Health Research paper

I need two copies. I just need Project Proposal and annotated bibliography for me and my friend. Other drafts due at later date

Topic 1: Frequent use of Emergency Department in Saudi Public Hospitals: Implications for Primary Health Care Services

Topic 2: Mental Health Issues facing Military Veterans

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NURSES’MOTIVATION AND TURNOVER 2

Motivating Nurses to Reduce Turnover and Deal with the Nursing Shortage

April 28, 2018

Abstract

The work nurses undertake require them to be physically and psychologically fit as they handle complicated cases and failure to be focused can be fatal to the lives of patients. Therefore, nurses require constant motivation to help them remain focused and driven in taking care of patients. Failure of nurse motivation in healthcare can be detrimental to the quality of care offered and can also lead to high professional and organizational turnover. The research focuses on nurses’ motivation to help reduce turnover and also deal with the nurse shortage. Through a systematic review, the research identified past studies from credible journals that address nurses’ motivation and turnover. The results reveal that hospital administrators can motivate nurses through wages that correspond to their duties, financial incentives, resource availability, effective management of human resources, career development opportunities, promoting autonomy, encouraging transformational leadership, and recognizing nurses’ efforts. Policy makers can implement policies that require a specific nurse-patient ratio to help reduce burnout and promote patient outcomes which helps to increase nurses’ motivation. The research contributes to a body of research on nurses’ motivation filling a gap of research that addresses the economic, financial, healthy policy, branding, and strategic approaches. The research makes the conclusion that health leaders and policy makers have a role to play to increase nurses’ motivation and reduce turnover.

Keywords: Nurses’ motivation, turnover, intention to leave, job satisfaction, career development opportunities, nursing staffing.

Introduction

Nurses play an instrumental part in healthcare as they aim to improve the quality of life of patients. The work nurses undertake require them to be physically and psychologically fit as they handle complicated cases and failure to be focused can be fatal to the lives of patients. Therefore, nurses require constant motivation to help them remain focused and driven in taking care of patients (Baljoon, Banjar, & Banakhar, 2018). Failure of nurse motivation in healthcare can be detrimental to the quality of care offered and can also lead to high professional and organizational turnover.

According to the Bureau of Labor Statistics, registered nursing is among the most lucrative professions in the United States with an estimated job growth rate of 16%, the highest among all other occupations. An estimated 1.1 million additional nurses are needed by 2024 to avoid nursing shortage (Bureau of Labor Statistic, 2016). This shows the need to motivate nurses so as to avoid high professional turnover and also to motivate other potential nurses to join the field so as to avoid a shortage which would be fatal for the health of the general population.

Nurse turnover in the United States is on the rise and it can be attributed to poor working conditions and lack of motivation for nurses. According to the 2018 National Health Care Retention and Registered Nurses Staffing Report, the rate at which nurses are leaving their jobs in the United States is on the rise. The 2017 turnover rate was 18.2% which is the highest rate for the decade (Nursing Solutions, 2018). Additionally, the turnover among new nurses is also high which negatively affects the quality of care. Kovner, Brewer, Fatehi, and Jun (2014) revealed that approximately 17% of new nurses leave the job in the 1st year while an estimated 33% left their nursing jobs after two years.

The cost of nurses’ turnover is high for both hospitals and patients. Registered nurses turnover in a hospital can lead to organizational costs of approximately $6.4 million (Kovner et al., 2014). The financial loss associated with bedside RN turnover is approximately $50,000 (Nursing Solutions, 2018). This means that an average hospital loses between $4.4m-$7.0m with the current RN turnover rate. The costs of nurses’ turnover are high and they have a negative impact on the already declining hospital margins which can lead to an increase in the cost of healthcare. Additionally, the high registered nurses turnover rate negatively affects the quality of care as the staffing ratios decline meaning that a nurse takes care of many patients which can lead to burnout, decreased motivation and organizational loyalty, and decreased performance.

The increased professional turnover among nurses is a major concern and is caused by various factors. One such factor is nurse burnout. Nurse burnout is caused by high number of working hours and high patient-nurse ratio. Nursing work is physically and mentally demanding and hence working for long hours can lead to burnout which negatively affects nurses’ performance. The burnout can reduce the quality of care offered to patients compromising the overall care to patients. When nurses experience burnout, their job satisfaction and performance declines which leads to reduced motivation and subsequent professional turnover. Therefore, there is a need for hospital administrators to have reasonable working hours, patient-nurse ratios, and shifts to prevent nurse burnout hence motivate them and reduce nurse turnover.

