An Executive’s Guide to Keeping One of Your Hospital’s Most Valuable Resources
With no end in sight for the nation’s nursing shortage, hospitals are placing greater emphasis on retaining their current RN staff. It’s a complex process, requiring in-depth knowledge of the needs and wants of the nursing staff and lots of creativity. “You have to know what motivates nurses to stay,” says Pamela Thompson, CEO of the American Organization of Nurse Executives. To that end, many hospitals regularly conduct retention or exit surveys to understand what’s on nurses’ minds.
Leadership involvement is also important. “Nurses need to see support from the administration,” says Laura Janiscewski, competency development coordinator at North Arundel Hospital, Glen Burnie, Md. She says the hospital’s president and chief nursing officer make a point of getting to know the nursing staff; the CNO has lunch with nurses after they’ve been on the job for three months to make sure the job meets their expectations.
For hospitals that have successfully implemented retention programs, the trick seems to be in providing good working environments and professional development and to accommodate individual lifestyles.
“Most of the time, if nurses feel challenged and have the opportunity to grow in their career, they will be happy,” says Stacey Brull, R.N., director of magnet/professional development at Good Samaritan Hospital in Baltimore. The hospital offers courses for certified nurse assistants and licensed practical nurses to become registered nurses. It also offers a program for RNs to receive their bachelor of science in nursing degree.
The stresses of the job can be compounded by responsibilities outside of the workplace. Hospitals are doing what they can to support nurses on a personal level, which is where creativity mostly comes into play. From concierge services that help nurses with errands to day care to flexible scheduling, hospitals are doing whatever it takes to allow nurses to focus on their work and keep them in their jobs for years to come.
“It’s definitely a retention tool,” says Eric Artis, vice president of human resources for Presbyterian/St. Luke’s Medical Center, Denver, of the hospital’s concierge program. “It alleviates a lot of the burden from nurses, allowing them to concentrate on the job at hand.”
To foster staff retention, organizations need to develop environments in which nurses want to work. Among other things, nurses want safe workplaces that promote quality health care. “It’s the role of the nurse executive and nurse manager to establish a work environment that supports professional practice,” says Pamela Thompson, CEO of the American Organization of Nurse Executives. “That’s one key piece to retention.” It’s also important that nurses play an active role in shaping their environment. “Nurses want to work in a place that brings high quality to patients and know they have a role in the process,” says Susan Shelander, director of recruitment and retention for Memorial Hermann, Houston. Creating such an environment is not easy. The Nursing Organizations Alliance developed a set of principles to help hospitals and other health care entities create positive work environments. More than 40 nurse organizations, including AONE, have endorsed the principles.
| 1 | Respectful collegial communication and behavior | • Team orientation • Presence of trust • Respect for diversity |
| 2 | Communication-rich culture | • Clear and respectful • Open and trusting |
| 3 | A culture of accountability | • Role expectations are clearly defined • Everyone is accountable |
| 4 | The presence of adequate numbers of qualified nurses | • Ability to provide quality care to meet client/patient needs • Work and home life balance |
| 5 | The presence of expert, competent, credible, visible leadership | • Serve as an advocate for nursing practice • Support shared decision-making • Allocate resources to support nursing |
| 6 | Shared decision-making at all levels | • Nurses participate in system, organizational and process decisions • Formal structure exists to support shared decision-making • Nurses have control over their practice |
| 7 | The encouragement of professional practice and continued growth/ development | • Continuing education/certification is supported/encouraged • Participation in professional association encouraged • An information-rich environment is supported |
| 8 | Recognition of the value of nursing’s contribution | • Reward and pay for performance • Career mobility and expansion |
| 9 | Recognition of nurses for their meaningful contribution to the practice |
Source: The Nursing Organizations Alliance, 2005
| ONE | Sustained leadership commitment to workforce as a strategic imperative |
| TWO | A culture centered around employees and patients |
| THREE | Work with other organizations to address workforce needs |
| FOUR | Systematic and structured approach to four strategies outlined in the 2002 AHA report, “In Our Hands.” They include: foster meaningful work, improve the workplace partnership, broaden the base to attract a more diverse workforce and collaborate with other organizations, including other hospitals in the community and schools, to ensure an adequate workforce in the future. |
| FIVE | Excellence in human resource practice |
Source: The AHA Commission on Workforce for Hospitals and Health Systems, 2005
Nursing employment status in U.S. community hospitals shows the largest upward shift in full-time RNs. Full-time LPNs showed the largest decline over the five-year span.
|
Nurse types
|
2004
|
2003
|
2002
|
2001
|
2000
|
1999
|
| Full-time RN |
826,658
|
796,715
|
772,479
|
751,095
|
745,113
|
739,086
|
| Part-time RN |
452,882
|
449,340
|
431,274
|
413,832
|
424,801
|
397,950
|
| Full-time LPN |
99,883
|
103,635
|
104,058
|
104,534
|
101,683
|
106,739
|
| Part-time LPN |
42,945
|
45,367
|
43,600
|
43,446
|
45,011
|
45,561
|
Source: American Hospital Association, AHA Hospital Statistics, 2005
Nurse turnover rates are stabilizing, compared to last year.
