BUSI 646 Week 1 Discussion Board Forum 1 Example

Discussion Board Forum 1: Strategic Human Resources Management in Health Care

BUSI 646 Managing Human Capital in Healthcare, Discussion Board Forum 1

Thread by [Student Name]

The hospital, its staffing figures and the classmates are composites; the textbook, Scripture and the peer-reviewed sources cited are real.

Our 260-bed hospital's strategic plan calls for a 24-bed cardiac step-down unit to open in eighteen months, and the unit will need about 38 additional registered nurses. Human resources has been asked to recruit them. The difficulty is that we already hire close to 90 new graduate nurses a year and lose 27% of them before their first anniversary, so the recruiting team spends much of its effort replacing nurses rather than adding them. If nothing changes, the new unit will open by moving nurses from units that are already short. The cost of that pattern is already visible in our budget: last year the hospital spent about $4.1 million on overtime and agency coverage, and the units with the highest first-year turnover were also the units with the most overtime.

Pynes and Lombardi (2011) describe strategic human resources management as the alignment of workforce practices with an organization's mission and goals, so that HR planning begins when the strategy is set rather than after the positions are posted. A transactional approach asks how many nurses to hire; a strategic approach asks how many nurses the plan requires, how many we will lose and what practices would change that loss. Under that view, a retention target is as much a part of the cardiac plan as the construction budget. The authors also stress that HR planning depends on data, which in our case means tracking turnover by unit, shift and length of service rather than as a single hospital-wide rate that hides where the losses happen.

The cost side is well documented. Bae (2022) reviewed 16 studies of nurse turnover in acute hospitals and found that all nine studies that measured costs found turnover expensive, through vacancy coverage, recruiting, orientation, overtime and the lower productivity of newly hired staff, while the studies of patient and workgroup outcomes partially supported harm from turnover as well. The cause side points to the work environment. Shah et al. (2021) drew on the federal nurse survey fielded in 2018 and found that among nurses who left a job in 2017, 31.5% named burnout as a reason. Those on schedules longer than 40 weekly hours were about three times as likely as those working under 20 hours to cite burnout, and nurses who left because of burnout most often described a stressful work environment and inadequate staffing. Our exit interviews tell a similar story: new graduates cite heavy assignments and little support on night shift. Seven of the last ten new graduates who resigned worked nights on the two medical units with the highest patient ratios, which points to a few specific conditions rather than a general problem with the generation of nurses we are hiring.

I proposed that the cardiac plan carry two workforce targets: hire 38 nurses and cut first-year turnover from 27% to 15% within two years. To reach the second, every new graduate would have a trained preceptor for at least twelve weeks, no new graduate would take charge or float in the first six months, and managers would sit down with each new nurse one, three and six months after hire. Overtime above 48 hours in a pay period would trigger a review. HR would report first-year turnover to the board quarterly, beside the construction milestones, so the people side of the plan receives the same attention as the building.

In Luke's Gospel, Jesus pictures someone beginning a tower without first estimating its expense, who pours the foundation, runs out of means and becomes a joke to everyone watching (English Standard Version Bible, 2001/2016, Luke 14:28-30). A hospital that budgets for the walls of a new unit but not for keeping the nurses who will work inside it has laid a foundation it cannot finish. Counting the cost, in human resources, means counting departures as carefully as hires.

Reply to Naomi

Naomi, your thread proposed responding to rising burnout among the nurses and medical assistants in your multi-site primary care group by purchasing a meditation app subscription and offering a quarterly wellness day. I appreciate that you treated burnout as a workforce risk and not a personal weakness, and the cost of the app is low compared with replacing even one nurse. The evidence suggests, though, that a program aimed at the individual may not touch the causes your staff are describing.

Aiken et al. (2023) surveyed 21,050 physicians and nurses at 60 U.S. hospitals in 2021 and found high burnout among 47% of nurses and 32% of physicians. When asked which interventions would most improve their mental health and well-being, both groups ranked management changes to care delivery above programs directed at their own mental health, and improving nurse staffing ranked first, chosen by 87% of nurses. Fewer than 10% of clinicians described their workplace as joyful. Panagioti et al. (2017), in a meta-analysis of 20 controlled interventions involving 1,550 physicians, found that interventions reduced burnout modestly overall, but interventions aimed at the organization, for instance redesigned workloads, rosters or team structures, produced larger effects than those directed at individual physicians. Those two findings suggest that the app may help a few staff members cope but will not change what is wearing them down. Primary care is not a hospital, and the studies above did not include medical assistants, but the pattern of burnout tracking workload and staffing has been reported across many clinical settings, so it is a reasonable starting assumption until your own survey data say otherwise.

