solved Grayson County Regional Health Center is a private, not-for-profit, 225-bed

Grayson County Regional Health Center is a private, not-for-profit, 225-bed acute care hospital located in a rural community in a southeastern state. The hospital provides a broad range of inpatient and outpatient services, including cardiology, obstetrics, gynecology, general surgery, internal medicine, urology, family medicine, dermatology, pediatrics, psychiatry, radiology, nephrology, ophthalmology, occupational medicine, and rehabilitation services. The center offers 24-hour emergency care. The center is built on a 96-acre site, and its service area includes Grayson County and parts of three neighboring rural counties. In
the last 20 years, the region has suffered severe economic setbacks.
Most of the textile industry has moved out of the region because of
outsourcing, and the town itself has fallen into disrepair. An
increasing proportion of the population—33 percent of children and 22
percent of the elderly—lives below the poverty line. The county has a
civilian labor force of 27,568 and currently has an unemployment rate of
13 percent. The county’s infant mortality rate is 2 percent.The
center has 85 physicians, representing 29 subspecialties, on staff. It
has affiliation relationships with two academic health centers—one about
90 miles away, and the other 100 miles away. The center employs more
than 800 people, is fully accredited by The Joint Commission, and is
certified to participate in Centers for Medicare & Medicaid Services
(CMS) programs. The center is governed by an 18-member board of
trustees, which includes the chief of the medical staff, the immediate
past chief of the medical staff, the chief executive officer, and 13
members selected by the board from the community at large.The
center has strong community ties. Its staff members participate in
community health screenings, health education programs, and health
fairs. It serves as the meeting place for many support groups. Although
it has been under financial stress for the last five years, it continues
to have strong support in the community.The
employee turnover rate at the center is 40 percent. Over the last few
years, the turnover rate for nurses has ranged from 15 to 50 percent.
Physician recruitment and retention are also major concerns. Currently,
only one radiologist is practicing in Grayson County, and there is a
shortage of physicians in all specialties.The
center relies heavily on Medicaid and Medicare revenue, leaving the
hospital in a difficult financial condition. It is unable to pay market
rates for nurses and other professionals, so nursing units are
understaffed, and nurses feel overworked and underpaid. The quality of
patient care may also be decreasing. A local newspaper article reported
that patients at the center were often left on stretchers in the hallway
for long periods, staff members were unresponsive to patient and family
concerns, and crying in the hallways is not unusual.Nurses
and other professional groups report poor communication between senior
management and employees. Bad relationships between middle managers and
frontline staff are also a problem in some departments. This situation
became particularly difficult two years ago when the center embarked on a
large building project. Employees could not understand how the center
could afford to build new facilities but was unable to pay market rates
to its staff.The
nursing turnover problem at the center has reached crisis proportions.
Recent exit interview surveys indicate that financial concerns are the
major reason for leaving. The center has tried numerous strategies,
including improving the work environment by adding amenities (such as
lower prices in the cafeteria) and training middle managers. For a short
time 18 months ago, nurse salaries matched market rates, but the center
fell behind again shortly thereafter. The RN vacancy rate currently is
18 percent.As
a consultant to the center, you are expected to make recommendations to
address the nursing shortage. Specifically, you have been asked to
develop short-term strategies to cope with the current crisis and
long-term strategies to improve the overall recruitment and retention
picture. Consider the following questions: How will you identify the most important reasons for the current shortage?How will you develop specific short-term and long-term strategies?