Another factor that is influencing nurse turnover is the aging population. The aging population in America requires additional health services that may strain the nursing workforce. The population of Americans aged 65 years and above is at the highest. With the baby boomer generation reaching the retirement age, the population of those aged 65 years and above is bound to increase to an estimated 73 million in 2019 (Grant, 2016). Additionally, some diseases that were terminal previously are now survivable leading to an increased need for health services. This increase in healthcare utilization can strain the workforce which leads to increased turnover. Additionally, the nursing workforce is also aging and with the increased use of technology in healthcare such as electronic health records, it may be difficult for the aging nurses to cope which leads to professional turnover (Grant, 2016).

Another factor that contributes to nurse turnover is career and family. Since nursing is predominantly female, some leave the profession to take care of the family especially during child-bearing years. Although some may return to the profession after some time, others may choose other careers contributing to the increasing nursing turnover.

Therefore, the nursing turnover in the United States is an issue of concern and there is a need to address it so as to improve the quality of care and avoid nursing shortage. To address nurses’ turnover, it is important to ensure that nurses’ motivation levels are high. Nurses’ motivation is linked with their performance, job satisfaction, and organizational loyalty (Baljoon, Banjar, & Bankhar, 2018). When nurses are motivated, their performance is high which helps to improve the quality of care offered to patients. Additionally, motivated nurses have high job satisfaction which can help reduce professional turnover while high organizational loyalty helps to reduce organizational turnover which has a positive impact on organizational costs (Baljoon, Banjar, & Bankhar, 2018). One way to motivate nurses is by having an adequate staffing ratio. An adequate staffing ratio helps to reduce nurse burnout which subsequently increases nurses’ performance and job satisfaction. In a hospital setting where the number of nurses is low compared to the number of patients, there is a high likelihood of readmissions which shows reduced nurse performance. Additionally, high patient loads among nurses also leads to increased infection rates (Cimiotti, Aiken, Sloane, & Wu, 2012). However, having high nurse staffing levels leads to fewer deaths, reduced infection rate, lower readmission rates, and shorter hospital stays (Blegen et al., 2011; Kjellstrom, 2017). Therefore, hospital administrators should be focused on having a sufficient staffing ratio to motivate nurses. Other ways to motivate nurses include financial incentives, good working conditions, appropriate scheduling, opportunity for career advancement, and offering opportunities for skill development.

This paper will focus on how hospital administrators can motivate nurses to address the issue of nurse turnover and shortage of nurses. This research will contribute to an already existing research field on nurse motivation and nurse turnover which is its academic significance. Hospital administrators and health policy makers can also use the research to formulate policies in health institutions to help improve nurses’ motivation and reduce nurses’ professional and organizational turnover which is the practical significance of the research. The research will address how nurses’ motivation is related to nurses’ turnover and quality of care and seek to find ways to increase nurses’ motivation and job satisfaction. The key units of analysis for the research include nurses’ motivation, nurse turnover, quality of care, organizational commitment, and nurses’ job satisfaction.

The paper will have the methodology, literature review, results, and discussion sections. The methodology section will discuss the methods applied to conduct the research. The literature review will discuss credible and relevant studies that address the issue of motivating nurses. The results and discussion section will discuss the results and what they mean for hospital administrators. The discussion section will also give recommendations on how health professionals should incorporate the findings of the study to create a good working environment that motivates nurses to improve their job satisfaction and organizational loyalty.

Methodology

The research is a systematic review of past studies on nurses’ and turnover. Past studies used in the research were search in well-known journals such as Cochrane, ScienceDirect, PubMed, and Medline. They key search terms included “nurses’ motivation,” “nurse turnover,” “nurse shortage,” and “nurses’ intention to leave.” The initial search result yielded 63 journal articles. After screening their title and abstract, I was left with 36 journal articles that met the inclusion criteria. The other journal articles were disregarded because they were published before 2009, were non-peer reviewed, did not address the research topic, and employed informal methods to collect data. After careful examination of the searched articles, only 15 meet the inclusion criteria. For the articles to be included in the study, they had to have been published in the past 10 years, addressed how to improve nurses’ motivation, be peer-reviewed, and addressed nurses’ turnover. A review of the articles was then conducted that analyzed the results of the studies and how they relate to nurses’ motivation and turnover.

The dependent variables for the research are nurses’ turnover and nurses’ motivation. The motivation of nurses affects their turnover as low motivation levels increase the likelihood of nurses’ turnover. The independent variables are the ones that affect nurses’ motivation and include wages, financial incentives, burnout, career development opportunities, staffing ratios, autonomy, leadership style, and recognition. The hypothesis of the study is that the independent variables affect nurses’ motivation which in turn affects nurses’ turnover rates.

