Development of the McDonough Optimum Staffing Method, Capstone Project Example

Abstract

Many nurses are not prepared for the challenges they face working with mental health patients, which is cited as a primary reason for the extensive turnover rate in this industry. Currently, there is a greater than 10% vacancy for mental health nursing positions in a majority of hospitals. While some individuals believe that they are underprepared for work in these facilities, others leave because they wish to continue their education in another institution. Both of these problems can be resolved by providing nurses with comprehensive training programs, which will ultimately allow them to become more effective practitioners while coping with their new or continuing experiences as mental health professionals. Therefore, health care institutions can resolve the issues that lead to turnover by providing their staff with support, which is expected to contribute to enhanced patient care. Issues of resolving staffing crisis need important consideration as way to ensure that the health rights of mental health patients will be protected. Staffing is an integral aspect of the quality of output realized in any given organization, relative to its industry within which it operates. Staffing involving mental health nurses is a complex issue and requires an evaluation of the issues that continue to evolve throughout the profession. The use of a questionnaire instrument may serve as an effective means of understanding the dynamics of nurse staffing and to determine how nurses feel about their roles as mental health providers.

Staffing has long been a concern in nursing as, has been acknowledged by the registered nurses and the heightened demand in the health care system  creates more burdens on the workforce in every specialty especially mental health. Many nurses are not prepared for the challenges they face working with mental health patients, which is cited as a primary reason for the extensive turnover rate in this industry. Currently, there is a greater than 10% vacancy for mental health nursing positions in a majority of hospitals (McAllister et al., 2014).The focus of this paper is to elaborate on how  different article address this problem in the following paragraphs.

Problem Statement

The clinical environment in which I am currently working has low employee morale because nurses are staffed for long hours at a time and given many responsibilities while on shift. Furthermore, the staffing issue has required nurses who are not regularly scheduled to fill in for their coworkers (McAllister et al., 2014). Nurse callout is detrimental because other nurses are required to make up for an individual’s inability to work. Many nurses are required to work 12 hour shifts or longer in many instances, and require their days off to recover (Wynn, 2013). When they are unexpectedly called into work, this markedly reduces patient quality of care; since the nursing staff is tired, they are unable to care for their patients with the highest level of quality. As a consequence, the quality of care at understaffed institutions or institutions with related staffing problems is diminished.

These institutional challenges could reasonably be resolved by hiring a larger staff so that callouts do not impact the quality of care that patients receive or that the nurse staff is able to deliver. However, this is often not a reasonable resolution because hiring additional staff is often expensive. Therefore, it is important for these institutions to focus on employee retention instead. Offering professional development programs to staff members will help them cope with the demands of their job, which makes this a reasonable resolution to this problem. Furthermore, strict policies can be put in place to ensure that the number of nurse callouts are minimized, thereby increasing the quality of each individual nurse’s work day. Overall, providing nurse staff with the tools they need to succeed is a necessary way to ensure that they will be prepared for diverse challenges and that they will know how to take time off of work in a manner that will not impair the abilities of their replacements to work with patients effectively. Studies have shown that such programs will improve the organizational culture of the hospital, which will also increase employee morale (Redknap et al., 2015).

Problem Description

PICO question: Can providing nurses with training specific to the needs of mental health patients allow the nurse retention rate to decrease by no more than 5% over a six month long intervention period?

• P – Staffing in mental health facilities reduce the quality of patient care.
• I –– Providing mental health nurses with enhanced training programs to help them cope with the challenges they will face, thereby decreasing the nurse turnover rate. Specifically, nurses will be provided with data that is pertinent to their individual health care facility so that they are aware of the individual needs of their patients.
• C – The standard training employees receive when they are hired, which includes information regarding hospital operations, but not information specific to mental health nursing.
• O –– The nurse retention rate will decrease by no more than 5% over the six month intervention period.

