Benchmark: Capstone Project Change Proposal



Grand Canyon University


Nurse shortage has been a on going problem within the health care field and has become a giant to many organizations. Studies have shown that there is more nurse leaving a place of employment faster than hiring nurses in. There are many factors that play into the nurse shortage, such as the aging population of nurses, not enough entry-level nursing schools, nurse turnover, etc (RWJF, 2018). With that said, this paper will talk about nurse turnover rates within organizations, and interventions to implement an outcome that will decrease the nurse turnover rates.

Problem Statement

The nursing home the author’s practice at find high nurse turnover rates to be a huge concern, because turnovers cost an organization a lot to recruit and train new nurses. One reason for nurse turnover in organizations is nurses are finding their job to be less satisfying as the days continue to pass, and poor work environment continues to incline (Dotson, 2013). Many nurses reported that their workloads were heavy, and their work environment lacked friendliness and warmth. Among many nurses, teamwork was a highly talked about topic, because these nurses have stated teamwork did not exist on the unit they worked on; nursing task and roles were not clearly identified that made their ability to deliver quality care not easy (Omar, 2013).

Nurses also reported that the reason for their intentions to leave their previous place of employment was strictly due to poor quality management. Good leadership and management come from management showing respect, honesty, and recognition to staff. Nurses have made known that they did not have the support on the floor from management with supplying them with the resources needed, to perform their duty, moreover, management did not support nursing autonomy (Dotson, 2013).

When nurses leave a place of employment faster than the organization can bring in nurses it resulted in nurse shortage and inadequate staffing. Overworked nurses felt more stressed and burnout that their job performance had become impacted, and delivering quality care was hard to accomplish (Adam, 2016).

Literature have shown that high mortality rate and high failure to rescue rates has a direct relationship to inadequate staffing, and nurses have become increasingly stressed and fatigued to where they were not able to perform at or beyond the extent of nursing practice (Cox, 2015).

Purpose of the Change Proposal

The main intention of a change proposal is to formally propose a change that can improve the scope of work or service. According to Parker, by 2022, 100,000 registered nursing jobs will become available per year as 500,000 seasoned nurses will retire, hence, making the nurse shortage critically high. Nursing turnover rates have been critically rising adding to the statistics of nurse shortage (Parker, 2014). The author’s practicum site have not found the true solution to retaining their nurses and are forced to constantly recruit, and offer sign-on bonuses. However, recruiting and retraining nurses have cost the organization millions of dollars and have not guaranteed that these nurses will stay (Parker, 2014).


The PICOT statement for this capstone project change proposal as followed:
Population: Administrative team is constantly faced with the inability to retain their experienced nurses at River Valley Care Center.

Intervention: With the utilization of evidence-based practice to understand the underlining cause of nurse’s intentions to leave their place of employment. Management will be educated on techniques and cognitive behaviors to improve nurse job satisfaction and work environment.

Comparison: The research of intervention will compare the effectiveness of previous and current methods to decrease turnover rates within an organization. These methods include previous methods like sign-on bonuses, recruiting experience nurses, and current methods like improve teamwork, communication, supporting nurse autonomy, and decrease the workload.

Outcome: To determine the education incentive to improve management skills that implement supporting nurse’s values and beliefs, creating firm relationships with nurses, using effective communication, and decreasing workload will decrease the nurse’s intention to leaving, increasing the facilities turnover rate.

Time: Eliminate or reduce high nurse turnover rates in 90 days. The duration of this research for the capstone project change proposal is distributed within 10 weeks of the capstone course.

Therefore, the PICOT question is, For the nursing home administrative team (P), does improving work environment and job satisfaction (I) compared to recruiting with sign-on bonuses (C), reduce turnover rates within 90 days (T).

Literature Search Strategy Employed

Peer-reviewed scholarly articles dated from 2013 to 2018 was used to support this capstone project to eliminate or decrease high nursing turnovers. The search engineer used to conduct this research was through EBSCOhost of Grand Canyon University library. Keywords used to find the right articles for this research was nurse turnover, turnover intention, intention to leave, nurse shortage, and nurse job satisfaction.

Applicable Change or Nursing Theory Utilized

Evidence based practice gives the best researched evidence that is backed by expert, therefore, evidence-based practice will give optimal health care decisions that are smart and informative on screening, counseling preventive medicine, test and treatment. Evidence based practice is designed to improve patient safety and outcome through the best researched techniques and treatments in healthcare that also aims at improving the nursing practice and quality care (Wang, 2015). One major problem River Valley Care Center had was nurse’s intentions to leave causing the facility a increase in the nursing turnover rates.

