Are nurses leaving in record numbers? Act now to reduce vacancy rates
The nursing shortage will only get worse’; find ways to keep nurses
Editor’s note: This is the first of a two-part series on the nursing shortage. This month, we tell you how to retain nursing staff. Next month’s ED Nursing will cover ways to recruit nurses.
Are you finding it increasingly hard to staff your ED? Many nurse managers interviewed by ED Nursing report high vacancy rates due to a nationwide nursing shortage.
Nurses not only are leaving EDs for other hospitals, but they also are abandoning the profession altogether, warns Diana Contino, RN, MBA, CEN, CCRN, president of Emergency Management Systems, a Monarch Beach, CA-based consulting firm that specializes in staffing issues. "Many ED nurses have given up working in hospitals and are leaving to work for private physicians’ offices, pharmaceutical companies, or billing companies," she says.
The shortage will only get worse, Contino predicts. "Nurses want a decent work environment and need to feel supported." Since many nurses feel unsupported and overextended in their current jobs, nurses are leaving in record numbers, she adds.
Recent studies already have confirmed a shortage of nurses in California and New York. One study estimated that based on projected population growth in California, the state will need an additional 43,000 registered nurses by 2010, and an additional 74,000 by 2020.1 In New York, researchers found a 25% decrease in nursing school graduates in the past five years.2 According to the study, hospitals in New York City already are having significant difficulty recruiting ED nurses.
Need a motivator?
Here are effective ways to retain ED nursing staff:
• Create a career ladder for nurses.
An opportunity to earn more money based on performance is a powerful motivator for ED nurses who want to advance in the clinical area, says Cynthia Wright, RN, MS, educational coordinator for the ED at Tallahassee (FL) Memorial Regional Medical Center, which has a career ladder in place for nursing staff.
The program gives nurses an incentive to work on cost-saving and quality-improvement projects, she notes. Examples include making follow-up calls to patients, reviewing charts for quality assurance, giving presentations in the community, and checking for lost charges. (See Professional Nurse Advancement Program, contained in the full PDF of this issue.)
Each nurse is given a packet that lists more than 200 clinical ladder tasks that give ideas for earning points. Nurses also can submit their own ideas for projects to a committee for approval, says Wright. Nurses submit a list of completed projects to the department head, and the lists are reviewed by a nursing committee on an annual basis, Wright explains. Nurses are assigned a certain number of points for each task and given a quarterly check ranging from $200 to $800, depending on the number of points earned, she says.
• Work the floor.
"As a manager, I have almost always occasionally worked the floor to stay close to staff issues," says Contino. "This also allows me to validate the problems staff are having, so I am able to give my supervisors objective input and suggest effective solutions."
• Hire a charge nurse.
Nurses might have family issues that prevent them from giving additional hours, says Contino. "They really want to be involved, but want to do the extra work on their work time," she says.
A designated charge nurse who does not have a primary patient care assignment addresses this issue, says Contino. "This enables staff to attend committee meetings, work on performance improvement projects and marketing efforts, such as speaking at local schools and educating their communities."
• Be sure you’re getting the support you need.
Managers also need support from the hospital, Contino says. "They need management training, secretarial support, and technology education," she argues. "Without these tools, they are unable to effectively be supportive of their staff."
To obtain this support, ask administration for funding for computer education firms, community college courses, or instructors to teach in the hospital’s computer learning lab, suggests Contino. "If there are several hospitals in the area, they may want to collaborate on educating managers on software programs."
• Give staff a choice.
When Chris Lewandowski, RN, nurse manager of the ED at Kennedy Health System in Turnersville, NJ, found she had too many open night shifts to operate safely, she gave nurses a choice for how to address the problem. "I asked them if they would rather rotate to off-shifts for a six-week schedule, or pick up one extra shift of overtime [on the off-shifts] per nurse for the six-week schedule," she says.
At a mandatory staff meeting, nurses decided to support the off-shifts by doing overtime. "This prevented open shifts at other times. It was required of everyone, and I did my fair share, too," reports Lewandowski.
No quick or easy solution
The solution to the short-staffed night shifts wasn’t quick or easy, notes Lewandowski. "There were days we worked short, but I worked along side of the nurses," she says. "Eventually, the staff would come in for overtime rather than see me spend extra time here. They are now very considerate of my time away from the ED. If for some reason we have a hole in the schedule, they handle it among themselves."
• Enlist colleagues to give nurses education.
