The first section of the Quality Healthcare Workplace Model involves the driving forces behind employee engagement. These drivers include work environment, job characteristics, and organizational support. The lack of two of the three of these drivers, work environment and organizational support, are emphasized by American Sentinel and the University of New Mexico as being top reasons for nursing turnover. Nurses can often feel over worked in a hectic work environment. This environment could be attributed to the types of patients they see, the level of risk those patients are, the number of comorbidities the patients have, and the nurse-to-patient ratios. For instance, according to NursingLicensing.org (2018), “A survey of nurses by the American Nursing Association found 54% [of nurses] saying that they did not have sufficient time to spend on each patient, despite 43% of the respondents working longer hours during the prior year.” Patients not receiving quality care from their nurse, because the nurse is spread too thin between numerous patients. Not only is quality scarified, but the nurses end up over-worked and stay past the twelve-hour mark of their shift end. Nurses stay late in order to complete necessary paperwork and give report on patients to the oncoming nurse. By focusing on making improvements to the three drivers, work environment, job characteristics and organizational support, the second and third sections of the Quality Healthcare Workplace Model are predicted: individual and organizational outcomes. Individuals, such as nurses, feel that they are engaged and capable and qualified of the work they are doing in his/her department, specialty or service. A second individual outcome that is anticipated for this model would greatly benefit nurses, and that is employee health, safety and quality of work-life. By creating these two individual targets to improve employee engagement, the nursing staff can focus on doing the best job that they can by practicing at the top of their licensure, but they can also feel that work is not dictating and controlling their lives. When a job takes over one’s life, it can be daunting and can cause disengagement. Nurses will inevitably have burnout if their needs are not focused on. Thus, by focusing on the three drivers and the two individual outcomes for the Quality Healthcare Workplace Model, nurses should have improved engagement, and thus improved retention. The third section of the Quality Healthcare Workplace Model involves the overall organization’s anticipated outcomes, including quality and patient safety; retention, recruitment and employer reputation; and employee productivity and costs. A main idea behind employee engagement is that when employees are actively engaged, patient safety and the quality of patient care are boosted. This particularly applies to the nursing staff. If a nurse is unhappy with his/her job, they are less likely to go above and beyond the call of duty to make sure that the patient is happy and has a quality hospital stay. When employees are disengaged, employee productivity declines and turnover rates increase. When turnover rates increase, costs also increase. Thus, by focusing on employee engagement and the three drivers of employee engagement, organizations will be creating satisfied employees, improving retention, improving productivity, and improving patient safety and quality of the patient visits. When retention improves, the turnover costs of a single nurse referenced previously will decrease. This allows for the healthcare entity to put the funding toward hiring new talent to developing internal talent and leadership. When using a boat for an example, engaged nurses will not poke holes in the boat. Unengaged nurses will, and a boat with holes will sink. A healthcare entity cannot function without its array of nursing staff, including Certified Nursing Assistants, or CNAs; Licensed Practical/Vocational Nurses, or LPNs/LVNs; and Registered Nurses, or RNs. By increasing the engagement of the nurses and their satisfaction as employees, a healthcare entity can have very rewarding results. There has been a large push for employee engagement improvements across different healthcare entities in the United States. These organizaitons form survey questions that are then distributed to employees that anonymously respond and complete the surveys. Though the survey cannot link answers to a specific employee, it can link them to a department to determine not only how the overall entity is doing in terms of satisfied employees, but in terms satisfaction in specific departments. One product that has developed a set of twelve questions that predict the most engaged employee work places. Gallup has a database with over 35 million respondents. With their vast quantity of respondents, Gallup has “discovered there are 12 employee needs that, when met, improve your organization’s productivity,” (2018). These twelve questions, known as Gallup Q12, range from the individual’s basic job knowledge to having opportunities to grow and develop at work. For an organization, utilizing this tool would be very beneficial for determining where most of the engaged employees lay. If a healthcare entity were to take survey information from Gallup Q12 and notice that the nursing staff was disengaged, the organization could then dig deeper and find out why. Perhaps the nurses feel that they are working below their licensure, such as RNs doing CNA work most of the time, the entity can work toward moving the nurses into more appropriate positions for their training background. Perhaps the survey results reveal that nurses feel that they are stuck with no room for development and growth within the organization. This data and information can then be utilized to create a compensation package that contains tuition reimbursement to encourage nurses to get their Master of Science in Nursing or even become a Nurse Practitioner. This data could also be used to figure out where more support staff, such as Patient Care Techs, could come in handy so that the Registered Nurses could more effectively work within their licensure. Another topic that Gallup’s twelve questions analyze is the employee’s relatability to the organization and how they feel about their job’s importance. For instance, if a nurse is doing work at a teaching hospital, such