Literature review

This research relies heavily on past studies. Nurses’ motivation is a critical component in the performance of nurses as it gives them an increased desire to continue giving their best to meet the goals and objectives of the health institution and offering high quality care is one of the goals of health institutions such as hospitals. Therefore, it is important to know strategies that can help to maintain and improve nurses’ motivation to help in achieving the set goals and objectives. Some of the key constructs of the research include nurses’ motivation, nurse turnover, quality of care, organizational commitment, and job satisfaction. Nurses’ motivation can be defined as reasons why nurses act in a particular way. It is what guides them to maintain goal-oriented behaviors. Nurse turnover is the rate at which nurses leave their jobs. Nurse turnover can either be professional or organizational turnover. Professional turnover is when nurses leave the nursing profession entirely while organizational turnover is when nurses leave a given organization to another. Quality of care can be defined as the extent and effectiveness of health services offered to patients. Organizational commitment is the loyalty an employee has towards his/her employer. Organizational commitment is influenced by factors such as wages, working conditions, and career advancement opportunities. Job satisfaction is the feeling of contentment and fulfillment that drives employees. The literature review section will focus on financial, economic, health policy, marketing and branding, and strategic approaches to improve nurses motivation and reduce turnover.

Financial approaches

Financial approaches are an important factor in motivating nurses. This section aims to present past studies that reveal the financial approaches that can help motivate nurses to increase their job performance and their intent to stay.

McHugh and Ma (2014) revealed that the wages paid to nurses are a significant factor in their job satisfaction and intention to leave. The level of wages paid to nurses is an important factor for nurses’ outcomes although it does not disregard the influence of working environment and staffing ratios in the satisfaction and performance of nurses (McHugh & Ma, 2014). Therefore, paying a satisfactory wage is an important factor in increasing nurses’ organizational commitment and motivation. Nurses working in organizations that pay a better wage compared to other organizations are more motivated which increases their performance and they exhibit a lower intention to leave which helps to reduce the organization’s turnover costs (McHugh & Ma, 2014). Through a cross-sectional secondary analysis of nurses working in four states (California, New Jersey, Florida, and Pennsylvania), McHugh and Ma (2014) revealed that wages played an important role in reducing nurses’ intention to leave and increasing their job satisfaction.

The research further revealed that nurses working in hospitals with better working environment and better staffing ratios have lower cases of job dissatisfaction and when wages were added into the model, its effect on job satisfaction among nurses was significant (McHugh & Ma, 2014). A one standard deviation change in wages led to an increase/decrease in nurses’ job satisfaction by 9 percent (McHugh & Ma, 2014). However, McHugh and Ma (2014) revealed that although a favorable pay has a significant effect on nurses’ motivation, job satisfaction, and organizational commitment, better working environment and staffing ratios also had a considerable effect on attracting nurses to employment. Paying favorable wages should be integrated with a good working environment and better staffing ratios for optimal nurses’ job satisfaction and organization commitment.

Another study conducted by Herzer and Pronovost (2015) affirms that the use of financial incentives can be helpful in increasing nurses’ motivation and job satisfaction. Increased motivation and job satisfaction subsequently leads to increase performance, improved quality of care, and organizational commitment (Herzer & Pronovost, 2015). However, financial incentives should be goal-oriented and focused on team-based approached. The financial incentives should be rewarded to nurses’ teams that not only achieve the set goals and objectives but also who show considerable improvement in their performance. Additionally, financial incentives should be offered to teams since it is a better approach to improve quality of care (Herzer & Pronovost, 2015). Financial incentives such as performance-based bonuses, paid vacations, or paid for training opportunities can be helpful to improve nurses’ motivation. The findings of Herzer and Pronovost (2015) supports Aninanya et al., (2016) that states that performance-based incentives can help improve nurses’ motivation. Aninanya et al., (2016) carried out a research on theeffect of PBIs on workers in the maternity section in Ghana which revealed that PBIs increased their motivation to work. The findings of the research also shown that performance-based incentives motivated the nurses to increase their efforts in offering maternal health and PBIs also led to increased pride and job satisfaction. Herzer and Pronovost (2015) and Aninanya et al., (2016) assert that the usage of financial incentives and performance-based incentives are good financial strategies that can help improve nurses’ motivation, quality of care, and job satisfaction.

Health Economic approaches

Health economics is focused on the effective use of limited resources. This section focuses on past studies that show how the effective use of resources in healthcare can impact nurses’ motivation.

