HR Magazine, December 2002 - Employment and Staffing: An Acute Condition: Too Few Nurses


By By Diane Cadrain Dec 1, 2002

HR Magazine, December 2002

Vol. 47, No. 12

Employers show how to attract specialized workers when they're in tight supply.

Nurses are nervous,” says Camille Edwards, a registered nurse (RN) who is concerned about the effects of severe staffing shortages on her profession and her peers.

Edwards, a union organizer for the New York State Nurses Association, says many nurses arrive at work already worried that there won’t be anyone to take over when their shift ends. “They’re worried they’ll be charged with patient abandonment if they leave, worried they might not be able to care for their patients with limited resources, worried about getting written up, worried about hurting patients,” she says. “That takes a terrific toll on them. I’ve had nurses have strokes at the end of their shifts.”

Another nurse, a 14-year veteran, says the metropolitan hospital where she works is “hiring unlicensed workers—people with incomplete nursing education—because they can’t find enough nurses. The new hires know nothing about dialysis, checking shunts, interpreting labs or monitoring EKGs. The doctors get angry with us because when they ask about a patient, we have to ask them to wait a minute because we’re taking care of someone else. They give us extra patients, and all we can do is make sure they don’t [suddenly worsen] on us.”

The Scope of the Problem

The shortage of qualified nurses is stretching nurses on the job to their limits, driving them out of the profession in despair, compromising patient well-being and forcing HR professionals in health care companies to take extraordinary steps to find solutions, experts say.

The shortage “started in the early ’90s, when hospitals decided to downsize” and when laid-off nurses turned to other professions, says Barbara Blakeney, MS, RN, president of the American Nurses Association (ANA). “We lost a lot of good nurses that way, and that made work more difficult and stressful for those remaining. Also, the nursing population is aging—the average nurse is 43. And at the same time, baby boomer [patients] are aging, and they require more health care.”

Working conditions have become so stressful for nurses that, according to a recent ANA survey, 75 percent of respondents felt that the quality of nursing care at their facility had declined in the past two years, more than 40 percent said they wouldn’t feel comfortable having a family member in their facility, and 54 percent said they wouldn’t recommend the profession to their family members.

According to the U.S. Department of Health and Human Services, in 2000 there was a shortage of 110,000 nurses (6 percent of the estimated number needed), and if nothing is done to ease the shortage, it will continue to grow—to 275,000 by 2010, to 507,000 by 2015, and to 808,000 by 2020.

Working Around the Problem

Nonetheless, many HR professionals in health care companies are dealing with the crisis head-on. “We increased the number of our recruiters,” says Joseph Cabral, director of career services at New York Presbyterian Hospital (NYP). “And we make sure they understand that, with health care unemployment at 0 percent, recruitment isn’t a 9-to-5 job. Recruiters have to make themselves available when the applicants are—call people in the evening, come in at 7 for an interview and work job fairs on Saturdays.

“We also keep them in touch with the business,” he says. “They have to have an appreciation for the bottom line and understand the product they’re selling. They should constantly be asking, ‘How can I sell you this hospital?’”

Peg Brubaker, vice president of HR Support Services at NYP, says: “You need the investment and support of senior management to help look at the recruitment picture, quantify your retention issues, look at the costs per hire. It has to be a collaborative effort: ‘How do we solve this?’”

At Montana Hospital Association (MHA) Ventures Inc., which offers services and products to the association’s member health providers, collaboration among member hospitals is key to filling nursing vacancies, says recruiter Lisa Helle. “We formed the Montana Recruiting Alliance, which is open to all facilities for an annual fee. Hospitals can place unlimited openings on our web site. We also place joint ads in the local media. If three facilities join in one ad, they get bigger ads and more exposure for less cost. It takes some of the pressure off hospital HR departments, and at the same time brings in more applicants.”

Helle also finds it useful to attend career fairs. “You have to network with educational facilities—colleges, high schools, even middle schools,” she says. “You talk to teachers and counselors. Tell them if a hospital is open for visits from interested students. We have to get more students in the pipeline.”

Anthony Disser, chief nurse executive at Inova Fairfax Hospital in Fairfax, Va., also mines education resources for health care job applicants. “We have a summer camp for middle school students, giving them an inside look at what goes on,” he says. “We also have summer externships for nursing students on college breaks, in which they can earn money and have first choice for jobs when they graduate.”

Health care recruiters recommend other tactics, too. For example, NYP’s Cabral suggests that employers spiff up their web sites to attract potential job applicants. He also says: “Give department managers ‘talent spotter cards’ for people they meet at conferences. Ours have a link to a hotline number, and, when that number rings, our employment specialist knows it’s a referral and uses a special script.”

