Introduction
The COVID-19 pandemic became a severe challenge for the world and demonstrated the critical importance of the stable work of the healthcare sector. The constantly growing number of patients required mobilization of available resources, their practical use, and distribution to stop the further spread of the virus and provide care to patients. Health workers became critical contributors to final successes as their competence and skills helped to act in the most complex cases. However, they also became one of the most vulnerable groups which accepted the burden of the coronavirus and faced a new challenge. It resulted in a growing number of psychological problems, increased burnout rates, and a lack of desire and motivation to continue working in the sphere. However, the sufficient supply of nurses is one of the critical demands for the stable and effective work of the healthcare sector. For this reason, it is vital to focus on resolving this problem to avoid worsening the situation. Using effective nurse retention strategies, such as the provision of mental health support and cultivation of organizational resilience, it is possible to counteract the turnover and burnout during the pandemic.
Following this thesis statement, the paper offers a literature review linked to the problem to create the theoretical background. At the same time, the project outlines strategies that can be used to address the issue, facilitators and possible stakeholders who can support the proposed plan, and strategies to implement the positive change. The IHI Model of Improvement PDSA framework is employed to create the foundation of the project. At the end of the paper, a summary and conclusion are given to structure the acquired information.
Assessment of the Problem
The problem of turnover and burnout rate has always been topical for the modern healthcare sector. In multiple cases, nurses lost their motivation to continue working, which introduced the need for additional specialists. However, during the pandemic, the problem became worse as most hospitals reported significant shortages in experienced and educated staff (Galanis et al., 2021). Statistics showed that every healthcare unit in the state had a deficit of employees, and there were about 500,000 jobs to recoup to return to the pre-pandemic levels (Bellanti et al., 2021). It can be viewed as the result of tiredness, accumulated stress, fear, and burnout peculiar to nurses during the pandemic (Bellanti et al., 2021). In such a way, the problem becomes more significant and demands immediate intervention to attain positive change.
At the same time, the growing turnover and burnout rates demonstrate the systemic problem peculiar to the existing healthcare. For decades, the nurses’ needs have been disregarded as no steps were made to improve their positions and make them less vulnerable (Kim et al., 2020). They always suffered from the lack of safety, complex schedules, low wages, and complex working conditions (Bellanti et al., 2021). However, during COVID 19 pandemic, these issues became more significant as new stressors such as the fear of death and severe complications emerged (Galanis et al., 2021). Additionally, being the first to work with patients, nurses faced a higher risk of being infected and witnessing suffering and multiple negative emotions (Galanis et al., 2021). It preconditioned the increased topicality of the discussed problem and the need for effective measures to address it.
Literature Review
The existing body of evidence proved the high relevance of the selected problem. Mirzaei et al. (2021) stated that new stressors which emerged during the COVID-19 outbreak resulted in a significant increase in nurses’ desire to leave and their burnout rates. This intention became a threatening sign demonstrating the need for change to stop the further reduction in the number of experienced specialists and support the stable work of healthcare facilities (Galanis et al., 2021). The investigation of the problem demonstrated that factors leading to an increased number of issues included psychological challenges, lack of support, ineffective self-care measures, and feeling of not being appreciated (Kim et al., 2020). Effective management of these factors would help to attain positive change.
Speaking about the possible strategies to address the problem, investigators offer several approaches. Mirzaei et al. (2021) stated that by focusing on the mental health of nurses, it was possible to reduce the level of stress and burnout, which could help to retain them. Under these conditions, professional mental health support became one of the critical factors vital for resolving problems nurses have and assisting them in preserving their motivation to work. At the same time, it will help to avoid the accumulation of extra stress and the development of depressive states among nurses.
Overall, hospitals; unpreparedness for such challenges can be seen as another factor impacting the health workers’ desire to leave. Rangachari and Woods (2020) said that most healthcare organizations avoided supporting their specialists during the pandemic. It results in growing dissatisfaction with the current conditions. For this reason, cultivating organizational resilience is another possible strategy to attain positive outcomes (Bellanti et al., 2021). In general, the literature review showed the relevance of the problem and outlined the effectiveness of the employed methods. Effective management of issues mentioned above can help to resolve the problem and attain positive change.
