Running head: FIRST-LINE NURSE LEADERS AT FRIENDLY HOSPITAL 1

A System Change: Strategies to Retain and Recruit First-line Nurse Leaders at Friendly Hospital

Camille Y. Holland

University of North Carolina Greensboro

Academic Integrity Pledge: I HAVE ABIDED BY THE UNCG ACADEMIC POLICY ON

THIS ASSIGNMENT: Camille Y. Holland November 1, 2017

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Summary

A. Title: A System Change: Strategies to Retain and Recruit First-line Nurse Leaders at

Friendly Hospital

B. Location: Nursing department

C. Proposed start date: January 2, 2017

D. Project duration: September 2, 2017 (8 months)

E. Expected Cost: $7500.00

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Background

The Problem

Friendly Hospital (FH) is a 800 bed facility located in Durham, North Carolina. It serves the

Durham, Orange, Person, Granville, Alamance, and surrounding counties. In the community,

FH is known for having professional and caring staff provide quality patient care in a warm and

comfortable environment. However, the executive leadership team has discovered that there has

been a decline in the number of first-line nurse leaders (FLNLs) over the past year. This

discovery along with the dynamic changes occurring in healthcare organization such as

restructuring of hospital networks, value-based purchasing, and economic fluctuations has

created more challenges for Friendly Hospital. At FH, the role of the FLNL includes the 1)

direct-line responsibility for patients with staff nurses and others reporting directly to them 2)

participation in the hiring process/performance management of staff nurses 3) supervision of

nursing staff 4) facilitating the growth and development of future nurse leaders.

Friendly Hospital has experienced a significant decline in first-line nurse leaders (FLNLs)

over the past year. For example, FH has experienced a loss of four FLNL since January 2017.

According to the staffing report, FH has an overall shortage of six FFNLs. The executive

nursing leadership report that FLNL leave their positions because of factors such as burnout,

increased job demands, job promotion, and retirement. As an effort to understand why there is a

growing shortage of FLNLs at Friendly Hospital, the guiding questions include: 1) What are the

factors causing the shortage of FLNLs at Friendly Hospital? 2) How does the shortage affect the

future growth and expansion of FH 3) What resources can FH implement to prevent the

impending shortage of first-line nurse leaders? Therefore, the executive leadership is

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recommending the implementation of a change project that will focus on the recruitment and

retention of FLNLs.

Relevant Literature

According to the literature, the shortage of FLNL is not only a problem affecting FH. In the

United States, more than 67,200 nurse manager vacancies are predicted by the year 2020

(Shirley, 2006). According to Wong and Laschinger (2015), as an increasing number of

frontline managers begin to retire, fewer nurses are showing interest in applying to these stressful

positions signaling the possibility of a future shortage. A recent national survey of Canadian

nurses found that only 24% of direct care nurses were interested in pursuing a nurse management

role; with interest in the role steadily declining with age (Hewko, Brown, Fraser, Wong, and

Cummings, 2014). Additionally, the shift towards more clinical opportunities for advanced

practice nurses has an impact on the recruitment of nurses to middle-management positions

(Brown, Fraser, Wong, Muise, and Cummings 2012). The review of the literature indicates that

there are limited studies conducted by researchers on this topic.

Supportive Programs & Activities at Friendly Hospital

Friendly Hospital has several programs that will serve to supplement the change project. For

example, the nurse mentoring program provides support to FLNLs. Upon request by the FLNL,

a senior nurse is assigned to the FLNL to serve as their mentor. They provide guidance and

support to them regarding their role and responsibilities as FLNL. Friendly Hospital, offers a

one month orientation to newly hired FLNLs. The program provides information on the role and

responsibilities as a FLNL, and informs them about future opportunities for growth and

development in leadership. This program is only available during the FLNL orientation.

Friendly Hospital provides financial support for NLs wanting to attend continuing education for
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leadership and management. They are supportive and recommend NLs to advance their nursing

education, and leadership role.

Determining the project need

The need for the project was determined during an executive nurse leadership meeting. In the

meeting, the Chief of Nursing (CNO) explained that the shortage of FLNLs is a serious problem

at FH. She explained how leadership is an important aspect for the growth and development of

staff at Friendly hospital. Furthermore, she stated that this could cause a serious negative impact

such as significant loss of nurse leaders, decreased retention of nursing staff, negative

organizational culture, loss of quality patient care, and emotional distress by the nurse leaders.

The CNO explained that early initiation of the change project could have positive outcomes on

the retention and recruitment of FLNLs. Since the CNO was able to effectively communicate the

importance of implementing the change project, she received support from all of the members of

the executive leadership.

Guiding Theory

The general psychosocial work environment model is the theoretical framework that guides

this change project. According to this model, the experienced level of job demands and control

or decision latitude, and other psychosocial characteristics are determinants of the individuals’

stress response and its health consequences. As a result, this will aide in determining if FLNLs

will stay, or leave a managerial position. In addition, this theory will predict the sustainability of

FLNLs in terms of 1) no turnover 2) healthy work attendance 3) no burnout (Skagert et al.,

2011). This theory is connected to FH’s change project because it indicates job demands and

psychosocial characteristics can influence if FLNLs stay at the hospital.

