Photos
Courtesy of Clarian Health |
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Nurse Lori Swoboda explains LifeLine services to
a group of Career Camp students at Clarian Health
in Indianapolis. |
It's been four years since Jeremy Jackman, RN, became
a nurse. But he hasn't forgotten his first day on the
job.
"They gave us a bunch of patients," he said.
"It was kind of trial by fire."
When his employer, St. Mark's Hospital in Salt Lake
City, started a mentoring program for new nurses, Jackman
offered to help.
"I volunteered so I could make it easier for other
people," he said. "A lot of times, people
come in, they're thrown into it, it's high stress, they
don't know what they're doing exactly, and that doesn't
create a good working environment. The stress finally
gets to them and they quit."
St. Mark's is one of a number of organizations and
individuals, including health care employers, nursing
schools and legislators looking for solutions to the
nation's nursing shortage. At St. Mark's, experienced
nurses like Jackman who agree to mentor a new hire receive
bonuses for every six months that the new hire stays.
The nurses are matched for skills and interests, and
both have a lighter workload until the less experienced
nurse is up to speed.
Last year, 24 percent of the nurses who left the hospital
did so after only three months or less. But no new hires
have quit since the program began in January.
The mentoring program at St. Mark's is working, but
the payoff for other programs may not happen so quickly.
Experts caution that it could be years before it's clear
which ideas and innovations should spread and which
should be sent to the junk heap.
But one thing is certain, they say: To solve the shortage
problem, policy changes and programs not only must increase
the supply of nurses, they must reduce the steady stream
of nurses leaving hospitals to a trickle by making nurses
a valued and respected part of the health care system.
Decades ago, nursing was one of the few career options
for women. But as more highly paid and prestigious jobs
opened to them, fewer and fewer women chose nursing.
Through the years, nursing hasn't attracted men and
minorities. Men remain a sliver of the nursing population,
while the number of minorities in nursing is just a
fraction of their percentage of the population. The
growth of managed care in the 1990s contributed to the
problem as well. As companies worried about declining
profits, they cut their nursing staffs.
The declining number of people entering the profession
and job cuts contributed >> not only to the present
shortage, but created stressful working conditions for
the nurses who stayed.
In a NURSEWEEK/AONE study, seven out of 10 hospital
nurses polled said they had witnessed a negative effect
on patient care quality because of the shortage. At
least two out of three working RNs said they'd seen
an increase in the turnover of experienced nurses, more
patients per nurse and an increase in overtime or double
time for nurses in the past year, according to the survey.
Those problems are expected to escalate in the next
20 years. In 2000, the number of registered nurses in
the country was 6 percent below the demand, according
to a new report from the National Center for Health
Workforce Information and Analysis by the U.S. Health
Resources and Services Administration.
That number will leap to 29 percent by 2020, according
to the report.
Many of the new initiatives geared toward curbing the
shortage are designed to ramp up the number of people
entering the profession. Many states have passed bills
to increase student enrollment in nursing schools and
to add school capacity.
At the federal level, Congress recently passed the
Nurse Reinvestment Act that President Bush signed into
law. The act is a multipart piece of legislation designed
to attract and retain nurses. Nursing advocates hail
its quick passage as a victory, but its lasting effect
remains to be seen. No money has yet been attached to
the act, and advocates say getting as much as the law
needs will be an uphill battle.
Meanwhile, health care employers also have started
to look at ways to increase the nurse supply. Some,
like Clarian Health in Indianapolis, are doing that
by reaching out to minorities.
For the past four summers, the hospital has hosted
a career camp for local minority at-risk youth. The
camp, in partnership with Goodwill Industries, puts
kids in the hospital during the day for a three-week
period. They shadow the health professional of their
choice, learn more about different health careers and
are mentored by hospital staff.
The experience may be brief, but it leaves a lasting
impression, said Sherry Makely, Ph.D., manager of educational
services for Clarian. "We did a quick telephone
sampling [after the camp] and found the majority of
them are continuing on with their health career plans,"
she said.
Several have come back to Clarian, Makely said. "We
hire a few of the best ones to be interns, or we hire
them to work part time in an after-school job. They
get to know us, and they realize that we have a support
system here," she said.
Clarian would like to reach more minority youth through
a partnership with the Indiana Minority Health Coalition.