Planning
Considering the critical influence of the COVID-19 pandemic on the healthcare sector and the growing number of nurses who wanted to leave their jobs, the project focused on retention strategies to address this issue. The proposal (see Appendix) outlined the goals of the incentive, which include the improvement of nurses’ mental health, the cultivation of a better working environment, and the overall improvement of the situation. The planned timeframe was about six months, and evaluation of results would help to determine the effectiveness of the planned interventions and whether they can be recommended for other units to help attain positive outcomes and reconsider the existing negative tendencies. The project rested on the existing evidence proving the effectiveness of such measures and their practical utility regarding the current situation in the healthcare sector (Beck et al., 2020). The project might help to analyze the problem and create the basis for new improvements.
The foundation for this project was offered by the IHI Model of Improvement and PDSA framework. It was viewed as a tool for enhancing and boosting positive change by clear guidelines on how to attain the current goals. It consisted of the two parts such as the three fundamental questions that should be asked before starting the project and the Plan-Do-Study-Act (PDSA) cycle employed to test any interventions in real-life settings (Institute for Healthcare Improvement, n.d.). Setting aims, establishing measures, and selecting changes, it was possible to create the objectives and ensure they are attainable and relevant to the project. As for the PDSA cycle, it provided ground for decision-making, introducing changes to the project, and making it more effective. The model was used as the guideline for the project as the three major questions impacted the formulation of goals, while the PDSA cycle was used to determine whether the selected interventions could be used in real-life conditions.
Development and Design
As stated previously, the project was designed using the IHI Model for Improvement and PDSA cycle. It influenced the development and design of strategies that might be needed to achieve project aims. First, answers to the central three questions helped to select the most effective methods to achieve the goal. These included working with hospital managers and nurses to use the planned retention strategy (Institute for Healthcare Improvement, n.d.). Second, the PDSA cycle was applied to test the model, its relevance, and whether the proposed intervention can suffice and help to improve the current state (Institute for Healthcare Improvement, n.d.). At the same time, possessing a clear vision of goals, it was possible to determine the resources needed for the project. These included internet references and relevant literature to create an effective tool to address the current problem.
The project presupposed the involvement of human beings, meaning that ethics also played an important role. The respect for human dignity, as one of the Major Provisions of the ANA Code of Ethics, served as the basis for the project (American Nurses Association, 2015). It was vital to consider participants’ needs and avoid their violations. The project was voluntary and aimed at helping individuals who need it and who feel it can assist them in reducing their stress levels (Harb et al., 2019). Finally, the intervention was performed regarding the existing population and organizational culture (Yeager & Wisniewski, 2017). It meant that the existing preferences and values should be investigated to ensure the project does not violate current rules, beliefs, or concepts. In such a way, the prep work included the investigation of the selected units’ work, analysis of its functioning, and designing interventions regarding the code of ethics and existing culture.
QSEN Competency
The project also addressed one of the primary QSEN competencies, which was safety. It could be defined as the minimization of risk or harm to patients and caregivers through system effectiveness and individual performance (QSEN, n.d.). As stated previously, high burnout and retention rates can be viewed as the result of multiple factors, including the accumulation of stress associated with being exposed to biological hazards (QSEN, n.d.). It means that nurses suffer from numerous concerns linked to safety areas. At the same time, the feeling of being protected is one of the major factors influencing workers’ motivation and their readiness to continue working. For this reason, it became critical to address Safety competence as it is the key to improving results and minimizing adverse outcomes.
The project directly promoted this competency as it presupposed the management of factors having a negative influence on the mental health of nurses. It also meant that these aspects might result in substantial harm done to specialists at different levels (Stelnicki et al., 2020). By providing mental health assistance, it was possible to reduce the level of stress, which is linked to safety areas. Research showed that anxiety and the emergence of chronic diseases or other psychological and physiological issues are related to the mood of a specialist (Stelnicki et al., 2020). In such a way, the correct knowledge of methods to reduce stress and assistance might contribute to better results among nurses and provide them with working mechanisms to become motivated and healthy. For this reason, the project addressed several important aspects of nurses and promoted their competencies in various areas vital for a health worker.