Willis-Shattuck et al., (2009) conducted a systematic review of past studies to evaluate the factors that promote nurses performance and retention. One of the factors identified in the study was hospital infrastructure and resource availability. In this case, resources include medical supplies and equipment (Willis-Shattuck et al., 2009). Inadequate equipment and medical supplies necessary to perform nursing duties appropriately is a key de-motivator among nursing professionals. When the working environment does not have sufficient equipment and supplies, nurses are not confident about their abilities which negatively affect their performance. Declining performance among nurses acts a de-motivator which can lead to organizational and professional turnover in the search for more satisfaction (Willis-Shattuck et al., 2009). Therefore, it is important for hospital administrators to ensure that necessary equipment and medical supplies are available as it allows the nursing professionals to utilize their knowledge to the fullest which provides intrinsic motivation and increase nurses intention to stay (Willis-Shattuck et al., 2009). Resource availability should be one of the primary considerations since patient care cannot be effective if the accurate resources are not used.

Nurses also make an important part of hospital resources. They are tasked with patient care which is the main function of hospitals and hence there is a need to ensure that the human resources are utilized efficiently. Burnout continues to be a major issue among nurses and it negatively affects their efficiency and motivation. Aiken, Sloane, and Stimpel (2012) argue that nurses’ working hours have a direct impact on the job satisfaction, burnout, and turnover. Their research showed that nurses working for longer hours had high burnout rates and also had a lower intention to stay. A nurse working for about ten to eleven hours had a lower intention to stay compared to a nurse working for eight to nine hours per day. As the number of working hours increase, nurses’ intention to stay decreases (Aiken, Sloane, & Stimpel, 2012). Nurses with high burnout indicate that they intend to leave the organization within a year usually due to job dissatisfaction. Aiken, Sloane, and Stimpel (2012) argue that hospital administrators should manage human resources effectively to help increase job satisfaction hence increase their intention to stay. This can be achieved by having reasonable working hours for nurses to prevent burnout which is a major contributor for both professional and organizational turnover.

Health Policy Approaches

Health policies aim to make positive health impact in the society. When considering nurses’ motivation, it is important to formulate and implement policies that aim to increase nurses’ job satisfaction and their intention to stay. One way to do so is by formulating and implementing health policies that standardize nurse staffing ratios to help prevent nurse burnout and also for better patient outcomes. Paulsen (2018) conducted a research to investigate the impact of nurse staffing ratios on patient outcomes and nurse motivation. Research has revealed that adequate nurse-patient ratio helps to reduce patient mortality and failure to rescue. Additionally, adequate nurse staffing ratio leads to shorter hospital stays while lower staffing results in increased mortality (Paulsen, 2018). The improvement in patient outcomes due to appropriate nurse-patient ratios increases nurses’ job satisfaction which translates to increased organizational commitment hence reduced intention to leave (Paulsen, 2018). Paulsen (2018) advocates for health policy changes to mandate specific nurse-patient ratio. California has already implemented legislation requiring specific nurse-patient ratio which can be replicated by other state governments to improve patient outcomes and also increase nurses’ motivation. However, there is usually a limitation in knowing the right nurse-patient ratio given that increasing the number of nurses will lead to increased healthcare costs (Paulsen, 2018).

Instituting policies that promote career development and regular training of nurses can also be helpful in reducing nurses’ turnover and increasing their motivation. Yang, Liu, and Zhang (2015) conducted a research on the impact of organizational career growth on nurses’ intention to leave and concluded that lack of career advancement opportunities led to increased nurse turnover. Career development is measured on four dimensions that include acquisition of professional skills, realization of career goals, speed of promotion, and salary increase (Yang, Liu, & Zhang, 2015). Hospitals that provide nurses with career advancement opportunities witness improvements that are led by the employees. Providing career advancement opportunities for nurses’ increases organizational loyalty hence reduced turnover rates. In Maslow Hierarchy of Needs, career development belongs to self-actualization (Yang, Liu, & Zhang, 2015). Nurses want to achieve their highest level and providing career advancement opportunities would be a way to achieve it. Therefore, it is important for health leaders to institute policies that aim to promote career development opportunities through providing regulation education and training, and promoting nurses to help improve overall retention rates (Yang, Liu, & Zhang, 2015). Nationwide policies to ensure nurses get career development opportunities such as training to increase the skill mix can be helpful in reducing professional turnover and helpful in dealing with the shortage of nurses.

