Recruitment and Retention of Nursing Staff from a Nurse Manager Perspective

Introduction

Proper recruitment and retention of nursing staff are absolutely critical to managing the flow and patient processes within any hospital or healthcare organization. Without proper nursing recruitment and retention, it will take significantly longer to see and treat patients, as well as manage process flows within the organization. The following will discuss the issue of recruitment and retention of nursing staff from a nurse manager perspective. It will discuss the nurse shortage and the factors impacting recruitment and retention and address broad human resource applications that have been proven to increase engagement and the quality of patient outcomes. This paper will state the problem and purpose of the proposal, as well as explain why this topic is appropriate. It discusses the implications of researcher bias and describes the proposed methodology and sampling techniques to be employed. 

Purpose and Appropriateness of Topic

Recruiting and retaining nurse staff is a challenging problem as a result of the current environment of nursing shortages. Factors impacting a nurse’s decision to join an organization include the reputation of the facility, its employment and training policies, and its independence and self-sufficiency. Factors which impact a nurses decision to leave or stay includes the impact of their input, inclusion in decision making, level of engagement, and the respect and team relationship level of the work environment (Shader, 2001). Shift schedules and workloads are also extremely significant factors in determining a nurse’s choice to remain at an organization (Shields &Ward, 2001). The purpose of this proposal is to provide data and analysis for how recruitment and retention can be improved using specific tactics in order to solve the problem of the nursing shortage. 

Human resource management by advanced-level nurses theory can be efficiently applied to management of nurses by health care organizations. By optimizing services, properly managing staff, and planning and forecasting for the future, human resource management nurses can be helpful in the recruitment and retention of other nurses (Dunn, 2010). Studies show that recruitment and retention has a statistically significant relationship with the mortality of patients and best outcome practice (West, Guthrie, Dawson, Borrill, & Carter, 2006). This is because employees who are more engaged and feel respected are better able to take care of patients and even transfer positive attitudes to them (Cangelosi, Markham & Bounds, 1998). The increased level of morale and quality of care directly impacts patient outcomes. It, in turn, makes for a work environment in which one cares to remain. These findings suggest that nursing managers and decision-makers should have an acute focus on improving the functionality of recruitment and retention in order to improve patient care along with the work environment (Carayon & Gurses, n.d.). As a result, this will be an appropriate research topic because it will highlight and develop the need for improved human resource-based nurse management practices to impact retention and recruitment and provide data for which tactics work best. Improved patient outcomes and improved work environments for those who deliver the care.

Role and Bias as Researcher

As a researcher, it is possible that bias may contribute to the end results of the study. It is necessary to identify potential areas of bias in order to account for them and maintain the validity of the data. Selection bias may occur if the selected sample selects itself through volunteering for the study. In this case, the data may be skewed to reflect more engaged nurses rather than those who are not. This will degrade the ability to understand how and why nurses leave because the sample is comprised of employees who are happy with their position and involved. Measurement and instrument bias should also be considered. As this study is intended to be quantitative, it is possible that measurement tools or data collection processes may cause bias that will skew the weight and results of the study.

Sampling Techniques and Methodology

A quantitative research methodology will be used for this study. Cluster sampling can be used to divide the population into groups and will involve the selection of random samples from larger units to smaller units (Polit & Beck, 2010). One or more clusters will be chosen randomly and the individuals within the chosen cluster can be sampled. Probability or systematic sampling can also be used to divide the population size into more manageable sample sizes in order to establish a sample interval. The research will select various individuals in the identified health care organization and outline their incentives for continued employment as well as incentives for new nursing staff. Factors such as pay and the institutions ranking will be incorporated and compared to the numeric values of the number of interviewed nurses who were acquired within a given data set.  By comparing and contrasting the quantitative data, we can determine which factors are most associated with retention and recruitment.  Factors such as engagement, the opportunity for upward mobility, and work relationships will be broken down and identified within the health care organization. A quantitative study will ensue to compare and contrast the rate of retention at the organization in order to determine which factors most often correlated with nurses leaving, staying or joining. The target audience will be male and female nurses ages 23 to 50. This range will capture new graduates looking for nursing positions as well as veteran nurses who are deciding to leave or remain at their organization. Ethnicity is not a specific factor; however education levels will be broken up into two groups including Bachelors and Master’s degree nurses in order to quantitatively determine if education is a factor. Those with low economic status will be excluded in order not to skew the results using a sample of individuals who would take any job because of the income. Those with medium to high economic status will also be factored and provide a better sample that includes the types of non-monetary factors which support retention and recruitment rates versus purely monetary.

Hypothesis

It is hypothesized that the perceived ability to move up in one’s nursing career will play a significant role in nursing recruitment and retention. It is possible that the focus and importance of the ability for one to move up will increase as the nurse gains tenure and increases in age and experience. Other factors may also have supporting roles of varying importance that will be discovered as research progresses.

