Nursing workforce shortages remain a serious concern for healthcare organizations because they affect patient safety, employee well-being, and the continuity of healthcare services. When healthcare facilities operate with insufficient nursing personnel, existing staff often assume additional responsibilities, experience increased occupational stress, and struggle to maintain consistent standards of patient care. Research by Alzoubi et al. (2024) identifies important relationships among nursing workloads, burnout, turnover intentions, and healthcare quality. These challenges demonstrate the need for organizational interventions that address both staffing availability and the working conditions influencing nurses’ decisions to remain employed.
Evidence-based practice (EBP), implementation science (IS), and quality improvement (QI) provide complementary approaches to addressing these challenges. EBP identifies interventions supported by research, implementation science examines how those interventions can be integrated into routine practice, and QI evaluates whether the changes improve organizational performance. This assessment examines three potential healthcare settings for an EBP and QI initiative addressing nursing shortages. It identifies St. Francis Health Services as the preferred setting, evaluates the stakeholders involved, examines the organizational practice problem, and proposes the Knowledge-to-Action (KTA) Framework to guide implementation and sustainability.
Selecting an appropriate healthcare organization is essential to the success of an evidence-based improvement initiative. The selected setting should demonstrate a meaningful practice problem, sufficient organizational support, access to relevant stakeholders, and the ability to evaluate outcomes. Three healthcare organizations are considered for this project: St. Francis Health Services, Riverwood Regional Medical Center, and Lakeside Rehabilitation and Care Center.
St. Francis Health Services is considered a potential implementation setting because the nursing workforce challenges described in the available evidence are relevant to its operations. Robinson (2022) reported that St. Francis Medical Center experienced staffing shortages during the COVID-19 pandemic, requiring additional personnel support to maintain healthcare services. Although this report concerns a particular period and facility, it provides a documented example of how staffing pressures can disrupt healthcare operations.
For this assessment, St. Francis is evaluated as a potential site for implementing strategies that strengthen nurse retention, improve workforce planning, and support employee development. The proposed project would benefit from collaboration among nursing leadership, human resources, frontline nurses, and quality improvement personnel.
An important consideration is whether the organization currently has sufficient administrative capacity, staff engagement, and data systems to support the initiative. These capabilities must be confirmed through organizational assessment before implementation.
Riverwood Regional Medical Center represents an acute care setting in which staffing availability is particularly important for emergency services and timely clinical interventions. Riverwood Healthcare Center (2021) documented an emergency department leadership appointment, demonstrating the organization’s involvement in managing emergency care operations.
Emergency departments require coordinated staffing arrangements because patient demand and clinical acuity can change rapidly. Inadequate nursing coverage may increase workload pressures, reduce operational flexibility, and affect the timeliness of patient care.
Riverwood offers a relevant environment for evaluating staffing interventions, particularly those involving workforce scheduling and emergency department support. However, the feasibility of an organization-wide project would depend on leadership approval, staffing resources, and the availability of reliable workforce information.
Lakeside Rehabilitation and Care Center is considered as a long-term care and rehabilitation setting. Nursing shortages in these environments are especially concerning because residents may require ongoing clinical monitoring, assistance with daily activities, medication management, and coordination of complex care.
Research examining nursing homes has identified relationships among nurse burnout, job dissatisfaction, and missed nursing care (White et al., 2019). Such findings demonstrate why long-term care facilities are important settings for workforce improvement initiatives.
A facility such as Lakeside could potentially benefit from structured mentorship, supportive supervision, and improved staff scheduling. However, the assessment does not establish its actual staffing levels, organizational resources, or existing retention programs. These factors would need further evaluation before determining whether the organization is prepared to undertake the proposed initiative.
Each potential implementation setting presents opportunities and limitations that may influence the effectiveness of an EBP and QI initiative. The following comparison distinguishes proposed advantages from organizational characteristics that require confirmation.
|
Healthcare organization |
Potential strengths |
Potential limitations |
|---|---|---|
|
St. Francis Health Services |
Documented historical staffing challenges; opportunities for multidisciplinary collaboration and workforce improvement |
Current QI capacity, leadership support, and access to staffing data require verification |
|
Riverwood Regional Medical Center |
Relevant acute care environment; opportunities to improve emergency department staffing and workforce coordination |
Variable patient demand, clinical workload pressures, and possible implementation disruptions |
|
Lakeside Rehabilitation and Care Center |
Focused long-term care environment; opportunities for targeted retention and mentorship initiatives |
Organizational resources, workforce size, and available improvement infrastructure are not established |
St. Francis emerges as the preferred setting because its documented experience with staffing shortages provides a relevant starting point for a proposed improvement project. Nevertheless, selecting the organization does not establish that current workforce conditions remain unchanged from those described in earlier reports.
