Academic Master

Health Care, Nursing

System Change Project: High Turnover of Nurses

The nurse job market is a factor of the registered nurse turnover; a vital indicator of the job market and a measure for the healthcare system analysis. However, there is a contradiction in its definition where some definitions state that it is any nurse leaving any organization while others may include involuntary and voluntary hence resulting in various turnover rates. Despite this inconsistency in definition, turnover gives a deeper insight when addressing work environments in an organization as well as policies about the nursing workforce. The rate of nurse turnover has a great impact on the safety of the patients in acute care hospitals.). Statistics from Streamline Verify as of March 2016 rank healthcare as third of the top industries with high turnover rates. Also, it expresses that within three years into employment, 43 percent of recently authorized medical attendants working in doctor’s facilities leave their occupations. Moreover, 33.5 percent leave after two years while 17.5 percent work just for one year.

When nurse leaves their job in a healthcare organization, the result is the creation of a vacancy that affect the operation of the healthcare. Other nurses are forced to work overtime and sometimes experience burnout as a result of long hours and a high patient load. The causes of turnover are promotion, burnout, retirement, personal matters, salary, and moving. This paper focuses on Kotter’s eight stages of change and discusses how the theory is applied to manage the high turnover rate of nurses. Kotter’s eight stages of change can be applied to control the high turnover rate of nurses in a healthcare organization.

Description of the selected change model for high turnover of nurses

Kotter’s model states that there are 8 fundamental steps in the change process and that neglecting any step can result in the failure of the whole initiative. He developed the stages based on research of 100 organizations that were undergoing a process of change. He then identified and extracted the success factors and combined them into a methodology called the 8-step process Leading Change. The eight steps of change according to Kotter are creating urgency, forming a powerful and guiding coalition, creating a vision and a strategy for change, communicating the vision, removing obstacles and empowering employees for action, creating short-term wins, building on the change and consolidating gains, and strengthening the change anchoring the changes in corporate culture.

When these eight stages are adhered to without skipping a single stage, a change in the rate of turnover of nurses is inevitable. The primary thought is that change isn’t a straightforward and speedy process and requires earlier arranging and even once the change has been actualized there is still more to be done to guarantee the activity’s prosperity. In the event that healthcare organizations follow these steps with prior necessary preparations, the long-term success of the change activity will probably be observed.

  1. Creating

    a sense of urgency

It is vital to create the “need” for change, rather than just “want” for change, which is essential for likely support by the management and the success of the change eventually. By bringing up the idea of change that attributes to the success of the healthcare organization, a powerful force onsets. Once, the individuals in the work environment become aware of an existing problem and the idea (solution) to the problem is identified, support for the change will likely rise. Hence, by conversing about the likely happenings and the directions to be taken by the organization, support for the idea of change will be realized.

In healthcare organisations, generating a solution that will help control the rate of turnover of nurses will ensure that individual nurses will support. The nurses already know that there is a high rate of turnover among them and will welcome a solution to the issue. Creating a forum where the nurses raise and discuss the high rate of turnover will kick start the creating urgency process. Also, it is essential to identify potentials and repercussions that might come up in the future. Since there are many stakeholders in a healthcare organization, identifying their possible reactions to the idea of change should be considered. Giving the individuals in the organizations the results of the turnover of nurses of operation and convincing them that we can reduce the rate of turnover and its impacts. Finally, involving the key stakeholders and requesting their involvement in the change, an organization will provide likely support before proceeding to the next stage.

  1. Forming powerful guiding coalitions

Leading a whole change alone is a hard task, hence building a coalition that will help direct the other individuals is vital. In order to build a powerful coalition, consideration should be put when selecting the individuals to make the coalition. A coalition should consist of individuals with a wide range of skills, and experience, and guarantee the most extreme viability. The benefits of shaping a coalition are powerful correspondence all through the association, the appointment of assignments, and the guarantee that there is support of progress throughout.

In a healthcare organization choosing, effective leaders besides the key stakeholders ensure that a powerful coalition is formed. The leaders and key stakeholders could be the individuals who brought the idea to the table and own the idea who will surely involve and commit themselves to the entire process. Through collaboration, complementing each other, and providing drive to each other, teams’ make life easier and the successful change process.

  1. Create a vision for change

A change is normally an activity that is convoluted and can’t be understood effortlessly, for the most part among the people at the lower end of the chain of command. Consequently, making a vision that is straightforward, reasonable, and involves the general point of the change is essential in producing support all throughout the association. Furthermore, the vision should be moving to have the most extreme impact.

By creating a vision that describes the aim of the healthcare organization to reduce the number of nurses turnover and eventually benefit the nurses, patients, and the rest of the stakeholders. Describing the vision involves determining the core values, and developing the ultimate vision as well as the strategies to develop it. Since the vision describes the challenges faced by nurses in their jobs, its effects on the patients and other stakeholders, a sustainable inspiration is already developed. The team leaders chosen earlier have the task of communicating this vision to the team members and maje sure they are committed to the change.

  1. Communicate the vision

Communication of the created vision is an important factor to garner enough support among the individuals in the company. The best way to communicate this vision is through an already-built coalition because it has networks in every area of the organization. Continual communication of this message is also an essential factor because there might be other competing messages that are being spread.

The secret is to spread the change in the vision repeatedly in a powerful and convincing manner. Connecting the vision to all the crucial aspects of the success of the organization such as performance and reviews. All the arising concerns and issues from the individuals in the healthcare organization should be handled honestly and with involvement.

