IHP 600 Module 8 Milestone Three Example

Milestone Three: Recommendations and Implementation Plan for Nurse Retention

[Student Name]

Southern New Hampshire University

IHP 600: Social and Organizational Issues in Healthcare

Module Eight Milestone Three

[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 Three: Recommendations and Implementation Plan for Nurse Retention

Milestone Two found that Summit Valley's nurse departures are driven mainly by heavy patient loads, unstable schedules, missing break relief, unsupported transition for new nurses and a lack of voice. This milestone recommends a response to each cause, estimates costs and savings and lays out the rollout: the sequence, the people accountable and the numbers that will show success.

Recommendation One: Cap Medical-Surgical Assignments

Day-shift assignments on medical-surgical units should be capped at five patients per registered nurse and night shift at six, with charge nurses free of a patient assignment. Aiken et al. (2010) compared nurses in California, where a state mandate set minimum ratios including a one-to-five standard for adult medical and surgical floors, with peers in New Jersey and Pennsylvania, states without such rules. Nurses under the mandate looked after fewer patients each, and lower workloads were associated with lower patient mortality and with less nurse burnout and job dissatisfaction. Summit Valley does not face a mandate, but the evidence supports adopting a similar standard voluntarily.

Recommendation Two: Dedicated Break Relief

Each medical-surgical unit should have a break relief nurse from 10 a.m. to 6 p.m., rotating through assignments so every nurse receives a full meal break. The role also offers a lighter assignment option for experienced nurses returning from leave or approaching retirement, which may retain some who would otherwise leave.

Recommendation Three: A Twelve-Month Residency

New graduates should enter a twelve-month residency combining monthly seminars, a trained preceptor with a reduced assignment for the first twelve weeks and a mentor for the full year. Goode et al. (2013) drew on a decade of evaluation across hospitals using one national residency model for new BSN graduates and reported that residents' confidence and competence grew over the year and that first-year turnover among residents was lower than rates typically reported for new graduates. They also found the most difficult period came around six to twelve months, which argues for support well beyond orientation.

Recommendation Four: Voice and Schedules

Each unit should form a practice council of elected staff nurses that meets monthly with the manager, reviews staffing concerns and reports progress in the unit huddle. Self-scheduling with a six-week posting window should replace the current two-week manager-built schedule, giving nurses more predictability and control.

Recommendation Five: Targeted Night Differential

Base pay is near the regional median, so a broad raise is not recommended. Night shift turnover is 9 points above day shift, however, and a $3 per hour increase in the night differential would bring Summit Valley in line with the two nearest competitors.

Costs and Offsets

The five recommendations add about $3.9 million a year at full scale. If turnover falls from 24% to 16%, about 62 fewer nurses would leave each year, saving roughly $3.2 million in replacement costs, and agency spending could fall by an estimated $2.5 million. Savings arrive over eighteen to twenty-four months, while costs begin immediately, so a phased start reduces financial risk.

Table 1. Annual Costs and Projected Offsets at Full Scale

Note. Composite estimates prepared with the finance office.

Implementation Timeline

Phase one, months one to six, launches caps, break relief and councils on the three highest-turnover units and begins the first residency cohort. Phase two, months seven to twelve, extends the changes to the other three medical-surgical units if phase one targets are met. Phase three, the second year, adapts the model for the emergency department and night shift and writes the standards into policy and budget.

Owners

The chief nursing officer sponsors the plan and chairs a monthly steering group. The director of medical-surgical nursing owns caps and break relief, the residency sits with the clinical education director, councils and self-scheduling belong to each unit manager, and the finance director owns the cost and savings dashboard. Human resources owns hiring and the night differential.

How Staff Will Be Involved

The plan will fail if it is designed for nurses rather than with them. Each phase one unit council will review the draft cap rules and break relief schedule before launch and can propose changes, such as starting relief earlier on units with heavy morning discharges. Two residents from the first cohort will join the residency advisory group, and a short pulse survey every six weeks will ask staff whether the changes are working as intended. Concerns raised through these channels will be answered in writing within two weeks, a small commitment that directly addresses the belief that complaints go nowhere.

Measures

Outcome measures are registered nurse turnover by unit, first-year turnover and agency hours. Process measures are percentage of shifts within the cap, breaks taken, residency attendance and council meetings held. Balancing measures, which catch unintended harm, include emergency department boarding time and overtime on units not yet in the program. Results will be posted monthly on each unit.

Table 2. Selected Measures and Targets

Note. Baselines from composite hospital data.

Decision Point and Readiness Check

Before phase two, the steering group will review results and repeat the readiness survey. Weiner (2009) argued that readiness depends on members' commitment and their confidence that the change can succeed, both of which shift as people see results. If efficacy scores have risen from 36% and phase one targets are largely met, expansion proceeds; if not, the group will adjust before spreading a model that is not yet working.

Risks

The main risks are hiring enough nurses to staff the caps, pressure to end the trial if savings lag and bed-flow delays. Mitigations include recruiting the first residency cohort early, agreeing savings expectations with finance in writing and a bed-flow protocol developed with hospitalists.

Conclusion

Five recommendations, each tied to a root cause, offer Summit Valley a realistic path to cutting turnover from 24% toward 16%. A phased start, named owners, clear measures and a readiness check before expansion give the plan the structure earlier initiatives lacked.

References

Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., Spetz, J., & Smith, H. L. (2010). Implications of the California nurse staffing mandate for other states. Health Services Research, 45(4), 904-921. https://doi.org/10.1111/j.1475-6773.2010.01114.x

Goode, C. J., Lynn, M. R., McElroy, D., Bednash, G. D., & Murray, B. (2013). Lessons learned from 10 years of research on a post-baccalaureate nurse residency program. Journal of Nursing Administration, 43(2), 73-79. https://doi.org/10.1097/NNA.0b013e31827f205c

Weiner, B. J. (2009). A theory of organizational readiness for change. Implementation Science, 4, Article 67. https://doi.org/10.1186/1748-5908-4-67