The organization would need to provide current information about nurse turnover, staffing vacancies, employee satisfaction, and existing recruitment practices. Without these baseline measures, the effectiveness of an intervention cannot be evaluated accurately.
St. Francis Health Services is selected as the proposed implementation site for the EBP and QI initiative. The primary justification is the relevance of its documented staffing challenges and the opportunity to examine how evidence-based workforce strategies could support organizational stability.
The initiative would focus on reducing avoidable nursing turnover, improving employee satisfaction, and strengthening organizational support for nursing personnel. These priorities are consistent with research linking workplace conditions and workload pressures to nurses’ intentions to leave their positions (Alzoubi et al., 2024).
The proposed setting also provides an opportunity to integrate several organizational functions. Nursing leadership can identify staffing challenges, human resources personnel can examine recruitment and retention patterns, and nurse educators can support professional development interventions.
Successful implementation would depend on establishing a multidisciplinary project team and confirming that the organization can collect meaningful workforce and patient safety information. This assessment therefore presents St. Francis as a proposed implementation setting rather than suggesting that organizational approval or project activities have already occurred.
The site selection process involves evaluating organizational relevance, implementation feasibility, stakeholder participation, and opportunities for measurable improvement. These criteria help determine whether an EBP initiative can address an identified practice problem while remaining compatible with organizational priorities.
St. Francis was preferred because the available documentation establishes a historical workforce challenge that could reasonably inform a nursing retention project. Riverwood offers opportunities to examine staffing concerns in acute care, while Lakeside represents the distinctive workforce demands associated with long-term care.
The decision also considers the potential for sustaining improvement. Recruitment initiatives alone may not resolve nursing shortages if working conditions continue to encourage employees to leave. An effective strategy must therefore examine the factors contributing to turnover and develop interventions that address those factors.
For St. Francis, the proposed approach combines professional mentorship, flexible scheduling, and supportive leadership practices. These interventions would require an initial organizational needs assessment to determine their appropriateness and feasibility.
Final site approval should depend on confirmation of organizational readiness, access to workforce data, and willingness among stakeholders to participate in the improvement process.
Stakeholder engagement is fundamental to implementing organizational change because workforce interventions affect multiple departments and professional groups. The proposed initiative at St. Francis requires collaboration among executive leadership, nursing administrators, human resources personnel, nurse educators, quality improvement specialists, and frontline nursing staff.
Executive leadership would provide authorization, establish strategic priorities, and determine whether sufficient resources are available. The director of nursing would oversee clinical implementation and ensure that proposed changes remain compatible with patient care requirements.
Human resources personnel would contribute information about recruitment, turnover, vacancy rates, and employee retention practices. Nurse educators would coordinate mentorship and professional development activities, while QI specialists would support data collection and evaluation.
Frontline nurses are particularly important because they experience staffing challenges directly and can identify practical barriers to implementing proposed changes.
|
Stakeholder |
Proposed responsibilities |
|---|---|
|
Chief Executive Officer |
Approve the initiative, allocate resources, and provide executive oversight |
|
Director of Nursing |
Lead nursing implementation, coordinate clinical teams, and monitor staffing outcomes |
|
Quality Improvement Specialist |
Establish performance indicators, collect data, and evaluate project outcomes |
|
Human Resources Manager |
Analyze recruitment and retention patterns and support workforce policies |
|
Nurse Educators |
Develop mentorship programs, provide training, and assess professional development needs |
|
Frontline Nurses |
Identify workflow concerns, participate in interventions, and provide implementation feedback |
Stakeholder engagement should begin before intervention selection. Structured discussions, staff feedback sessions, and collaborative planning meetings can help identify the underlying reasons for employee dissatisfaction and turnover.
This approach is important because workforce challenges may vary across departments. An intervention that benefits one nursing unit may require modification before being introduced elsewhere.
The central practice problem addressed in this assessment is the shortage of nursing personnel and its potential consequences for healthcare quality, employee retention, and organizational performance.
Nursing shortages are influenced by several interconnected factors, including workload intensity, occupational burnout, limited professional support, and workforce turnover. Alzoubi et al. (2024) examined relationships among nursing workloads, burnout, turnover intentions, and healthcare quality, highlighting the importance of considering workforce conditions when developing organizational improvement strategies.
