IHP 600 Module 3 Milestone One Example

Milestone One: Registered Nurse Turnover at Summit Valley Medical Center

[Student Name]

Southern New Hampshire University

IHP 600: Social and Organizational Issues in Healthcare

Module Three Milestone One

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Milestone One: Registered Nurse Turnover at Summit Valley Medical Center

The final project for this course analyzes a social or organizational issue inside a health care organization and recommends a response. This first milestone selects the issue, registered nurse turnover at Summit Valley Medical Center, and frames it: what is happening, how large the problem is, why it matters and where the analysis will focus.

Organizational Context

Summit Valley is a 310-bed nonprofit regional hospital serving a mixed rural and suburban county of about 240,000 people. It employs roughly 780 registered nurses across nine inpatient units, the emergency department and procedural areas. It is the only hospital within 40 miles offering cardiac catheterization and a level III trauma center, so staffing shortfalls affect the whole region rather than a single facility.

Problem Statement

In the most recent fiscal year, 187 registered nurses left Summit Valley, a turnover rate of 24%, up from 15% three years earlier. The loss is concentrated among newer nurses and on medical-surgical units, and it is being filled with costly agency staff and mandatory overtime that further strain those who remain. Unless the hospital addresses the working conditions and culture driving departures, turnover is likely to keep rising and to affect patient safety.

Where Turnover Is Concentrated

Hospital-wide figures hide important variation. Nurses in their first year left at a rate of 38%, compared with 17% among those with more than five years of service. Medical-surgical units lost 31% of their nurses, while the ICU lost 14%. Night shift turnover exceeded day shift by 9 percentage points. These patterns point toward specific working conditions rather than a general labor market effect that would touch every unit equally.

Table 1. Registered Nurse Turnover by Group, Last Fiscal Year

Note. Composite figures from human resources records.

What Turnover Costs

Summit Valley's finance office puts each nurse departure at about $52,000 once recruitment, orientation, lost productivity and temporary coverage are counted. At 187 departures, that is roughly $9.7 million a year. Agency staffing alone cost $9.2 million, much of it at rates about double the hourly cost of employed nurses. Overtime rose 34% in two years. For a hospital operating on a margin of about 1.5%, these costs threaten investment in equipment and services.

Why It Matters for Patients

Hall et al. (2016) systematically reviewed studies of health care staff well-being and patient safety and found that poor well-being and moderate to high burnout were associated with poorer patient safety outcomes, such as errors, in most of the studies they examined. Turnover and burnout are linked; nurses who leave often cite exhaustion, and those who stay absorb heavier assignments. At Summit Valley, medication events reported on medical-surgical units rose 22% over the same period, though reporting practices may also have changed.

Why Workload Belongs in the Frame

A common response to turnover is to raise sign-on bonuses. Yet in exit interviews only 18 of 97 departing nurses named pay as their main reason. Research on staffing points elsewhere: Aiken et al. (2002) reported that nurses caring for more patients each were more likely to be burned out and dissatisfied with their jobs, conditions that precede leaving. On Summit Valley's medical-surgical units, nurses commonly carry six or seven patients on day shift, compared with four or five on units with lower turnover.

An Organizational, Not Individual, Problem

The hospital's current response is a resilience workshop offered to new graduates. Shanafelt and Noseworthy (2017) argued that burnout is largely driven by organizational factors, such as workload, inefficiency, lack of control and loss of meaning, and that leaders therefore carry responsibility for reducing it. They proposed strategies ranging from acknowledging the problem and measuring it to developing leaders and redesigning work. Framing turnover as an organizational problem shifts attention from fixing nurses to fixing the conditions in which they work.

What Has Been Tried

The hospital has responded in three ways so far. Sign-on bonuses of $10,000 were introduced eighteen months ago and did raise applications, but first-year departures rose over the same period, suggesting the bonus attracted nurses without keeping them. A resilience workshop for new graduates had 62% attendance and positive evaluations, yet the units those graduates joined saw no change in turnover. Agency contracts filled gaps quickly but created resentment when agency nurses earned more for the same shift. Each response treated a symptom rather than the conditions behind departures.

Data Sources and Their Quality

The figures in this milestone come from human resources separation records, finance reports on agency and overtime spending, the annual staff survey and coded exit interviews. Separation records are reliable for counts but classify reasons loosely, so exit interviews are used for motives. Survey data are self-reported and limited by a 59% response rate. Later milestones will add interviews with unit managers and a review of scheduling data.

Scope of the Analysis

The project will focus on registered nurses in inpatient units, where turnover is highest and data are most complete. It will not address physician or support staff turnover, although those issues interact with nursing. Pay structures will be considered only as they compare with regional markets, since the organization's financial position limits large wage increases.

Goal and Measures

The overall goal is to reduce registered nurse turnover from 24% to 16% within two years, with first-year turnover falling below 25%. Supporting measures will include unit-level turnover, agency hours, overtime, staff survey scores on workload and speaking up and reported medication events.

Questions for Later Milestones

Three questions will guide the rest of the project. What are the root causes of turnover, especially on medical-surgical units and among new nurses? Which stakeholders hold influence over staffing, scheduling and culture, and where do their interests diverge? What combination of changes, and what implementation approach, is most likely to reduce turnover within the hospital's constraints?

Conclusion

Registered nurse turnover at Summit Valley is large, costly, concentrated among newer nurses and on specific units and linked to patient safety. It is best understood as a product of working conditions and culture rather than individual shortcomings, which makes it a problem the organization can act on.

References

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1993. https://doi.org/10.1001/jama.288.16.1987

Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O'Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PLOS ONE, 11(7), Article e0159015. https://doi.org/10.1371/journal.pone.0159015

Shanafelt, T. D., & Noseworthy, J. H. (2017). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129-146. https://doi.org/10.1016/j.mayocp.2016.10.004