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Strategic Planning: Nurse Retention

Alexandra Sanders

Capella University

NURS-FPX6210 Leadership and Management for Nurse Executives

Dr. Mary Ellen Cockerham

October 16, 2021

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Strategic Planning: Nurse Retention

Introduction

Strategic planning in healthcare consists of short-term and long-term goals. The goals of

an organization are set according to economic trends, government policies, and technological

advancements. Planning is essential for a health care organization to succeed (Strata, 2018).

Strategic planning allows for several entities to occur, including but not limited to increased

employee motivation and engagement, developing and sharing a vision with staff, and increased

collaboration and cooperation from staff ( Strata, 2018). Strategic planning is a systematic and

orderly process that healthcare organizations use to develop external opportunities to capture

internal goals to achieve the organization's mission and purpose while enhancing values for

involved stakeholders (Rodríguez Perera & Peiró, 2012). There are five reasons healthcare

organizations should employ strategic planning: 1) increasingly informed, educated healthcare

consumers; 2) increasingly skilled competing healthcare providers are available; 3) limited

resources available; 4)focus is shifted from healthcare provided to the satisfaction of the

consumer for financial reimbursement; 5) increase in size, needs, and complexity of the

healthcare consumers (Rodríguez Perera & Peiró, 2012). The need for nurses and retention will

continue to grow over the next five to ten years. Stakeholder needs and consumer needs will

drive the necessity of skilled nurses who are familiar with the facility. No matter what a facility

employs strategically, stakes are high in the healthcare industry—achieving goals can be the

difference between life and death (Jackson, 2020).

Strategic Plan

A pledge not to harm is sworn in health care, so it is essential not to use a strategy with

uncertainty, miscommunication, and an unstructured vision (Fobare, 2019). The Regional

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Medical Center (RMC) is a small, rural hospital having issues with nurse retention. Due to high

nurse-to-patient ratios and non-competitive salaries and benefits, many nurses have left RMC to

work at other facilities. The Wound Center (WC), a department with the RMC system, has 100%

nurse retention. RMC is hoping to use the WC as a model to obtain improved nurse retention

numbers. The WC was open in 1998 and has had the original nurses and added more since its

inception. The nurses who have added to the staff express that teamwork and camaraderie are

two main reasons they stay. They receive a raise when they achieve certification, and their salary

is comparable to the other centers in the area. RMC wants to have nurse retention at a minimum

of 80% across the facility and will ask the nurses in the WC to assist them in their goal. The plan

to obtain 80% nurse retention does have barriers. Many nurses have worked at RMC and left for

a higher salary and gone where their opinions on patient care are heard. Word of mouth regarding

compensation and the nurse-to-patient ratio has hurt recruiting at RMC. Other facilities giving

sign-on, retention, and referral bonuses and having smaller nurse-to-patient ratios have also hurt

RMC's retention. The nurse retention plan will address these barriers and lend ideas on how they

can be overcome.

Using the Strength, weakness, opportunities, and threats (SWOT) analysis tool, the

leadership and management teams completed an analysis at RMC. A decision was made for

patient safety and to maintain and hire quality nurses, a plan for nurse retention was devised. The

mission and values of RMC are to provide quality and compassionate care to their patients. They

serve the patient first and treat patients, families, and staff with respect. They strive to see, hear,

and believe in each other and always respond with their best (tRMC Health, n.d.).

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There are two short-term goals and one long-term goal we hope to establish with this

plan. The short-term goals involve working with the board and accounting to set up sign-on

bonuses and referral bonuses for nurses and increase positions to decrease the nurse-to-patient

ratios. The long-term goal is to attain 80-90% nurse retention. The short-term goals will be

completed in six months, and the long-term goal will be accomplished in 5 to 8 years. For the

short-term goals to be reached, the following will need to be addressed:

1. Work with the board and accounting to establish a bonus plan.

2. Discuss with the leaders in the WC what they do to promote teamwork and

camaraderie.

3. Uphold the values of RMC by hearing and believing in each other and pulling

together to increase nurse retention by improving patient safety by decreasing the

nurse-to-patient ratio.

The long-term goals will make RMC an employer of choice and have 80-90% nursing

retention. The plan will be accomplished over the next 5 to 8 years. RMC has had a poor

reputation in the community for many years related to the lack of nurses and the high patient care

ratios. Improving nurse retention will improve patient ratio numbers and, in turn, improve

morale that could be reflected in the community's opinion of the facility. Interventions for the

long-term goal will be:

1. Establish a nurse residency program. This will provide the facility with new nurses

and increase nursing satisfaction

2. Establish a school of nursing or contract with an existing school that will allow for

nurse education and give new graduates a job at the facility at graduation

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3. Become a facility that offers state benefits and retirement plans to entice nurses to

stay.

The short-term goals will help the long-term goals succeed by helping make the facility a

more desirable workplace. This plan will help reduce the staffing ratios by having new nurses

available from the school and residency programs. The establishment of bonus monies will

incentivize new hires to apply and current staff to recruit nurses. A barrier to this plan will be if

RMC cannot be competitive with the other facilities in the area. The project will not succeed if

RMC cannot meet or exceed the bonuses other facilities offer or meet the staffing ratios.