Insufficient staffing can create a cycle in which existing nurses experience increased workloads, resulting in greater emotional exhaustion and dissatisfaction. These conditions may encourage additional staff departures, placing further pressure on the remaining workforce.
The consequences extend beyond employees. When nurses are responsible for excessive workloads, opportunities for patient education, care coordination, and timely clinical monitoring may become limited. Naseem et al. (2024) discuss the implications of staff shortages for patient safety and healthcare quality.
Workplace conditions are important determinants of whether nurses remain in their positions. Organizational approaches that focus exclusively on hiring may provide temporary staffing relief without addressing the reasons employees leave.
Professional development opportunities and supportive leadership can contribute to a more positive working environment. Cleaver et al. (2021) examined factors influencing older nurses’ retirement decisions, demonstrating that workforce retention is influenced by complex professional and personal considerations.
Work flexibility is another relevant issue. Lee and Chang (2022) examined relationships involving work satisfaction, flexibility, and nurse burnout. Their work provides a rationale for considering scheduling arrangements as part of a broader retention strategy.
Psychological well-being must also be addressed. Green and Kinchen (2021) examined mindfulness meditation in relation to stress and burnout among nurses. Although mindfulness interventions may provide individual support, they should complement rather than replace organizational efforts to improve staffing conditions.
Together, these findings support a multifaceted improvement strategy that addresses both employee experiences and institutional workforce practices.
EBP, implementation science, and QI serve different but connected purposes within the proposed project.
Evidence-based practice guides the selection of interventions through the integration of research findings, clinical expertise, and relevant stakeholder preferences. In the St. Francis initiative, EBP would support decisions about mentorship, scheduling flexibility, and employee support programs.
Implementation science focuses on the processes that enable evidence-supported interventions to become part of routine organizational practice. This includes identifying barriers, evaluating organizational readiness, engaging stakeholders, and adapting interventions to local conditions.
Quality improvement provides the methods for determining whether changes produce measurable benefits. The project would use routinely collected organizational information to evaluate retention outcomes, employee satisfaction, and relevant indicators of patient safety.
These approaches are complementary rather than interchangeable. An intervention may have research support but still fail if employees are unable to implement it consistently. Similarly, an intervention may be successfully introduced without producing meaningful improvements in retention.
The integration of all three approaches allows the project to examine both implementation success and organizational outcomes.
The Knowledge-to-Action Framework is selected to guide the translation of research evidence into practical workforce improvement strategies at St. Francis.
The framework distinguishes between knowledge creation and the action cycle. Knowledge creation involves identifying and synthesizing relevant evidence and developing practical knowledge tools. The action cycle supports the adaptation, implementation, evaluation, and sustainability of evidence-informed practices.
Bhardwaj et al. (2021) describe the application of the KTA Framework within a health promotion initiative, illustrating its usefulness for organizing the movement of knowledge into practical action.
The framework is appropriate for the proposed nursing workforce project because staff retention is a complex organizational problem. Evidence-supported interventions must be adapted to local staffing patterns, organizational policies, employee preferences, and available resources.
The KTA Framework also supports continuous assessment of implementation barriers and outcomes. This is important because workforce initiatives may require adjustments as organizational conditions change.
A review by Østergaard et al. (2023) examined knowledge translation frameworks in family-focused nursing care, providing additional context for their application within nursing practice.
Identify the practice problem
Review current staffing vacancies, turnover patterns, employee concerns, and relevant patient safety indicators to establish the scope of the workforce challenge.
Identify and synthesize relevant knowledge
Examine research concerning nurse retention, professional mentorship, flexible scheduling, occupational burnout, and supportive leadership.
Adapt knowledge to the organization
Determine which interventions are compatible with staffing requirements, workforce policies, financial resources, and the needs of nursing personnel.
Assess barriers and facilitators
Consult frontline nurses, managers, and human resources personnel to identify barriers such as scheduling constraints, limited training time, and inadequate organizational support.
Select and implement interventions
Introduce a structured mentorship program, evaluate scheduling flexibility, and establish mechanisms for regular employee feedback.
Monitor knowledge use and evaluate outcomes
Assess whether interventions are adopted consistently and whether turnover, job satisfaction, and workforce stability improve.
Sustain successful changes
Incorporate effective practices into organizational policies, orientation procedures, leadership responsibilities, and ongoing QI activities.
The framework should be applied iteratively. For example, if a scheduling intervention increases employee satisfaction but creates difficulties maintaining safe clinical coverage, the project team would need to modify the scheduling approach before expanding implementation.