Solution Description: Incorporating Theory

It is imperative that the shortage of the workforce of nurses be addressed to meet the current and future demand in nursing especially mental health nursing. The problem is not only shortage of human resources but the ability of an organization to maintain nurses; those who are hired.  Kanter’s theory of empowerment would be used as a measure to decrease retention of nurses at not more than 5%.  Powerless nurses are less satisfied with their jobs and more susceptible to burnout and depersonalization (Manojlovich, 2007). Rosabeth Moss Kanter is a management guru who has developed several management theories including the structural empowerment theory.  Kanter’s theory of structural empowerment is a good framework to explain concepts related to negative workplace behaviors, such as turnover. Kanter asserted that the structure of the work environment is an important correlation of employee attitude and behaviors in organizations and that perceived access to power and opportunity structures relate to the behaviors and attitudes of employees in organizations. (Nedd, 2006). There are two components of her theory: The first one is based on the growth, mobility and chance to increase knowledge and skills and the second is the structure of power which refers to the ability to access and mobilize resources, information and support for one’s position in order to get a job successfully done.

According to kanter, there is s relationship between empowerment, nurses’ job satisfaction and retention rate. Empowerment of nurses refers to providing access to opportunities relating to possibility of growth within the organization and increased knowledge such as introduction of professional development programs within the organization. Also, one’s ability to access resources such as financial means, materials, time and supplies required to do work determines output and satisfaction. With this theory, employees would be able to have access to technical knowledge and expertise required to accomplish the job and the understanding of organizational policies and decisions. Feedbacks received form peers, subordinates and superiors would serve as support. . When staff has opportunity and power, they are motivated, feel more in control, have increased well-being and have greater job satisfaction.

As far as incorporating the theory into my project, a review of evidence that support the change would be done and shared with management and colleagues. It would also involve seeking for consultation with policy makers within the organization and outside of the organization. Management has a significant role in the incorporation of the theory, thereby creating conditions for work effectiveness by making sure those employees have access to the information, support and resources required to accomplish work and that they have ongoing opportunities for growth. (Orgambídez-Ramos, & Borrego-Alés, 2014).

Implementation Plan: Nursing Human Resource Implementation Plan

Healthcare is an industry that is highly responsive to the quality of human resource that is employed to execute the different functions required. The healthcare industry is currently plagued with variability in staffing. This has been characterized by different levels of employee qualification, experience and satisfaction in different medical institutions. Staffing in mental health facilities is facing some crisis which needs to be addressed urgently. Currently, there is a greater than 10% vacancy for mental health nursing positions in a majority of hospitals (McAllister et al., 2014).  This is linked to the general differences in incentives that employees experience within the workplace. Incentives influence the ability of nursing staff to handle challenges faced when working with patient care.

This has been compounded by the inappropriate allocation of nurse staffing resources, accentuating activities as opposed to meeting rising patient demands. This skewed allocation of resources causes internal systemic inefficiencies that have also been found to play a significant role in the high rate of nursing staff turnover that has characterized the nursing profession (O’Brien-Pallas, Murphy, Shamian, Li, & Hayes, 2010) With numerous nursing functional areas experiencing overlaps in their functions, ambiguous roles and responsibilities that result from skewed allocation of nursing staff resources tends to cause frustration, mental health issues and anxiety amongst nursing staff. This has compounded the rate at which nursing staff turnover is experienced. This problem and proposed solution would be presented to the nurse manager and administration who would request for a meeting with the stakeholders where a presentation would be done.

Intervention (Proposed Solution)

A human resource implementation plan is proposed to provide a solution to the problems and challenges that have been highlighted in the section above. Providing mental health nurses with enhanced training programs to help them cope with the challenges they will face, thereby decreasing the nurse turnover rate. Specifically, nurses will be provided with data that is pertinent to their individual health care facility so that they are aware of the individual needs of their patients. It is important that certain fundamental aspects be taken into consideration so as to; (1) improve the quality of healthcare services dispensed to patients, (2) mitigate the number of medical errors performed by the nursing staff, (3) enhance loyalty and improve staff motivation, (4) adequately allocate nursing staff resources, (5) adequately define functional roles and duties, and (6) mitigate nursing staff turnover (Flynn, Liang, Dickson, Xie, & Suh, 2012). This shall be achieved through the implementation of a number of policies and programs within the human resource department.

