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Please include thesis, and Avoid using I, YOU, YOUR on an academic paper TOPIC: high nursing turnover and inadequate staffing. In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice. Develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal: 1. Background 2. Clinical problem statement. 3. Purpose of the change proposal in relation to providing patient care in the changing health care system. 4. PICOT question. 5. Literature search strategy employed. 6. Evaluation of the literature. 7. Applicable change or nursing theory utilized. 8. Proposed implementation plan with outcome measures. 9. Discussion of how evidence-based practice was used in creating the intervention plan. 10. Plan for evaluating the proposed nursing intervention. 11. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome. 12. Appendix section, if tables, graphs, surveys, educational materials, etc. are created. Review the feedback from your instructor on the Topic 3 assignment, PICOT Question Paper, and Topic 6 assignment, Literature Review. Use this feedback to make appropriate revisions to these before submitting. Prepare this assignment according to the guidelines found in the APA 7th edition Rubic_Print_Format Course Code Class Code Assignment Title Total Points NRS-493 NRS-493-O502 Benchmark - Capstone Project Change Proposal 200.0 Criteria Percentage 1: Unsatisfactory (0.00\%) 2: Less Than Satisfactory (75.00\%) 3: Satisfactory (79.00\%) 4: Good (89.00\%) 5: Excellent (100.00\%) Comments Points Earned Content 80.0\% Revisions Incorporated as Directed by Instructor 5.0\% Revision is omitted. Revision is incomplete. Many aspects are still incomplete, inaccurate, or unclear. Most key aspects were revised. Some aspects are still vague or contain minor inaccuracies. The key aspects were revised. The revision generally improves the accuracy and clarity of the project. All revisions are incorporated. The revision greatly improves the accuracy and clarity of the project. Background 5.0\% Background of clinical problem omitted. Background of clinical problem is incomplete. Background of clinical problem are summarized. There are minor omissions or inaccuracies. Some support or information is needed. Background of clinical problem are presented. Minor aspects are unclear or require support. Background of clinical problem are clearly and logically presented. Relevant support and rationale are evident. Clinical Problem Statement 5.0\% Clinical problem statement omitted. Clinical problem statement is incomplete. Clinical problem statement is summarized. There are minor omissions or inaccuracies. Some support or information is needed. Clinical problem statement is presented. Minor aspects are unclear or require support. Clinical problem statement is clearly and logically presented. Relevant support and rationale are evident. Purpose of Change Proposal 5.0\% Purpose of the change proposal in relation to providing patient care in the changing health care system is omitted. Purpose of the change proposal in relation to providing patient care in the changing health care system is incomplete. Purpose of the change proposal in relation to providing patient care in the changing health care system is summarized. There are minor omissions or inaccuracies. Some support or information is needed. Purpose of the change proposal in relation to providing patient care in the changing health care system is presented. Minor aspects are unclear or require support. Purpose of the change proposal in relation to providing patient care in the changing health care system is logically presented. Relevant support and rationale are evident. PICOT Question 5.0\% PICOT questions is omitted. Topic is presented but criteria is incomplete. Topic and most criteria are presented. There are minor omissions or inaccuracies. Some support or information is needed. Topic and criteria are presented. Minor aspects are unclear or require support. Topic and criteria are clearly and logically presented. Relevant support and rationale are evident. Literature Search 5.0\% Literature search strategy employed omitted. Topic is presented but criteria is incomplete. Topic and most criteria are presented. There are minor omissions or inaccuracies. Some support or information is needed. Topic and criteria are presented. Minor aspects are unclear or require support. Topic and criteria are clearly and logically presented. Relevant support and rationale are evident. Evaluation of Literature 5.0\% Evaluation of literature omitted. Evaluation of literature is incomplete. Evaluation of literature is summarized. There are minor omissions or inaccuracies. Some support or information is needed. Evaluation of literature is presented. Minor aspects are unclear or require support. Evaluation of literature is clearly and logically presented. Relevant support and rationale are evident. Change or Nursing Theory 5.0\% Change or nursing theory omitted. Change or nursing theory is incomplete. Change or nursing theory is summarized. There are minor omissions or inaccuracies. Some support or information is needed. Change or nursing theory is presented. Minor aspects are unclear or require support. Change or nursing theory is logically presented. Relevant support and rationale are evident. Implementation Plan and Outcome Measures 10.0\% Implementation plan and outcome measures are omitted. Implementation plan and outcome measures are presented is incomplete. Implementation plan and outcome measures are summarized. There are minor omissions or inaccuracies. Some support or information