The coalition has applied for a grant to help minority
high school students learn about careers as nurses,
pharmacists and other health care professions affected
by the shortage. The partnership would set up a telementoring
program partnering children around the state with health
professionals from matching racial or ethnic backgrounds
and fund career days in high schools.
Other hospitals have come up with innovative ways to
increase the nursing pool from within. At Holy Family
Hospital in Methuen, Mass., nursing assistants are paid
to go to school to become nurses.
"Some of our students have families that they
couldn't support if they didn't have that additional
pay," said Jacqui Collins, MSN, RN, the hospital's
clinical educator. "It just gives them an edge
when they get to school."
The program began in February 2001. Nursing assistants
regularly work 32 hours per week at Holy Family. But
students get a break. Those taking between four and
seven hours of classes each week receive eight hours
paid credit and work just 24 hours. Students who are
in class seven to 12 hours per week work half time and
earn 16 paid hours for being in class.
Although the nurses haven't yet graduated, Collins
said she expects the program to be a success.
"We're comfortable with them, we know that they
have great work ethics and that they're good [assistants],
and that will translate into good nurses," she
said.
Attracting more students to nursing is one strategy.
Hospitals also are trying to give existing nurses more
educational options. A common complaint among nurses
is that it's difficult to advance professionally. Some
employers are tackling this dilemma by offering employees
a little scholastic assistance.
Catholic Healthcare West, a nonprofit organization
with 42 hospitals in Arizona, California and Nevada,
is one example. The organization has partnered with
Holy Names College in Oakland, Calif., in a distance-education
program to help nurses with associate degrees and nurses
from other countries earn baccalaureate degrees conveniently.
Classes taught by college faculty are beamed to eight
Catholic Healthcare West hospitals from a studio at
the college. The nurses can take classes without having
to search for a program or trying to squeeze classes
into their work schedules.
The program now has about 60 distance-learning students,
but Fay Bower, DNSc, FAAN, chair of Holy Names College
Department of Nursing, hopes to double the number of
students next year.
"I think it's opened the nurses' eyes to what's
possible at the institution they're in, beyond what
they're doing, so they have new skills, new ideas and
knowledge," Bower said.
Other hospitals are trying to retain nurses by improving
inhouse technology in the hopes that it will enhance
the work environment.
Children's Hospital and Health Center in San Diego
has initiated a new system on desktop and laptop computers
in several departments to help eliminate frustrating
paperwork. The program carries forward old parts of
charts so nurses don't have to rewrite the same information.
Finding specific information is easier with the electronic
charts because nurses can search through different windows
on the screen rather than wade through papers and sloppy
handwriting. Several people can view the chart at once,
too.
But the best part of the program is the "help"
key. Instead of explaining how to use the system, the
key provides the kind of assisstance that a busy nurse
needs, including the range of normal temperatures for
children of different ages and explanations on performing
unfamiliar procedures.
Staff and administrators say the new technology-particularly
the help key-has proved popular with nurses.
"New staff coming in from another aspect of nursing,
especially the adult world, use it tremendously,"
said Seja Plavisic, RN. "I still see those of us
who are seasoned for decades using it. I look things
up to see whether I'm on the cusp of care with certain
kids or not," she said.
"I don't know if it's saving time," said
Linda Travis Macomber, MBA, RN, clinical informatics
analyst at the hospital. "But it's saving lives
and nurse frustration, and that's a huge issue in nurse
retention," she said.
While some employers are trying to make nurses want
to stay, others are encouraging nurses to grow roots.
Help in buying a home is a new benefit offered by some
hospitals. Fannie Mae, a housing financial services
provider, is working with more than 50 health care employers
across the country. While some employers choose to offer
only counseling, the most typical perk offered to nurses
is a no-interest loan forgiven at 20 percent per year
in the course of five years, said Beth Marcus, director
of Fannie Mae's National Community Lending Center.
The loan works because "from the employer's perspective,
your goal is to get them to stay. From the employee's
perspective, they get the money up front," she
said.
How well nurses like the new benefit is difficult to
tell because Fannie Mae didn't start to track its use
in hospitals until a year or two ago, Marcus said. But
within Fannie Mae itself, where housing assistance has
long been a part of the benefits package, turnover in
nine years was 25 percent lower among employees who
used the housing benefit compared to those who didn't,
Marcus said.