Marketing and Branding Approaches

Marketing and branding are critical in improving the image of the nursing profession which is appropriate in increasing retention rates and attracting other people into the nursing profession. Bencekovic et al., (2016) internal marketing can be helpful in improving the nursing profession. Internal marketing involves effective communication between the employer and the employees in an effort to meet the needs of clients. This can be achieved through training for marketing, internal communication, support from the management, including employees in foreign communication, and human resource management (Bencekovic et al., 2016). Some of the strategies that can be used to improve the image of the nursing profession include connecting with other professionals through professional organizations community, developing partnerships with clients and other caregivers, upholding high professional standards, and use of tools such a the media and websites (Bencekovic et al., 2016). To strengthen the status of the nursing profession, it should follow the needs of the public and inform the public about the profession. This can be achieved through by presenting nursing services and programs to the public and promote professional excellence among nurses (Bencekovic et al., 2016). The use of internal marketing is helpful in improving work and organizational environment which is linked to job satisfaction and developing internal programs that help to increase retention rates. Internal marketing helps to attract and retain employees in an organization due to increased organizational loyalty (Bencekovic et al., 2016). Using websites can also help to promote the nursing profession and improve their image which can help nurses feel their profession is respected and appreciated hence reduce professional turnover (Bencekovic et al., 2016).

Somers, Finch, and Birnbaum (2010) carried out a research on how to market the nursing profession to help attract more people into nursing and increase retention rates. To accomplish this, it is important to understand how people become aware of nursing and also understand what motivates people to pursue a nursing career. The research revealed that nursing students can be put into two divergent sections; traditionals and instrumentals. Traditionals view nursing as an opportunity to make positive impact in people’s lives and improving patients’ quality of life. Instrumentals view nursing as a career to give them financial security and career advanacement (Somers, Finch, & Birnbaum, 2010). Therefore, it is important to have different marketing strategies to appeal to the needs of the distinct segments.

For traditionals, marketing strategies should focus on showing the tangible impact of the nursing profession in improving people’s quality of life. This includes extending outreach programs for the students to interact with nurses in a clinical setting and build relationships with nurses early enough to help create awareness of the nursing profession. Other marketing strategies to appeal to the traditionals include; developing materials that show the tangible advantages of the profession and the positive difference nurses make, outreach programs that focus on how nurses make positive impact in peoples’ lives, and position the profession as one that make positive difference (Somers, Finch, & Birnbaum, 2010). The strategies to appeal to the instrumentals include; outreach programs to ensure interaction with nurses in clinical settings, develop materials that show the economic and psychological freedom of nurses, and position nursing as a profession that provides an opportunity for upward mobility, and job security (Somers, Finch, & Birnbaum, 2010). Using the aforementioned marketing strategies will be helpful in attracting prospective students to the nursing profession and also retain them in the profession reducing nursing turnover.

Strategic approaches

Strategic approaches can be helpful in increasing organizational commitment, job satisfaction, and motivation to work in the organization hence reduced organizational turnover among nurses. This section will review literature that relate to strategic approaches to reduce nurses’ turnover and increase their motivation.

Appreciation and recognition

Hughes (2017) argues that appreciating and recognizing nurses’ efforts can be helpful in increasing their motivation and intention to stay in an organization. Recognizing nurses’ positive efforts helps them feel valued which increases their intrinsic motivation to improve their performance. Appreciation should be communicated in a positive way that nurses feel it is genuine so as to have the intended effect. Appreciation can take various forms such as gifts, paid holidays, opportunity for career development, and promotion (Hughes, 2017). When nurses see that their efforts are recognized, they are highly motivated to increase their performance and their organizational commitment increases hence reducing turnover rates.

Promoting nurses’ autonomy

Promoting nurses’ autonomy can also be helpful in increasing their work motivation. Autonomy gives independence to nurses to use evidence-based practices that they feel can be helpful in improving patient care. Supervisors should work with nurses to identify any evidence-based practices that nurses feel are helpful and support nurses in their implementation of such practices (Baljoon, Banjar, & Banakhar, 2018). Supervisors should not be willing to maintain the status quo but should focus on providing avenues for nurses to use new and innovative practices that can be helpful in improving their productivity (Baljoon, Banjar, & Banakhar, 2018).

Transformational leadership

Gardner (2010) argues that transformational leadership can be helpful in improving nurse retention. Transformation leaders focus on building relationship with employees, building a supportive environment, encouraging innovation, and ensuring that employees learn from their mistakes (Gardner, 2010). In the nursing work environment, nurses need leaders that understand their needs, encourage them to be innovative, communicate effectively, and leaders who allow them to learn from their mistakes instead of criticizing them. Therefore, transformational leaders can build a good relationship with nurses and promote innovation which is key in motivating nurses and promoting organizational loyalty (Gardner, 2010).

Findings and Discussion

The main objective of the research was to find financial, economic, health policy, marketing and branding, and strategic approaches to deal with nurse motivation and nurse shortage. In the recent past, the nursing profession has been negatively affected by high turnover rates and less people entering into the profession. With the changing health needs of the population, it is important to deal with the high nurse turnover and shortage to ensure that the quality of care offered is great which will lead to improved patient outcomes.

