The fact that nursing shortages are growing across the country is nothing new. It has been a persistent problem for more than a decade. Throughout that time, nursing shortages have gained a lot of coverage by the national media, in magazines and newspaper columns. In comparison, solutions do not get the same attention.
What is the extent of the problem in 2019?
Mary Caldwell of the Atlanta News Now wrote that 72% of Chief Nursing Officers surveyed by AMN Healthcare reported they were experiencing a moderate shortage of nurses. Most of the nursing leader respondents said they believed that nursing shortages would worsen with time. AMN reported that only 7% of Chief Nursing Officers said they faced no nursing shortages at all.
Caldwell writes that nursing shortages have a far-reaching domino effect throughout an organization. She cites research showing how shortages can damage staff morale and cause nursing turnovers, both affect patient care and satisfaction. Other research cited by Caldwell shows there are also higher death and failure-to-rescue rates within hospitals with low nurse-to-patient ratios.
According to Moody’s Investors Service, labor is among the largest of hospital expenses; nursing shortages are causing these costs to soar higher. In the effort to attract candidates and compete for the best healthcare talent, facilities are offering more benefits and sign-on bonuses. As a result, this means profit margins are smaller. A trend that Caldwell says will continue to happen if there is a lack of plausible solutions.
What does the retention and recruitment environment look like for nurses?
The 2017 RN Work Project gives us a clearer understanding of what is happening and just how challenging it is to recruit and retain nurses.
The report shows that 17% of newly registered nurses leave their employer within the first year, with up to 30% of nurses leaving within two years. Press Ganey’s National Database of Nursing Quality Indicators supports these findings from the RN Work Project. Press Ganey found that 21% of newly accredited nurses leave within the first year. When researchers asked about nurse career plans in the next three years, 26% of hospital nurses said they would investigate other options outside of nursing or will choose to retire.
Press Ganey’s Chief Nursing Officer, Christy Dempsey, says today recruiting involves understanding there are different drivers for job satisfaction among nurses. Dempsey says that studies show that the average cost for a bedside nurse ranges from $38,000 to $61,000, with a per hospital cost that is “between $4.4 million and $7 million.”
Rush Oak Park Hospital’s nursing shortage solution
This inspiring story shows how a visionary Chief Nursing Officer named Karen Mayer solved Rush Oak Park Hospital’s nursing shortage. At the start of her tenure, the facility faced challenges with recruitment and retention of nurses. There was a 22% turnover of nursing staff, with some departments experiencing a 24% turnover.
Compared with its competitors at the time, Rush Oak Park Hospital had a negative reputation for poor quality outcomes. They also competed with surrounding hospitals to recruit healthcare talent and attract patients. Hospital leadership blamed the nursing staff, physicians lacked respect for the nursing staff and the facility had a high turnover of nursing executives resulting in a lack of clear direction and vision.
The priority for Mayer was to focus on recruitment while improving the hospital’s reputation. The initial strategy was to hire graduate nurses from a local school. Mayer understood that graduates have a challenging time finding their first job because they lack experience. She also recruited clinical nursing leadership from the same school who were entry level, Master’s prepared. Twenty-five percent of her first hires were graduates.
Mayer then worked with HR to contact applicants quickly, within 24 hours after they had applied. Her goal was to identify and hire staff that was qualified and wanted to be part of making Rush Oak Park Hospital successful. She also implemented a shared governance culture and a clinical progression ladder designed to promote career advancement. Today 84% of the hospital nurses have BSN’s, 20% hold Master’s, and in 2016, the hospital received Magnet accreditation.
Today, the hospital is much improved, mainly due to Karen Mayer’s clear leadership and innovative ideas. The hospital now has a turnover of 8.3%, down from 22% and is prized for quality nursing.
Allegheny Health Network’s solution is to encourage former nurses to return
Claire M. Zangerle, Chief Nurse Executive at the Allegheny Health Network, says nurses leave for a variety of reasons. Often, they leave to pursue travel nursing or to work for other types of healthcare providers like insurance companies. Zangerle says there are options to consider internally to stop nursing shortages.
Zangerle implemented an innovative RetuRN Practice Program as a solution to encourage nurses to return to the profession. The program offers flexible scheduling to accommodate individual needs. Nurses commit to a 3-hour slot at any time during the day, night, evening, weekend or holiday shifts. They fill-in for other nurses during breaks or short leaves they also perform patient admissions, discharges, and provide patient education.
Many participants in this program have been out of nursing practice for extended amounts of time. To get up to speed, they do online refresher courses and take advantage of the clinical shadowing offered by the program.
The program assists applicants through onboarding, validating their nursing license and providing additional resources. It also monitors job satisfaction once the participant starts work.
With the program’s first initiation, Zangerle hired 22 nurses ranging from 0.5 FTE to 1.0 FTE. The retention rate for the program is 100%.
How to stem nursing shortages
As research shows, healthcare facilities across the country continue to experience nursing shortages. Nurses are an integral component of successful patient care. Their contribution to patient care has a direct impact on the bottom line. As Mary Caldwell writes, shortages have a “far-reaching” effect; patient care suffers as a result. The hospital metrics such as patient outcomes also are negatively impacted. The ripples keep on going, damaging the hospital’s reputation.
Fortunately, there are brave and innovative nursing leaders such as Karen Mayer who transformed the fortunes of Rush Oak Park Hospital. Mayer proves that innovative thinking and strong direction is a solution to nursing shortages. She is an example that all CNO’s should emulate to move their hospital forward. Hospital leadership needs to keep faith that despite many nurses leaving the fold, there is hope for a brighter future, as long as the right steps are implemented to correct the issue.
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