Management Action Plan for Nurse Retention in Hospitals

Introduction

A Management Action Plan (MAP) is a series of steps required to achieve a specific goal using defined resources within a set time period. This paper focuses on an action plan for an identified Opportunity for Improvement (OFI) in a hypothetical hospital — XYZ Hospital — and develops a course of action for addressing that opportunity. Along with the plan itself, a list of possible actions is presented so that measurable goals can be set, after which accountability, measurement, and monitoring procedures are established.

Every organization tries to hire the most qualified and experienced employees for optimal performance, and hospitals are no exception. Highly skilled staff — in the form of doctors and nurses — is required to provide better services to patients in a high-performing hospital (Lowe, 2012, p. 29). Investment in employee recruitment and training should be regarded as a valuable asset so that knowledge management within the hospital remains effective. Nurse turnover causes serious operational difficulties and proves to be a major hindrance to providing quality patient care. Increasing nurse retention requires high job satisfaction (Pietersen, 2005, p. 19), and hospitals therefore need a stable, well-trained nursing staff for effective patient care.

Identification of the Problem or Opportunity for Improvement (OFI)

It has been reported that the financial cost of losing a single nurse is equivalent to that nurse's annual salary (Hunt, 2009, p. 3). Furthermore, a hospital may lose approximately $300,000 per year when annual nurse turnover rises (Hunt, 2009, p. 3). This situation creates additional problems: a decline in healthcare service quality, longer patient stays due to nursing staff shortages, and an increased risk of hospital-acquired illnesses. If such conditions persist, hospitals are likely to lose patients who are dissatisfied with service quality. This is a significant concern, because losing nursing staff costs hospitals not only financially but also reputationally. Nursing staff shortages also place greater workload on remaining nurses, which can trigger further turnover (Jacky, 2011). Hiring and training replacement nurses incurs additional costs that further burden the organization (Jones & Gates, 2007).

This situation identifies an Opportunity for Improvement (OFI): nurse retention rates should be increased, and nurse turnover must be decreased to ensure better healthcare provision and a secure standing in the healthcare industry. For effective MAP implementation, it is crucial to understand what drives this problem. Several factors contribute to nurse turnover, including work overload, lack of clarity about job tasks, failure to receive the respect nurses expected upon joining, poor management communication around critical issues, pay inequalities, absence of trust and coordination among coworkers, and physically demanding or difficult work schedules (Hunt, 2009, p. 5; Asegid, Belachew, & Yimam, 2014, p. 4).

Nurse retention rates can be improved when nurses are satisfied with their jobs. According to Locke and Hanne, job satisfaction consists of aspects of one's job that interest a person and motivate them to work purposefully (Bhatnagar & Srivastava, 2012). Five key facets of job satisfaction have been identified: salary, advancement opportunities, the work itself, the quality of supervision, and relationships with coworkers (Bhatnagar & Srivastava, 2012).

In the following sections, goals based on these causes are determined, possible actions are outlined, priorities are set, responsibilities are assigned, and completion dates are established for effective MAP implementation at XYZ Hospital.

The primary objective is to reduce the nurse turnover rate in hospitals by increasing nurse job satisfaction. The overall success of the organization depends on retaining its "knowledge capital." A focused set of measurable goals helps address the issue appropriately:

Goal 1: Maintain a suitable nurse-to-patient ratio so that each nurse is not overloaded with patients and does not feel excessive workload — which is a primary driver of staff attrition.

Goal 2: Establish a competitive salary structure that encompasses both performance and loyalty rewards for nurses.

Goal 3: Provide an adequate work-life balance for nurses in order to boost overall employee satisfaction.

The success of MAP implementation will be measured and assessed through two methods: nurse job satisfaction (via questionnaire) and employee retention rate, both discussed in detail in later sections. Realistic constraints that may arise during plan creation include reluctance from top management or coworkers to participate, as well as time and budget limitations. True costs are often either overestimated or underestimated, and unexpected factors — such as sudden increases in market salary rates — may emerge during execution. Management also needs time to observe what additional activities nurses are or are not performing, so that resources can be allocated effectively.