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Objectives of the Project

The objectives of the change project include 1) no turnover of FLNLs within eight months 2)

the recruitment of two FLNL within eight months 3) no complaints of burnout from the FLNLs

after four months 4) development of a positive organizational culture of FLNLs within six

months. Furthermore, the executive leadership understands that the change project is a team

effort that requires support from the entire nursing department.

The objectives will be measured by the results of one or no FLNL vacancies over the course

of eight months. If there is a vacancy, it will be addressed by the team to determine if it is

preventable or non-preventable. For example, a NL may be retiring, relocating to another area

that is unrelated to the negative issues surrounding the increased turnover of FLNLs. There will

be weekly anonymous surveys addressing the occurrence of burnout with the FLNLs. The

surveys are a tool to measure the level of burnout. Additionally, the executive leadership will

hold town hall meetings to obtain positive/negative feedback i.e. burnout, intentions to leave,

stressful situations from the FLNLs. The FLNLs will be encouraged to use the open-door policy

to discuss issues and concerns to the senior leaders and executive leadership at FH.

Expected Results & Work Plan

Overall Results

This plan will accomplish the retention of FLNL at FH within eight months. To promote the

retention of the nurse, the senior nurse leaders will maintain close contact with the FLNLs. As a

result, this will aide in early detection of the potential loss of a FLNL. Although it may be

challenging to have buy-in from the staff at the beginning of the project, the senior nurse leaders

will continuously show empathy and provide support to the FLNLs. The senior nurse leaders

will encourage the FLNLs to express their feelings about their current work environment i.e.
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feelings of burnout, lack of senior nurse leader support. If it is discovered that the FLNL are

lacking managerial support, the senior nurse leaders will immediately address the issue and

provide ways to offer support.

The CNO could offer to recruit new FLNL from within to save on the costs of advertisement

and training new staff. Additionally, the nursing department could offer in-house nurse

leadership training classes to be conducted by the senior nurse leaders as an alternative to paying

for outside vendors.

Change Project

Objective Interventions Staff Costs Notes Duration

FLNL- Advertisment- (3) Human $3500 In-house 8 months

Recruitment online, emails Resources recruitment
*Recruit from would provide
within i.e. an opportunity
clinical ladder to save $$ for
the hospital
Mentor Assign FLNL to (6) Senior None 8 months
Program- a Mentor Nurses
Expansion *Monitor
progress
Continuing Offer programs (2) Nurse $4000 *Monitor staff 6 months
Education to FLNL, Educator attendance
Leadership *encourage
Courses attendance
Buddy Program Assign a Senior (6) Senior None ACNO will 8 months
Nurse Leader Nurses monitor
Buddy, Monitor progress
progress,
*Provide
emotional
support to
FLNL
FFNL In-house Encourage (2) Human None *Collaborate 8 months
expanded FLNL to enroll Resources with Nurse
orientation in program Educator
program *Continuation
of initial
orientation
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Outcome Results of the Project

After the conclusion of the project, there will be one or two newly hired FLNL. The

recruitment of new nurse leaders should be a slow process because of the importance in creating

a positive organizational culture is important to retain staff. Additionally, there will be no loss of

FLNL by the end of the project. The FLNL will not complain of burnout at the end of the

project. They will openly express their thoughts and feelings regarding the i.e. Buddy/Mentor

Expansion program to the CNO and ACNO throughout the project. There will be continuous

monitoring of the program by the senior nurse leaders and ACNO. This will be an effective

measure to maintain sustainability.

Challenges

Friendly Hospital may experience challenges such as obtaining buy-in from staff to provide a

supportive environment that provides ongoing mentorship, adequate orientation, and that their

work is valued and appreciated. It may also be challenging to create a more resilient staff.

According to Hudgin (2015), nurse leaders who display a high level of resilience are more likely

to remain in their position. The execution staff may also need direction for creating a supportive

environment for the FLNLs. For example, the incorporation of evidence-based literature will

enable to establish a plan for this. The cost of the change project could be a challenge for FH,

because the hospital’s budget may be affected by the program.

The lack of evidence based research and other change projects may limit the comparison of

data reports to other healthcare organizations. According to Skagert et al. (2011), no other study

has investigated actual turnover among healthcare managers. Additionally, the lack of United

States (US) research studies will limit the comparison of data for a wider geographical region for

FH. For example, the role and responsibilities may be different in countries outside of the U.S.
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According to Shirey (2006), the significant changes in the nurse manager’s role and current work

environment may limit the variety of data.

