding fit and career direction with relatively low cost and commitment (Zhao & Liden, 2011).

Employee selection decisions

People should be chosen carefully for the graduate to RN program. The acquisition and preparation of human resources is key when competing through people. Organizations must take utmost care with how it choses employees (Noe et al., 2012, p. 232). Employment decisions directly impact the hospital, in this case HSN, and the graduate nurses’ career. Selection standards should be identified to ensure the greatest chance of a successful hire. A person must have knowledge, skills and ability. Assumptions can be made from GPA, clinical placement, work experience, and interview responses. Research indicates that traditional testing, assessment and interview, without proper care, can be unreliable, low in validity, and even biased against certain groups (Noe et al., 2012, p. 248). Selection processes may need to be adapted where attributes are assessed for suitability are assessed during a student nurses’ clinical rotation at HSN with the university, this would allow managers and clinical educators to identify candidates and assess them in the workplace. Another area for improvement would be in the interview, training managers in effective interviewing techniques. Developed interviews that are structured standardized and focused on achieving a small number of goals resulting in a quantitative rating on a small number of dimensions have been shown to be effective in comparing interviewed candidates for selection (Noe et al., 2012, p. 248)

Training and development

Training and development for the graduate nurse to RN program is managed by the education department at HSN. Employee training and development needs are traditionally managed through specialized nurse managers in the hospital. This process has the potential to create a conflict between training goals and organizational strategies. To ensure training modules and clinical experiences are aligned with strategic organizational plans the HR department plans to implement regular reviews on program alignment to ensure that the program, skills and knowledge remain aligned with the anticipated workforce needs.

Organizational commitment

Organizational commitment is the degree to which an employee identifies with the organization and commits to put forth effort on the organizations behalf (Noe et al., 2012, p. 457). Within healthcare many factors can lead to a lack of organizational commitment or job dissatisfaction resulting in retaliatory behavior aimed at the organization. Job satisfaction is important to employees, and nursing, as a career, is not always able to provide this due to the nature of the work, so it is important that management evaluates what is important to the employee to assist in fulfillment of one’s important job values (Locke, 1976). Activities such as assessment of prosocial motivation and encouraging graduate nurses to be in control of clinical experience selection can promote the positive impact of nursing. Strategies should be designed and implemented to focus on motivating helping behavior.

Many of these attributes are already in place at HSN but they are not imbedded or in-tune with the needs of the graduate nurse transitioning from the somewhat protective learning environment or the university, into the fast paced high pressure workplace of the hospital

Benefits planned to be achieved

With management support, stakeholder involvement and development HSN can develop a strong team dedicated to developing a pipeline of well qualified, knowledgeable nurses to meet the RN staffing needs of the hospital.

Change is required to ensure HSN remains an employer of choice for new nurses seeking to enter the hospital setting, this is a very competitive market. Developing university partnerships, marketing to, and aligning with graduating nurses to secure the best nurses for the HSN program would secure a higher number of program graduates and reduce the costs associated with active recruiting.

The development of an improved program will ensure that resources are being used wisely, and with positive retention results meet the skilled nursing requirements of HSN in the future. The commitment of HR support for the program aligning hospital strategies and goals to gain competitive advantage will allow the program have the flexibility to evolve as change expertise dictates. Current staffing trends that are detrimental to morale may be eliminated or reduced, promoting job satisfaction, organizational stability.

Elimination of cultural barriers may be one of the most challenging aspects of improving how we maintain a competitive advantage here, introduction of manager cultural diversity training utilizing Hofstede’s cultural dimensions and communication skills training that increases awareness and provides solutions for cultural harmony in the workplace.

From an educational standpoint the current program develops strong clinical leaders who have become valued members of the HSN clinical team, unfortunately the numbers of nurses reaching this level needs to be better supported to entice, develop, and keep nurses in nursing. The true benefits that can be realized with a review of and adoption of strategic plan improvements to the current graduate nurse program can develop a competitive advantage for HSN.