DHA 715 Week 6 Human Resource and Workforce Risk Analysis Example

Eleven Resignations in Six Weeks: Treating Nurse and Physician Workforce Loss as an Enterprise Risk in Rural Hospitals

[Student Name]

University of Phoenix

DHA/715: Risk Management in Complex Health Organizations

Week 6 Assignment

[Instructor Name]

[Date]

The rural hospitals, resignations, vacancy rates, costs, survey results and plan are composites written for a model paper; research findings come from the sources cited.

In six weeks, eleven registered nurses resigned from the medical-surgical unit at one of the network's rural hospitals. The hospital closed eight of its twenty-four beds, diverted some admissions to a regional hospital an hour away and paid agency nurses at more than twice the hourly cost of staff. The regional vice president added workforce loss to the region's risk register as one of its highest risks. This paper analyzes that risk and proposes a plan.

The Region's Workforce Data

The data showed a broad problem. Across the four hospitals, registered nurse vacancies averaged 17%, first-year nurse turnover reached 31% and agency spending tripled over three years to $7.4 million. Two of the region's nine employed primary care physicians and one of its three general surgeons had announced departures.

Why Nurses Left

Exit interviews with the eleven nurses pointed to workload, mandatory overtime, schedules posted with little notice, a manager who left and was not replaced for months and pay below a regional hospital an hour's drive away. Several described being threatened by patients or visitors in the emergency department while floating there.

Burnout and Dissatisfaction Among Nurses

The rural experience matches research. McHugh and colleagues analyzed survey data from 95,499 nurses and found much higher job dissatisfaction and burnout among nurses caring directly for patients in hospitals and nursing homes than among nurses in other roles, with particular frustration over health benefits, and patient satisfaction was lower in hospitals with more dissatisfied or burned-out nurses (McHugh et al., 2011). When nurses are exhausted, patients notice, and the risk shows up in quality as well as payroll.

Why Workforce Loss Is a Safety Risk

Workforce loss connects to the safety program. The region's record review found falls and medication errors clustering on understaffed shifts, and agency nurses unfamiliar with local systems were involved in a disproportionate share of reported events. Workforce risk is therefore patient safety risk.

Physician Burnout

Physicians face similar pressures. A national survey of 6,880 physicians found that 54.4% reported at least one symptom of burnout in 2014 compared with 45.5% in 2011 and that satisfaction with work-life balance fell from 48.5% to 40.9%, while little changed in the general working population; after adjustment, physicians had nearly twice the odds of burnout (Shanafelt et al., 2015).

Rural Physicians

In the rural hospitals, physicians carry heavy call schedules because few colleagues share them. The departing general surgeon took call every third night and weekend. Losing one physician increases the load on those who remain, raising their own risk of leaving. Recruiting replacements is slow: rural hospitals compete with urban systems offering larger salaries, shorter call schedules and jobs for spouses, and candidates often ask about schools and broadband before they ask about pay.

The Cost of Losing Clinicians

Leaders act on costs. Shanafelt and colleagues argue that organizations can calculate a business case for investing in physician well-being, including the costs of turnover, lost revenue from reduced productivity and financial risks from lower quality, patient satisfaction and safety, and they offer conservative formulas for estimating return on investment (Shanafelt et al., 2017).

Applying the Business Case

Using that approach, the region estimated the cost of losing a registered nurse at about $52,000, including agency coverage, overtime, recruiting and orientation, and the cost of losing a general surgeon at more than $1 million, mostly in lost surgical revenue and locum coverage during a recruitment that can take a year or more. At current turnover, nurse losses alone cost about $4.3 million a year.

Workplace Violence as a Workforce Risk

Violence contributes to departures. The region's emergency departments recorded 146 incidents of verbal threats or physical assault against staff last year, and staff said many more went unreported. Staff who feel unsafe leave, and those who stay may avoid certain patients. Rural emergency departments are especially exposed: security officers are often shared across the campus, patients in mental health crisis may wait days for a psychiatric bed and help from law enforcement can be twenty minutes away. Three of the eleven nurses who resigned mentioned a specific incident in which they felt no one had their back.

Employment Risks

The region also faces employment risks: wage and hour claims from missed breaks, credentialing gaps when agency staff start before verification is complete and discrimination or retaliation claims when complaints are handled poorly. Last year one agency nurse worked four shifts before the staffing office discovered her license had lapsed in another state. Human resources will now confirm licensure through the national database before any shift is scheduled, and managers will be trained in handling complaints.

Plan Element One: Staffing and Schedules

The region will end mandatory overtime except in emergencies, post schedules six weeks in advance, create a shared regional float pool and set staffing thresholds that trigger help before shifts become unsafe.

Plan Element Two: Pay and Benefits

Pay will be brought to the regional market median, and health benefits will be reviewed, given evidence that nurses are frustrated with them. Retention payments will be tied to staying two years, and nurses who precept new graduates will receive a differential.

Plan Element Three: Violence Prevention

Emergency departments will add security coverage at night, a behavioral alert flag in the record, de-escalation training and a simple reporting process with follow-up for every incident.

Plan Element Four: Leadership and Well-Being

Unit managers will be hired promptly when positions open and trained in retention. Physicians will receive shared call arrangements with the academic center, and a peer support program will be offered to all clinicians.

Plan Element Five: A Local Pipeline

The region will partner with community colleges on nursing programs, offer tuition support for local students who commit to working in the region and host residents and students from the academic center. Students who train in a rural hospital are more likely to consider working there, and the region will track how many return after graduation. High school programs that introduce students to nursing assistant and pharmacy technician roles will add entry points for local young people.

Measures

Measures include vacancy and turnover rates by unit, the share of shifts meeting staffing thresholds, first-year turnover, agency spending, closed beds, violence incidents reported and followed up, engagement scores and exit interview themes. Results will be reported monthly to the regional risk committee and quarterly to the board, and the workforce risk rating on the register will be revised as results change. The chief nursing officer owns the nursing measures and the medical director the physician measures.

Conclusion

Eleven resignations showed that workforce loss is an enterprise risk affecting safety, access and finances. Evidence links nurse burnout to patient experience and documents rising physician burnout, and a business case shows the high cost of losing clinicians. A plan addressing staffing, pay, violence, leadership and a local pipeline gives the rural region a path to stability.

References

McHugh, M. D., Kutney-Lee, A., Cimiotti, J. P., Sloane, D. M., & Aiken, L. H. (2011). Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Affairs, 30(2), 202-210. https://doi.org/10.1377/hlthaff.2010.0100

Shanafelt, T. D., Hasan, O., Dyrbye, L. N., Sinsky, C., Satele, D., Sloan, J., & West, C. P. (2015). Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clinic Proceedings, 90(12), 1600-1613. https://doi.org/10.1016/j.mayocp.2015.08.023

Shanafelt, T., Goh, J., & Sinsky, C. (2017). The business case for investing in physician well-being. JAMA Internal Medicine, 177(12), 1826-1832. https://doi.org/10.1001/jamainternmed.2017.4340