Clarification of Measurable Goals

Before identifying specific actions to achieve the measurable goals stated above, the root causes of the OFI must be considered. In addition to those already mentioned, further contributing factors include lack of upward mobility, nursing being a second-career choice for some individuals, a demanding work environment, poor hospital working conditions, and a stereotyped image of nurses in society (Flinkman, Isopahkala-Bouret, & Salantera, 2013). The following actions are generated through brainstorming as ideas and options for mitigating the identified OFI:

i. Making jobs more attractive to nurses would help attract a greater number of new nurses while retaining existing ones. This can be accomplished by increasing compensation and benefits, supporting flexible work schedules, providing career development opportunities, and improving the organization's employment policies.

ii. Screening and shortlisting nurses who are "fit for the job." It is essential to match nurses to appropriate job duties, since a poor fit is detrimental both to hospital services and to the nurses themselves. This can be achieved through structured assessment tools that evaluate job fitness, and by providing realistic job previews prior to hiring.

iii. Guiding newly hired nurses to communicate clearly with the appropriate departments and authorities within the hospital.

iv. Active management of nurses by providing opportunities for them to contribute their input and perform to their full potential. Nurses should be rewarded for good performance and consistently supported in career development. They should also be granted some autonomy in scheduling their work routines so they can better manage work-life balance.

List of Possible Actions

v. Building teamwork and providing support from coworkers to help nurses gain confidence and feel comfortable in the work environment.

vi. Addressing nurse stress proactively by appointing staff counselors who are dedicated to supporting hospital staff members — especially nurses — whenever they experience strain, so that personal difficulties do not interfere with patient care quality.

It is important to review the above list and prioritize the most critical steps. All six actions are considered necessary; none can be dropped without adverse consequences for nurse retention or job satisfaction. However, some steps are more foundational than others and are addressed first.

The first prioritized step is making jobs more attractive to nurses. Starting from the very beginning of the nurse-hiring process makes it easier to retain nurses through the subsequent steps. If this first step of the MAP clearly specifies what needs to be done, the remaining steps are simplified. Increasing compensation and benefits, supporting flexible work schedules, providing career development opportunities, and improving employment policies all contribute to higher job satisfaction, which in turn leads to high-quality patient care and an enhanced hospital reputation.

The next critical step is promoting teamwork, respecting nurses' contributions, and ensuring management support, so that employees develop a sense of belonging and obligation toward the hospital. When nurses feel they belong and are committed to the organization, retention improves. Research has found that when nurses believe they have adequate time to perform their duties, the quality of care they provide is higher, and patients report greater satisfaction (Janicijevic et al., 2013, p. 157).

Although all steps are essential, a few further examples illustrate why none can be omitted. Building teamwork and peer support makes nurses feel comfortable and more engaged, increasing job satisfaction and long-term retention. Screening and shortlisting nurses who are fit for their specific roles is equally critical: nurses placed in roles that do not match their competencies are less likely to perform effectively in emergency situations (Buchan & Aiken, 2008, p. 3268), and the salary cost of retaining a poor fit is an unnecessary financial burden. Selecting the right nurses for the right roles leads to both efficient, high-quality patient care and higher nurse job satisfaction. Similarly, ensuring that nurses are not operating under excessive stress — and mandating clear communication channels — are steps whose omission would have damaging consequences for the hospital.

For each action, preparatory activities that should be completed beforehand are listed below.

Conclusion

Employees are an asset to any organization, and management must take special precautions to keep them satisfied. Today, in highly competitive times, the healthcare industry is also facing this challenge, especially regarding nurses — a profession that is not valued and respected as it should be. Hospitals must recognize the worth of nursing and formulate policies that retain skilled nurses and their specialized knowledge, enabling the organization to provide the highest quality of healthcare to patients. By implementing the MAP developed in this paper, XYZ Hospital can meaningfully reduce nurse turnover, improve job satisfaction, and secure a stronger position in the healthcare industry.