Capability Development

Organizations in the 21^st century are faced with the daunting task of hiring and retaining high quality, qualified and experienced staff. However, owing to the nature of business, an organization may alternatively opt to develop talent internally, increasing the value of its workforce from within (Sorrell, 2010). Such organizations foster a sense of belonging and ownership in its employees, enhancing employee satisfaction and loyalty.

Recruitment and Selection

This entails the rigorous process of identifying only the best individuals to take on open positions within the company. While capability development is an integral part of improving nursing staff performance, there is an inherent need to ensure experience and innovation within a healthcare institutions staff. This will be facilitated by a rigorous recruitment and selection process.

Technology

Technology seeks to enhance an employee’s or worker’s ability by making work much simpler and faster. Through technology, the elements of human error can be mitigated or averted by using computerized systems in the production process for goods and/or services (Hanrahan, 2009). This is essential for efficiency, the true measure of productivity. Technology helps an employee to produce more over a relatively short period of time, while reducing errors in the process. According to the information, technology is a requirement for productivity.

Rationale

The proposed human resource management policy and framework is integral to success of the modern day human resource department in the healthcare industry. Each component of the policy and framework has been developed to address the six key issues identified.

Capability development improves the quality of care dispensed to patients by ensuring more competent healthcare professional attending to the patients (Slizer & Dowell, 2010). With the ability of younger healthcare professionals to receive guidance and training from more experienced professionals, they gain hands-on knowledge on how to mitigate medical errors. This is also instrumental in mitigating staff turnover. Capability development is integral in employee retention in mental health institutions.

Kanter, in his theory of organizational structure development highlights the need to create a work environment that fosters growth and development. When leaders empower other individuals within the organization, an environment for growth is created. The proposed plan is in line with Kanter’s theory as it depicts the six preconditions of empowerment;

1. Opportunity for advancement
2. Access to information
3. Access to support
4. Access to resources
5. Formal Power
6. Informal Power (Kirwan, Matthews, & Scott, 2013)

There are two components of Kanter’s theory: The first one is based on the growth, mobility and chance to increase knowledge and skills and the second is the structure of power which refers to the ability to access and mobilize resources, information and support for one’s position in order to get a job successfully done.

Data-based people management is essential in identifying medical errors before they occur and develop ways to mitigate these errors. This is also integral in identifying the strengths of every given staff member to necessitate adequate allocation of staff. This is also the foundation of adequately defining the functional roles and duties of staff members. A rigorous recruitment and selection is key to determining the quality of healthcare services patients receive. This quality is enhanced by the use of technology. Technological advancements enhance processes and procedures, mitigating errors associated with the human element.

Evidence in Literature

A rigorous staffing process is one of the assured techniques to ensure high quality healthcare services delivered to patients. According to How, L. (2013), inadequate staffing is found to be responsible for a reduced quality of patient care. In order to reduce turnover, employees require incentives that develop a sense of belonging and ownership (How, 2013). The literature further highlights the importance of enhanced training programs within the human resource department. Internal training programs are integral in developing the skills and ability to handle the challenges that the face working in patient care.

Flynn, Liang, Dickson, Xie and Suh highlight the causes of medical errors and the manner in which they are handled. The researchers conducted a study that revealed nurses have the ability to effectively intercept medical errors when they are provided with comprehensive educational and cultural support. This educational support is achieved through internal training and talent management programs (Flynn, Liang, Dickson, Xie, & Suh, 2012). This opinion is echoed by McAllister, Happell and Flynn’s research. Nurses are able to identify problems before they become severe when they have a conducive work environment (McAllister, Happell, & Flynn, 2014). This work environment can also be enhanced through the use of technology.

The lack of an adequate work environment has been attributed to high levels of nurse staff turnover. Research revealed that role conflict and role ambiguity is largely responsible. Defining the roles for each nurse is integral to developing an efficient and free-flowing system. This can be achieved through the application of an effective recruitment and selection process that employs staff according to the given roles and responsibilities. Variability in the quality of healthcare is one of the most significant problems facing nurse staffing in the 21^st century. McDonough sheds light on the fact that staffing techniques currently employed directs bulk of nurse staffing resources for activities as opposed to meeting patient demand, which rises every passing day (McDonough, 2013). Optimally allocating resources requires the application of data-based people management techniques.