as UAMS, and he feel that his calling is more pediatric oriented than adult oriented, his values and morals may not align with the organization. This could lead to burn out, as the nurse may feel that their work is not satisfying an internal moral compass. However, if the nurse is aligned with the mission, values and goals of the organization, he may feel more satisfied with his job and perform hand over fist better than his unsatisfied nurse counterparts. Another item of that Gallup’s Q12 addresses is recognition. Nursing can be a thankless job. People who come into the hospital for an in-patient stay are usually very sick. They may not always recognize the nurse for what he does for them, whether it is required, such as changing sheets, checking vitals, or administering meds, or whether it is voluntary, such as getting an extra pillow for comfort or a warmed blanket because the patient is cold. Nursing can be thankless, and by having a manager formally recognizing employees, it can lift the spirits of nurses and let them know that their work does not go unnoticed. It shows the nursing staff that there are people who are truly thankful for the hard work and the countless hours that is invested in their patients. This can create and foster an internal sense of pride and self-worth, creating a much happier, engaged employee. The Gallup Q12 is just one helpful and recommended tool to analyze the workforce and improvement processes in place. In Human Resources in Healthcare: Managing for Success, Bruce Fried and Myron Fottler outline a few key practices that can help prevent an unengaged nursing workforce. These include, “involve nurses in unit decision making” “provide adequate support staff,” and “examine workload and quality data,” (Fried, 2015, p. 467). By having nurses participate in making decisions for their units, nurses can express issues that they combat day-to-day, such as having too many patients per one nurse or lack of nursing support staff. When the staff comes together to create a plan for each day or for the month or quarter, it is imperative that every aspect of the workforce for a department or area is acknowledged. By acknowledging the needs of employees, such as nurses on a Med-Surge floor, a plan of action can be decided on, and everyone can feel that their opinion is truly noticed and heard. By valuing the input of the staff, nurse managers help validate the needs and opinions of the nursing staff. Supplying nurses with a support staff extremely increases the nurses’ ability to function at the top of their licensure. For instance, in Labor and Delivery, a hospital volunteer could be responsible for answering phones and allowing individuals in and out of the department. In this department, there could also be approximately one Patient Care Tech, or PTC, per two nurses. This PTC would be responsible for cleaning any bodily fluids or beverage spills that could occur while a mother is having her stay. They could also be responsible for checking vitals and supplying the soon-to-be or new mother with ice chips and crackers. Another responsibility a Labor and Delivery Patient Care Tech could be assigned is to escort new parents and babies to the car and check that car seats are installed properly, new parents are taught how to fasten in the new babies into those car seats, and that the new parents understand the importance of safety and new babies while traveling. These examples of responsibilities would be delegated to the Patient Care Tech and taken away from a Registered Nurse, allowing the RN to focus on other measures within the department, such as aiding in a birth, monitoring a high-risk pregnancy, or preparing a new-mother for a cesarean delivery. The third factor that Fried and Fottler mention, analyzing the workload and its relation to quality is also important. Quality is becoming a more and more prominent and important aim in healthcare. According to CMS, the Center for Medicaid and Medicare Services, the Hospital Value-Based Purchasing, or VBP, Program intends to make “the quality of care better for hospital patients…[and to make] hospital stays a better experience for patients,” (The Hospital, 2018). The way the CMS VBP Program operates is by “withhold[ing] participating hospitals’ Medicare payments by a percentage,” (The Hospital, 2018). This reduction and withholding is then used to create an incentive for hospitals who accept Medicare as an insurance to increase quality standards. When the organization focuses on analyzing a nurse’s workload in its relation to quality, there could be a large impact on how the hospital is reimbursed for its services. If a nurse’s work or patient load is too large, the quality of care can suffer for any patient. For patients, specifically Medicare patients, the hospital could lose reimbursement dollars, thus making less revenue for its fiscal year. Less revenue could equate to fewer positions available, which could, in turn, drive up patient workload for nurses. By focusing on this workload in relation to quality, implementing decisions with nurses input in mind, and by hiring support staff for nurses, nurses should feel that the organization is supporting them in his/her efforts to provide the best care possible for each patient while functioning at the top of his/her licensure while keeping the quality providing care to patients high. When analyzing nursing turnover rates and burnout, it is important to remember that nurses are members of the healthcare workforce that are there because they found a passion in helping and caring for others. When one finds a passion that can be incorporated into a career path, that person will never truly work a day in his/her life. When nurses feel overworked and underappreciated, they can begin to feel the start of burnout setting in. This can lead to high turnover rates. In order to combat nurse turnover rates and burnout head-on, an organization can utilize Gallup’s Q12 to assess current employees. The results can also be integrated with the Quality Healthcare Workplace Model to create the ultimate employee-centered entity. When a healthcare entity truly acknowledges the value behind employee engagement, whether it is a more enjoyable work experience or higher quality scores and reimbursement from CMS, they can begin to see how important it is to develop an engaged nursing staff.