At Kennedy’s EDs, interested nurses and physicians were asked to provide intradepartmental education, says Lewandowski. "They focused on the areas of weakness for staff who may not have had a comprehensive orientation," she explains.
The staff members who contributed were paid for their time, stresses Lewandowski. "It provided them an opportunity to make money away from the clinical area, which is very highly regarded," she says.
Experienced nurses were encouraged to broaden their scope of education and practice away from the clinical setting, notes Ledanowski. "This was a key recruitment tool for me."
• Give nurses a flexible schedule.
On first thought, nurses might say they want more money, but a flexible schedule might be even more important, says Cynthia K. Russell, RN, MSN, ED director at Frederick (MD) Memorial Healthcare System. "My staff will work for this community hospital for slightly less because we promote flexibility."
The ED uses a version of self-scheduling, says Russell. "Nurses request the work schedule they prefer, with the understanding that they will not always get what they ask for," she explains.
Shifts of eight, 10, and 12 hours are offered, along with seasonal programs in which the staff can work during certain times of the year, says Russell. "For example, a nurse might work summer, winter, spring, and then be off in the fall," she explains. "Or nurses can work the school calendar year to be off with their children."
Shift combinations also are allowed, with two 12-hour shifts and two eight-hour shifts per week.
The ED has seen an increase in part-time nurses, and offers benefits to these nurses, says Russell. "Benefits are given to 0.9 FTEs," she reports. "We also give benefits to our weekend options nurses, which are 0.5 FTEs."
Nurses are allowed to figure out holiday coverage and on-call times, says Russell. "It is a lot more manager time to promote all this input, but it is worth it," she stresses. "The goal is to give staff the flexibility to attend children’s events and family commitments."
Give them an incentive
• Pay nurses to do extra work.
You can’t expect nurses to do work that they are not getting paid for, says Contino. "There has got to be some incentive to go the extra mile," she says.
Most ED nurses want to be involved, serve on committees, and facilitate change, says Contino. "However, they want to be paid for this extra effort, and they don’t usually want to donate time on their days off," she explains.
Managers may take the attitude that this involvement comes as part of the ED nurse’s role, says Contino. "I agree, but nurses need to be paid for their time," she says. "It is amazing how involved staff will be if they are given the time to accomplish the projects."
Unfortunately, many hospitals have an organizational culture of "nurses have to work volunteer time, and if they don’t like it, leave, and we’ll replace them with someone who will," says Contino. "Now, there is no one to replace them with."
References
1. Coffman J, Spetz J. Maintaining an adequate supply of registered nurses in California. Image J Nurs Sch 1999; 31:403-407.
2. Battles H, Wing P, Salsberg S. Meeting Future Nursing Needs of New Yorkers: The Role of the State University of New York. Rensselaer, NY: Center for Health Workforce Studies, University at Albany; 2000.
Sources
For more information on retaining nursing staff, contact:
• Diana Contino, RN, MBA, CEN, CCRN, Emergency Management Systems, 24040 Camino Del Avion, Suite 123, Monarch Beach, CA 92629. Telephone: (949) 493-0039. Fax: (949) 493-7568. E-mail: [email protected].
• Chris Lewandowski, RN, Emergency Department, Kennedy Health System, 435 Hurfville-Crosskeys Road, Turnersville, NJ 08012. Telephone: (856) 582-2642. Fax: (856) 582-2712. E-mail: [email protected].
• Cynthia K. Russell, RN, MSN, Emergency Department, Frederick Memorial Healthcare System, 400 W. Seventh St., Frederick, MD 21701. Telephone: (301) 698-3326. Fax: (301) 698-3946. E-mail: [email protected].
• Cynthia Wright, RN, MS, Emergency Department, Tallahassee Memorial Regional Medical Center, 1300 Miccosukee Road, Tallahassee, FL 32308. Telephone: (850) 431-5081. Fax: (850) 431-6425. E-mail: [email protected].
A 75-page report, Meeting Future Nursing Needs of New Yorkers: The Role of the State University of New York, can be downloaded at no cost from the Center for Health Workforce Studies Web site (chws.albany.edu). It is also available in printed form for $25, including shipping and handling. To order, contact: Debbie Krohl, Center for Health Workforce Studies, School of Public Health, University at Albany, One University Place, Suite 200, Rensselaer, NY 12144-3456. Telephone: (518) 402-0250. Fax: (518) 402-0252. E-mail: [email protected].
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content