A Crisis in Nursing Los Rayos del Sol Medical Center is ahospital and surgery center located in Florida. A facility with 500beds, it has recently partnered with the Mayo Clinic. Los Rayos isexperiencing high turnover. The nurse average turnover rate is 14%for hospitals, while Los Rayos has a turnover rate of 21%. Newgraduate nurses turnover at a rate of 27% within their first year,with an additional 37% of those new nurses wanting to leave. At LosRayos, new nurse turnover is 40%. The hospital spends an average of13 weeks to fill a vacant position and thousands of dollars perhire. Turnover often leaves units understaffed and having poormorale and lower quality of patient care. Why are the nursesleaving? Los Rayos strives to provide the highest quality patientcare, but it also has to manage costs to comply with governmentregulations. Thus, over the past 10 years, Los Rayos has made anumber of changes. Ten years ago, Los Rayos changed the staffingmodel. All units had two licensed nurses and a housekeeper.Housekeepers were minimum wage staff that helped nurses do thingslike washing linens and stocking the nurses’ station with basics.These tasks can take a lot of time away from nurses’ normal jobduties of doing rounds, charting, administering doctor’s orders,and helping patients. Los Rayos promoted the housekeepers to healthtechs, who were supposed to do more patient care tasks, but mostwere not equipped with the skills. At the same time, Los Rayosreduced the number of nurses by one. This raised staffing ratiosfrom 12 patients to one nurse to 22 patients to one nurse. Otherchanges included the following: • Eight years ago, Los Rayos cutthe annual employee picnic and Christmas party in order to savecosts. • Five years ago, Los Rayos expanded nurses’ jobs to engagein activities like cost cutting and quality control. It requirednurses to provide three to five cost-saving ideas per year or theywould be negatively evaluated on their performance appraisals. •Two years ago, Los Rayos began using tablets for patients’ chartsand dispensing medicine. To prevent drug theft, medicine carts wereequipped with a new security system that requires nurses to scanthe patient’s hospital bracelet with the tablet, select themedication, and confirm the order before the tablet sent theinformation to the cart and unlocked the needed medicine. While itprevents theft, the process caused frustration to both the nurseand the patient. • A year ago, Los Rayos began requiring all itsnurses to take turns developing, planning, and presentingcontinuing education courses. Nurses are required to complete 60hours of continuing education annually for license renewal. • Sixmonths ago, Los Rayos changed from 8-hour to 12-hour shifts toreduce costs and allow patients to be closer to their caretakers.However, patients from the maternity and geriatric wards havecomplained about only seeing nurses at the start and end of shift.Some employees like 12-hour shifts; however, most agree that theseshifts are exhausting, and the nurses often state they don’t havethe time and energy to “go the extra mile” for colleagues andpatients. Discussion Questions 1. How might the changes Los Rayosmade affect nurses’ attitudes? What problems to the hospitaloutcomes might poor nurse attitudes cause? 2. Which of the jobattitudes from the chapter do you feel is the biggest contributorto nurse turnover and why? The smallest contributor and why? 3. Howmight leadership and the personality of nurse managers andadministrators be affecting the situation? Be specific. 4. If youwere the director of a hospital and going to do a survey ofemployee attitudes, which attitudes would you include on thesurvey? Why?