is needed. Implementation plan and outcome measures are presented. Minor aspects are unclear or require support. Implementation plan and outcome measures are clearly and logically presented. Relevant support and rationale are evident. Use of Evidence-Based Practice in Intervention Plan 10.0\% Use of evidence-based practice in intervention plan omitted. Use of evidence-based practice in intervention plan is incomplete. Use of evidence-based practice in intervention plan is summarized. There are minor omissions or inaccuracies. Some support or information is needed. Use of evidence-based practice in intervention plan is presented. Minor aspects are unclear or require support. Use of evidence-based practice in intervention plan is clearly and logically presented. Relevant support and rationale are evident. Plan for Evaluating Proposed Nursing Intervention 10.0\% Plan for evaluating proposed nursing intervention omitted. Plan for evaluating proposed nursing intervention is incomplete. Plan for evaluating proposed nursing intervention is summarized. There are minor omissions or inaccuracies. Some support or information is needed. Plan for evaluating proposed nursing intervention is presented. Minor aspects are unclear or require support. Plan for evaluating proposed nursing intervention is clearly and logically presented. Relevant support and rationale are evident. Potential Barriers and Plan to Overcome Barriers 10.0\% Potential barriers and plan to overcome barriers are omitted. Potential barriers and plan to overcome barriers are incomplete. Potential barriers and plan to overcome barriers are summarized. There are minor omissions or inaccuracies. Some support or information is needed. Potential barriers and plan to overcome barriers are presented. Minor aspects are unclear or require support. Potential barriers and plan to overcome barriers are clearly and logically presented. Relevant support and rationale are evident. Organization and Effectiveness 15.0\% Thesis Development and Purpose 5.0\% Paper lacks any discernible overall purpose or organizing claim. Thesis is insufficiently developed or vague. Purpose is not clear. Thesis is apparent and appropriate to purpose. Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. Argument Logic and Construction 5.0\% Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. Criteria 3Mechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0\% Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English. Format 5.0\% Paper Format (use of appropriate style for the major and assignment) 2.0\% Template is not used appropriately or documentation format is rarely followed correctly. Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent. Template is used, and formatting is correct, although some minor errors may be present. Template is fully used; There are virtually no errors in formatting style. All format elements are correct. Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) 3.0\% Sources are not documented. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. Total Weightage 100\% Running Head: High turnover rates 2 2 High turnover rates High turnover rates Student’s Name Institutional affiliation Introduction High turnover rates of nursing staff have adverse effects in the organization and they influence the quality of patient care and the nursing practice because of the congestion and the delays that result from the turnover. The turnover rates are caused by job dissatisfaction as the nurses feel that their needs are not catered for in the facility. One of the reasons for the dissatisfaction is being overworked due to the mandatory overtime. The high rates of turnover disrupt the functioning of the organization and impact on the patients and the nursing practice negatively but there are nursing and evidence interventions that help correct the issue. Clinical Problem (High turnover rates) P- Oncology nurses I- reduced mandatory overtime C-nurses with the regular mandatory overtime O- low turnover rates T- one year PICOT question: Will oncology nurses who have reduced mandatory overtime have low turnover rates compared with nurses who have regular mandatory overtime over one year? Evidence-based solution One solution which works in reducing turnover rates for nurses and other employees is increased wages and salaries for the employees. Monetary rewards represent one of the easiest ways to motivate nurses to work harder and stay in a particular organization. Nurses who feel that they are underpaid compared to nurses in other similar facilities or compared to the amount of work they do always end up quitting their jobs when they get a chance (McDermid et al., 2020). The oncology setting thus can increase the pay of the nurses and have more financial benefits such as medical covers and insurance to help cater for the nurses’ treatment when need be. Nursing intervention One solution for the increased turnover rates in the oncology settings is to lower the amount of mandatory overtime for the nurses. Nursing being a demanding profession most of the nurses are required to work overtime especially in case of emergencies in the organization. These overtime hours should be structured in a manner that considers the needs of the nurses. Nurses have personal matters and issues that they need to attend to and also feel fatigued when they work for long hours. When the nurses have to work for long then they end up feeling that they are not considered by a medical facility and hence end up looking for better organizations to work for. Patient care High turnover rates will always impact negatively