Nursing experts say these programs generally are good
steps toward a solution.
The St. Mark's and Holy Names programs are particularly
good ideas, said Joanne Spetz, an adjunct fellow at
the Public Policy Institute of California at the University
of California, San Francisco.
The mentoring program is "a good start to really
try to give new nurses a chance to ease into it and
give them more structured guidance to help them learn
the ropes," she said.
But the program does have a pitfall, Spetz said. If
a new hire quits for reasons that have nothing to do
with the mentor, the mentor still is punished, she said.
The nursing assistants who complete the Holy Names
distance-learning program are a better bet than average
nursing school graduates, Spetz said. "People who
work in a health care environment before they go into
nursing have a more realistic view about what nursing
is, and are more likely to stay," she said.
But Spetz and other experts say employers are just
starting to tackle the biggest issue in solving the
nursing shortage.
If employers want nurses to stay, they must respect
nurses' opinions and concerns and help nurses feel they
are doing the best they can for patients, said Rose
Gonzalez, head of legislative affairs for the American
Nurses Association.
"We believe that when you provide nurses with
a say in patient care and make them part of the decision-making
process, care improves and the nurses are more likely
to stay," she said.
Gonzalez said the ANA strongly supports the Magnet
hospital program by the American Nurses Credentialing
Center, a subsidiary of the ANA. The program awards
special status to hospitals that show best practices
and excellence in nursing and caring for patients.
To earn Magnet status, a hospital must follow standards
for improving patient care, promote quality professional
nursing practice, pay attention to the cultural and
ethnic diversity of patients and staff, and have strong
leadership and support for nurses from nursing executives.
More than 50 health care centers have received Magnet
status since the program started in 1993, and studies
on the hospitals have shown that nurses at Magnet hospitals
are less likely to suffer from job burnout than at non-Magnet
facilities.
The Magnet program "does work to change the culture
of the institution to value and respect nurses,"
Gonzalez said. "That's why we are very supportive
of that program. We believe it is the workplace that's
driving nurses away."
A system that consistently gives nurses a voice in
patient care and makes them a respected part of the
health care workforce may seem a far-off dream. But
getting there isn't as difficult as it seems.
Baptist Health Care, with five hospitals in or near
Pensacola, Fla., is one example of how an employer can
dramatically change for the better for nurses and patients.
In 1996, turnover among nurses at Baptist Hospital
was 30 percent annually. Before 1996, the hospital also
was well below average in patient satisfaction.
The administration decided to make a change by placing
more focus on patients and on employees. Nurses now
get more of a say in the day-to-day running of the hospital.
They are encouraged to make suggestions on improving
patient care and cutting costs. Staff members interview
prospective new hires, and a majority of them must agree
on a new person before he or she is hired.
Employees continue to earn an annual merit raise averaging
3.5 percent, but after 1996, management added an annual
market adjustment to keep wages at the median level
for the area. Management also decided to promote an
open culture by sharing the company's financial information,
encouraging employees to talk about any problems.
Nurses can do small things to help patients independently.
They can bend visiting hours on special occasions, get
family members meal tickets if they've arrived late
and are hungry, or buy patients or family members small
gifts, according to Brian Jones, RN, who works in the
hospital's intensive care unit.
"The bosses kind of let you do what needs to be
done, and they back you with whatever they need,"
he said. "You can have a policy and a procedure
all day long, but there's always times you need to do
things like this to do what's right for the patient."
Changes like these may seem small, but they've made
a big difference. This year, Baptist Health Care was
one of two hospital systems on Fortune Magazine's list
of the top 100 companies to work for.
Baptist Hospital is in the 99th percentile in patient
satisfaction, according to Press Ganey Associates. Nursing
turnover at the hospital is down to 12 percent-an 18
percent drop from the hospital's 1996 rate.
Part of the present turnover may be due to a price
war among hospitals in the area. Like most nurses, money
is a consideration for Jones. But he has no intention
of leaving Baptist Hospital anytime soon.
"Once you start working where I work, there are
a lot of other things that are more important than money,"
he said.
Contact
Jessica M. Scully at Jessicam_scully@yahoo.com.
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