The findings of the research can be categorized into the financial, economic, health policy, marketing and branding, and strategic approaches to help deal with nurse turnover and shortage. The financial approaches include paying better wages and financial incentives to help in motivating nurses to reduce turnover and attract prospective nurses to the profession (McHugh & Ma, 2014). Nurses’ wages should correspond to their duties and they should feel that they are properly remunerates. Nurses’ salary scale should be reviewed upwards to correspond with their roles and responsibility in the healthcare industry. Although increasing wages may be difficult considering the high cost of healthcare, a cost-benefit analysis can help determine the appropriate wage increase for nurses. Additionally, giving financial incentives such as performance based bonuses can also help in addressing nurses’ motivation (Herzer & Pronovost, 2015). When nurses see their efforts being appreciated through financial incentives, their external motivation increases and this may help increase their organizational commitment hence reduce turnover rates.

Economic approaches identified in the research focus on efficient use of resources. One way to improve nurses’ motivation is by ensuring that resources needed such as medical supplies and equipment are readily available. Availability of resources improves nurses’ performance as it leads to improved patient outcomes. Availability of resources increases nurses’ motivation to work as they feel they can achieve the desired results with the resources at their disposal (Willis-Shattuck, 2009). Additionally, the effective management of human resources is a critical motivating factor for nurses. Therefore, health leaders should provide reasonable working hours to reduce burnout among nurses as it increases job dissatisfaction and the intention to leave. Nurses do not need to work long shifts for better patient outcomes, but the efficient management of the nurses can help increase their performance and patient outcomes.

The research also revealed that healthy policies that stipulate specific nursing staff ratios can be appropriate in increasing nurses’ motivation. Having an adequate nurse-patient ratio leads to better patients’ outcomes and reduces the risk of burnout which helps to increase job satisfaction and intention to stay (Paulsen, 2018). Therefore, state and federal governments should consider legislating policies that mandate specific nurse-patient ratio. However, determining the appropriate nurse-patient ratio presents a challenge to health leaders. Policies that promote career development opportunities for nurses should be implemented. Career development opportunities that constitute self-actualization needs are major motivator among nurses. Nurses who receive no career development opportunities such as educational training and promotion opportunities feel unappreciated becoming less motivated which increases their intention to leave (Yang, Liu, & Zhang, 2015). Therefore, it is important for health leaders to regularly give career development opportunities to nurses to increase their motivation and intention to stay. Implementing policies that promote career development opportunities can also help attract prospective nurses to the profession as they feel their career will advance over the years.

Internal marketing is a key marketing approach that can be used to motivate nurses and increase organizational loyalty. The use of internal marketing is helpful in improving work and organizational environment which is linked to job satisfaction and developing internal programs that help to increase retention rates. Internal marketing helps to attract and retain employees in an organization due to increased organizational loyalty (Bencekovic et al., 2016). It is also important to market the nursing profession to prospective nurses. This can help deal with the nursing shortage and also ensure they remain in the nursing profession after recruitment. Marketing strategies to reach prospective nurses include developing outreach program to promote interaction with nurses in the clinical setting, developing materials that portray nurses as people who make positive change in the society and who have economic freedom, position nursing as a profession that makes positive difference in peoples’ lives and a profession that provides opportunity for upward mobility, job security, and career advancement (Somers, Finch, & Birnbaum, 2010). This will be helpful to attract prospective nurses to the profession and hence deal with the nursing shortage.

The strategic approaches that can be used to increase nurses’ motivation and reduce turnover include appreciation and recognition, promoting autonomy, and encouraging transformational leadership. Health leaders should be focused on appreciating nurses’ efforts either through gifts, paid holidays, or promotion so they can feel valued and recognized. This increases nurses’ motivation and organizational loyalty. Health leaders should also promote autonomy among nurses to help promote innovation driven by evidence-based practices. Encouraging transformational leadership which focuses on innovation, effective communication, good relationship with employees, and mentorship can be helpful in increasing nurses’ motivation and organizational loyalty (Gardner, 2010). Health leaders should aim to create an environment that recognizes nurses’ efforts, promotes autonomy, and encourages transformational leadership to increase organizational loyalty.

The results of the research provide great aspects of improving nurses’ motivation and the nurses’ shortage. The results of the study can be used by hospital administrators to know how they can improve the motivation of nurses and reduce their intention to leave. Health policy makers can also use the results to know how to make the nursing profession attractive to prospective nurses and hence deal with the nursing shortage.

The limitation of the research is the access to journal articles which was hindered by the subscription fees needed to access some journals. The journals articles used in the research were free and the lack of subscription hindered access to wide range of journal articles which would have increased the scope of the research.