Employing internal talent pipeline management is integral in ensuring employees have the adequate incentive to provide the best quality of healthcare. This is in line with Redknap, Twigg, Rock and Towell’s research that highlights benefits and incentives as factors of continued effective performance.

Implementation Logistics

The implementation of the proposed plan will be executed in stages. While the stages are distinct, certain aspects of these phases recur across the board, and as such integration may be both sequential and simultaneous.

Change Management

The introduction of new technology, such as the Electronic Health Record (EHRs) can be faced with considerable resistance. This part involves the introduction of all the physicians to the system to be used in the near future. The fact that the EHR is being developed does not guarantee its use in the clinical arena or the hospital. People may resist it due to lack of common benefit with the organization, lack of will to adapt to new work process and the fact that people conduct a cost-benefit analysis on the issue.

User training

Technology plays an integral part of delivering health services to patients. As such, there is a considerable need to develop a plan that ensures all employs develop the necessary technological aptitude to enhance accuracy. Mental health nurses employ a number of new technological innovations to enhance the management and treatment of mental disorders. Technological innovations such as Virtuality Realty Exposure Therapy (VRET) and mobile applications have become important complementary techniques for managing post-traumatic stress disorder (PTSD).

Other technology such as electronic health records (EHR) systems are currently the desired industry standard globally. As such, training on the features, functions and effective use of the EHR system is crucial. Perfect time has to be set and training done in groups to reduce cost, unless one- on-one experiments and explanations are necessary. In making the plan for the training process, decision of training and the actual training have to begin before the go-live period (lectures notes, EMI and change management strategies).  There should be selection of a group of staff members to go for training by the vendor. All staff are then tested for computer skill, and if they don’t have these essential skills, they should be trained first in this field. The cost of the training is then determined. Mode of training may include quality documentation trainings, tailored training, and instructor-led classroom training. In other cases, there may be computer-based training and independent lab exercise/ study.  The next step after training is assessment of the trained medical representatives.

Usability of Technology

Technology, an important factor of mental health services dispensation, can only be useful if its users find it usable. Technology such as the virtual reality system (used in VRET) and the EHR system have to be configured in a manner that it reduces amount of time required to accomplish a given task. This ensures that medical health professionals administer accurate diagnosis on mental health patients, and be able to detect anomalies that may lead to considerable implications on the patient’s mental health. In addition, it should offer a high degree of consistency in every intended aspect in the hospital. By reducing errors and enable multitasking.

Talent Pipeline Development, Recruitment and Selection

Retention of employees is paramount to ensuring consistent and sustainable growth. As such, taking advantage of the talent within the organization and nurturing it. Mental health practitioners that show the potential to develop innovative and revolutionary techniques to impact the industry should be nurtured (Wynn, 2013).

Mental health institutions and organizations should align talent pipelines to their talent management initiatives by employing a competency framework that maps strategic objectives to the standards of performance as well as the whole Talent Development framework stream of the organization (Greenberg & Sweeney, 2010).

The systematic processes involved in building talent with the mental health institution or organization entails:

• Identification of the human resource needs within the organization
• Identification of the talent management strategy and approaches the organization can employ
• Identification of the resources available to the organization to pursue the optimal talent management strategy that best suits the organization. This will involve determining the scope of the talent management strategy, its limits and its capabilities based on the resources, financial and man power, that is available to the organization.
• Identification of the employees that poses the potential and talent that is required within the organization
• Execution of the desired talent management strategy
• Re-evaluation of the talent management strategy (Conger, 2010)

Resources

The implementation of the plan is dependent on the availability of a number of factors that are critical for success. These factors include the resources required for the accomplishment of the plan.

Staff

This is the most important resource required. The plan has been developed and designed for nurse staff to develop the skills required to accomplish healthcare at the highest possible level. The organization requires employees within the organization as they formulate its internal pipeline. Their availability and willingness to participate in the program determines the level of success that can be achieved through the implementation of the plan.

