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Here are some of the ways in which hospitals are trying to fill critical care nursing slots:
Hosting a booth at a specialty conference, where nurses can share on-the-job experiences first-hand.
Marketing aggressively with traveling agencies. Little Company of Mary Hospital in Torrance, Calif., has increased the money it spends to hire nurses out of state to tie them to longer contracts. The six "travelers" presently working there have 13-week relationships at a time.
Using logistics teams or work teams on a unit to review ways to enhance its operation. At Little Company of Mary, the critical care logistics team is examining ways to streamline the paperwork and information flow.
Retaining nurses. Nurse managers at University Hospital in San Antonio, Texas, are making their environment an inviting place to work, said Phyllis Gordon, MSN, RN, clinical nurse specialist. Examples might include allowing nurses to gain experience in other areas or making part-time employment an option to prevent critical care burnout.
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American Association of Critical-Care NursesCritical care shortage = more training programs By Valerie J. Nelson ||| When the shortage of nurses dried up in the ’80s, so did the critical care internship and training programs that many hospitals offered. But now critical care nurses are at a premium and training programs are making a comeback.
The return of preceptorships is one of several signs indicating an undersupply of skilled nurses in hospitals, which can be linked to downsizing. Critical care nurses seeking secure employment transferred to other settings, such as subacute or home care, while managers refrained from replacing them, because they did not want to have to turn around and lay off new hires, experts say.
"I have just now started hearing talk about a shortage," said Melissa Biel, MSN, RN, director of practice for the American Association of Critical-Care Nurses, after returning from an AACN board meeting recently. "People were seeing it in some areas. We were kind of surprised."
While gauging the scope of the problem is difficult, at least one nurse blames the shortage to downsizing that began two years ago. Stefanie Tabone, RN, director of practice for the Texas Nurses Association, says experienced nurses who were let go reassimilated into home care or other jobs, while facilities tried to move new graduates into a system that was taking care of sicker patients.
"There is a need for people to be experienced and competent quickly," said Tabone. "It’s a challenge. You don’t have the luxury of housing people in acute care beds and bringing people up to a level of practice with high-acuity patients. I don’t know what you do. Set up orientation programs that build the skill?"
For some institutions, orientation programs are part of the solution. At The Medical Center at the University of California, San Francisco, new graduate and critical care training programs—staples of the ’80s—are starting up. More than 200 people applied for 25 spots in the new graduate program. If the programs are successful, and if the need continues, a yearlong critical care training program might be set up to admit applicants from other hospitals, said Georgia Couderc, RN, the medical center’s patient care manager of the adult intensive care unit.
Internships have worked well to train critical care nurses at Saddleback Memorial Medical Center in Laguna Hills, California, said Anita Lambert, RN, operations manager of critical care. The 10-week internships are usually aimed at diversifying an experienced med/surg nurse’s skills, but an occasional new graduate has gone through the program.
Little Company of Mary Hospital in Torrance, California, is considering reinstituting its critical care internship program, an update of a program used to train nurses in the late 1980s. To gain entry, applicants must have telemetry experience. They take a six-week didactic course, followed by a clinical course. The paid internship lasts three to six months, and participants are required to stay at the hospital for at least a year. The training worked so well before that the hospital still employs a couple of interns who completed it in the ’80s.
Other creative solutions are springing up to meet the demand for critical care nurses. With money for education dwindling, hospitals near San Antonio, Texas, have joined together during the last three years to present critical care training courses. Several hospitals have also formed a critical care consortium, which presents courses in the area and is composed of educators from the various hospitals, said Phyllis Gordon, MSN, RN, clinical nurse specialist at University Hospital in San Antonio.
While a critical care nursing shortage has not hit that area of Texas, hospitals are seeing a trend toward fewer and less-experienced applicants for critical care positions. In Texas overall, many of the experienced critical care nurses are turning to careers in home health or other more procedure-oriented areas, Gordon said.
The situation in Texas mirrors the nation’s. The AACN is receiving reports that hospitals hiring for critical care positions are unable to say they only want experienced critical care nurses. Last month, some hospitals in the Houston and Dallas areas offered the equivalent of a signing bonus to experienced critical care nurses, Tabone said.
The AACN is seeing more critical care nurses using their skills in other areas in the profession, Biel said. "The majority of people are still in critical care units in acute care hospitals. But people are moving.
"People are taking their critical care skills and applying them to subacute care and home health. They are able to take what they learned as a critical care nurse and apply it to patients in other places," she said.
The allure of more autonomy has brought nurses into home care at the same time patients require more sophisticated care providers. "A lot of critical care nurses are independent actors anyway," Tabone said. "I have heard concerns also of the utilization of nurses who have a hospital orientation without a home orientation."
At Little Company of Mary, many experienced critical care and telemetry nurses shifted to taking care of patients in their homes rather than in hospitals. Nurses could have greater options, said Kathy Harren, MHA, RN, the hospital's director of nursing for critical care and emergency. "They could leave critical care, which they spent up to 20 years in, and not lose equity. The advantage to us is we have dynamic experts taking care of people in the field."
The turnover rate at Little Company of Mary is low; many of the nurses have been at the hospital for a decade or more, but more vacancies have been arising since 1995. The hospital wants to see its nurses grow professionally, and many of them are returning to school to get their nurse practitioner’s license, Harren said.
Harren has the job of filling shifts in critical care in which every bed is filled. For now, nurses who pull an extra shift in critical care can earn $100 bonuses. The hospital also cross-trained some telemetry nurses to support critical care and expanded its relationships with registries to sign up temporary employees for 13-week, full-time assignments.
