By Jane Erwin
Photo by Margie Paschke
June 17, 1999

It’s not easy to fill empty nursing positions, and nursing executives know it. That’s why they’re putting programs into place to keep the nurses they already have. But persuading nurses to stay means earning their trust—and that’s not easy to do, experts say.

California hospitals are having a tough time filling all types of positions, especially specialty openings, said Janet Coffman, associate director for workforce policy at the UCSF Center for Health Professions. “In California, we started hearing about difficulties in late 1997. Real wages declined in the mid-’90s for RNs statewide,” Coffman said.

In the effort to retain employees, nurse executives are examining pay scales, benefits, and scheduling, Coffman said. Some have even reverted to tactics they used during the last shortage, such as offering 40-hour pay for three 12-hour shifts, she said.

State and regional hospital associations are also working to find ways to keep nurses satisfied, said Monty Clark, regional vice president of the Healthcare Association of Southern California. Hospital groups are creating task forces to consider workforce questions. They’re meeting with community college systems to try to expand the number of students in nursing programs, Clark said.

“The attrition rate seems to be going up as some nurses move into other health careers or change careers,” Clark said. “As hospitals, we are concerned with the numbers. There doesn’t seem to be enough nurses of quality, for lack of a better word.”

Surveying the work force

In November 1996, the American Nurses Association surveyed more than 7,500 nurses about their perceptions of health care and nursing practice. Twenty-four percent said they would not remain in nursing, up from 14 percent the previous year.

So what kind of work environment are nurses looking for? They want “a good place to practice, a place where they feel supported and feel good about taking care of patients, a place where nurses are valued,” said Marjorie Beyers, PhD, RN, FAAN, director of the American Organization of Nurse Executives.

An AONE nursing staffing survey published in February shows it’s taking much longer than two or three years ago for executives to fill positions. “More than one-third of the respondents who recruited for specialty nurses such as OR, obstetrics, and ER reported the time to fill these posts had increased over the past six months,” Beyers said. “Small hospitals took the longest to fill—90 days vs. 42 days for mid-size and 47 for large.”

Making it work

St. John’s Regional Medical Center in Oxnard uses several strategies to create a more pleasant work environment for nurses. The efforts have kept retention rates high, said Vickie Lemmon, MSN, RN, St. John’s chief nursing executive.

“The more participatory we can make things, the more [nurses] we’ll retain. Nurses are very knowledgeable and creative people, valuable on multidisciplinary teams,” Lemmon said. “It’s important to establish relationships that are based on win-win solutions to problems.”
Salaries are a big factor in retaining staff, experts say. St. John’s did a salary review last year and adjusted salaries throughout the organization. The facility found turnover decreased substantially, Lemmon said.

St. John’s also sponsors staff development days. Instead of attending a one-hour meeting each month, nurses are paid for staff meetings, committee work, and inservice training sessions held all at once during four-hour sessions eight times a year.

Signs of success

The efforts seem to be working. The medical center has seen an increase in applicants in recent months, Lemmon said. “We had about 30 nurse vacancies last winter. We have hired more lately, but I know the shortage will make staffing an ongoing issue.”

At Methodist Health Care System in Houston, they’re focusing more on retention than recruiting, even though some positions are going unfilled. “We need the best nurses to provide the best care,” said Pamela Triolo, PhD, RN, FAAN, senior vice president and chief nursing executive.

The hospital has looked at turnover and found most nurses who quit leave in their first three years. That’s why the hospital is developing a program called Pathway From Novice to Expert, which “provides all the skill sets and information [nurses] need in their first years here,” Triolo said. “It has special preceptor training and also includes topics such as conflict management and staying successful in today’s environment.”

Other efforts at Methodist include offering more flexible hours and benefits packages, competitive salaries, and leadership development programs. Methodist is also developing a two-year accelerated master’s program with the University of Texas-Houston Health Science Center School of Nursing. In addition, management is opening up the lines of communication by holding quarterly nursing assemblies with 30 minutes of announcements and 30 minutes during which nurses can ask any questions they want, Triolo said. “Nurses love communication,” she said.