on various elements in the healthcare setting but mostly on the quality of patient care. When the nurses leave an organization to get jobs elsewhere an organization is left without adequate staffing. Inadequate staffing results in patients getting very minimal medical attention since the time they spend with nurses is very limited (Martin & Ramos-Gorand, 2017). To help ensure that patients are served well and the quality of the patient care is high, nurses have to be at the right levels in an organization and hence the organization must always ensure that it hires more nurses to replace those who quit. Health care agency Various healthcare agencies are connected to the issue of high turnover rates of nurses in organizations. Nurse staffing agencies can help solve this issue because they provide qualified nurses to help fill in the positions which are left by the nurses who quit their jobs. The advantage of using a nursing agency is that the organization can be guaranteed that the quality of healthcare is at the optimum level (Martin & Ramos-Gorand, 2017). The agencies secure contracts for nurses to work in various facilities. If nurses are employed on a contract basis then the rates of turnover go down as well. Nursing practice The nursing turnover rates impact negatively on the nursing practice in an organization. When nurses quit work then organizations are left with nurses who are not enough to meet the needs and demands of the patients. The existing nursing staff will always get overwhelmed when the work is too much and end up losing the morale to work hard (Wang & Yuan, 2018). Turnover rates impact negatively on the productivity of nurses and the engagement they have in the healthcare setting. The new nurses who are hired to replace the gone nurses are in most cases not skilled for the jobs and that affects the quality of services offered. References Martin, C., & Ramos-Gorand, M. (2017). High turnover among nursing staff in private nursing homes for dependent elderly people in France: impact of the local environment and the wage. Économie et Statistique, 493(1), 49-66. McDermid, F., Mannix, J., & Peters, K. (2020). Factors contributing to high turnover rates of emergency nurses: A review of the literature. Australian critical care, 33(4), 390-396. Wang, Y., & Yuan, H. (2018). What is behind high turnover: a questionnaire survey of hospital nursing care workers in Shanghai, China. BMC health services research, 18(1), 1-7. 2 Nursing Turnover and Inadequate Staffing in Oncology Setting Students Name Institution Course Instructors Name Date Nursing Turnover and Inadequate Staffing in Oncology Setting The oncological unit cares for critically ill patients who need constant care and attention. Therefore, the department needs sufficient nurse-patient ratios to ensure that the ailing individuals receive adequate holistic care suited to their individual needs. However, a high turnover rate is experienced amongst the nurses in the department, causing the few remaining nurses to contend with mandatory overtime (Carter & Bright, 2020). The situation leaves them dissatisfied and derails the smooth running of the organization, giving rise to the research question: Will oncology nurses who have reduced overtime have low turnover rates compared with nurses who have regular mandatory overtime over one year? A review of literature that explores this issue will provide significant insights and evidence that can be applied in the clinical setting to resolve this critical issue. Inadequate staffing is a crucial issue that needs an evidence-based solution that will help reduce the turnover rates of the professionals. The solution includes addressing the issue of mandatory overtime, which is a source of dissatisfaction among nurses. Comparison of Research Questions Several articles analyze the impact of reduced overtime on the turnover rates of nurses. They undertake investigative research to answer varying research questions surrounding the issue. Elshahat et al. (2019) investigate the question: What is the relationship between nurses quality of work life and their turnover intentions. Similarly, Carter and Bright (2020) also scrutinize the relationship between mandatory time and turnover rates in patients. The authors analyze the research question: Is there a relationship between mandatory overtime, nursing fatigues, and patient safety? Al Sabei et al. (2020) also explore the issue of high turnover rates amongst nurses. The authors explore the research question: Is the nursing work environment related to turnover rates and quality of patient care? On the other hand, Hariyati and Nurdiana (2018) took an i-depth analysis of the strategies that can aid in reducing high turnover rates among nurses. The authors scrutinized the research question: Does create a positive work environment, effective leadership, professional development, and adequate staffing ratios help increase retention of nurses in a medical institution. Park and Koi also explored the turnover rates of nurses in medical facilities. The authors explore the research question: What factors influence the rate of turnover of Korean acute care hospital nurses? Burmeister et al. (2019) also investigated to unearth content that answers the research question: What are the determinants of nurse absenteeism and the intent to leave? Shaffer (2020) also explored strategies that promote the retention of nurses through a study that aimed to answer the research question: What can employers do to increase the rate of nursing retention? Further, Zhou et al. (2021) studied the impact of internal and