Nursing Turnover in Public Hospitals in New York City

Executive summary
The provision of public health in New York City is one of basic necessity needed by the growing population. Given that not every citizen can afford insurance, public hospitals become the primary source, and center of convenience and comfort to a considerable number of the population in the USA. In line with this, New York City public health facilities should continually improve service delivery to customers by ensuring that citizens health is not at risk since their health is the wealth for the country. For that reason, evidence-based practice comprises of improving clinical practice and work environment through the implementation of collected and processed research findings (French, 2002). The results are used to provide high quality and cost-efficient patient care. The management of public health hospitals should ensure that employees are satisfied and that also the health facilities uphold evidence-based practice which endorses strict adherence to values and procedure required for the provision of quality health care. To attain all this, the following milestones will be incorporated;
Proposed Care Support
First and foremost, evidence-based practice plays a significant role in ensuring that patients get the best service. As such, and for this to be attained, it means that nurses offering medical services should be more productive, streamlined, individualized, and dynamic to exploit clinical decisions (Porter, 2009). Towards this, they should first be satisfied with their work to make sound decisions that will not afterwards affect the health of the patients and subsequently make the organization to pay after being petitioned for compensation by the affected patients due to misdiagnosis. Accordingly, job satisfaction is brought along by several factors that should be offered by management and which include; effective communication, transformational leadership, teamwork and diversity inclusion. The hospitals management should use efficient and effective communication with nurses that not only touches on their responsibilities but also directly touches the organization given that they want job assurance. The organization will offer that communication, and through all this, everyone will feel that they matter. That way, quality delivery shall not be compromised in any way.
Value-Based Support
Public hospitals will need to invest a lot on infrastructure, different types of equipment and materials given that evidence-based practice uses all these components on daily operations. They include; infection control, Intravenous Catheter Size and Blood Administration, Oxygen use in patients with Chronic obstructive pulmonary disease (COPD) as well as measuring Blood Pressure Noninvasively in children. By doing so, all this is done by the staff that should thoroughly be trained to be well versed with the system and specific equipment and this enables staff to develop skills that make them satisfied with their work. Through that, the personal growth of employees will allow employees to form behaviours and norms that will facilitate the successful expansion of the public hospital.
Data Evidence
As stated in the introduction, public health facilities are affordable to many citizens, given that not all citizens can afford health insurance. As such, hospitals management should ensure that there are no burnout levels, stress levels, and job dissatisfaction. Going forward, the administration will be required to create a pleasant environment that supports productivity and teamwork, thereby enhancing personal job satisfaction. Currently, when employees work under high levels of stress to meet work demand and target set by the management, their esteem goes down, and in that condition, it becomes hard to improve productivity, carry the same vision and keep commitment to their duties. The enabling environment created by management shall ensure that the level of relations is improved which shall, in turn, increase the development of policies, thus mend team building and healthy interaction between the management and nurses. Nurses will also need to participate in decision making since they integrate with patients, and as such, they know some solutions to the challenges that public hospitals face. The Hospital will also be required to add some input so that the level of commitment and autonomy can be enhanced.
Strategies
The first strategy to be employed should be creating a functional and enabling environment that will improve the relationship between the management and nurses for its human relations that enables work to be done effectively. The situation will be facilitated through open communication where ideas and decisions shall be shared be made openly, thus ensuring that all pertinent issues are resolved, thereby reduce employee burn out. Once the employees are satisfied, interpersonal relationships will grow hence create teamwork which shall ease execution and delivery of organizational duties. Secondly, the employees will need to be provided with a room for improvement, which will be facilitated through training and development. Training and development will ensure the nurses are conversant with evidence-based practice five steps which include asking, acquire, appraise, apply and assess. By so doing, they will solve all problems given that they have the expertise, know values and understand patient preferences.
Strategy Defence
Management plans and oversees the execution of Hospital goals. Be that as it may, on the other hand, nurses are the executors of the work and based on that, they can either promote or demote the organization based on the working environment created by management. A pleasant working environment revolves around job satisfaction that prompts excellent delivery to the patients. Equally, leadership shapes effective management that grows the culture and values. For work to be done appropriately, employees should possess the requisite skills and knowledge to avoid overlap of duties. They should also be provided with the required materials and equipment, which matches evidence-based practice.
Change Theory
Theory change analyses how a given intervention can be used to lead to specific change development. Rogers theory change has five stages comprising of awareness, interest, evaluation, implementation and adoption (Ousey & Gallagher, 2007). For that reason, awareness has been created that there is a need to equip public health care facilities with equipment and staff. That management will also create a conducive environment for the employees by ensuring that employees are satisfied with their work to provide quality service as resonated by evidence-based practice. This is an area of interest to citizens, and as such, after evaluation, my project should be implemented given that it meets the required threshold.
Change Assessment
As stated herein above, health is a basic necessity which is not affordable to many citizens. In addition, as the government tries to streamline its operation, the same is met with various interests which are developed by different governments voted in now and then and based on that, the health agenda becomes outdated. For that reason, the best alternative would be to equip public hospitals with materials and equipment’s that will help leverage health. Employees are the executors of the work, and as such, the right environment and effective transformational leadership will ensure that public health systems and procedures work out. Finally, the top-level management (board of directors) should work hand in hand with the middle level (managers) and low-level class (nurses). All these levels and departmental heads will be united by communication and teamwork.

References
French, P. (2002). What is the evidence on evidence-based nursing? An epistemological concern. Journal of Advanced Nursing, 37(3), 250-257. doi: 10.1046/j.1365-2648.2002.02065.x
Ousey, K., & Gallagher, P. (2007). The theory-practice relationship in nursing: A debate. Nurse Education in Practice, 7(4), 199-205. doi: 10.1016/j.nepr.2007.02.001
Porter, M. (2009). A Strategy for Health Care Reform — Toward a Value-Based System. New England Journal of Medicine, 361(2), 109-112. doi: 10.1056/nejmp0904131

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