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Institutions are also expanding scheduling allowances and shift preferences to accommodate student schedules (Lavizzo-Mourey, 2012). Tuition reimbursement and discounted, partnership programs are a significant trend in employee engagement and retention of employees who receive assistance from their employer. It is a win for both employee and employer, by boosting magnet status, and also supporting career longevity with opportunities for those obtaining advanced degrees. A second employee engagement trend in healthcare systems is the opportunity for flex scheduling. A resounding amount of nurse feedback in the last decade supports the positive aspects of flexible hours, scheduling, and shifts, promoting engagement and retention (Trossman,2016). When nurses are allowed input on unit-based scheduling and decision-making powers, it provides transparency and gives nurses empowerment in their environment (Trossman, 2016). Research conducted in hospitals with unit-based councils that implemented a flexible scheduling mechanism provided positive feedback and better staffing retention outcomes over time (Trossman, 2016). Flexible scheduling initiatives can include "self-scheduling," where staff selects their shifts initially, and nurse managers fill in holes based on the census (Trossman, 2016). Another flexiblestaffing model includes a float pool or “on-call” staff members to relieve the team when an influx of admissions or events occur (Trossman, 2016). Nurses feel less over-worked and report feeling “supported” in these models, resulting in lower burn out levels, and higher retention of employees (Trossman, 2016).Employee Engagement and Healthcare Quality
ORGANIZATIONAL PERFORMANCE11Employee engagement is essential in the retention of staff to provide care in a health care system, but it is also crucial in producing positive patient outcomes. Research provides evidence of how lack of engagement can produce increased medical errors, malpractice, and adverse patient outcomes (Decker & Rabat-Torki, 2016). In healthcare today, performance-based reimbursement standards loom over healthcare administrations to “pay for the best service, not mistakes,”(Decker & Rabat-Torki, 2016, p. para 3) and leadership must look to the root cause ofmany errors – the lack of employee engagement. Leadership must be held accountable for the quality of care their employees provide and strive for excellence in all aspects, including engagement activities (Decker & Rabat-Torki, 2016). Studies show that employee engagement begins and grows with investment in talent development, and healthcare leaders must implement systems for employees to flourish and grow to remain engaged (Decker & Rabat-Torki, 2016). Employees with higher performance appraisals are more likely to continue in their current role and provide higher levels of quality care (Decker & Rabat-Torki, 2016). Employers who provide clear communication at all levels of care tend to have higher patient outcomes than those who poorly communicate throughout their