  1. Removing obstacles

In the previous stages, the main focus has been on ways to build the strength of the change initiative. However, in this stage we determine the factors that reduce the chance of success of the change initiative. Obstacles such as traditions, legislation, individuals, or even physical obstacles are always there to block the path to success. This stage, therefore, identifies this obstacle earlier and without breaking any other areas of the organization breaks them down using the available resources.

One of the ways of overcoming these obstacles is ensuring that both the organizational processes and structure are set up and lined up with a general organizational vision. Utilizing proactive activities to evacuate these impediments by constantly checking for obstructions or individuals who are opposing change. Finally, using the reward system where those endorsing and supporting the change are rewarded and those resisting are punished.

  1. Creating short-term wins

Usually, changes are a long-term investment with rewards taking long time to reap causing unrest among those supporting the effort of making the change initiative successful. Therefore, it is important to create short-term wins which is very advantageous to the overall morale of the organization. These short-term goals are useful tools that help to keep the stakeholders motivated and keep moving in the right direction. The wins are used to justify both the investment and effort hence helping the staff to re-motivate and continue backing the change. These short-term goals are also more achievable and less expensive hence reducing the chances of possible failures. Rewarding the contributions of those involved in meeting the targets is also a great way of keeping the change initiative going.

  1. Consolidate gains

Kotter argues that an important factor that ensures that changes are sustained and cemented for a long after accomplishing change is building on the change. Failure may arise towards the end of a project in the event that a lack of concern sneaks in, and the task has not been done legitimately. For proceeded with change, continue defining objectives and examining anything that should be possible betterly. Dissect examples of overcoming adversity independently and enhance from those individual encounters.

  1. Anchoring change in the corporate culture

Changing the propensities and processes of employees isn’t generally enough to ingrain culture change in an organization. The progressions should be a piece of the center of the organization keeping in mind the end goal to have an enduring impact. With a specific end goal to advance the adjustment in the center of the healthcare organization keeping senior partners on board, urging new employees to receive the progressions, and praising people who embrace change is imperative.

Presentation of selected change model for reducing high turnover of nurses

The prevalence of nursing turnover is primarily due to the few qualified nursing in the candidate. This scarcity presents the nurses with a lot of job opportunities, hence the nurses can confidently quit their jobs because they can readily find employment. When a nurse quits, healthcare organization experience difficulty filling the vacant position due to its cost. Healthcare organization, therefore, supports increasing the number of competent applicants in the market labour. One of the ways through which they can do this is through conducting community outreach programs with students with the aim of encouraging students to follow nursing vocations. Furthermore, giving educational grants that offer scholars a privilege to work with the organization for amount of time upon graduation, besides providing non-nursing employees with educational support and help them acquire nursing degrees. The process should also lobby government to invest by creating new nursing schools or bolstering remote medical caretakers to come and work in the USA. However, this process requires a lot of time and resources to accomplish, closing more than those required to run a healthcare organization. Also, there are no short-term wins on the monetary implication of nursing turnover.

Organizations are required to attract qualified nursing candidates for the vacant positions by using all possible means. Candidates usually evaluate a job opportunity based on the location, the working hours, the salary, and the learning experiences in the job opportunity. However, changing the location of the company contributes minimally to attracting qualified nursing applicants. Organizations can incredibly draw in competitors effectively by changing their compensation structure, plan outline, and formative open doors that accompany the nursing position. Developing and communicating an effective employment brand to applicants helps attract qualified candidates. Resources are coordinated towards characterizing and promoting the one-of-a-kind social qualities and professional openings that make the association an alluring work environment. Branding should be done carefully, since creating an inaccurate image of the culture will lead to an eventual increase in the turnover rate because nurses will know the reality once they start working in the organization.

Effectively managing the hired nurses is crucial in retaining nurses and reducing the turnover rate. Managers, therefore, need to be given priority on a change initiative by improving their managerial performance. Managers need to be provided with knowledge, tools, and time so that they effectively engage the nurses around the workplace issues that drive turnover. One of the managerial behaviors that should be addressed is clear communication of work expectations to nurses, providing information that shows how nurses are performing with respect to their work objectives and giving medical attendants a chance to contribute to approaches to enhance execution thus giving medical attendants a feeling of independence and control over their work. Building teamwork is another vital management behavior that helps nurses with a platform they can relieve work stress, and address a performance problems by providing a steady workplace. Henceforth, medical caretakers can depend on everyone around them to keep up elevated amounts of patient care, beat troublesome difficulties, and adapt candidly to depleting nature of their occupations. Improving work routines to oblige medical attendants’ inclinations reduces the turnover rate by increasing the nurses’ sense of value and having control over their jobs.


Nursing turnover and the more extensive nursing lack that portrays it is one of the best money-related emergencies that is confronting healthcare organizations in the United States. The financial viability of a healthcare organization is pivoted by nurses, and it is become increasingly hard to attract and retain enough qualified nurses by this organization. A large number of research has been conducted regarding the turnover of nurses. This research has found that it is essential to identify a common factor that influences a nurse to pursue a certain job as well as stay in the job once hired.

By employing Kotter’s 8-model of change these organizations can utilize the finding of this research as leverage and invest in the possibilities that will help guarantee an unfaltering workforce comprising qualified and drew in medical attendants. With the suggestion of numerous answers for this issue is beneficial to the association, hierarchy is relied upon to grasp these techniques to guarantee organizations are achievement and the patients receive high levels of care.



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