Implementation
Implementation of the outlined project demanded a specific strategy to ensure its success and the ability to attain the desired goals. First, it was vital to guarantee that the unit, management, and nurses were ready for the proposed intervention. Their attitude and vision of the proposed strategies should serve as the basis for decision-making about the project’s initiation. Second, the desired number of participants should be available to monitor how the measure works and use their data to conclude if the selected retention strategies are effective in managing the outlined conditions (Uthaman et al.,2016). Finally, the project’s implementation depended on the available resources as the provision of mental health assistance and improvement of the organizational resilience can be guaranteed if there are available time, specialists, and rooms. For this reason, these factors should have been considered before the initiation of the project.
The project had the following facilitators and key stakeholders. First, the policy-makers, in general, might be viewed as the actors supporting it as its success might help to resolve the problem of burnout among nurses and outline ways how to address the project. Second, hospital managers were also taken as both facilitators and stakeholders as they played an active role in the project and, at the same time, were interested in it as it might resolve the problem of understaffing and improve outcomes (Loveland, 2016). Nurses who were provided with the intervention were also stakeholders of the project as they contributed to its success and offered their data to conclude about the future of such interventions. The collaboration between these parties was the key to attaining success and guaranteeing that the project would help to understand the outlined problem and resolve it.
At the same time, some possible barriers had to be considered when planning the intervention. First, fall, the pandemic, and measures associated with it limited opportunities for cooperation with nurses and managers. Second, the deficit of resources and the high working load of nurses became another barrier to the successful implementation of the selected intervention (Jeffreys, 2020). Finally, nurses’ resistance could have been a factor influencing projects’ results. Under these conditions, it was vital to create a pool of strategies helping to overcome these challenges. First, protocols for safe cooperation were developed. They would help to avoid extra risks and remain in touch with specialists. Moreover, to minimize nurses’ resistance, a clear explanation of the project’s goal and its purpose was established. Finally, hospital managers were engaged in the cooperation to gather their support. The combination of these measures helped to attain the desired outcomes and realize the project.
Evaluation
The evaluation was a significant part of this project as it helped to determine the problem areas and correct them. At the same time, positive aspects can be noted to add them to new incentives. As for the given proposal, the aims seemed attainable and measurable. The reduction in burnout and turnover rates was attained by using the measures outlined in the project. Under these conditions, the use IHI Model of Improvement and PDSA framework helped to create the basis for the successful development and integration of the project. The chosen measures helped to establish an effective paradigm and promote positive change following its initial aims and desired results. The IHI model was potent in determining how to address the problem and what possible measures might be needed to overcome challenges.
Reflection
The project had some strengths and weaknesses that could have been improved. First, it addressed the real and relevant problem, which could be viewed as one of the leading advantages. Using strong evidence and recent investigations in the area, a practical and potent solution to high burnout rates was offered (Lesley, 2021). It helped to attain desired outcomes and ensure hospitals would have enough trained specialists. At the same time, it was possible to improve the project by involving more stakeholders and focusing on the investigation of more retention strategies that could help to promote positive change in the area. Using data provided by nurses before the intervention would be more effective as it would help to determine the most effective intervention that could be used to help them. For this reason, some areas might be enhanced in the future. Furthermore, the project demonstrated the current level of my knowledge and readiness to use it in various situations or projects. It demanded employment of my skills and experiences and also helped to discover weak areas that should be improved. For this reason, the project contributed to my personal and professional development.
Conclusion
Altogether, turnover and burnout among nurses became one of the most important problems during the pandemic. For this reason, the use of effective retention strategies was the most effective way to counteract this process. The proposed project focused on employing mental health support as a possible measure to assist nurses in their daily activities and guarantee they do not suffer from extremely high-stress levels. It presupposed three phases and used the IHI Model of Improvement and PDSA framework as the foundation. It was expected a significant reduction in the level of stress and improvement of the mental health of nurses as a result of the project. The results can also be used as the basis for future research and investigation in this area.
References
American Nurses Association. (2015). Code of ethics for Nurses with interpretive statements. Web.
Beck, A. J., Page, C., Buche, J., & Gaiser, M. (2020). The distribution of advanced practice nurses within the psychiatric workforce. Journal of the American Psychiatric Nurses Association, 26(1), 92–96. Web.
