Continued from Page 1

A recent report by the Institute of Medicine [see "Working conditions require 'substantial changes,' " Nov. 17 issue] suggests that reducing agency use is also critical because it cuts down on the risk of medical errors. The report, released Nov. 4, stated that "Whenever possible, health care facilities should avoid using nurses from temporary agencies to fill staffing shortages."

Although retention strategies are critical to reducing dependency on agencies, nurse executives said it would have been impossible to meet this goal unless hospitals also are willing to pour resources into hiring more nurses.

Bingle decided to go directly to the agency nurses to see if there was a way to attract them to be employees. She interviewed agency nurses and asked why they worked for an agency rather than the hospital.

"Lots of people think it's the money that attracts them to agencies," Bingle said. "But the nurses I talked to wanted the freedom to say when they were going to work and didn't want to be bugged all the time."

Bingle took this information back to the hospital's human resources department and came up with the idea of creating a 13-week traveler program for people who lived in the community.

These local traveler nurses would work the shifts that were difficult to fill at the hospital, such as evenings and nights, and the travelers could decide which 13 weeks they wanted to work.

Bingle's facility also developed a refresher program that attracted
anywhere from six to 16 students per class, and the hospital hired about 70 percent of the nurses who completed the program.

The facility also created a program that allows staff nurses to work additional hours to earn extra money.

All for one

Although she credits the human resources and nursing departments for toiling every week to prepare the agency-free deadline, Bingle said it would not have been possible without the support of the top leaders in the hospital.

"It has to be a strategic imperative of the whole organization," she said. "It can't just be a nursing thing. We had support all the way up to the CEO. It can't be people down here hoping. Hope is not a plan. You have to have a plan."

While many hospitals are attempting to eliminate agency use altogether, others are zeroing in on the departments that use agency nurses most heavily.

At Community Memorial Hospital of San Buenaventura in California, hospital executives found that registry nurses were often hired in critical care units. To change that pattern, the hospital started an internship program for employees who wanted to train to become nurses in critical care units.

The hospital continued to pay employees as they participated in the program, which offered specialty training in labor and delivery, the OR, the emergency department or the ICU. About 12 students graduate from the program per year.

Rhonda Spiegel, MPA, RN, assistant director at the hospital, said that these graduates help the hospital avoid using as many expensive agency nurses, and some of the money saved is funneled back into the program.

"It is a trade in dollars," Spiegel said. "Some of the dollars we are saving in reduced registry we are spending in the program.

"In the long term, though, it puts us in a better position, and is better for patient satisfaction. We'd rather have a competent nurse who wants to stay than the revolving door of the agency."

Successful strategies

Like her nurse executive counterparts, Kathy Walsh, MS, RN, chief nursing officer at Memorial Hermann Southeast Hospital in Houston, agreed that it was daunting at times to stop relying on agencies, and the hospital's success hinged on tackling the problem on several fronts.