Proposed Implementing Plan with Measured Outcome

Education and management or leadership training will be implemented to help management retain nursing staff through decreasing workload, giving strength and guidance, acknowledging work performance and supporting values and belief, and promoting teamwork (Roulin, 2014). Management at River Valley Care Center should hire more nurses that share the same vision as the facility, and that can offer longevity. Hiring more nurses to fulfil different positions (e.g team lead, break relief, etc.) will put more nurses on the floor to decrease workload, such as nurse-patient ratio, scheduling labs or appointments, task and treatments, medication passes, and communicating with physicians. Management can give guidance, direction, and sense of stability to their nursing staff to improve performance effectiveness and job satisfaction. A bureaucratic leadership role will allow the nurses to share ideas and vision to resolve issues and improve nurse and patient outcome (Goodare, 2017).. Moreover, management encourage and support teamwork within the nursing staff, so that everyone feel like they are equally apart of the facilities vision to promote quality care to all individuals of the community.

Identification of Potential Barriers to Plan Implementation, and a Discussion of How These Could Be Overcome

The main barrier this research project faced was inability to change, among management that feel that their management skills do not need retouching. Even though, the nurses at River Valley Care Center have the intention on leaving due to job dissatisfaction and poor work environment, the facility seems to think to recruit and sign-on bonuses to replace nurses is the solution. Nurse retention methods previously stated will decrease the facility cost to recruit and train. These methods will promote job contentment, and guarantee longevity and commitment to the facility.


Appendix A: Poster Presentation

Appendix B: Letter to Management

The research “Literature review: Why do we continue to lose our nurses?,” was conducted to understand why nurses leave their current place of employment less than 3 years of employment. A semi-structed interview was used among moderate to large group of articles with keywords of nurse, and leaving nurses, that was later narrowed down to 22 articles to focus the research on. Research had suggested that the main cause of nurses leaving the position was due to deteriorating work environment, lack of teamwork and lack of support from an organizational level. Moreover, nurses felt that if their values and belief was not supported or equal to the organization values and belief, then a disconnected relationship was for sure to occur.

Therefore, this study has drawn the conclusion that job satisfaction and poor work environment had a direct relationship to nurse turnover (Goodare, 2014).

For my capstone project, I would like to identify the reason for nurse turnover or nurse intentional turnover. Retaining nurses can save the facility money that would be used to recruit and train new nurses, and improve quality care and outcome. With that said, I suggest these methods to retaining nurse as followed:

Appendix B: Letter to Management

  • Hiring more nurses to fulfil different positions (e.g team lead, break relief, etc.)
  • Provide guidance, direction, and sense of stability
  • Allow the nurses to share ideas and vision through collaboration
  • encourage and support teamwork
  • Appendix

Thank You!

  • Decrease workload


Goodare, P. (2017). Literature review: Why do we continue to lose our nurses?. Australian Journal Of Advanced Nursing, 34(4), 50-56.


Adams, S. L. (2016). Influences of Turnover, Retention, and Job Embeddedness in Nursing Workforce Literature. Online Journal Of Rural Nursing & Health Care, 16(2), 168. doi:10.14574/ojrnhc.v16i2.405

Cox, P., Willis, K., & Coustasse, A. (2014). The American Epidemic: The U.S. Nursing Shortage And Turnover Problem. Insights To A Changing World Journal, 2014(2), 54-71.

Dotson, M. J., Dave, D. S., Cazier, J. A., & McLeod, M. D. (2013). Nurse retention in rural United States: A cluster analytic approach. International Journal Of Healthcare Management, 6(3), 184-191. doi:10.1179/2047971913Y.0000000037

Goodare, P. (2017). Literature review: Why do we continue to lose our nurses?. Australian Journal Of Advanced Nursing, 34(4), 50-56.

Omar, K., Abdul Majid, A. H., & Johari, H. (2013). JOB SATISFACTION AND TURNOVER INTENTION AMONG NURSES: THE MEDIATING ROLE OF MORAL OBLIGATION. Journal Of Global Management, 5(1), 44-55.

Parker, F. M., Lazenby, R. B., & Brown, J. L. (2014). The Relationship of Moral Distress, Ethical Environment and Nurse Job Satisfaction. Online Journal Of Health Ethics, 10(1), 48. doi:10.18785/ojhe.1001.02

Roulin, N., Mayor, E., & Bangerter, A. (2014). How to satisfy and retain personnel despite job-market shortage: Multilevel predictors of nurses’ job satisfaction and intent to leave. Swiss Journal Of Psychology, 73(1), 13-24. doi:10.1024/1421-0185/a000123

RWJF. (2014). Nearly One in Five New Nurses Leaves First Job Within a Year, According to Survey of Newly-Licensed Registered Nurses. Retrieved from–acc.html

Wang, Y., Dong, W., Mauk, K., Li, P., Wan, J., Yang, G., & … Hao, M. (2015). Nurses’ Practice Environment and Their Job Satisfaction: A Study on Nurses Caring for Older Adults in Shanghai. Plos ONE, (9), doi:10.1371/journal.pone.0138035

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