Pynes and Lombardi (2011) argue that human resources practices work best when they are aligned with the conditions of the work itself, and your exit data would show which conditions matter. If medical assistants are leaving because they room patients for two providers at once, a wellness day will not fix that ratio. I would suggest keeping the app, since it is inexpensive, but spending most of your effort on one organizational change, such as protected time for inbox work or a fixed ratio of assistants to providers, and measuring its effect on turnover over six months.

Exodus 18 offers a striking parallel. When Jethro saw Moses judging the people from morning until evening, he told him that what he was doing was not good and that the work was too heavy for him to do alone. Jethro did not recommend rest for Moses; he recommended restructuring the work by appointing capable leaders over smaller groups so that Moses could endure (English Standard Version Bible, 2001/2016, Exodus 18:17-23). Your staff may need the same kind of answer: a lighter and better-shared load, not only better ways to carry the current one.

Reply to Victor

Victor, your thread argued that your rural hospital should continue to rely on travel nurses for its 22 open positions, because recruiting permanent staff to a small town has failed for two years and travelers at least keep beds open. That is a realistic position, and the evidence on safety is more reassuring than many managers expect. Aiken et al. (2013) linked surveys of 40,356 nurses in 665 hospitals with outcomes for about 1.3 million patients and found that hospitals using more agency-employed supplemental nurses initially appeared to have higher mortality, but the association disappeared once the quality of the work environment was taken into account. Hospitals with many supplemental nurses tended to have poorer work environments, and it was the environment, not the travelers themselves, that was linked to worse outcomes.

The financial and strategic picture is less comfortable. Pynes and Lombardi (2011) note that strategic workforce planning considers both the cost and the continuity of each staffing source, and travel contracts usually cost far more per hour while building no lasting capacity. A second study suggests where permanent staff might come from. Muir et al. (2024) surveyed 7,887 nurses in New York and Illinois who had recently ended health care employment and found that although planned retirement was the leading reason, 26% cited burnout or emotional exhaustion, 21% insufficient staffing and 18% family obligations. The authors noted that the nurses who left were demographically similar to those still working, which suggests a pool of experienced nurses who might return under the right conditions.

For a rural hospital, that pool may live within a few miles. I would suggest testing a local return-to-practice program that offers shorter shifts, weekday-only schedules or school-hours positions, which address the family obligations those nurses reported, along with a refresher course for those who have been away. Even replacing five travel contracts with local nurses would free money to improve the work environment that the first study tied to patient outcomes. You could also offer current travelers who have enjoyed the community a path to permanent positions, with a signing bonus funded by the savings from ending their contract, since several hospitals have converted travelers this way and a nurse who already knows your unit needs little orientation.

Proverbs tells the herdsman to pay close attention to the state of his animals, because wealth does not endure on its own (English Standard Version Bible, 2001/2016, Proverbs 27:23-24). Travelers can keep your beds open for a season, but the condition of your own staff, and of the nurses in your town who have stepped away, is what will determine whether the hospital can staff itself in five years. Attending to them now, while travelers cover the gap, is the kind of foresight that keeps a small hospital independent.

References

Aiken, L. H., Lasater, K. B., Sloane, D. M., Pogue, C. A., Fitzpatrick Rosenbaum, K. E., Muir, K. J., McHugh, M. D., & US Clinician Wellbeing Study Consortium. (2023). Physician and nurse well-being and preferred interventions to address burnout in hospital practice: Factors associated with turnover, outcomes, and patient safety. JAMA Health Forum, 4(7), e231809. https://doi.org/10.1001/jamahealthforum.2023.1809

Aiken, L. H., Shang, J., Xue, Y., & Sloane, D. M. (2013). Hospital use of agency-employed supplemental nurses and patient mortality and failure to rescue. Health Services Research, 48(3), 931-948. https://doi.org/10.1111/1475-6773.12018

Bae, S. H. (2022). Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review. International Nursing Review, 69(3), 392-404. https://doi.org/10.1111/inr.12769

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Muir, K. J., Porat-Dahlerbruch, J., Nikpour, J., Leep-Lazar, K., & Lasater, K. B. (2024). Top factors in nurses ending health care employment between 2018 and 2021. JAMA Network Open, 7(4), e244121. https://doi.org/10.1001/jamanetworkopen.2024.4121

Panagioti, M., Panagopoulou, E., Bower, P., Lewith, G., Kontopantelis, E., Chew-Graham, C., Dawson, S., van Marwijk, H., Geraghty, K., & Esmail, A. (2017). Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. JAMA Internal Medicine, 177(2), 195-205. https://doi.org/10.1001/jamainternmed.2016.7674

Pynes, J. E., & Lombardi, D. N. (2011). Human resources management for health care organizations: A strategic approach. Jossey-Bass.

Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open, 4(2), e2036469. https://doi.org/10.1001/jamanetworkopen.2020.36469