Healthcare Workforce Retention & Attrition: An Assessment of Demand & Supply of Registered Nurses (RN)'s Crisis in Australia (Essay Sample)

Health Workforce Retention & Attrition:
An Assessment of Demand & Supply of Registered Nurses (RN)’s Crisis in Australia
By Firstname Surname
MED 504: Healthcare and Nursing Management
Prof. Jane B. Hudson
North Sydney University
RD451 B67T Road, Alton RT68
28th October 2015
Health Workforce Retention & Attrition:
An Assessment of Demand & Supply of Registered Nurses (RN)’s Crisis in Australia
The ability to effectively provide quality healthcare services depends on the availability of skilled and motivated clinical workforce. Nonetheless, the nurses’ efficiency and job longevity is delimited by increasingly complex job environments, stressful workloads due to high nurses’ turnover, low wages and having to deal with an increasing number of patients who are conscious about care quality, an upsurge in chronic diseases and an aging population in need of specialized care under the prevailing budget constraints (DH, 2012; Doiron, Hall & Jones, 2008). Whereas Australia is experiencing a severe shortage of RNs with private health providers out competing public hospitals for this scarce resource; the critical role played by the few RNs in running the health system has not been fully appreciated as RNs still lack the decision making autonomy (Armstrong, 2009). Hence while Australia still needs more tech-savvy and culturally competent nurses, this per se is an insufficient pre-condition for innovative healthcare (NACNEP, 2008): According to Sandall et al. (2011, p. 1), optimal clinical quality will be realized when the ‘right staff doing the right thing at the right time in the right place’ are engaged into the health system.
The nursing profession constitutes the greatest proportion of any healthcare system’s workforce. In addition to providing direct services to patients; nurses too are ideally major stakeholders in the formulation and implementation of health management policy (NACNEP, 2008). It is estimated that the nurses make up 52 percent of Australia’s health workforce. It is also projected that in 2016 the RNs’ supply and demand will stand at 241,380 and 254,541 respectively; giving a deficit of 13,162. Moreover, it is postulated that about 29.8 percent of RNs are aged 50+ and forecasted that in 10-20 years, 50 percent of the healthcare employees would have retired (ACN, 2015; HWA, 2012; Sayers & DiGiacomo, 2014). Despite the critical role played by RNs in health management, Health Workforce Australia has predicted that by 2025 Australia will be having an approximate nurse shortfall of 110,000 (El Haddad, Moxham & Broadbent, 2013). The interconnected factors behind the nurse shortages include resignation of RNs, escalating local and global demand for RNs and limited training capacity (NHWT, 2009).
Factors Responsible for the Job Dissatisfaction, Burnout & Attrition among RNs in Australia
The dynamics incidental to a RN’s decision to exit the profession, stay on as a nurse or re-train for a different specialty within Australia’s healthcare system can be specific to an institution, relate to an employee’s role/position, personal preferences and/or be systemic to the expansive working environment (Brown et al., 2013; Dawson et al., 2014; Flinkmann, Isopahkala-Bouret & Salantera, 2013). It is posited that a poor working environment poses a great hindrance to enjoyment of work life. The work environment aspects with profound impact on the nurses’ job satisfaction include poor skill-mix, low nurse – patient ratios, poor leadership and decision making, rigid shifts, poor pay, resource inadequacy (Dawson et al., 2014). In a study conducted on 362 nurses from three Australian States, it was established that poor skill-mix posed a serious problem across hospitals. It was reported that the fact RNs were required to work alongside nursing students, casuals, EENs and immigrant nurses had contributed to work disruptions, increased workload, inefficiency and stress; and thus the tendency by RNs to exit the nursing profession (Dawson et al., 2014; Flinkmann, Isopahkala-Bouret & Salantera, 2013).
Beyond the working environment nurse career burnout and eventual exit can also be attributed to managerial factors specific to a hospital such as organizational culture, values and more so, work aspects relating to professional development, leadership, trust and mutual respect and communication relationship (Brown et al., 2013; Brunetto, Farr-Wharton & Shacklock, 2012). It is held that organizational commitment is inversely correlated to the RN’s stay/exit decision. Thus incidences of workplace mistrust and disrespect between RNs and nurse managers or physicians; will by creating a conflict between a nurse’s attitudinal state and the organization’s vision and values increase job dissatisfaction and the probability of an employee quitting duty (Brown et al., 2013; Dawson et al., 2014). Conversely, organizational culture has a greater bearing on the leadership style and the nurse unit manager (NUM) - RNs’ communication relationship. It is argued that turnover among RNs is lowest under a transformational leadership style that empowers, values employees and embeds effective communication relationships across the clinical team (ACN, 2015; Brown et al., 2013; Brunetto, Farr-Wharton & Shacklock, 2012).