Strategic Goals and Outcomes

Using the Strength, weakness, opportunities, and threats (SWOT) analysis tool, the

leadership and management teams completed an analysis at RMC. A decision was made for

patient safety and to maintain and hire quality nurses, a plan for nurse retention was devised. The

mission and values of RMC are to provide quality and compassionate care to their patients. They

serve the patient first and treat patients, families, and staff with respect. They strive to see, hear,

and believe in each other and always respond with their best (tRMC Health, n.d.). The short- and

long-term goals established fall in line with the mission and values of RMC. The proposed plan

is to improve ethical issues by utilizing evidence-based practice. The project can increase nurse

retention by giving bonuses, making safer patient ratios, and establishing programs to educate

and place new nurses. By creating the school and residency program, the students can be directly

taught the mission and values of RMC. The long-term goals will require 5 to 8 years to complete,

given RMC has not had a residency program before, so there are gaps in how to start this, and

establishing a school will potentially require new buildings and instructors to teach.

Environments

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Strategic goals and outcomes address the use of technology and affect cultural, ethical,

and regulatory environments. The ethical environment can be addressed by identifying if any

ethical problems are seen frequently at the facility, educate and encourage the staff to seek out

the ethics/risk management teams as they need, support a positive ethical environment by having

policies and guidelines, and promote open discussions and an atmosphere that is caring and non-

threatening to staff. Ethics in nursing requires receiving and providing support to increase the

capacity to practice and discuss ethics day-to-day (Makaroff et al., 2014).

Cultural environment refers to the backgrounds of the nurses, in this aspect, that will be

employed. This includes race, gender, religion, culture, and sexual orientation. RMC is in a

predominantly African American community. Cultural awareness programs and staff training,

promoting cultural competence, and identifying specific areas to target staff development efforts

and leadership training can make RMC more culturally sensitive (McElroy et al., 2016). Having

a culture of equality and showing that all staff that meets criteria are considered for advancement

in the facility offers a culture of opportunity for all. When nurses feel as if they are not

competing with one another and that there is a culture of equality, they feel at home in the

workplace.

Investing in improved nursing work environments, such as technology, is crucial to

retaining nurses (Van den Heede et al., 2013). Having the most technologically advanced

equipment can be an incentive for nurses to stay. Having a computer system and electronic

medical record system, and charting system that is user-friendly and easy to navigate increases

nurse satisfaction. RMC has a state-of-the-art documentation system that is easy to navigate and

well known throughout the nursing realm. They have a well-rounded technology department and

have nurses on staff who help, create and improve the documentation system. Having all this

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extra assistance for nursing staff can help create an environment of progress and lead to less

frustration, therefore helping with retention.

Policies and procedures for hiring and retention go in line with the mission and values of

the facility. With values like see, hear and believe in each other (tRMC Health n.d.), nurse

retention policies reflect those values. The delivery of high-quality care, policies, and regulation

needs to reflect what is required to keep nurses. Policies related to self-scheduling can be

enticing to nurses to stay at the facility. Policies regarding paid time off, medical leave, and

retirement that are accessible to nurses allow them to see some of the benefits of staying at the

facility. When staff feels they have access to support, resources, and information to succeed in

their role, they are more likely to think that organizational policies are intended to benefit them.

Therefore they will be more committed to accomplishing corporate goals and stay in their jobs

(Wilson, 2005).

Leadership and Healthcare Theories

For RMC to attain the 80-90% nurse retention goal, leaders must have the skills to

motivate, empower, communicate, inspire, and create a positive work environment. Leaders need

to create a mission and vision, mandate, develop and transform the organization and its staff,

create a positive environment, and adapt to future changes and needs (Kumar et al., 2014).

Leadership will need to meet with the planning committee to identify any changes or

modifications that need to be made to the plan based on their nursing staff's response to questions

regarding what makes them stay or want to leave the facility.

For the nurse retention plan to be successful, the leadership style employed is

Transformational leadership. Transformational leaders are team-centric. It is necessary to have

nursing retention and base it on what the WC could do, showing teamwork, inspiring staff,

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collaborating, and being inclusive (DiFranza, 2019). Transformational leaders are understanding;

they bring everyone together and help define goals (DiFranza, 2019). Transformational leaders

gain the trust of their staff; they look to improve the staff's skills and self-esteem. This type of

leader can lead their team through change more successfully (Giltinane, 2013).

For this nurse retention plan, a transformation leader will help the group reach their goal

of 80-90% nurse retention because they will work with the group and with each individual in the

group. Transformation leaders recognize strengths and weaknesses within the group and the

individuals in the group. Having a leader who motivates and inspires the group leads to 80-90%

retention.

The healthcare theory that could best benefit this project is utilization management. It is

a proactive approach to managing health care. This plan needs to be proactive in that nurse

retention is critical to patient care, safety, and quality of care. Utilization management looks at

the organization's priorities, conducts research, and determines who will benefit from decisions.

All this information allows management to set appropriate goals and evaluate and develop

policies and guidelines (Lewis, n.d).

Surveys will be given to staff members asking about their thoughts on the organization,

why they stay, and what factors cause them to leave. This would be strictly anonymous, and later

the planning group would meet to discuss the findings. Leadership would then also go to local

nursing schools and job fairs in the community to recruit staff and have the new framework for

nurse retention to show the changes being made to entice nurses to stay at RMC.

Conclusion

The nurse retention plan modeled from the WC and expanded to include all RMC shows

the staff that they are essential to RMC and essential for living up to the mission and values

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RMC has shared with the community. Creating a plan to increase nurse retention increases nurse

satisfaction. The community can better trust the facility, and nursing staff will stay because they

receive the same benefits that other facilities give to the team. Working together with nursing

and management, listening to staff, and providing them with comparable salaries, bonuses, and

benefits will increase nurse retention and, therefore, increase nurse recruitment. RMC will follow

its mission and values of delivering high-quality care to the community and seeing, hearing, and

believing in the staff that cares for the community.

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