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Application of Theory

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Nurses have to make numerous decisions on a day to day basis. Some are simple decisions and other issues are more complex and require guidance to make decisions. Nursing theory is one way for nurses to make decisions based on problems or situations they face. As Cody (2003) states, “one learns to practice nursing by studying nursing theories” (pg. 226). This statement can be applied to problem solving and decision making. By using theory, nurses can apply concepts to solve problems, since practice is derived from theory. It is also noted by Cody (2003), that “nursing practice will be transformed to the betterment of humankind when all nursing practice is fully autonomous and guided predominantly by nursing theory” (pg. 230). This includes all aspects of nursing including nursing leadership, nursing education, nursing informatics and health policy.

The middle range nursing theory of nursing intellectual capital is one that was developed to understanding how nursing knowledge within healthcare organizations influences patient and organizational outcomes (Covell, 2008). It is comprised of two mutually supporting concepts of nursing human capital and nursing structural capital. Nursing human capital is influenced in the workplace by nurse staffing and employer support for continuing professional development and is directly related to patient and organizational outcomes. The nursing structural capital is directly related to patient outcomes (Covell, 2008). The following sections of this paper will focus on the problem of nursing turnover and retention and the strategies that can be used to solve this issue by applying nursing theory. Problem/Issue

The problem of nursing turnover and retention of nurses is a global problem. Numerous studies have been done on the causes of nursing turnover and how to prevent it within a healthcare organization. At the facility where I work, nursing turnover and retention has always been a problem that our nurse executives and nurse managers have worked to correct. The problem is that, since our facility is run by the state government, it makes it extremely difficult for middle management to implement change when it does not come from our state office officials. I have seen many nurse managers come and go in the just over two years that I have been there due to the fact that they can’t implement change to correct one of the biggest problems our facility continues to face. By exploring this issue further, my belief is that as a future nurse executive, I may be able to bring this issue to the forefront of their focus.

O’Brien-Pallas, Murphy, Shamian, Li, and Hayes (2010), conducted a research study to determine factors and elements that influenced nursing turnover. In their study they found that lack of team support, lack of autonomy, inability to deliver care according to skills learned, support for ongoing professional development, salary, and legal implications were all top reasons that nurses left certain healthcare organizations. In another research survey entitled, “Staying in Nursing: What Factors Determine Whether Nurses Intend to Remain Employed,” the authors state that “managers have a direct influence on the work environment, work processes, and work rewards such as praise and recognition, all of which influence nurses’ intentions to remain employed” (Carter & Tourangeau, 2012, pg. 1591). Having an effective nursing leadership presence in any healthcare organization that rewards nurses for doing a good job and provides a strong foundation is what keeps nurses in their current positions.

Without these attributes, nurses are more exposed to negative factors which in turn, leads to decreased retention and increased turnover rates. Other factors in this study in reference to nurse retention include some of the same reasons mentioned in the previous study. These included provision of autonomy, pay, organizational support, and access to educational opportunities for career development (Carter & Tourangeau, 2012). From an examination of the literature in regards to nursing turnover and retention, it is evident that solid nursing leadership, management, and executive support are essential components to reducing the nursing turnover rates among healthcare organizations. If the structure at the top tier is broken, then the bottom tiers have nothing to hang to, they become broken themselves, have no direction, and are unable to function without necessary guidance from leadership and management. Strategy

There are various strategies that can be used to solve the problem of increasing nurse retention and decreasing nursing turnover. Strategies from offering sign-on bonuses for nurses if they stay employed with the organization for a certain length of time to offering a better benefits package then a competing organization are some common ways that come to mind when thinking of how employers get the attention of nurses to join and remain with a certain company. However, these approaches only go so far and are often not that beneficial when it comes to nurse retention and decreased turnover rates. As it currently stands, any nurse with a degree may be hired to work at my current facility. This includes both LVN’s and RN’s with two or four year degrees. Also, when nurse managers are not able to staff the facility with an adequate amount of nurses due to the high turnover rates, the facility employs agency nurses to come in and take care of the residents.

The facility serves a unique population, that of the developmentally disabled. Residents at our facility range from those that have a mild developmental delay with no medical conditions to certain individuals that have profound delays with complex and fragile medical conditions. Most of our residents are those that have extremely complex and rare medical problems; therefore it becomes difficult for the nurses to understand their conditions with only a basic to no comprehension of their diagnoses and the inability to care for them efficiently without specialized education and training. One strategy that could be beneficial to decreasing the turnover rate of nurses at the facility where I work is one that is identified by Covell & Sidani (2013) in the middle range nursing theory of Nursing Intellectual Capital. They state that, “it is the combination of human capital indicators that influence better quality patient care and retain registered nurses” (no pg.).