Project Implementation

Roles and Responsibilities

The Chief Nursing Officer (CNO) will be responsible for the planning and management of the

project operations. The CNO will provide bimonthly scheduled reports of the status of the

project to the executive leadership. The Associate Chief Nursing Officer (ACNO) will be

responsible for implementing the strategies of the project. The ACNO will establish workgroups

to facilitate in organizing the objectives of the project. There will be Senior leaders appointed to

lead the workgroups. The workgroups will focus on the Buddy program and he Nurse mentoring

committee. At FH, a senior nurse leader has more than five years or more experience, and the

same role and responsibilities as a FLNL. The Chief Financial Officer will monitor the

hospital’s budget for implementation of the project. The CNO will provide ongoing scheduled

reports to the Chief Executive Officer (CEO).

Coordination with other Supportive programs

The workgroups will incorporate other programs offered at FH such as the mentoring group

and FFNL orientation. The utilization of the current hospital programs can be economical for the

project. For example, the workgroups will encourage leaders of the mentoring group to

collaborate their ideas and thoughts. In turn, this will strengthen the workgroup because the

present strategies will be included in the workgroups. Additionally, the workgroups will be

encouraged to communicate with the current groups to form relationships that will generate a

wealth of knowledge pertaining to the change project. This will promote individual and team

empowerment.
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Project Sustainability

The change project will involve strategies that will provide direction and guidance for

sustainability at FH. The ongoing strategies will enable FH to maintain the retention/recruitment

of FLNLs. Therefore, the workgroups will create realistic and long-term strategies. The change

project will demonstrate sustainability by the FLNLs showing no turnover, no burnout, and a

positive organization culture beyond the completion of the change project.

Procedures for Monitoring the Project

The ACNO will be responsible for monitoring and ensuring that the activities are occurring as

planned. The ACNO will request that schedule reports be provided about the committees, from

the senior nurse leaders. She will report her findings to the CNO on a regular schedule. The

CNO will clarify any areas of concerns, and seek clarification if needed. In turn, the CNO will

report her findings to the executive leadership team.

Project Communication Plan

The project will be communicated to the FLNLs by the senior leaders and executive leaders at

FH. Having effective communication has an impact on the successfulness of the implementation

of a program. The, the CNO and ACNO will hold town hall meetings before implementing the

change project. During the town hall meetings, the CNO and ACNO will explain the factors

surrounding the shortage of FLNLs at Friendly Hospital. They will describe implementation

process of the change project, and how it will help in retention and recruitment of FLNLs. They

will conduct town hall meetings during scheduled shifts to involve all the FLNL. The senior

leaders will encourage feedback from the FLNLs to gain better insight of the problem. They will

incorporate other forms of communication to such as email/text message reminders, text perform

“burnout” surveys, programs i.e. buddy program, nurse mentor program. The CNO and ACNO
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will remind the senior nurses to provide ongoing communication and documentation of the goals

and status of the FLNL.

Importance of the Change Project to Nursing Leadership

This project is important to nursing leadership because it demonstrates an effort to support the

retention of FLNLs in healthcare organizations. It shows that FH is concerned about the growth

and development of nurse leadership. Friendly Hospital is proactive in ensuring that leadership

is strongly represented within their healthcare organization.

Although there is minimal research literature on the subject, this change project shows an

effort to address the issue. In turn, this could motivate other healthcare organizations to perform

change projects and conduct more research on the topic. Also, it shows how the retention of

nurse leaders is imperative to the existence of transformational and servant leadership. This

concept emphasizes that leadership is a process that should be passed on to new nurse leaders to

replace the retiring nurses. If nursing leadership is loss, it will impede the growth and

development of potential future nurse leaders. Therefore, healthcare organizations must

recognize that leadership is the foundation for their existence, and seek opportunities that

promote it’s sustainability.

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References

Brown P., Fraser, K., Wong, C., Muise, M. & Cummings, G. (2012). Factors influencing

Intentions to stay and retention of nurse managers: a systematic review. Journal of Nursing

Management, 21, 459-472. doi: 10.1111/j.1365-2834.2012.01352.x

Hewko, S.J., Brown, P., Fraser, K., Wong, C.A., & Cummings, G.G. (2015). Factors

Influencing nurse managers’ intent to stay or leave: a quantitative analysis. Journal of

Nursing Management, 23,1058-1066. doi: 10.1111/jonm.12252

Shirey, M.R. (2006). Stress and Coping in Nurse Managers: Two Decades of Research. Nursing

Economics, 24(4), 193-211.

Skagert, K., Dellve, L., & Ahlborg Jr., G. (2011). A prospective study of managers’ turnover and

Health I a healthcare organization. Journal of Nursing Management, 20, 889-899.

doi: 10.1111/j.1365-2834.2011.01347.x

Wong, C.A. & Laschinger, H.K.S. (2015). The influence of frontline manager job strain on

burnout, commitment and turnover intention: A cross-sectional study. International Journal

of Nursing Studies. 52, 1824-1833. doi: 10.1016/j.ijnurstu.2015.09.006

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