Data Collection Methods

As described above, a simple random sample of a nursing population cluster will be obtained. Such a sampling method is deemed advantageous in the acquisition of large amounts of data due to its low cost and administrative challenges (Ivers et al., 2011). The sample size will be estimated based on Hsieh, Bloch and Larsen's (1998) linear and logistical regression model for health sciences. Specifically, this sample size methodology involves accounting for a variance inflation factor (VIF), a simplified method of determining the increasing variance associated with increasing or decreasing sample sizes (Hsieh et al., 1998). As this study will involve a linear regression test to determine the relationship between multiple outcomes and nursing staff retention, this approach was believed to provide a level of simplicity and consistency needed to minimize the possibility of a Type I error (Platt et al., 2010). A type I error occurs when the null hypothesis is falsely rejected (Platt et al., 2010). In other words, this would refer to attributing a particular factor as a cause of nursing retention or dropout, when, in fact, there is no significant relationship (Platt et al., 2010). Once the sample is obtained, a paper-pencil questionnaire will be submitted to each eligible participant. Paper-pencil questionnaires are advantageous because of the ability to gather data from large sample populations, as well as their ease of use and low administrative difficulties (Turvey, Sheeran, Dindo, Wakefield & Klein, 2012). Furthermore, paper-pencil questionnaires allow for participant anonymity and reduce the probability of biases such as social desirability and other forms of total survey error (Touvier et al., 2010). Although paper-pencil questionnaires provide several advantages, they may also be associated with some drawbacks, such as low response rates and skipped questions (Touvier et al., 2010). Therefore, questionnaire will be completed in the presence of the primary investigator to reduce the chance of these types of error (Haase, Schultheiss, Kempocke, Thomas & Ziemssen, 2012). 

Instrumentation

The instrumentation utilized in this study will include a 20-item paper-pencil questionnaire aimed at determining variables that impact nursing staff retention rates. This instrument will include four sub-domains assessing potential mediating factors for nursing staff retention, including a) work environment; b) shift schedules and workloads; c) morale and quality of care, and d) upward mobility. These sub-domains were selected based on previous research (i.e., West et al., 2006; Cangelosi et al., 1998; Carayon & Gurses, n.d) identifying these factors as significant determinants of nursing staff retention. Each sub-domain will consist of four closed-ended five-point Likert scale items. These items will include the following responses: Disagree Strongly; Disagree; Neither Agree nor Disagree; Agree, and Agree Strongly. Items will be ordered randomly, with two items worded affirmatively and two items worded negatively for each sub-domain. All responses will be presented in brief, targeted sentences, and participants will be required to respond as to how much they agree or disagree with each response. Demographic information used in this instrument will include age; sex; years of employment; education level; and income level. Each of these demographic variables will be subject to linear regression testing to determine their modifying impact on nursing staff retention. While it is acknowledged that the current instrument has yet to be validated through confirmatory factor analysis, it is believed that the novelty of the current study and its exploratory nature warrant the development of a new instrument. It is hoped that the data gathered from this study can be used for subsequent validity and reliability testing. Once the instruments have been completed, all responses will be entered into a statistical analysis package and correlated through the linear regression model above. 

Description of Data to be Collected

The data collected in the current study will include the responses obtained from the pencil-paper questionnaire. In order to maintain integrity in the data collection process, steps will be taken to ensure accuracy both during and after the instrumentation phase. Specifically, attempts to standardize the data collection will be made in order to prevent inconsistency or environmental influences on participant responses. Specifically, one researcher will be responsible for implementing all data collection sessions and just one researcher will be responsible for subsequent coding and analysis. Additionally, all data collection sessions will be conducted in the same room and consist of the same instructions to promote standardization of the study protocol. When all data has been gathered for analysis, each participant will be given an identification number, and the responses will be coded independently using the standard version of the Statistical Package for the Social Sciences (SPSS; IBM 2013) software. Identification numbers will be utilized to eliminate any potentially identifying information from the analysis process, but still enable the primary investigator to assess differences in key demographic variables (Lyberg et al., 2012). Once the data has been entered and coded into the software package, distributions will be subsequently assessed where appropriate and a linear regression model will be utilized to determine the relationship between various instrumental sub-domains and their impact on nursing staff retention. 

Research Procedure

Following the sampling procedures, instructions will be sent out to each respondent regarding the nature and purpose of the current study, as well as their rights as human participants. To ensure ethical integrity, all participants will be instructed that they are not required to take part in the current study and that they have the option of leaving any response blank if they should choose (Portaluppi, Smolensky & Touitou, 2010). Informed consent will be required by each participant prior to engaging in the data collection process. Once consent has been obtained, participants will be instructed to schedule an appointment with the primary research in which they can complete the pencil-paper questionnaire. The questionnaire will take approximately 20 to 30 minutes, and all data collection sessions will take place in the same room. The primary investigator will be present during all data collection sessions in order to clarify any of the items. However, efforts will be made to ensure that there is no coercion or influence of any kind and that each participant is ensured full confidentiality. Following completion of the instrument, each participant will receive a debriefing about the purpose of the study. Contact information for the primary investigator will be provided, should participants wish to receive copies of their completed data sets. Following the data collection process, instruments will be subsequently entered into the statistical program described above and subjected to further analysis. Correlations between variables will be determined through linear regression modeling, and demographic variables will be entered to determine their individual impact on nursing staff retention rates. All data gathered in this study will be stored securely in a locked file cabinet in the primary investigator's office and kept for a period of seven years. In accordance with current healthcare research standards (e.g., U.S. Department of Health and Human Services, n.d.), all data from this study will be destroyed after a period of five years. 

Conclusion

In conclusion, the shortage of nurses in the health care industry presents a significant problem that must be reviewed and studied in order to properly manage it. In order to analyze and evaluate information to provide applicable recommendations, this proposal outlines a research process that will help to gather and process useful information for nurse managers. Through quantitative sampling techniques and the aforementioned methodology, the resulting research will provide a firm foundation for data evaluation and critique of the health care industry.  As retention and recruitment are integral to the overall quality outcome and health of patients and the work environments of nurses, this research proposal is appropriate. 

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