New tool tackles nursing shortage

June 06, 2003

A multi-purpose tool developed to assess the involvement of nurses in their work environment could take a bite out of the nursing shortage by increasing recruitment and retention, according to Penn State researchers.

"Each time there is a major nursing shortage, major studies are conducted to determine the cause of the shortage," says Dr. Donna Sullivan Havens, the Elouise Ross Eberly Professor of Nursing and professor-in-charge of research at the Penn State School of Nursing. "It always gets back to nurses wanting to be more involved in their work environment and decisions."

However, nursing shortages still appear periodically and many hospitals are having trouble filling and keeping their nursing staff. Staff turnover not only incurs large costs of hiring and training new employees, but also adversely affects the quality of patient care.

Many organizations turn toward short-term solutions, like signing bonuses to solve the problem. However, organizations such as the American Nurses Association, American Hospital Association, the VA and the Joint Commission on the Accreditation of Healthcare organizations are encouraging long-term improvements in the culture of the nursing practice environment, including implementation of features that have made magnet hospitals successful.

Havens developed the Decisional Involvement Scale (DIS) as a multipurpose instrument to diagnose, evaluate and develop organizational strategies for the work environment where registered nurses practice. Havens and Dr. Joseph Vasey, research associate at Penn State's Center for Health Care and Policy Research, have been working to validate this instrument. Their results are published in the May issue of the Journal of Nursing Administration.

"It is clear that momentum for change is building, causing nurses and hospitals to focus on building nursing practice environments that provide staff nurses a strong voice in matters of nursing practice and patient care," the researchers say in the May issue of the Journal of Nursing Administration. "To enhance nurse decisional involvement, measures are needed to identify opportunities for change and to monitor attainment of targeted goals."

The DIS consists of 21 items that measure actual and/or preferred involvement in decisions for the staff registered nurses and managers on a nursing unit. The DIS can be used both before and after changes to evaluate status and successful implementation, but can also be used to decide upon the necessary changes.

The DIS asks that each task be rated as to who should have responsibility. The choices are staff nurses only, primarily staff nurses with some administration/management, equally shared by administration/management and staff nurses, primarily administration/management with some staff nurse input, and administration/management only. The items covered include scheduling, unit coverage, budgetary needs, interviewing, hiring and staff evaluations as well as standards for RN support staff, monitoring of standards and relations with physicians as related to patients.

"Each hospital and work environment is different," says Havens. "In all cases, for all items, the nursing staff does not necessarily want more involvement. Sometimes, well-meaning administrators thrust a responsibility on the nursing staff because administrators assume they want more involvement and they actually do not. The DIS can be used as an organizational development tool to identify areas in which staff nurses would like to participate more."

The example of magnet hospitals is a good one. Originally, 41 hospitals were rated as magnet hospitals because they succeeded in attracting and keeping nursing staff. All these hospitals shared similar traits, including the inclusion of the nurse executive as a formal member of the highest decisionmaking body in the hospital, a flat organizational structure for nursing services, decentralized decision making at the unit level, administrative support of nurses decisions about patient care, and good communications between nurses and physicians.

"Magnet hospitals have now turned into a self nominated process requiring application and rigorous documentation and the American Nursing Credentialing Center is the body that now approves the designation," says Havens who has completed several studies on magnet hospitals and published her findings. "More and more hospitals are submitting applications and there are now 68 magnet hospitals across the country and 1 in the UK."

The first magnet hospitals were designated in 1983. Now, using the DIS, hospitals can evaluate their environments and make the changes necessary to establish them as magnet hospitals and as better places for nurses to seek work and to remain. At the same time, hospitals are decreasing the cost of cyclical professional turnover and increasing the quality of patient care.

Penn State

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