Human capital indicators can be described as the information nurses receive from formal education, continuing professional education, specialized training, and hands-on experience (Covell, 2008). I think it has become essential for state nursing officials to step back and think of the population that is at our current facility and re-evaluate the root cause of nursing turnover at the facility. Covell & Sidani (2013) state that “nurse managers may consider retaining a nursing staff that is composed of nurses with university degrees, specialty certification, and experience” (no pg.). If the job description is altered to require that applicants have the aforementioned requirements, it is known a nurse is inclined to stay in a field that are familiar with and have a certain amount of experience in due to the level of comfort they feel. This would in turn hopefully lead to a decreased turnover rate, better nursing retention, and an improved quality of care that residents receive.

There are three ways in which nursing state officials can implement change for nurse managers to follow. First hiring a greater proportion of bachelor’s prepared registered nurses, second reimburse nurses for furthering their education, and lastly by making efforts to retain registered nurses with university degrees. By implementing these small changes it is noted to increase the care that patients receive and have fewer occurrences of adverse events (Covell & Sidani, 2013). If these few small changes were implemented at the facility where I work, it is quite possible that the turnover rate would start to decrease. Another strategy that could be used to increase nurse retention would be the facility participating in continuing professional development of their nurses. As it currently stands, the state does not offer tuition reimbursement for nurses that want to further their education and obtain advanced degrees.

Also, nurse managers that provide further opportunities for learning and maintenance of skills, policies, and protocols, “enhances their knowledge and skills, which may lead to the retention of experienced and knowledgeable registered nurses, better quality patient care, and lower orientation costs” (Covell & Sidani, 2013, no pg. ). A legal aspect of the Nursing Intellectual Capital strategy being employed is the issue of healthcare organizations providing continuing professional development. It is well noted that “improvement in patient outcomes such as symptom management and the production and reduction in adverse effects following nurse participation in continuing professional development” (Covell, 2009, pg.40). Adverse effects have the potential for legal issues such as lawsuits to arise from what occurred. If nurses are provided continuing professional development and a decrease in adverse effects are noted as one of the effects of providing such, then it becomes less of a legal issue to employ the strategy. Conclusion

The application of nursing theory in the profession is essential to the profession today. Theory can be used to guide practice, theory can be derived from research, and it can be used to solve problems from a leadership, policy, education, or informatics standpoint. Nursing was derived from early theorists and has now developed into a standard within the profession. This paper took the problem of nursing turnover and nurse retention, explained common reasons for increased turnover and decreased retention, and then applied the middle range nursing theory of Nursing Intellectual Capital and applied the theory it to solve the problem of nursing turnover in a particular facility. From this, new knowledge arises on how nurse executives can implement new hiring requirements as well as continuing education to improve patient outcomes and reduce adverse events based on middle range nursing theory. By implementing this strategy, nurse executives and will be able to directly influence the care patients receive based on who is hired and the opportunities and benefits they provide the nurses employed within a healthcare organization.

Carter, M. R., & Tourangeau, A. E. (2012). Staying in nursing: What factors determine

whether nurses intend to remain employed? Journal of Advanced Nursing, 68(7),

1589-1600. doi:10.1111/j.1365-2648.2012.05973.x

Cody, W. K. (2003). Nursing theory as a guide to practice. Nursing Science Quarterly,

16(3), 225-231.

Covell, C.L. (2008). The middle-range theory of nursing intellectual capital.

Journal of Advanced Nursing 63(1), 94–103. doi: 10.1111/j.1365-


Covell, C. (2009). Outcomes achieved from organizational investment in nursing

continuing professional development. Journal of Nursing Administration,

438-443. doi:10.1097/NNA.0b013e3181b92279

Covell, C. L., & Sidani, S. (2013). Nursing intellectual capital theory: Implications for

research and practice. Online Journal of Issues in Nursing, 18(2), 1.


O’Brien-Pallas, L., Murphy, G., Shamian, J., Li, X., & Hayes, L. (2010). Impact and

determinants of nurse turnover: A pan-Canadian study. Journal of Nursing

Management, 18(8), 1073-1086. doi:10.1111/j.1365-2834.2010.01167.x

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