A formal mentorship program is recommended to improve professional support, particularly for newly recruited nurses and employees transitioning into unfamiliar clinical responsibilities.
Experienced nurses could provide guidance regarding clinical workflows, communication practices, organizational expectations, and professional development. Mentorship may help employees feel more supported during challenging transitions.
The proposed program would include mentor orientation, defined participation expectations, scheduled discussions, and periodic evaluations.
However, mentorship must be implemented without creating unreasonable additional responsibilities for experienced nurses. Appropriate workload planning and administrative support would therefore be necessary.
Scheduling flexibility is another proposed intervention because work arrangements may influence employee satisfaction and burnout.
Potential approaches include self-scheduling opportunities, predictable shift rotations, and structured procedures for requesting schedule adjustments. Lee and Chang (2022) provide relevant evidence concerning work flexibility and nurse burnout.
Scheduling changes must preserve appropriate clinical coverage and avoid distributing undesirable shifts unfairly among employees. Nursing leadership should therefore evaluate scheduling proposals using staffing requirements, patient acuity, and employee feedback.
Leadership practices influence the working environment and may affect employee engagement and retention.
The proposed project would establish regular opportunities for nurses to communicate workplace concerns, recommend improvements, and receive feedback about organizational decisions.
Brief interdisciplinary huddles may also support communication and teamwork. Rowan et al. (2022) conducted a systematic review examining the effects of huddles on healthcare teams’ work engagement, teamwork, and job satisfaction.
These communication practices could complement broader retention strategies by improving coordination and strengthening relationships between employees and organizational leadership.
A structured evaluation process is necessary to determine whether the proposed interventions improve nursing workforce stability. The initiative should begin with a baseline assessment followed by a pilot implementation period and subsequent outcome evaluation.
The initial assessment would examine employee turnover, nursing vacancy rates, job satisfaction, and participation in existing professional development activities. This information would help the project team identify priority areas and establish measurable improvement objectives.
The proposed intervention could be piloted within one nursing department over approximately six months. During this period, the project team would implement mentorship activities, evaluate scheduling adjustments, and collect regular staff feedback.
Quality improvement methods, including Plan-Do-Study-Act (PDSA) cycles, could complement the KTA Framework by allowing the organization to test small changes before implementing them more widely.
|
Performance indicator |
Evaluation method |
Proposed improvement objective |
|---|---|---|
|
Nurse turnover rate |
Human resources employment records |
Reduce turnover by 10% relative to baseline |
|
Employee satisfaction |
Anonymous staff surveys |
Improve favorable responses by 15% relative to baseline |
|
Nursing vacancy rate |
Monthly workforce reports |
Reduce unfilled nursing positions |
|
Mentorship participation |
Training and participation records |
Achieve 90% participation among eligible new nurses |
|
Scheduling satisfaction |
Employee feedback surveys |
Improve satisfaction with scheduling arrangements |
|
Patient safety |
Existing incident and quality reports |
Maintain or improve relevant safety indicators |
These objectives are proposed planning targets rather than established organizational benchmarks. Final targets should be determined after reviewing baseline performance, staffing requirements, and available resources.
The evaluation should also distinguish implementation outcomes from workforce outcomes. For example, high participation in a mentorship program demonstrates that the intervention has been adopted, but it does not independently establish that employee retention has improved.
A meaningful evaluation must therefore examine both intervention participation and measurable organizational changes.
Implementing workforce improvement strategies requires attention to fairness, employee confidentiality, patient safety, and responsible resource allocation.
Staff satisfaction surveys should protect employee privacy and allow nurses to express concerns without fear of retaliation. Workforce data should be accessed only by authorized personnel and reported in ways that protect individual employees.
Scheduling interventions should also be implemented equitably. Offering flexibility to certain employees without considering the needs of others may create dissatisfaction and undermine team cohesion.
Patient safety must remain a priority throughout the project. Workforce changes should not reduce necessary clinical coverage or place excessive responsibilities on inexperienced personnel.
Organizational leaders must also consider financial sustainability. Although mentorship programs and scheduling improvements may require initial investments, they could potentially reduce costs associated with repeated recruitment, orientation, and employee turnover.
The project team should evaluate these costs alongside workforce and patient care outcomes before recommending long-term implementation.
St. Francis should begin by conducting a comprehensive nursing workforce assessment to identify current staffing concerns and determine which factors contribute most significantly to employee turnover.
Based on the findings, the organization should prioritize interventions that address documented employee needs. Structured mentorship and improved scheduling practices represent reasonable starting points, provided that leadership and frontline nurses consider them feasible.