external stressors on nursing turnover. The investigative process aimed to answer the research question: What are the effects of nursing stressors on turnover? A Comparison of Sample Populations The studies that investigated issues concerning nursing turnover and mandatory overtime utilized different population samples. Elshahat et al. (2019) utilized a total of 148 nurses working in a government healthcare facility. On the other hand, Carter and Bright (2020) analyzed scholarly articles and journals that discussed the issues. On the other hand, the sample population utilized by Al Saibei et al. (2020) was 207 nurses working in a public medical facility. The study differs from Hariyati and Nurdiana (2018) study, which analyzed 8910 scholarly sources from different databases that discussed the issue. The selected sample size by Park and Ko (2020) was 96,156 nurses who were incorporated in a cohort study. Similarly, Burmeister et al. (2019) undertook a comprehensive study that incorporated nurses from seven different countries involved in the direct care of patients to determine their experiences with mandatory overtime and nurses turnover rates. Consequently, Shaffer (2020) carried out secondary research using peer-reviewed sources, while the sample used by Zhou et al. (2021) was 654 nurses from different counties in China. A Comparison of the Limitation of the Studies The investigative studies conducted in the articles incorporated in the literature review had various limitations. The limiting factor in the survey by Elshahat et al. 2019) was a small sample size. On the other hand, the limiting factor noted in the investigative process undertaken by Carter and Bright (2020) was time constraints. The time dedicated to the study was limited, which impacted the amount of data compiled. The data collection process was the primary limitation in the study undertaken by Al Saibei et al. (2020) and Hariyati and Nurdiana (2018). The studies used close-ended questions, which restricted the responses of the participants. On the other hand, the limitation of the study by Park and Ko (2020) was the age of data. The authors analyzed content from many articles, some of which were old; hence, they may be outdated. The main limiting factor in the study by Burmeister et al. (2019) was the profile of the sample. The authors did not consider the diversity present in the population while selecting the participants. On the other hand, the primary constraining aspect in Zhou et al. (2021) study was the time factor. Conclusions and Recommendations for Future Research Analysis of the studies shows that mandatory overtime is a significant cause of dissatisfaction among nurses, resulting in high turnover rates. The cause of the discontentment with mandatory overtime is excessive exhaustion that causes that negatively impacts the health and wellbeing of the nurses. Further, it increases errors in the clinical settings and compromises the safety of patients. Therefore, it is recommended that further research should be undertaken to determine the strategies that can be used to motivate nurses to develop an inclination for mandatory overtime in situations where the practice is essential and the measures that can be instigated to reduce the need for mandatory overtime and increase the rates of retention of nurses. References Al Sabei, S. D., Labrague, L. J., Miner Ross, A., Karkada, S., Albashayreh, A., Al Masroori, F., & Al Hashmi, N. (2020). Nursing work environment, turnover intention, job burnout, and quality of care: the moderating role of job satisfaction. Journal of Nursing Scholarship, 52(1), 95-104. https://sigmapubs.onlinelibrary.wiley.com/doi/pdf/10.1111/jnu.12528 Burmeister, E. A., Kalisch, B. J., Xie, B., Doumit, M. A., Lee, E., Ferraresion, A., ... & Bragadóttir, H. (2019). Determinants of nurse absenteeism and intent to leave: An international study. Journal of nursing management, 27(1), 143-153. https://deepblue.lib.umich.edu/bitstream/handle/2027.42/147841/jonm12659.pdf?sequence=2 Carter, T., & Bright, K. (2020). NURS 360: For a great deal of nurses they are subject to having to participate in mandatory overtime, are nurses that are required to participate in mandatory overtime, just as successful and functional in care for patients as nurses who are not required to participate in mandatory overtime?. https://digitalcommons.longwood.edu/cgi/viewcontent.cgi?article=1063&context=spring_showcase Elshahat, E. M., Shazly, M. M., & Abd-Elazeem, H. (2019). Relationship between quality of work life and turnover intention among staff nurses. Egyptian Journal of Healthcare, 10(1), 178-193. https://ejhc.journals.ekb.eg/jufile?ar_sfile=56499 Hariyati, R. T. S., & Nurdiana, N. (2018). Retention Strategy to Minimize Nurse Turnover: A Systematic Review. International Journal of Nursing and Health Services (IJNHS), 1(2), 99-109. https://www.ijnhs.net/index.php/ijnhs/article/download/47/20 Park, B., & Ko, Y. (2020). Turnover rates and factors influencing turnover of Korean acute care hospital nurses: A retrospective study based on survival analysis. Asian Nursing Research, 14(5), 293-299. https://www.sciencedirect.com/science/article/pii/S1976131720300748 Shaffer, F. A. (2020). Nurse turnover: Understand it, reduce it. https://www.myamericannurse.com/wp-content/uploads/2020/08/an8-Turnover-728.pdf Zhou, L., Kachie Tetgoum, A. D., Quansah, P. E., & Owusu‐Marfo, J. (2021). Assessing the effect of nursing stress factors on turnover intention among newly recruited nurses in hospitals in China. Nursing Open. https://onlinelibrary.wiley.com/doi/full/10.1002/nop2.969