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14170 Benchmark Change Initiative: Implementation, Evaluation, and Sustainability

The University of Texas Medical Branch (UTMB) facility prides itself in being a premier
institution of care. The application of evidence-based practice in several of its units has made it
improve on its provision of services. However, the human aspect of the hospital has
demonstrated certain weaknesses that the leadership should address. An analysis of the UTMB
reveals that the ratio nurses to patients goes beyond the recommended level of 1: 6. The analysis
further revealed that the high nurse to patient ratio exists due to a high turnover rate at the
facility. As such, addressing the turnover rate will play an important role in ensuring that the
ratio aligns with the recommendation of the American Nurses Association of 1:6. The present
paper will thus focus on the implementation, evaluation and sustainability of the nurse turnover
change initiative at the UTMB medical-surgical unit.
The Need for Change

Nurse turnover has created a rapidly growing human resource issue in the contemporary
healthcare sphere. Hospital managers have stated that nurse turnovers have certain consequences
since it leads to the disruption of hospital service operations (Tang & Hudson, 2019). The
UMTB has suffered the consequence of high nurse turnover as demonstrated by its high nurse to
patient ratio at the medical-surgical unit. As a consequence of high turnover rate at the medical-
surgical unit, it experiences a high risk-adjusted mortality. Moreover, the medical-surgical unit
also experiences higher lengths of stay at the unit compared to other units.
The presence of high turnover rates at the medical surgical unit of UMTB has also
increased the cost of care for an individual patient. Due to the extended length of stay at the unit,
the amount of money spent on individual patients have increased remarkably since the medical-

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surgical unit started registering increased nurse turnover. Suggestive evidence shows that high
turnover rate at the unit has increased its operational costs (Tucker et al., 2019). An analysis
shows that cost of hiring and training new nurses for the medical-surgical unit has skyrocketed
since its nurses started leaving.
The loss of nurses for the medical-surgical unit has also led to staffing problems for the
unit. Consequently, the unit suffers the loss the trained and experienced nurses, an imbalanced
composition of remaining and new nurses and nurse shortages (Tang & Hudson, 2019). The
staffing problems have resulted in challenges in arranging work and formulating schedules for
nurse managers. As a result, the situation necessitates increased overtime for remaining nurses.
The resultant effects of nurse turnover cause reduced morale amongst the nurses at the unit,
which negatively impacts most parameters of healthcare quality.
Driving Forces

The driving forces for nurse turnover entails multifactorial factors in the form of
economic, social and political aspects. The medical-surgical unit at UMTB suffers from factors
such as absence of support from the nurse leadership. Organizational variables such as the lack
of leadership play significant roles in the presence of nurse turnover (Scruth, Garcia, & Buchner,
2018). The nurse leadership at the medical-surgical unit of UMTB lacks the requisite skills to
motivate the nurses hence their high turnover rates. Moreover, the high nurse-to-patient ratio
results increased workload for the nurses. The overworking of nurses through strategies such as
forced overtime makes them susceptible to burnout, which exacerbates the turnover rate issue.
The limited growth opportunities at the unit also leads to nurses quitting in pursuit of
places where they abound for them. External factors such as the local labor economy does not

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favor the hospital hence the high rates of turnover. Moreover, State of Texas does not have a law
guiding on the number of nurses per patients, which makes hospitals try to save money by
keeping the ratio high (Cimiotti et al., 2019). Also, the presence of high competition from other
healthcare players has accelerated the rate at which UMTB medical-surgical unit loses nurses.
An analysis of the healthcare environment reveals that the competitors perhaps have better
policies and offer more incentives, which attracts the medical-surgical nurses from UMTB.
The presence of a high turnover rate will have a direct impact of the remaining nurses and
the patients. The remaining nurses have to work twofold and sometimes threefold due to
understaffing. These nurses also have to persevere with forced overtime, which leads to other
issues such as burnout (Scruth, Garcia, & Buchner, 2018). On the other hand, the patients suffer
since the quality of services offered have reduced. The impact of nurse turnover on quality
parameters has in turn negatively affected patient satisfaction with the services offered at the
medical-surgical unit at UMTB.

Stakeholder Evaluation

The proposed change for the issue of nurse turnover entails a multifactorial approach
including inculcating the organizational culture during hiring, providing effective
communication of organizational goals during the same period, and offering opportunities for
growth through courses that improve competence. The nurse managers will take a frontline
approach in the change initiative. During this period, nurse managers will need to change their
approach in terms of communicating the unit’s goals, objectives and culture to the new nurses to
make them feel part of the team (Hughes, 2017). Moreover, the new nurses at the facility will
greatly benefit from the change initiative since they will find a new culture of doing things at the
facility, which will persuade them to stay longer. The veteran nurses will also benefit from the

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change initiative since their workload will reduce and the facility will give them increased
opportunity to grow at the facility.

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