Technology

Technology is an integral aspect of the plan, most of the improvements have been centered around, or complemented by technological aspects. The most significant is the computer hardware required to run the EHR.

Education Materials

One of the significant aspects of the plan is the introduction of internal improvement programs for the staff. There is need for the use of educational materials to facilitate the training programs.

Assessment Tools

There are a number of assessment tools that can be employed to ensure success of the plan. Talent management has become such an integral part of organizations today that there is need for regular SWOT analyses Invalid source specified. The use of SWOT analysis in talent management is to critically analyse the efficiency and effectiveness of talent management techniques that are being employed by any given company.

Evaluation Plan: Methods of evaluation

Staffing involving mental health nurses is a complex issue and requires an evaluation of the issues that continue to evolve throughout the profession. It is necessary to address some of the challenges that impact mental health nursing and how staffing continues to be a difficult issue in many ways. The staffing matrix in mental health nursing must be identified through the development of a method that will determine the impact of different interventions and how they are likely to influence nursing practice and outcomes. The questionnaire instrument must address the following research question: Does specific training provide nurses who treat mental health patients reduce the retention rate by less than five percent over a six-month period?

The use of a questionnaire instrument may serve as an effective means of understanding the dynamics of nurse staffing and to determine how nurses feel about their roles as mental health providers. The survey instrument must address critical questions regarding quality of patient care and its relationship to training for mental health patients; in addition, the questions must address skillset mix for registered nurses and how quality of care is contingent upon these skills over time (Chin How, 2013). Questions may include the following: 1) Does a diverse RN skillset translate into greater quality of care for mental health patients; and 2) Which skills are essential to treat mental health patients effectively? These questions and others may have an impact on how to better address the needs of mental health patients to improve patient care quality on a consistent basis.

The questionnaire should including questions that will analyze staff attitudes and the primary contributors to job satisfaction, as well as the characteristics that impact job dissatisfaction for this group, both before and after the implementation of a staffing matrix. It is imperative to recognize these limitations and to identify the reasons behind turnover and what prompts this change within the practice environment. Nurse burnout and turnover rate must be a primary focus of the questionnaire because it is likely to occur in the mental health field more frequently due to the stress of working with this patient population (Salyers, Rollins, Kelly, Lysaker, & Williams, 2013) .Nurse skill set must be identified in the questionnaire as a means of understanding what is required to treat mental health patients under the best possible circumstances that will positively impact patient outcomes.

One of the issues to consider with staffing for mental health nurses is to be aware of compassion fatigue and how this may also contribute to increased burnout for some nurses to the extent that it reduces quality of care (Ray, Wong, White, & Heaslip, 2013). Under these conditions, it is possible that mental health nurses may be influenced by the burden of mental health patients and the level of care and treatment that is required for this population, and this reflects a need to better evaluate the conditions under which nurses are able to care for these patients with an increased level of stress (Ray et.al, 2013). Under these conditions, some nurses may be limited by their own level of burnout and dissatisfaction within the mental health field. In addition, patient satisfaction may also be limited in some respects and may require further examination of the different areas whereby patient care is limited by the nurses who are employed and their perceptions of the practice environment. As a result, patient discharge surveys must be evaluated pre- and post-change in order to determine the effectiveness of any changes that have occurred. Patient discharge surveys must also evaluate nurses in the context of their ability to exercise skills that will positively impact patient care quality for this population.

It is of critical importance to include staff attitudes and perceptions of the nursing experience as part of the survey instrument, as this reflects any potential for change that could have an impact on this group of patients. In addition, it requires an evaluation of patient attitudes and perceptions in order to determine if nurses are a direct influence on their beliefs regarding quality of care and treatment. The survey must identify areas such as staff turnover, which is a complex process that also influences how care and treatment are perceived by patients. Turnover may be likely to impact mental health patients because it is difficult to care for this population without the appropriate skillset in place that will ultimately influence quality of care in different ways. The survey instrument must be able to capture the most relevant issues for nurses who work with mental health patients and to provide some perspective regarding what steps are required to ensure that patients are well taken care of at this level so that their health is not compromised in any way. Questions must address quality of care in a specific context and determine the skills required to meet expectations for mental health patients in order to measure improvements in their health status.

