The nursing shortage in the healthcare system

Problem Statement

Retention of experienced nurses and reduction of their turnover are chronic and costly challenges that many clinical facilities face. Organizations are focused on retaining their most specialized and talented nursing workforce to provide quality services and deal with the risk of nurse shortage being experienced in the United States. To this end, these organizations are focusing on increasing the satisfaction and retention of the nurses by promoting professional development, healthy working surrounding, and meaningful recognition. Despite the implementation of these approaches, the nursing turnover has continued to increase. Nursing turnover has the potential to directly affect a hospital’s ability to foster quality improvement and fiscal performance. For every Registered Nurse (RN), the financial implication tied to individual turnover ranges from $40300 to $64000. Furthermore, a percentage reduction in the turnover can financially save the hospital an average of $410,500 annually. In the contemporary healthcare sector, the RN total turnover rate is 19.1% for a population of full time and part time RN, respectively. Nonetheless, there is a significant difference in rate subject to geographic location, hospital size, specialty, and non-profit status.

Notably, in the South Central region, the nursing turnover has been on the increase among Ambulatory nurses who feel less engaged and dissatisfied, which ultimately contributes to increased turnover. The turnover has a negative fiscal impact on the healthcare organizations within the South Central Region. Loss of revenue due to turnover is associated with the shortage of workforce to meet patients’ demands and the cost of recruiting new nurses. Additionally, facilities in the South Central Region invest in the nurses by providing them with additional training and education to ensure that they are up-to-date with advancements in clinical care. This investment is made by the clinical facilities in the region; thus, making the facilities to be more concerned with retaining highly skilled and specialized nurses. As such, this project is conceived to propose a strategy that can be adopted to solve the current problem of nursing turnover in the South Central Region.

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Background of The Problem

In the contemporary healthcare system, the nursing shortage is considered as one of the main problem facing the system. Projections to 2020 suggest that there will be a shortage of professional and experienced nurses, which will have an adverse impact on the healthcare system that will have a negative ripple effect on patient outcome. Increased nursing turnover continues to exacerbate the nursing shortage issue in the clinical setting.

According to Nursing Solutions (2018), nursing turnover takes place in a healthcare organization whenever a nurse leaves a part-time or full-time position. This leaving may be voluntary or involuntary. Voluntary turnover involves a nurse seeking opportunity in other organization, whereas involuntary is exist from the job market due to termination on competency grounds. One of the factors that determine turnover is engagement. Nursing engagement refers to the level of satisfaction with the working environment among nurses.

Nursing staff members make up a large percentage of clinicians in the healthcare setting. This means that increased nursing turnover greatly impacts the productivity of an organization and reduces the quality of care and decreases the revenues. As such, it is vital for an organization to come up with approaches that would increase nursing retention than to undergo the rigorous process of hiring new nurses who are highly competent. One of the causes of increased nurses’ turnover stems from fresh graduate nurses (FGNs), leaving the workforce. In the clinical setting, FGNs experience challenges in transitioning in the healthcare environment. These challenges lead to high levels of burnout, decreased engagements, and turnover intention. This is a matter of great concern as an experienced nursing workforce is aging and approaching the retirement age. Additionally, this aging workforce is also faced with stressful situation in their family and work life that makes them opt out of the workforce or seek employment in other organizations without the clinical setting. Hence, if proper intervention strategies are not put in place to deal with these trends that exacerbate nursing turnover, the impending nursing shortage will be inevitable.

With the adverse consequences of increased nursing turnover, there is a large body of literature which had been developed to address the concerns of nursing retention and engagement. Notwithstanding, there are various complexities and factors that need to be considered in an effort to retain qualified and experienced nurses in a clinical setting that is demanding and specialized. Although most organizations have knowledge of the fact that nursing retention is a primary strategic imperative, most of these organizations do not integrate this issue in their operational plan. Currently, evidence-based approaches used to deal with the issue of nursing retention are centric to improving the behavior of nursing leaders. The rationale for this focus is that the behaviors of nurse leaders are positively correlated with employee engagement and retention. Particularly, three of the most used intervention to promote nursing retention include recognition, communication, and autonomy.

Proposed Intervention: Nursing Shared Governance


Shared governance is a concept that is rooted in the structural empowerment theory as developed by Kanter. In accordance with Kanter’s model, the employee’s working surrounding dictates their tendencies and engagement level. As such, this model holds that employees are more probable to achieve objective when they have access to structures of opportunity and power within the organization. On the one hand, power structure stems from the ability to access resources, information, and support that make duties more meaningful. On the other hand, opportunity structures our personal opportunities to grow and learn within one’s profession. Additionally, in order to make the employees’ duties meaningful, this model suggests that all stakeholders should be involved in the development of policies and protocols. Ultimately, with the increase in empowerment, the model postulates that retention and engagement will also increase.

Considering the structural empowerment theory and its application in the clinical setting presents an intervention opportunity. As RNs are given the power to engage in governance through constant involvement in clinical councils, they tend to grow in their leadership roles and begin to feel empowered. It is noteworthy that the concept of nursing shared governance was first introduced in nursing in 1984 by Porter, O’Grady, and Finnegan. In this pioneer application, Porter, O’Grady, and Finnegan (1984) established the significance of engaging bedside clinicians in the making of decisions concerning matters associated with the nursing profession. The authors recommended a flat nursing structure that gave power and opportunities to nurses who were closest to the patients by letting them hold informal and formal positions in the hospital committees.

Nursing shared governance by using structural empowerment is an essential element of the Magnet Model (ANCC, 2014). The Magnet Model is made up of five main components: “transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation, and improvement; and empirical quality results” (ANCC, 2014).

In order to solve the nursing turnover problem that is caused by ambulatory nurses being unengaged in the clinical setting, the component of focus within the Magnet Mode will be structural empowerment. According to ANCC (2014), structural empowerment relates to the utilization of shared governance with the aim of promoting shared decision making and supporting ambulatory nurses in their role as primary decision makers. The proposed implementation of the nursing shared governance within the South Central Region will be guided by structural empowerment.


Ambulatory nurses in the South Central Region are reported to feel unengaged. By definition, this means that they are not satisfied with their current job description, and may be intending to leave the workforce or join another organization where they feel engaged. The proposed change in practice focuses on the establishment of a Nursing Shared Governance. This is an important change in practice as it will present nurses in the ambulatory unit with the opportunity to make decisions in matters affecting them or their working environment. By so doing, the nurses are likely to feel empowered, thus being satisfied as they know that their job is meaningful. Besides, this intervention is significant because it enables nurses in the ambulatory section to grow in their profession. Particularly, this is associated with taking up a leadership role which was initially not possible. Furthermore, this strategy will also improve and increase communication between nurses as they share and present challenges and opportunities that present themselves within their working environment.


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