Job longevity or exit intent is also correlated to the degree of role or positional ambiguity within the hierarchy of healthcare delivery. As opposed to role clarity, in part, role ambiguity arises when RNs are compelled to undertake inconsistent and disempowering assignments or the working procedures are habitually dissimilar in substance (Brunetto, Farr-Wharton & Shacklock, 2012). Moreover, positional ambiguity and subsequent nurse exit decision occurs when there is a mismatch between role condition and professional expectations, work/life imbalance, inability to realize the desired care quality and absence of inclusive succession planning policy (Brown et al., 2013). Notably, persistent role/position ambiguity portends adverse implications on the RNs’ sense of empowerment and autonomy. Being accredited professionals, pervasive role ambiguity demeans the RNs’ technical ability and capacity to make autonomous decisions while on duty. In effect, since role clarity is positively correlated to autonomy; ambiguity impedes role enactment and optimization, entrenches discord, provokes RNs to detest their work and contemplate quitting (Brunetto, Farr-Wharton & Shacklock, 2012; Sayers, DiGiacomo & Davidson, 2011).
At a personal level it is observed that certain distinguishing traits, skills, characteristics, signature behaviors and dispositional elements could explain why a nurse’s decision to exit or keep working in the healthcare system. Arguably ardor, that is, an “emotional connection with work and the organization that goes beyond job satisfaction” will variedly determine a RN’s job longevity (Brown et al., 2013, p. 469). As such, in longitudinal case study conducted in Finland (2006 -11) it was established that (in)ability to ‘identify with stereotypical images of nurses’ is a vital determinant of how long newly registered nurses would stay in their careers (Flinkmann, Isopahkala-Bouret & Salantera, 2013, p. 7). Although most newly recruited nurses described nurses as ‘nurturing, altruistic, and willing to serve’, their career aspirations could not be synchronized with these traits (p. 7). Markedly, degree qualified RNs construct themselves as talented intellectuals and value career advancement. They regard prolonged nursing as not being in tandem with their skills and being emotionally immature, they find nursing less ambitious and opt to exit the profession (Brown et al., 2013; Flinkmann, Isopahkala-Bouret & Salantera, 2013).
Equally job dissatisfaction predisposed by excessive workload, administrative injustices, poor pay, resistance to change and inflexible work schedules, resource constraints, bureaucracy and deficient support systems is negatively correlated to the desire by RNs to continue providing nursing services (Brown et al., 2013; Dawson et al., 2013). Even though job satisfaction is multi-causal, workplace employee dissatisfaction is greatly attributed to excess workload. Extra nursing workload is epitomized by overcrowded emergency rooms, prolonged patient stays, low RN self-esteem, falls and arise in clinical errors that endanger patient safety (Berry & Curry, 2012; El-Sabili, 2012). As such workload (be it at unit, job, patient & situational levels) has been blamed for the rising cases of burnout, violation of protocols, stress, absenteeism, emotional exhaustion and turnover; thus aggravating the looming nurse shortage (Carayon & Gurses, 2008; Holland, Allen & Cooper, 2012). It is irrefutable that RNs’ staffing levels are inversely related to desired nurse/patient outcomes. Consequently, the remedy rests in implementing effective workload measurement systems and standardized nurse: patient ratios (Berry & Curry, 2012).
Workforce Planning and Means of Enhancing RNs’ Retention, Job Satisfaction & Performance
The projected continued exit of RNs from the medical profession is poised to create a serious dent in the quality, availability and affordability of Australia’s healthcare system in addition to compromising both the patient and nurse outcomes (Dawson et al., 2013; O’Brien-Pallas et al., 2004). This turnout necessitates that Australian government intervenes to correct market failures (i.e. under/over supply of RNs ) as well as ensure that there is equity and no wastage in the health provision (PC, 2005). (In)voluntary turnover impacts skills-mix, work schedules and care continuity...