Reducing Nursing Turnover by Implementing Innovative E-Health: A New Strategy for Incentivizing Nurses and Improving Organizational Culture Problem Identification:

Nursing turnover rates are a serious issue for hospitals: they are costly and result in lost time and energy in continuously training new staff (Twibell, 2012). Identifying the main reasons for nursing turnover and addressing them can lead to better nurse retention (Trivellas, Gerogiannis, Svarna, 2013).

The problem of nurse retention has been identified by academic scholars in journals like the Journal of Nursing Administration, which has estimated the cost of replacing a single nurse to be approximately $82,000 (Twibell, 2012). As Twibell (2012) reports, job satisfaction is the main reason new nurses leave and the poor sense of job satisfaction is related to too heavy workloads and the lack of their ability to guarantee patient safety. While Twibell goes on to suggest that these issues can be addressed by implementing pre-screening strategies when hiring new nurses, such as "pre-hire job shadowing" and "behavior-based interviews," (Twibell, 2012) this capstone project highlights the growing interest among nurses in the area of eHealth and telenursing, which uses electronic monitoring to assist caregivers and help patients to feel more comfortable (Barret, Wallis, 2013; Mills et al., 2013; Odeh, 2014).

E-Health and Telemedicine can be effective innovations in the industry that enable nurses to achieve job satisfaction, as eHealth can help nurses to feel that they are providing better care, making patients more comfortable, and prevent nurses from experiencing workplace fatigue.

The action steps that would be taken in order to implement this strategy include budgeting for eHealth innovation implementation; training workers on how to effectively use eHealth; reviewing the implementation roll-out; making modifications or adjustments as needed. This capstone project will focus on developing an educational framework to facilitate the implementation of eHealth by providing directives, tips, and guidelines on how to use telenursing in a safe and effective manner so that administrators can give their full support to implementation.

Rationale for Change/Innovation

Nursing turnover is costly for hospitals, which have to hire, train, and equip new nurses each time turnovers occur (Twibell, 2012). Hospitals lose millions of dollars per year as a result of nursing turnover. This is a costly problem that needs to be addressed and that can be addressed by adopting an innovative change in the way that hospitals empower nurses. By identifying the causes of turnover for nurses (low job satisfaction, overwork, and an inability to provide quality care), the hospital can boost nurse retention and reduce costs associated with turnover (Mbemba, Gagnon, Pare, Cote, 2013).

The most advanced and innovative way to address this problem is to reshape the organizational environment of the nurses by implementing eHealth services such as telemedicine (Kruklitis, Tracy, McCambridge, 2014). Telemedicine has been shown to reduce the stress that nurses experience from overwork, increase job satisfaction, and help boost the nurse's feeling of being able to provide quality care (Potter, Mueller, Mackinney, Ward, 2014). Telemedicine can be an effect means of empowering nurses and reducing turnover.

By changing the workplace organizational environment and making it more appealing to individuals who want to provide nursing in the Digital Age this innovative technique will help to reduce nursing turnover rates. Thus, this strategy for enhancing nurse retention would therefore help to avoid such high costs associated with turnover and simultaneously enjoy the added benefits of boosting workplace organizational culture and morale by making nurses feel that they are more in touch with the potential afforded them by the rise of digital technology (Kissack, Callahan, 2010).

Causes of the Problem

The causes of the problem of high turnover of nurses have been identified by researchers as general job dissatisfaction, work overload, and inability to deliver quality care to patients (Twibell, 2012; Odeh, 2014). Nurses experience fatigue due to staffing gaps, in which there are shortages of nurses available to make rounds and check on patients as well as to administer over the various jobs needed to be conducted at any one time (Fuhrman, Lilly, 2015). Staffing shortages stem from a need to maintain tight schedules for the sake of budgeting and also because of nursing turnover, as nurses are not available for shifts and others must fill the void (Taylor, 2014). This also leads to overwork, as nurses have to pick up the slack left behind by others, as the wards are insufficiently staffed. Job dissatisfaction results as nurses become frustrated with the workplace culture...

How can they provide quality care if they are insufficiently staffed, overworked, and unsupported in terms of having a strong workplace morale and organizational system in place? Thus, the root cause of the problem is that the hospital's ability to support the nurse is inadequately structured: too little support is given to nurses to meet their aims and as time goes on, nurses quit, perpetuating the cycle. In order to stop the cycle, an innovative change to the support system has to be implemented -- one that will allow nurses to provide better quality care without feeling overworked.
With new nurses arriving to the industry being familiar with digital interfaces and having come to adulthood in the Digital Age, it is natural that they would consider eHealth as a welcome advancement in the nursing industry and view it as a positive step and acceptable method of meeting the needs of patients and providing quality care for patients. For this reason telehealth is on the rise and is being viewed as the next step forward in providing patients with the care they desire and making nurses feel more like they can deliver the kind of care expected of them (Trossman, 2014; MayoClinic, 2015). While eHealth is being tried in various hospitals around the country there is still room for growth and implementation; in hospitals where it is not implemented, this project will be helpful as a means of supplying the educational material whereby the proper support can be instituted to make telenursing a reality for nurses, so as to improve their overall job satisfaction and thereby reduce turnover rates.

Identification of Stakeholders

Patients, nurses, physicians, family members, and administrators are all stakeholders in the innovative change recommended here to increase nurse retention in the hospital. A unit manager will be in charge of overseeing the eHealth department, and will thus have power in the innovative process; the manager's interest in the implementation will also stem from his/her role as an administrator seeking the best possible course to quality care; and the manager's influence is seen in the leadership potential of the role throughout the process. An educator will be needed to provide the proper guidelines set forward in this project to ensure that the proper steps are taken and the necessary support system provided for the nurses using the telenursing technology, keeping in line with the recommendations of researchers in the field (Lee, Lee, Kim, 2016). A quality improvement office will also be utilized to assess levels of quality care and staff nurses will be on call to facilitate the telenursing department as part of standard protocol. Family members will also be involved in the delivery of telemedicine as they assist loved ones (patients) in the transition process.

Stakeholders' interest, power, and influence.

The hospital administration will have significant power, interest and influence in the adoption of a telenursing strategy. The power that the administration has is that it can deny or approve the implementation process. Thus the administration is in the most powerful position in terms of whether telemedicine becomes a reality in the hospital. The interest that the administration has in approving telemedicine is that it can improve the conditions of the workplace environment, boost nursing retention, and reduce costs, which will save administrators from having to balance budgetary concerns with hospital objectives long-term. The influence that the administration wields in this innovative process is that it can promote or withdraw support from the project; if it promotes it, it can cultivate a positive morale centered on the implementation of telemedicine. While E-Health is still relatively new to the industry, its success and overall strategic aims have not been popularized and can be considered experimental. Convincing the administration that adoption of e-Health within the hospital would help to improve the organizational culture and create better conditions for nurses to help increase job satisfaction and reduce turnover would be a top priority. The data that is available on how and why e-Health can benefit both nurses and patients will need to be presented to the administration in a convincing manner so as to ensure that positive support is gained from this stakeholder.

Nurse practitioners will need to be educated on how to properly implement e-Health and telenursing strategies, the proper support systems to abide by, and the most effective method of providing quality care via telenursing platforms. Training will be a top priority for nurses. Their power in the innovative process of implementing telemedicine will be in their…