The recommendation of the research to health managers is to understand the needs of nurses so as to identify ways that can help improve their motivation. Using strategies such as reasonable wages, financial incentives, making resources available, reasonable shifts, promoting autonomy, and appreciating nurses’ efforts can be used in improving nurses’ motivation and health managers should practice such strategies to reduce turnover costs.

Future research can focus on how technology can help improve nurses’ motivation and reduce turnover. The impact of technology on nurses’ performance and motivation is also another area for future research. Future research can also focus on cost-benefit analysis of increasing nurses’ wages, and financial incentives as approaches to increasing nurses’ motivation.

References

Ananinya, G.F. et al. (2016). Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study. Global Health Action, 9:

10.3402/gha.v9.32404

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10.3402/gha.v9.32404

Baljoon, R., Banjar, H., & Banakhar, M. (2018). Nurses’ Work Motivation and the Factors Affecting It: A Scoping Review. International Journal of Nursing and Clinical Practices, 5: 277. doi:

https://doi.org/10.15344/2394-4978/2018/277

Bencekovic, Z. et al. (2016). The role and promotion of nursing. Acta Clinica Croatia, 55: 271-278. doi: 10.20471/acc.2016.55.02.14

Blegen, M.A., Goode, C.J., Spetz, J., Vaughn, T., & Park, S.H. (2011). Nurse staffing effects on patient outcomes: safety-net and non-safety-net hospitals. Medical Care, 49(4): 406-414.

Cimiotti, J.P., Aiken, L.H., Sloane, D.M., & Wu, E.S. (2012). Nurse staffing, burnout, and healthcare associated infection. American Journal of Infection Control, 40(6): 486-490.

Gardner, B.D. (2010). Improve RN retention through transformational leadership styles. Nurse Management, 41(8): 8-12.  doi: 10.1097/01.NUMA.0000384003.09214.ed.

Herzer, K., & Pronovost, P. (2015). Physician Motivation: Listening to What Pay for Performance Programs and Quality Improvement Collaboratives are Telling Us. Joint Commission Journal on Quality and Patient Safety, 41(11): 52-528.

Hughes, V. (2017). Leadership Strategies to Promote Nurse Retention. Scientific Journal of Nursing and Practice, 1(1):1-5.

Kjellstrom, S. et al. (2017). Work motivation among healthcare professionals: A study of well-functioning primary healthcare centers in Sweden. Journal of Health Organization and Management, 31(4): 487-502.

Kovner, C.T., Brewer, C.S., Fatehi, F., & Jun, J. (2014). What does nurse turnover rate mean and what is the rate? Policy, Politics, & Nursing Practice, 15(3-4):64-71.

https://doi.org/10.1177/1527154414547953

McHugh, M., & Ma, C. (2014). Wage, Work Environment, and Staffing: Effects on Nurse Outcomes. Policy, Politics, & Nursing Practice, 15(1): 72-80.

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Written Capstone Research Project accounts for 50% of your grade. Students are required to prepare their capstone research utilizing appropriate research design procedures. The proposal must include the following: 

I. I. Title Page: The title page should contain the title of the paper (no more than 15 words), the author’s name, course name and number, institutional affiliation, capstone advisor, and date. Follow APA style for appropriate formatting. 

I. II. Abstract: The abstract is a short summary of the paper generally between 200 – 250 words in length. The abstract should start with a brief theme sentence to orientate the reader about the overall issue addressed in the article. This sentence should grab the reader’s attention. The abstract should then indicate the main aim or purpose of the study. Next, the academic and/or practical importance of the study should be explained. The methodology used in the study should also be briefly described. The main findings of the study should be 

HCA 598 (20/SP) 4 

I. summarized. A statement of conclusions should indicate the contribution made by the study in filling gaps in the literature. Finally, the practical or managerial implications of the study’s findings should be highlighted where appropriate. 

I. III. Keywords: Include no more than 8 keywords that reflect the discipline, sub-discipline, theme, research design and context (industry and/or geographic location) of the study. 

I. IV. Introduction: The introduction can be described as the “executive summary” that provides readers a glimpse of what is to come and must grab the reader’s attention. In other words, the introduction must effectively “sell” the paper. This section includes the following: (1) the broad theme or topic of the study, (2) the academic and practical importance of the study, (3) a summary of the available literature with the most important previous studies that are relevant to the current research cited, (4) an indication of the most important gaps, inconsistencies and/or controversies in the literature that the current study will address, (5) a clear indication of the the core research problem/question to be addressed, the specific research objective that will guide your research, the context in which the study will be conducted, and the units of analysis of the study, (6) an outline of the structure of the rest of the article. 