The organization should establish a multidisciplinary implementation team responsible for coordinating project activities, monitoring performance indicators, and communicating progress.
Continuous employee involvement is essential because nurses can identify practical challenges that may not be apparent from administrative workforce reports. Their feedback should inform decisions about modifying or expanding interventions.
Finally, successful practices should be incorporated into routine organizational procedures rather than remaining temporary improvement activities. Policies, staff orientation processes, leadership accountability, and periodic workforce evaluations can help sustain beneficial changes.
Nursing workforce shortages create significant challenges for healthcare organizations by increasing employee workloads, contributing to occupational burnout, and potentially compromising patient care. Addressing these challenges requires more than recruitment efforts because workforce stability also depends on supportive working conditions, professional development, and effective organizational leadership.
This assessment identifies St. Francis Health Services as a proposed setting for an EBP and QI initiative addressing nursing shortages. The Knowledge-to-Action Framework provides a structured approach for translating research evidence into practical interventions while considering organizational readiness, stakeholder participation, and implementation barriers.
Structured mentorship, flexible scheduling, and supportive leadership are proposed as complementary strategies for improving nursing retention and employee satisfaction. By combining evidence-based practice, implementation science, and continuous quality improvement, the organization could develop a sustainable approach to workforce management. The success of the initiative would ultimately depend on verified organizational needs, measurable outcomes, and continued collaboration among nursing personnel and healthcare leadership.
Alzoubi, M. M., Mugheed, K., Oweidat, I., Alrahbeni, T., Alnaeem, M. M., Alabdullah, S., Abdelaliem, F., & Hendy, A. (2024). Moderating role of relationships between workloads, job burnout, turnover intention, and healthcare quality among nurses. BMC Psychology, 12, Article 1–9. https://doi.org/10.1186/s40359-024-01891-7
Bhardwaj, P., Jain, Y., Joshi, N., Singh, K., Suthar, P., & Joshi, V. (2021). Developing a health-promoting school using a knowledge-to-action framework. Journal of Education and Health Promotion, 10(1), 306. https://doi.org/10.4103/jehp.jehp_1139_20
Cleaver, K., Markowski, M., & Wels, J. (2021). Factors influencing older nurses’ decision-making around the timing of retirement: An explorative mixed method study. Journal of Nursing Management, 30(1), 169–178. https://doi.org/10.1111/jonm.13447
Green, A. A., & Kinchen, E. V. (2021). The effects of mindfulness meditation on stress and burnout in nurses. Journal of Holistic Nursing, 39(4), 356–368. https://doi.org/10.1177/08980101211015818
Lee, F., & Chang, Y.-J. (2022). The effects of work satisfaction and work flexibility on burnout in nurses. Journal of Nursing Research, 30(6), 82–93. https://doi.org/10.1097/jnr.0000000000000522
Naseem, S., Naseem, S., & Amir, Z. (2024). Effect of staff shortage on patient safety and quality of care. Annals of Human and Social Sciences, 5(4), 158–164. https://doi.org/10.35484/ahss.2024(5-IV)16
Østergaard, B., Eggenberger, S., LeMoine, D., Mulcaster, A., & Imhof, R. (2023). Implementation and efficacy of knowledge translation frameworks in family-focused nursing care: A scoping review. Journal of Clinical Nursing, 32(19–20), 7086–7100. https://doi.org/10.1111/jocn.16848
Riverwood Healthcare Center. (2021, November 29). Riverwood announces new emergency department manager. https://riverwoodhealthcare.org/riverwood-announces-new-emergency-department-manager/
Robinson, I. (2022, February 16). “Pressure on the system”: St. Francis battling medical staff shortage due to COVID. The News-Star. https://www.thenewsstar.com/story/news/2022/02/16/st-francis-medical-staff-shortage-u-s-air-force-provides-assistance/6755271001/
Rowan, B. L., Anjara, S., Brún, A., MacDonald, S., Kearns, E. C., Marnane, M., & McAuliffe, E. (2022). The impact of huddles on a multidisciplinary healthcare teams’ work engagement, teamwork, and job satisfaction: A systematic review. Journal of Evaluation in Clinical Practice, 28(3), 382–393. https://doi.org/10.1111/jep.13648
White, E. M., Aiken, L. H., & McHugh, M. D. (2019). Registered nurse burnout, job dissatisfaction, and missed care in nursing homes. Journal of the American Geriatrics Society, 67(10), 2065–2071. https://doi.org/10.1111/jgs.16051
