Research by Lee Ann Jarousse

The health care workforce shortage has abated, thanks largely to the Great Recession and its lingering effects, which have persuaded many employees to postpone retirement and are prompting a growing number of physicians to seek hospital employment.

Nursing is one staffing area in which some hospitals went from famine to feast. "When you look at the current economic situation, a lot of older nurses are staying in their positions," says Cheryl Peterson, R.N., senior policy fellow for the American Nurses Association. "As a result, we are hearing that new graduates are finding it difficult to get jobs."

But be warned: This is the calm before the storm. A larger, more challenging shortage across multiple disciplines is on the horizon. Experts predict a shortage of about 260,000 registered nurses and 150,000 physicians by 2025 and 38,000 pharmacists by 2030.

The twofold effect of America's aging population is to blame: Baby boomers are hitting retirement age just at the stage in life when they will require more health care. There simply won't be enough clinicians in the pipeline to fill the positions. "All of the factors that drove the shortages [before the] economic downturn are still there," Peterson says.

As the economy recovers over the next several years, employee turnover could spike, says Pam Thompson, R.N., the American Hospital Association's senior vice president for nursing and CEO of the American Organization of Nurse Executives. "Hospital executives should get to know their own environment and what people are thinking about doing in terms of their careers," Thompson says. It may be wise to bring in new graduates now so they will be ready when older nurses retire. "That's a big financial investment at a time when there's little extra money around," she acknowledges. "But you can't deliver patient care without a patient care workforce."

The scope of the pending workforce shortage will require a significant shift in the way care is delivered, and health care reform has sparked interest in doing just that, Peterson says. Thompson agrees. "It's important that we use professionals to their utmost scope of practice," she says. These include midwives, advanced practice nurses, physician assistants and others.

"Every organization will need to take a close look at its community and develop delivery systems that will address the community's needs," Thompson says. "The use of multidisciplinary teams will be the most effective way to do that."

Nevertheless, traditional strategies still apply to recruitment and retention. "Health care leaders set the tone for care that people experience," says Judy Kees, a coach for the Studer Group. Benefits packages, reward and recognition, and flexible scheduling go a long way toward building and sustaining a satisfied workforce. This gatefold looks at best practices in recruitment and retention and ways organizations can prepare for the pending workforce shortage.

10 Keys to Maintaining an Adequate Workforce

An ample, highly skilled workforce is crucial to the survival of hospitals and health systems. In anticipation of the pending workforce shortage, there are important steps organizations can take to strengthen workforce partnerships. Organizations should implement these steps now to ensure an adequate workforce in the future.

1 | Redesign workforce processes and adopt technology to increase efficiency, effectiveness and employee satisfaction. Engage midlevel providers to enhance care delivery and build collaborative, multidisciplinary teams.

2 | Focus on retention, including workers who have reached retirement age. One in three baby boomers is still in the workforce. Hospitals and health systems must engage older workers, allowing inclusion in decision-making and offering flexible work arrangements, among other things.

3 | Attract a new generation of workers. Attracting younger generations to the health care workforce is essential to maintaining staffing levels. Younger generations are drawn to high-tech fields and seek work-life balance. Keep in mind that the recruitment of younger workers may require a shift in traditional recruiting techniques to include such social media outlets as Twitter.

4 | Focus on hiring the right people. Behavior-based interviewing versus skill-based interviewing can build effective, long-term teams. Peer interviewing
provides additional insight into whether a candidate may be the right person for the job.

5 | Seek feedback. Conduct 30- and 90-day interviews to gauge the perception of new hires. This will enable timely action if expectations are not being met.
Daily rounds also provide an opportunity to get to know what's on employees' minds.

6 | Measure. Regular satisfaction or loyalty surveys help organizations stay on top of employees' needs and desires.

7 | Reward and recognize. Acknowledging and rewarding employees for excellence fosters goodwill and helps establish an environment in which employees want to work.

8 | Develop the workforce. Ongoing training provides employees with an opportunity to enhance their skills and enable advancement within the organization.

9 | Eliminate low performers. A poor performer can add to workplace stress and create a toxic work environment, not to mention the potential impact on
the quality of care. Eliminating poor performers will demonstrate the organization's commitment to quality and accountability to its employees.

10 | Provide a competitive benefits package. Appropriate compensation is a must, but creativity goes a long way. Organizations can enhance benefit
packages by offering on-site child care, concierge services, flex scheduling and housing allowances, among other things.

Source: Hospitals & Health Networks research, 2011

Case Studies

Use of Midlevel Providers to Fill Gaps in Physician Shortage

Providing care to a growing number of sick and elderly, coupled with a workforce shortage, presents an enormous challenge to health care organizations. New models of care must be developed to meet the health care needs of this group. At Sacred Heart Hospital, Eau Claire, Wis., the use of midlevel providers is seen as a prudent way to deliver quality patient care; and it will help fill the gaps anticipated by the impending physician shortage. As health care reform takes hold and more focus is placed on primary care, use of midlevel providers, particularly for chronic care management, makes sense, says CEO Steve Ronstrom. "That's where money can really be saved without sacrificing patient care," he says. But there are other uses as well, including placement of midlevel providers in palliative care and cardiac and neurosurgery. "That's part of the solution for sustainability," says Ronstrom. Use of midlevel providers can free up physicians' time while enhancing the care experience through better care coordination, he says.

Finding the Right Fit

Hiring the right people to work for the organization can go a long way toward ensuring a sufficient workforce long-term. Health care organizations, however, continue to struggle with hiring and retaining the right staff. PeaceHealth Southwest Medical Center in Vancouver, Wash., credits behavior-based interviews with reducing turnover rates within the facility. In the five years since behavior-based hiring was rolled out organizationwide, nurse turnover has dropped from 13 to 8 percent. The organization estimates a savings between $600,000 and $1,000,000 for every percentage point drop. "It's important to know whether a new hire will fit into our culture," says Dan Keteri, R.N., vice president of patient care services. Questions from the patient loyalty survey now are asked during the interview process to see if the individual will mesh with the organization's values. "We are looking for people who are patient advocates," Keteri says.