Dissemination Plan: Disseminating of the Project to Key Stakeholders and to greater nursing Community

A good research project is only implementable if it is well disseminated to the appropriate people or areas. The most important thing would be to make those directly affected such as the nursing staff, nurse managers, director of nursing stakeholders and the community aware of the nature of the project and the expected outcome of the project.  Taking enough time to elaborate on the negative effect of inadequate staffing which creates increased workloads, extensive work periods, mandatory overtime also generates work related stress and burn out; these directly affect patient care delivery and outcomes (Harmsworth & Turpin, 2000). Enlightening the stakeholders, on the impact of staffing in mental health and the urgency to address the problem would push them to action.. When awareness is done, further dissemination would be done by words of mouth and posters on the staff bulletin board. Creating an understanding of the project to those who are directly involved and this would be the nurses, the nurse manager, the director of nursing and stakeholders is vital to the success of the project. A team is created when the nursing staffs, nurse managers and the director of nursing have a better understanding, of the project share the same vision of and have some sort of ownership of the project (Walsh, 2010).

Though the team is aware of the significance of the project they have to be properly trained to disseminate the project for uniformity. This team would help to foster the dissemination of the project to the greater community. The next step would be putting the project into action by meeting the CEO of our company, the stakeholders and donors and writing to the council man and congressmen. The team that has been created would be informed in disseminating the project to the stakeholders and the community. Engaging the stakeholders at the onset of the dissemination provides financial support as they would be able to fund the project.

Conclusion

The chosen survey instrument must be comprised of questions that will have a positive impact on the nurses who work in the mental health field, including the recognition of their needs and wants at the highest possible level to promote greater satisfaction within the field. This process will demonstrate a need to be open and willing to modify staffing as necessary and to optimize working conditions in order to positively impact patients. This process will be effective in meeting the needs of these patients and in supporting a dynamic of care and treatment that will provide positive and meaningful support to mental health patients and that will impact their own level of patient satisfaction while receiving care and treatment from nurses who work within this field.

Resolving the employee staffing crisis is an important way to ensure that the health rights of mental health patients will be protected. While many individuals wish to work with this patient population, they quickly become stressed due to the long hours they are required to work in addition to the many responsibilities that they are given. Therefore, professional development programs can provide them with the skills necessary to avoid problems and to resolve these issues once they occur. Furthermore, these programs will help the nursing staff form a community, and each professional could serve as a resource for the others so that they are able to collaborate in a manner that will improve the patient experience at their institution. Furthermore, it is expected that such a program will increase employee morale and therefore increase employee retention. While some resources will need to be allocated to establish and maintain this program, this is the most cost effective solution and it is expected to improve patient care at the institution for a long period of time (Walker et al., 2015). Furthermore, since a fast employee turnover rate is costly due to the funds that are necessary to hire and train individuals, this program will allow the hospital to use its resources more efficiently

Summary of important articles

Graham, (2013) in an article, Career in mental health still an unlikely career choice for nursing graduates, are of the opinion that shortage in mental health is as a result choices nurses make right form graduation.  Graduates from nursing schools do not select mental health nursing as an option. According to this article, the shortage of nurses poses a threat to the future of mental health. Their proposal is for mental health nursing to be made more appealing and alternate pathway for registration provided for nurses who want to be mental health providers.

Neville, C., & Goetz, S. (2014), in Quality and substance of educational strategies for mental health in undergraduate nursing curricula, analyze the part universities have to play in promoting mental health nursing. Their suggestion is general overview of programs outlining the content and outcomes, clinical placement strategies, involvement of consumers and mental health nurses in curriculum delivery and oversight, e-learning strategies, and implementation of mental health majors

Mcdough, (2013) in the article Development of the McDonough Optimum Staffing Method  to demonstrates that evidence-based staffing decisions will make nursing more cost effective, proactive in mitigating potential risks, and ultimately, provide better patient care and outcomes. In effect, staffing has to be based on patients’ needs.