Bellanti, F., Lo Buglio, A., Capuano, E., Dobrakowski, M., Kasperczyk, A., Kasperczyk, S., Ventriglio, A., & Vendemiale, G. (2021). Factors related to nurses’ burnout during the first wave of coronavirus disease-19 in a University Hospital in Italy. International Journal of Environmental Research and Public Health, 18(10), 5051. Web.
Galanis, P., Vraka, I., Fragkou, D., Bilali, A., & Kaitelidou, D. (2021). Nurses’ burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of Advanced Nursing, 77(8), 3286–3302. Web.
Harb, A., Rayan, A., & Al.khashashneh, O. Z. (2019). The relationship between workplace bullying and positive mental health among registered nurses. Journal of the American Psychiatric Nurses Association. Web.
Institute for Healthcare Improvement. (n.d.). Science of improvement: How to improve. Web.
Jeffreys, M. R. (2020). Nursing universal retention and success (NURS) model: A holistic, discipline-focused framework. Journal of College Student Retention: Research, Theory & Practice. Web.
Kim, Y., Lee S., & Cho J. (2020). A study on the job retention intention of nurses based on social support in the COVID-19 situation. Sustainability, 12(18):7276. Web.
Lesley, M. (2021). Psychoanalytic perspectives on moral injury in nurses on the frontlines of the COVID-19 pandemic. Journal of the American Psychiatric Nurses Association, 27(1), 72–76. Web.
Loveland, L. (2016). Mental health nursing education: An instructor’s view. Journal of the American Psychiatric Nurses Association, 22(5), 409–410. Web.
Mirzaei, A., Moghaddam, R., & Soola, A. (2021). Identifying the predictors of turnover intention based on psychosocial factors of nurses during the COVID-19 outbreak. Nursing Open. Web.
QSEN. (n.d.). Graduate QSEN competencies. Web.
Rangachari, P., & L Woods, J. (2020). Preserving organizational resilience, patient safety, and staff retention during COVID-19 requires a holistic consideration of the psychological safety of healthcare workers. International Journal of Environmental Research and Public Health, 17(12), 4267. Web.
Stelnicki, A. M., Carleton, R. N., & Reichert, C. (2020). Nurses’ mental health and well-being: COVID-19 impacts. Canadian Journal of Nursing Research, 52(3), 237–239. Web.
Uthaman, T., Chua, T. L., & Ang, S. Y. (2016). Older nurses: A literature review on challenges, factors in early retirement and workforce retention. Proceedings of Singapore Healthcare, 25(1), 50–55. Web.
Yeager, V. A., & Wisniewski, J. M. (2017). Factors that influence the recruitment and retention of nurses in public health agencies. Public Health Reports, 132(5), 556–562. Web.
Appendix
Project Proposal
Background
The project focuses on reducing turnover and burnout among nurses during the pandemic. Today, most health facilities have a deficit of specialists impacting the effectiveness of care delivery and worsening results. For this reason, the program presupposes implementing mental health support and cultivating an organization’s resilience as effective retention strategies to counteract the outlined processes.
Objectives
- Successfully implement outlined retention strategies
- Improve nurses’ mental health by meeting their current needs and helping to manage stress
- Cultivate a better environment attractive for health workers
- Reduce burnout and turnover rates among nurses in selected facilities
Scope
The project presupposes three major phases vital for achieving the goal. Phase one presupposes the implementation of the proposed solutions and their integration into the work of the unit. Phase two involves monitoring of how the intervention works, possible difficulties, and its effects. Phase three is devoted to the evaluation of outcomes to create the basis for new improvement. It is expected that the psychological conditions of nurses will be improved, which will also lead to the reduction of retention and burnout rates.
Timeframe
Key Stakeholders
- Health workers
- Hospital managers
Monitoring and Evaluation
The progress will be controlled via interviews. Participants’ personal data should be collected before the implementation of the proposed methods and at the end of Phase two. Comparison of this information will show the current level of stress, burnout, and turnover intentions and help to conclude about the positive effects of the project and its contribution to the improvement of the unit’s results.