CA agencies fighting nursing shortage
Dearth of RNs, LVNs to widen in next few years
Just as California tends to lead the nation in lifestyle trends, the state’s home health industry is experiencing the leading edge of a nationwide shortage of nurses.
The state currently ranks near the bottom of the nation in the ratio of RNs to population. And it stands to only get worse. A study conducted by the California Nursing Work Force Initiative predicts continued shortages in all sectors, including home health, where the demand for RNs is anticipated to grow 11% by 2002. Home health demand for licensed vocational nurses is expected to increase by 41% during the same period.
Several factors are causing and exacerbating the shortage, say Connie Little, RN, MS, senior vice president, and Kerry Rodriguez Messer, director of policy, advocacy, and public affairs for the California Association for Health Services at Home, a nonprofit group representing the state’s home health providers.
First, even compared to an overall booming U.S. economy, California is doing particularly well, driven by the high-tech industry.
"When that happens, other opportunities open up for those who maybe traditionally would have gone a caregiver path," Rodriguez Messer says. "They may take another path because there are industries that are booming so much where the compensation is very high."
Meanwhile, state law requires one year of experience for home care nurses at licensed agencies, while other employers such as hospitals can hire nurses right out of school. Only recently did the state allow foreign experience to count toward that one-year requirement.
And other health care employers are upping the ante by offering such incentives as signing bonuses — an option home health agencies rarely have with today’s tighter budgets.
Little says the crunch is causing agencies to get creative. "Our members are trying to recruit at churches, at the vet, at the manicure shop, anyplace that people sit and talk. They have their staff recruit other nurses or LVNs [licensed vocational nurses]."
Coping with the crunch
Two California agencies — Pro-Care Home Health Services in Sacramento and Angeles Home Health Care in Los Angeles — that are weathering the tight job market use a variety of methods to reach out to nurses and retain the ones they have.
David Dial, Pro-Care’s owner, CEO, and administrator, calls retention a big part of his recruitment plan. "Obviously, if you keep your employees, you don’t have to recruit. The biggest efforts are usually made to replace employees that unfortunately you’ve driven off."
Among his retention tools are monthly birthday lunches for employees, an employee of the month program, a "safety bingo" game offering prizes for injury-free workdays and a year-end party with dinner and dancing.
"We spend thousands of dollars on it. I would guess it’s the largest company-paid party of its kind in the Sacramento area in home health," Dial says. "There’s an awards presentation for employees of the year and we give out 15 superior effort awards."
Beyond the material offerings to employees, Dial says he makes a point of letting his employees know how much they are valued. It’s not lost on him that many who come to Pro-Care from other agencies do so because they feel underappreciated.
"On Fridays, when most of the nurses come in, we all make serious priority efforts to get out there and greet them and let them know they’re doing a good job," he says. "A lot of respect for the nurses and pats on the back and some programs to let them know they’re important and you’ve just almost cut your recruiting expenses at least in half, if not by 75%."
Mary Dete, PHN, director of professional services for Angeles Home Health Care, says she’s heard similar complaints from prospective employees about lack of respect from other health care employers.
"The more hospitals mistreat their nurses, the better we do," she says. "When they play havoc with their schedules — the 10-hour day, the 12-hour day, when they don’t do things that enhance the practice so the nurse can build a niche — then they’re asking for it."
To help keep nurses, Angeles hired an extra scheduler, to work out scheduling problems and offered the option of a modified part-time plan for staffers. "I think it’s helped us retain a number of individuals who had come on intending to work full time, who’d had family life changes — either child care or parent care or work requirements for spouses, something that they couldn’t control and hadn’t anticipated," Dete says.
At Pro-Care, building and maintaining a good relationship with the nurses turns them into enthusiastic recruiters, spurred on by incentive programs that reward them for referring a nurse who signs on to the company, Dial says. The incentive usually is a few hundred dollars if the referral is hired and stays with the company for a specified length of time. "I have one nurse who’s brought me six people who have been with us now for over a year."
As a result, Dial says he spends no money advertising for recruitment and has managed to fill needed slots in his agency for all the major specialties that he needs.
At Angeles, an intensive orientation program prepares recruits for what they’ll find on the job. It includes a one-week, 40-hour classroom component and a one-week mentorship in the field, where the nurse is paired with an established employee who can demonstrate how things are done and sign off on return demonstrations.
After that, the employee spends 90 days in probation and his or her paperwork is reviewed by educator or a designated nurse.
"Our goal is to build them right and keep them," Dete says. One idea she’s seen used elsewhere and would like to implement at Angeles would be a ride-along day in which the prospective employee spends a day with a mentor just seeing how her day goes. The idea is to give recruits a true picture of what a job in home health is like, so they know what they’re getting into.
"People who don’t drive much, who don’t know how to organize and manage time very seldom come up to speed on those skills," Dete says.
Strategies for a more diverse workplace
One recommendation from the California Nursing Work Force report was to enhance cultural diversity in the work force, to help provide care for an increasingly diverse population. While the report specifically points to a lagging percentage of Hispanic/Latino RNs, Dete says there are other shortages, as well.
"In terms of a language subspecialty, we need those who are fluent in Korean or Farsi," she says. "That was new for us. I think we now have about 12 bilingual Korean RNs and three or four Korean-speaking home health aides. The Farsi population is beginning to increase both numerically in LA and in our staff. Those nurses tend to be at a premium; they are in very short supply."
Dial says his already diverse work force will be bolstered by plans to recruit overseas, specifically in the Philippines. A recent lawsuit forced the state to accept foreign experience toward the one-year home health requirement.
He says that with the help of a good immigration lawyer to obtain needed professional visas, it’s a fairly simple process, and not even that expensive since the nurse pays her own travel and living expenses.
"I’m lucky in that our director of nursing, who’s also my wife, is from the Philippines, so we go there once a year anyway," Dial says. "You simply go down to the hospitals there and ask if they want to go to the United States. You’ll have 150 people lined up and you can take your pick from the cream of the crop of RN-level experienced nurses. Finding them is a no-brainer."
Dial says he hopes to be ready to make the first recruiting trip in the next few months.
• Kerry Rodriguez Messer, Director of Policy, Advocacy and Public Affairs, CAHSAH, 723 S St., Sacramento, CA 95814. Telephone: (916) 554-6124. Fax: (916) 443-0652. E-mail: [email protected]. Web site: www.cahsah.org.
• Connie Little, Senior Vice President, CAHSAH, 723 S St., Sacramento, CA 95814. Telephone: (916) 443-8055. Fax: (916) 443-0652. E-mail: [email protected].
• David Dial, Administrator, Pro-Care Home Health Services, 7501 Hospital Drive, Suite 101, Sacramento, CA 95823. Telephone: (916) 681-4949. Fax: (916) 681-4888. Web site: www.procarehhs.com.
• Mary Dete, Director of Professional Services, Angeles Home Health Care, 3435 Wilshire Blvd., Suite 500, Los Angeles, CA 90010. Telephone: (213) 487-5131. Fax: (213) 387-8733.
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