Flynn, Liang, Dickson, Xie, & Suh, D. (2012).In their article attempt to demonstrate the impact of appropriate staffing to medication error. With safety being paramount to patient care, this article illustrates the relationship practice environment, nurse staffing levels, nurses’ error interception practices, and rates of no intercepted medication errors in acute care hospitals

Hanrahan, NP, (2009), in Analysis of the psychiatric-mental health nurse workforce in the United States, explores how shortage in supply of trained mental health nurses limits access to care for those who are in need of the services and impact of the nursing shortage on these consumers. According to Hanrahan, employers and state mental health departments could work collaboratively with schools of nursing to provide a continuous stream of psychiatric nurses into the workforce.

O’Brien-Pallas, Murphy, Shamian, & Hayes, (2010), in Impact and determinants of nurse turn over’ examine the impact of nurse turn over on managerial strategies on the unit. According to these authors, higher turnover rate and higher level of role ambiguity were associated with an increased likelihood of medical error. Also according to this article, proper management of turnover is a precursor for higher quality of patient care. Furthermore, a good understanding of role responsibilities by all the members of the care giver team would promote retention as proposed by theses authors.

Phillips, B. (2005), in A survey of mental health nurses’ opinion of barriers and supports for research, finds out that high workloads and lack of relief staffing appear as the greatest hurdles to mental health nurses participating in practice-based nursing research. In her finding, mentoring and flexible research designs are ways to overcome these barriers.

Kirwan, Mathew & Scott, (2012), in the Impact of the work environment of the nurses on patient safety outcome, also emphasize on safety. According to them, effective nurse staffing levels, nurse education levels and a positive work environment are factors that impact patient safety and patient outcome.

Sorrell, J. 2010), in retaining the experts: aging nurses in mental health.  addresses the cause of mental health nursing shortage from a different perspective- the ageing population of the nursing workforce and retirement. The author proposes an amendment in the safety of nurses because injured nurses usually leave work after being injured.

Redknap, Twigg, & Towel (2015), in Nursing practice environment, through light on the nursing shortage and impact on mental nursing. It proposes a solution which is involving nurses to come up with a retention plan. As far as this article is concern retention would be a strategy to ameliorate the shortage.

Roche and Duffield (2007) in Issues and challenges in the mental health workforce development, stipulate the future depends on the extent to which practitioners with specialized educational preparation and skills emerge. These authors support the fact that there have to be improvement in recruitment and retention strategies on the part of the institutions and governments

Thompson and Hamilton (2012) in elaborate on the impact of inadequate staffing on the therapeutic time and patient’s relationship with the nurses. According to these authors, it leads to poor patient outcome, poor patient satisfaction and increased risk for violence in the work environment.

Walker, Berry, Citron, Fitzgerald, Rapaport, Stephens and Druss (2015) analyze the pressure mounted on mental health nursing by the new health care Act and view solution as recruitment and retention of psychiatric providers with i incentive. According to these authors, the shortage is a big crisis following state wide assessment in 27 communities of mental health centers in Georgia.

McAllister, Happell & Flynn (2014) attempts to examine the root cause of nursing shortage in mental which is, the underrepresentation of the mental health curricular in the undergraduate content hence leading to  nurses not readily prepared to face the mental health challenge. According to these authors, the comprehensive nursing curriculum has to be revised to include mental health curriculum that will adequately prepare students for mental health workforce before graduation. These authors make use statistic stating: there is a greater than 10% vacancy for mental health nursing positions in a majority thereby demonstrating the gravity of this problem.

Wynn, S. (2015) States the expansion of the mental health care by the Veteran affairs brings more shortage to the nursing work forces. This author thinks encouraging veterans ages 18-24 by offering them credits earned while serving in the military would increase the number in the mental health workforce.

It is worth noting that these articles do not directly reflect the morbidity and mortality rates which occur, but on the other hand, risky situations such as medication errors and injury as a result of poor staffing could result to death.

References

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Greenberg, H., & Sweeney, P. (2010). Invest in your Best. T+D, 64(7), 56-59.

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Harmsworth, S. & Turpin, S., (2000). Creating an effective Dissemination strategy Retrieved www.innovations.ac.uk/btg/resources/publications/dissemination.pdf

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