The Introduction addresses the first criteria of the grading rubric “Identification and Development of a Solution for a Domestic or Global Health Services Management or Public Health Problem or Issue” 

I. V. Methods: This section includes a detailed description of the research methods that will be employed in your capstone project. The following areas must be addressed: (1) population and sample including the sample selection criteria, (2) study design, (3) data sources, (4) methods of data collection, (5) study variables (e.g., independent and dependent variables) specified in operational terms, (6) analytic methods to be used (make sure to identify the specific statistical procedures and discuss their appropriateness). You should describe your methodological choices in enough detail so that a reader who is not involved in your study will know exactly what you did and why. 

I. VI. Literature review: The literature review represents the core of the paper. This section includes (1) a brief discussion of where the specific topic under consideration fits into the “bigger picture” of the overall area under investigation, (2) conceptual definitions of all the key concepts/constructs included in the study, (3) a focused and synthesized discussion of relevant previous research findings involving the constructs/concepts relevant to your study, (4) a summary of existing approaches to the measurement of the relevant constructs, and (5) sufficient theoretical support for the hypothesis to be tested/problem to be addressed. 

The Literature Review addresses the rubric criteria one through six “identify and utilize appropriate Healthcare Economics, Health Policy, Marketing and Branding, and Financial Analysis Approaches to Develop and Propose Solutions using a Strategic Approach.” You must obtain at least two articles for each criteria. HCA 598 (20/SP) 5 

I. VII. Findings & Discussion: This section includes the key findings of your capstone project and appropriate managerial and policy recommendations. The following must be addressed: (1) a restatement of the paper’s main purpose, (2) a reaffirmation of the importance of the study by restating its main contribution, (3) a summary of the results in relation to the research objective WITHOUT introducing new material, (4) a detailed description of the key findings of your capstone project, (5) the managerial and policy implications of your key findings, (6) limitations of your capstone project and future managerial and policy recommendations, (7) insightful (i.e., non-obvious) directions or opportunities for future research on the topic. 

This section addresses the final criteria of the grading rubric “Evaluate Outcomes” 

I. VIII. References: A list of references must be included at the end. You are required to include at least 10 references from peer-reviewed research journals, using the “APA” style. You may use citations from trade journals, web sites, or other published or unpublished sources to supplement, but not replace, the minimum 10 peer-reviewed journal citations. 

Oral Presentation accounts for 30% of your grade. You are expected to prepare a 42” x 30 poster addressing the key information and findings of your capstone project and present it on campus to HCA faculty, students, and guests during finals week of the semester. The date and time will be provided during the first month of the semester. If travel to campus is a geographic challenge, you can record a professional presentation addressing the key information and findings of your capstone project. This exception must be granted by the program director. 

Further details on preparing a poster are provided in Moodle. 

Assignment Submission 

You need to submit both your final paper and poster to Moodle. 

When saving files related to any submissions for use in this course, please follow the format of: 

“LastName_FirstName_CapstonePaper” 

“LastName_FirstName_CapstonePoster” 

SCHEDULE OF ASSIGNMENTS Due Date1 

Assignment 

January 17, 2020 

· • Review the Capstone Research Project Requirements as presented in the syllabus. 
· • Send your preliminary capstone project topic to the faculty member noted in the initial email and receive approval. 

Week of January 20, 2020 

· • Topics will be approved, and Capstone advisor assigned 
· • Contact your assigned capstone advisor 

January 31, 2020 

· • Project proposal due with annotated bibliography (example in Moodle) attached due to your advisor. This does not need to be lengthy nor complete at this point. 
· • Discuss your proposal with your capstone faculty advisor identifying the topic, the approach you will be taking, and the significance of the issue. 
· • If using a method based on the study of human subjects, you should have completed your IRB application and be ready to go. 

February 28, 2020 

· • Submit paper first draft. 
· • Have a discussion on substance and progress with your capstone faculty advisor. 

March 27, 2020 

· • Second paper draft due. 
· • Have a discussion on substance and progress with your capstone faculty advisor. 

April 20, 2020 

· • The final version of the Capstone paper must be uploaded to Moodle by 11:55 p.m. EST 

April 27, 2020 

· • Final Poster due to your advisor and uploaded to Moodle. The HCA program will coordinate and cover the cost of printing. 
· • Posters submitted after this date will not be printed on campus and it becomes the responsibility (financial and otherwise) of the student to secure a poster. 
· • Presentation for those not coming to campus must be uploaded to Moodle by 5:00 p.m. EST2 

TBD 

Week of May 4 – 8, 2020 

6:00 – 8:00 p.m. 

· • Capstone Poster Presentations on campus2 

Congratulations! You have completed your capstone