Be visible, recruit around your profile as a high-quality institution and attend job fairs, experienced recruiters say. “Make sure the public knows that you honor your nurses,” says Disser. In addition, some say, you should combine open houses or job fairs with brunches, have employees bring their friends, and interview them on the spot.

‘Create a Culture of Retention’

Although it’s important to keep salaries competitive, money is not all it takes to retain good nurses. In a recent study of 83 hospitals, the University of Washington found that none of the 17 percent that raised salaries felt that higher pay was as effective as other approaches in recruitment and retention. The more influential efforts? Promoting teamwork. Creating a positive nursing environment. Lowering patient-nurse ratios. Making full use of nurses’ capabilities. Rewarding nurses with more decision-making authority.

“You have to create a culture of retention,” says the ANA’s Blakeney. “Employers can create a work environment that addresses the stress and strain of the job through a wholesale rethinking of their expectations. Nurses should have a say in setting appropriate work levels and reducing mandatory overtime.”

Although there is a shortage, adds Dr. Nancy Woods, dean of the University of Washington School of Nursing, hospitals with the best retention rates have sustainable, professional practice models that put nurses in a position to give a quality of care that satisfies them. Woods cites the concept of magnet hospitals, known for fostering workplaces that empower their nurses and are respectful of them.

The magnet-hospital concept is a creation of an ANA subsidiary, the American Nurses Credentialing Center. The center awards magnet status to health care organizations that provide the best in nursing care. Facilities that have attracted and retained nurses, even in the midst of shortage, share common characteristics: effective and supportive leadership, involvement of nurses in decision-making, participatory management, autonomy and accountability, and a supportive environment.

A Variety of Tactics

Other retention tactics that health care employers have found effective include employee satisfaction surveys to find out what nurses want, exit interviews to find out what they didn’t like and flexible scheduling to show that the employer knows that nurses “have multi-dimensional lives, that they need to have opportunities to leave the workplace and be refreshed,” Woods says.

NYP recently established flexible scheduling to enable employees to go to school. “A lot of our nurses work three or three-and-a-half days a week,” says Brubaker. “We know that work/family life issues are critical, and we accommodate them. You need to uncover and identify what employees want.”

Staffing experts also suggest that employers conduct incremental interviews with employees, asking them if they’re comfortable in the job, getting the training they need and getting the support of their supervisors. And, most important, ask if they’re looking for another job.

Among other recommendations:

  • Formulate a generous rehire-reinstatement program that would, for example, restore a nurse who comes back within a year to his or her original hire date and eliminate any waiting period for benefits.

  • Provide ample training. “The wise administrator creates opportunities for nurses to learn, through continuing education, in-service training and online learning,” says Woods. Inova’s Disser says: “We place a strong emphasis on continuing education and opportunities for nurses to grow through publishing and public speaking.”

  • Explore tuition assistance and loan forgiveness programs. In August President Bush signed the Nurse Reinvestment Act, which uses loan repayment programs and scholarships to encourage people to go into nursing, career ladder programs to keep them there and special loans to get more nurses to qualify to teach at nursing schools.

  • Consider temporary nurses. Hospitals are turning to temporary nurse agencies to fill vacancies. Temp nurses “know it’s a seller’s market, and they’re in a position to dictate their hours and, in some states, their salaries,” says Tony McDermott, CEO of HealthStaff Resources in North Andover, Mass. But in learning hospital policies and standards, temps may siphon off time from staff nurses. “They come into a new culture and they have to try to catch up,” says Dean Afaf Meleis of the University of Pennsylvania School of Nursing. “Temps have a role to play, but hospitals shouldn’t make it a way of life,” says the ANA’s Blakeney. If hospitals can think of creative ways to support the features that make temp work an attractive option for nurses, she says, they can better retain their regular staff members.

  • Consider foreign nurses. Some hospitals recruit nurses from abroad, particularly the Philippines, which educates more nurses than it needs. As with temp nursing, however, it’s an expensive tactic.

Measuring Results

With the retention strategies that NYP has implemented—satisfaction surveys, competitive salaries, generous tuition assistance—turnover droppped to 10.25 percent through last August from 12.5 percent for the year-earlier period and 15.25 percent the previous period, according to Brubaker and Cabral.

“Despite all that’s happening, this is the most exciting time to enter the profession, because nursing issues are very visible right now, and it’s become critical to look at solutions,” says Meleis.

Diane Cadrain is an attorney and has been covering workplace legal issues for 19 years. She is a member of the Human Resource Association of Central Connecticut.

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