|
2nd Quarter 2004 |
1st Quarter 2005 |
|
|
Increased |
31.6% |
17.1% |
|
Remained stable |
43.4% |
61.8% |
|
Deceased |
25.00% |
21.1% |
Source: Nursefinders Inc., Nurse Staffing Expense Survey, 2005
Work-related stress plays a key role in nurse satisfaction and retention. Nurses believe job stress plays a key role in the overall nursing shortage, nurses leaving hospital duty and the leaving the nursing profession entirely.
|
Yes
|
No
|
|
| Effects the overall nursing shortage |
85%
|
15%
|
| Effects nurses leaving hospital duty |
76%
|
245
|
| Effects nurses leaving profession |
77%
|
23%
|
Source: Nursefinders Inc., Nurse Staffing Expense Survey, 2005
A helping hand I Retaining older nurses is key if health care organizations are to avoid high turnover and vacancy rates. In 2000, only 9.1 percent of registered nurses were 30 years old or younger, according to the Health Resources and Service Administration’s Bureau of Health Professions. That same year, the average age of the nursing population was 45.2.
One reason older nurses leave the profession is physical stress. Tampa (Fla.) General Hospital implemented a patient-lift initiative to reduce back and other types of injuries among nurses and support staff. A dedicated lift team assists nurses and other staff when they cannot safely move patients. Since the initiative was launched in 2002, lift-related injuries have fallen 60 percent.
The team consists of 12 specially trained personnel who are available 21.5 hours per day, seven days a week. When a nurse needs assistance, he or she pages the team. Response time is about 15 minutes and the team averages about 100 calls per day. The team can lift a patient in five to seven minutes; it takes a lone nurse about 20 minutes to lift a patient. The hospital spent between $250,000 and $300,000 on lifting equipment and training the team on its use. That money has been recouped because of the need to hire fewer agency nurses, reduced workers’ compensation claims and a decreased rate of pressure ulcers among patients. “It’s had a big impact on nurse morale,” says Manon Short, the hospital’s injury prevention coordinator. Among other things, she says, the nurses credit the team with providing them more time for other nursing duties, allowing them to leave work on time.
Going once, going twice I In an effort to recruit and retain nurses, hospitals across the country are providing greater flexibility with work schedules. The move is viewed as a way to improve work/life balance, particularly for older nurses and working parents. “We’ll work around a nurse’s schedule,” says John Murphy, nurse recruiter for St. Peter’s Hospital, Albany, N.Y. Depending on the nursing unit, schedules can range from four-hour to 12-hour shifts. “Nurses can work every weekend and get full benefits,” he says. To provide nurses greater autonomy over their schedules, the hospital implemented an online shift bidding system five years ago. Nurses can name the lowest acceptable hourly wage rate they will accept. The hospital selects nurses based on pay rate, skill level, past performance and shift schedule. Bids can be made for daily or weekly shifts. Not only has the system improved nurse satisfaction, it is also credited with reducing the hospital’s need to employ agency nurses and helping to drop the nurse turnover rate to the single digits, Murphy says.
In the know I No one knows better about what nurses want more than nurses. That’s why Bayhealth, Dover, Del., hired a nurse to serve as a recruitment and retention specialist. In that position, Marianna Foard, R.N., works to match nurses with hospital openings. “I’m still very much a clinician,” she says. “I have to understand the level of acuity of the position and match it with the nurse’s skill set.”A key piece to nurse retention is getting the right nurse in the right position. The organization uses behavior-based hiring techniques to see if the nurse is the right fit for the position. If not, they look to see if the nurse may be better suited for another position. Foard frequently visits nursing units to talk with nurses about their experiences. “You have to establish a professional relationship with them and keep the lines of communication open,” she says. “People stay because they are satisfied and feel their opinion counts. That’s where a lot of organizations miss the boat.”
Signing off I Hospitals go to great expense to attract new nurses, offering tuition reimbursement, child care and even cars. Sign-on bonuses have been ubiquitous for the past several years, in some cases providing thousands of dollars for nurses to work for a short period of time. That, however, is changing as more hospitals view sign-on bonuses as a temporary fix that may negatively impact long-term staffing levels. For example, many nurses view sign-on bonuses as a contract and leave their position once the time period is over. Midland (Texas) Memorial Hospital stopped offering sign-on bonuses because of the message it sent to existing nursing staff. “Our nurses work day in and day out and weren’t getting anything,” says Margaret Robinson, vice president of patient care services. “The sign-on bonus offended our long-term employees.” Instead, the hospital opted for longevity bonuses. Nurses who have worked 10 years or more receive a bonus every two weeks based on a percentage of their salary. If a nurse has worked between 10 and 14 years, he or she receives a 3 percent longevity bonus every two weeks. The maximum a nurse can receive is 7 percent of salary. “Sign-on bonuses are short-lived,” says AONE’s Thompson. “They will only work if what nurses signed up for continues to be professionally rewarding.”
Nurse Friendly I The Texas Nurses Association developed a set of criteria to help create an ideal practice environment for nurses. The Nurse-Friendly Hospital Criteria include establishing systems to address patient care concerns, professional development, middle-management accountability, comprehensive nurse orientation and zero tolerance for abuse of nurses. Memorial Hermann Fort Bend, Missouri City, Texas, earned the nurse-friendly designation in September, hoping to create an environment where nurses will want to work. “Our nurses feel that their opinion is respected and that they are part of a collaborative team,” says Susan White, the organization’s CNO. “We’ve really created an environment in which nurses want to work.”
This article first appeared in the January 2006 issue of H&HN magazine.
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