MHA 543 Week 1 Workforce Trends and Talent Strategy Example

Twenty-Seven Percent Gone in Year One: Reading Workforce Trends and Diagnosing the Talent Problem at a Two-Hospital System in Omaha

[Student Name]

University of Phoenix

MHA/543: Tackling the Talent War in the Health Sector

Week 1 Assignment

[Instructor Name]

[Date]

The health system, its workforce figures and spending are composites written for a model paper; research findings come from the sources cited.

In the budget review for the coming year, the chief financial officer of a composite two-hospital nonprofit health system in Omaha, Nebraska, pointed to one line: $22 million spent on travel nurses. She asked the vice president of talent a simple question: why are we paying so much to rent nurses instead of keeping our own? This paper presents the vice president's analysis of national workforce trends, the system's own data and the root causes she found.

The System's Workforce

The system employs about 4,800 people across its two hospitals and outpatient sites, including about 1,650 registered nurses. Its hospitals have 560 licensed beds and serve a metropolitan area where two other large systems compete for the same workers.

The Numbers

The vice president assembled a year of data. The registered nurse vacancy rate was 11%. Overall registered nurse turnover was 19%. Turnover among nurses in their first year was 27%, and among those in their second year 21%. Nurses with more than five years of service left at 9%. Overtime averaged 7% of worked hours. Travel nurses filled about 140 positions at any given time, mostly on inpatient units.

National Trend: A Shrinking, Tired Workforce

National evidence shows similar pressures. In a survey spanning 45 states, 62% of nurses described heavier workloads during the pandemic and that about half felt emotionally drained, used up or fatigued a few times a week or more; the strain fell hardest on nurses early in their careers, those with a decade or less in practice, and it drove a 3.3% decline in the US nursing workforce over two years (Martin et al., 2023).

Reading the National Trend Locally

The national finding that younger, less experienced nurses were most affected matched the system's data: turnover was highest in the first two years. The problem was not mainly recruiting new graduates, which the system did well through partnerships with local nursing schools, but keeping them.

National Trend: Shift Length

Scheduling matters. In a large European study of hospital nurses, those assigned shifts lasting 12 hours or longer reported more exhaustion, less satisfaction with their jobs and their schedules and more plans to quit than colleagues on 8-hour shifts (Dall'Ora et al., 2015). The system's inpatient units schedule almost entirely in 12-hour shifts, and new graduates are typically assigned nights and weekends.

Why Engagement Matters

Engagement is not only a morale issue. A meta-analysis of 7,939 business units in 36 companies found generalizable relationships, large enough to have practical value, between unit-level employee satisfaction and engagement and outcomes including customer satisfaction, productivity, profit, turnover and accidents (Harter et al., 2002). Units where people are engaged lose fewer people, and the system's unit-level engagement scores showed the same pattern.

The System's Engagement Data

The system's last engagement survey showed wide variation among units. The five units with the lowest engagement had first-year nurse turnover above 35%; the five with the highest had turnover below 15%. The difference was not explained by patient acuity.

Exit Interviews

Exit interviews with 120 departing nurses were coded by theme. The most common reasons were feeling unsupported during the first year, unpredictable schedules and being floated to unfamiliar units, conflict with a manager and higher pay offered by competitors, in that order. Pay ranked fourth, not first.

Stay Interviews

To balance the picture, managers held stay interviews with 80 nurses who had stayed more than five years. They cited supportive managers, predictable schedules, colleagues and opportunities to learn, and most said they had nearly left in their first two years.

Root Cause One: Weak First-Year Support

The system's orientation lasted eight weeks, followed by little structured support. New nurses described feeling alone by their third month.

Root Cause Two: Schedules

New graduates carried the least desirable schedules, with frequent floating, and could rarely choose shorter shifts.

Root Cause Three: Manager Capacity

Some nurse managers oversaw more than 100 staff and had little time for coaching. The units with the widest spans had the lowest engagement.

Root Cause Four: Pay Compression

Competitors' sign-on bonuses meant new hires sometimes earned nearly as much as nurses with five years' experience, frustrating experienced staff.

Root Cause Five: Dependence on Agency Staff

Travel nurses filled gaps but also created resentment when paid far more, and each travel contract made core staff feel less valued, feeding further turnover.

Units Tell Different Stories

The vice president mapped turnover by unit. The medical-surgical units at the larger hospital, which took most new graduates, lost more than a third of first-year nurses, while the cardiac step-down unit at the same hospital lost fewer than one in ten. The step-down unit's manager had built a buddy system pairing each new nurse with an experienced colleague for a full year and let new nurses choose between 8-hour and 12-hour shifts after six months. The contrast suggested that the system already had its own solutions, unevenly spread.

Competition in the Local Market

The two other large systems in the metropolitan area had raised starting pay and offered sign-on bonuses of up to $15,000. Some nurses left for those bonuses, but exit interviews suggested that most who left for pay had already been unhappy for other reasons. Matching every bonus would be costly and would not address why nurses were open to leaving in the first place.

The Cost of the Problem

Using a conservative estimate of replacement cost per nurse, first-year turnover alone cost the system several million dollars a year in recruiting, orienting and covering vacancies, on top of the $22 million in travel spending.

What Not to Do

The analysis also ruled out some responses. A system-wide bonus for all nurses would cost more than $8 million a year without addressing first-year departures. Cutting travel nurses abruptly would overload remaining staff and accelerate turnover. The vice president recommended reducing travel positions gradually as retention improved, tying each reduction to measured gains.

Three Priorities

The vice president proposed three priorities for the coming year: a structured year-long residency for new graduates, scheduling reform that gives new nurses predictability and some choice of shift length and smaller spans of control for nurse managers on the highest-turnover units. Pay compression would be addressed in the next budget cycle, after a market study of experienced nurses' wages.

Measures

Measures include first-year and second-year turnover, vacancy rate, travel nurse positions and spending, engagement scores by unit and manager span of control, reviewed quarterly.

Conclusion

The chief financial officer's question about travel spending led to a diagnosis. National evidence of early-career burnout and research on shift length and engagement matched the system's own data: the largest losses came in nurses' first two years, driven by weak support, hard schedules and stretched managers. Addressing those causes, rather than simply paying more for temporary staff, is where the system's talent strategy must begin.

References

Dall'Ora, C., Griffiths, P., Ball, J., Simon, M., & Aiken, L. H. (2015). Association of 12 h shifts and nurses' job satisfaction, burnout and intention to leave: Findings from a cross-sectional study of 12 European countries. BMJ Open, 5(9), e008331. https://doi.org/10.1136/bmjopen-2015-008331

Harter, J. K., Schmidt, F. L., & Hayes, T. L. (2002). Business-unit-level relationship between employee satisfaction, employee engagement, and business outcomes: A meta-analysis. Journal of Applied Psychology, 87(2), 268-279. https://doi.org/10.1037/0021-9010.87.2.268

Martin, B., Kaminski-Ozturk, N., O'Hara, C., & Smiley, R. (2023). Examining the impact of the COVID-19 pandemic on burnout and stress among U.S. nurses. Journal of Nursing Regulation, 14(1), 4-12. https://doi.org/10.1016/S2155-8256(23)00063-7