IHP 600 Module 9 Final Project Example

Keeping the Nurses We Train: An Organizational Analysis of Turnover at Summit Valley Medical Center

[Student Name]

Southern New Hampshire University

IHP 600: Social and Organizational Issues in Healthcare

Module Nine Final Project

[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.

Keeping the Nurses We Train: An Organizational Analysis of Turnover at Summit Valley Medical Center

This report is written for the executive team and board of Summit Valley Medical Center. It combines a semester of analysis into one argument: the hospital's nurse turnover is an organizational problem with identifiable causes, and a phased set of changes can reduce it at a cost the hospital can bear. The report moves from context and causes to stakeholders, readiness and a recommended plan.

Executive Summary

One in four Summit Valley registered nurses left last year, including 38% of first-year nurses, at an estimated cost of $9.7 million. The main drivers are heavy assignments, unstable schedules, missing break relief, thin support for new graduates and a sense that concerns go unheard. The report recommends assignment caps, break relief, a twelve-month residency, unit councils with self-scheduling and a targeted night differential, starting on three units. At full scale the plan costs about $3.9 million a year and could return about $5.7 million if turnover falls to 16%.

Why This Problem Deserves Executive Attention

Bodenheimer and Sinsky (2014) argued that health systems pursuing better care, better population health and lower cost should add a fourth aim, the work life of those who provide care, because widespread burnout undermines the other three. Summit Valley's figures illustrate the point. Turnover drives agency spending that erodes a 1.5% margin, heavier assignments on understaffed units coincide with a 22% rise in reported medication events and patient experience scores on medical-surgical units trail the rest of the hospital.

Forces Outside the Hospital

The county's older population is growing, raising demand for inpatient care. Experienced nurses are retiring, the regional nursing school turns away qualified applicants for lack of faculty and travel agencies compete aggressively for staff. These forces explain why recruitment is hard but not why Summit Valley loses nurses faster than it did three years ago, or why some of its units hold on to staff far better than others.

What Is Happening Inside

Turnover ranges from 14% in the ICU to 31% on medical-surgical units and is highest in the first year. Demerouti et al. (2001) showed that high job demands are linked mainly to exhaustion while missing job resources are linked mainly to disengagement, and both patterns appear here. On the highest-turnover units, nurses carry 6.5 or more patients a shift, face mandatory overtime about twice a month and miss meal breaks on more than half their shifts; they also lack break relief, structured precepting and any say over assignments.

Culture and Silence

The staff survey found 72% of nurses feel supported by peers but only 41% on medical-surgical units feel safe raising concerns. Observation of huddles showed why: on the ICU, the charge nurse asks each nurse for concerns, while on two medical-surgical units huddles are three-minute announcements. Nembhard and Edmondson (2006) found that leaders who invite and value input create greater psychological safety, especially among lower-status staff, and that this safety supports involvement in improvement. Summit Valley's own contrast matches that finding and shows the needed behavior already exists inside the hospital.

Stakeholders

Three groups hold the greatest influence over the outcome: nursing leadership, finance leadership and medical-surgical nurses, whose collective influence has grown with a union petition. The finance office's caution about cost timing is legitimate and is addressed through a joint savings model and a phased start. Hospitalists, charge nurses, new graduates and patients each have a defined role in design and review.

Readiness for Change

A survey of 214 nurses found 84% agree change is needed but only 36% expect leaders to sustain it, a legacy of earlier initiatives that faded. The plan therefore emphasizes visible early action, manager authority to use new resources and monthly public reporting, rather than further persuasion.

Recommended Changes

Five changes address the causes directly: day assignments on medical-surgical floors limited to five patients, with six at night; a break relief nurse on each medical-surgical unit; a twelve-month residency with reduced preceptor assignments; unit practice councils and six-week self-scheduling; and a higher night differential of $3 an hour. Goode et al. (2013) reported, from a decade of evaluation of a national residency model, that residents gained confidence and competence across the year and left at lower rates than new graduates commonly do, with the hardest stretch falling between six and twelve months.

Costs, Savings and Phasing

Once every unit is included, yearly costs reach roughly $3.9 million; projected offsets from 62 fewer departures and lower agency use total about $5.7 million. Because costs come first, the plan starts on the three highest-turnover units for six months, expands to the remaining medical-surgical units after a formal review and reaches the emergency department and night shift in year two.

Table 1. Plan Summary

Note. Composite plan prepared for the executive team.

Measures of Success

The primary target is hospital-wide registered nurse turnover of 16% by the end of year two, and first-year losses below 25%. Process measures include shifts within the cap, meal breaks taken and residency attendance. Emergency department boarding and overtime on units not yet included serve as balancing measures. Results will be posted monthly on every unit and reviewed quarterly by the board.

Risks and Limitations

Hiring enough nurses to staff the caps is the largest risk, followed by pressure to end the trial before savings appear. The analysis relies partly on exit interviews and self-reported survey data, and the unit comparison shows association rather than proof. Because the analyst manages a unit, colleagues may have softened or sharpened what they reported.

Conclusion

Summit Valley trains good nurses and then loses them to conditions it can change. Easing workload, adding relief and support, giving nurses a voice and leading the change visibly offer the best chance of keeping them, protecting patients and restoring the hospital's finances.

References

Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573-576. https://doi.org/10.1370/afm.1713

Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The job demands-resources model of burnout. Journal of Applied Psychology, 86(3), 499-512. https://doi.org/10.1037/0021-9010.86.3.499

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

Nembhard, I. M., & Edmondson, A. C. (2006). Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. Journal of Organizational Behavior, 27(7), 941-966. https://doi.org/10.1002/job.413