Over 50% of workers are age 50 or over in the nation.(1) The graying of America’s working population is approaching and with it the understanding that knowledge transfer will be a much discussed challenge. Indeed organizations like the American Association of Retired Persons (AARP) are looking at various industries and the impact the retirement of the baby boomers will have on the workforce. The transition in technical knowledge based professions will be affected the most which includes nursing.
Although there is a current artificial unemployment situation in the nursing profession this is short term. Issues of profitability and companies wanting to stay financially viable means teaching institutions have reduced expenses. For hospitals, training new nurses costs money so there is a reluctance to hire. But it is expensive to replace a nurse who has long tenure. However, when demand for services and nurse retirement peak, medical centers may find themselves unprepared due to current cutbacks.
This blog has in the past outlined the unfolding nurse shortage. There are well qualified applicants for nursing schools but lack of space and faculty means they are turned away. Nurse turnover and retention of new graduates are problems. All of these factors only exacerbate the challenge of keeping nurses employed and fulfilled long enough for them to gain experience and hopefully in some cases further education.
Many of the factors that contribute to the challenge can be solved if experienced nurses stay in the profession.
So why do those nurses exit the profession? A significant reason is stress, caused by such factors as inadequate staffing levels, physically demanding work which can cause injury, work life balance especially if there is eldercare, or feeling undervalued or unappreciated, due to lack of support.
What are health care organizations doing to address experienced nurse retention?
The Robert Wood Johnson Foundation decided to examine the challenge and began with a white paper in 2006 that outlined possible evidence based solutions that could be implemented to retain older nurses.
In 2007 the Foundation started the program by funding the Wisdom at Work Retaining Experienced Nurses Initiative. They chose 13 health care organizations to receive 18 month grants of $75,000 to examine the solution to the challenge in a work environment. The 13 were selected by the following criteria: They were organizations recognized nationally for nursing, design, or technology achievements and they already had retention programs in place. Their programs focused on one of three areas: workplace design/ ergonomics, staffing/human resources,(change in organizational culture), or using technology to improve work process.
Nursing can be physically demanding especially when patient movement is involved, and there is always risk of injury. Many of the programs that fell into the ergonomics category were aimed at reducing the impact of patient movement with lift teams and other strategies. A few of the programs involved nurse input.
The human resource or staffing programs had adequate staffing levels as a key component. A couple initiatives involved experienced nurses controlling the admission process. One program kept nurses on their own units rather than shifting them to unfamiliar units. 2 involved increasing nurse wellness and job satisfaction. Another implemented a virtual ICU that experienced nurses could monitor from several locations.
In 2007, the Foundation examined case studies of top performing companies in terms of staff retention of older workers. 7 companies were selected 4 of which were health care organizations. All 7 organizations have been awarded distinctions such as Fortune 500 List of 100 best companies or American AARP’s Best Employers for Workers over 50. The next few paragraphs will summarize their successes.
Bon Secours Health System in Richmond, Virginia’s mission statement that workers remain for life is not merely lip service, but is executed through timely ongoing efficient communication. This communication involves staff input through surveys and feedback. They monitor patient satisfaction, quality outcomes as well as financial performance. They encourage flexible work and retirement arrangements, innovative benefits and professional development.
Monongalia Hospital in West Virginia has focused on strengthening the nursing culture in its medical centre with the goal of excellent patient care. Nurses were involved in the planning the design of the new addition to the hospital, an unprecedented involvement of staff in decision making. Monongalia understood that quality patient care involves nursing input, and to leverage nursing skill they use technology.
At Scripps Health in San Diego workplace culture and benefits are organized and adapted according to the differing life cycles of its nurses. There is a system wide forecasting of employment needs which is kept current. There are focused retention strategies to prevent talent loss, one of which is their mentoring program. Each employee decides how to achieve professional success and Scripps helps them get there. There are differing benefits for employees to select depending on their needs such as eldercare benefits and phased retirement options.
Carondelet Health Network in Arizona was always competing for staff with Phoenix and California and relied on contract labor to hire nurses. Executives decided to invest in the professional development of nurses as a way of retaining staff. They created an on site BSN program with paid tuition. They also partnered with a local university to offer a free MSN program as well with the stipulation that after graduation the nurses would serve as adjunct faculty. Retention has increased and the use of contract nurses has decreased.
Retention strategies must be able to be replicated nationally to be effective. This can occur if there is a system wide commitment to understanding the value of experienced nurses. This cultural shift must be supported by planning and making the business case for investing in strategies, and learning from other medical centers’ best practices. Feedback and data must be collected diligently on a regular basis. It may be that hospitals will collect data such as quantifying the value of experienced nurses. Other professions have done that and so can health care. Organizations must be open minded as situations change and not be tempted to apply temporary Band aid solutions.
If experienced workers stay in the profession and advance to leadership roles for example, the nurses entering the workforce will more easily acquire critical thinking skills and will be able to approach clinical situations in ‘the context of broader outcomes’(2). Leadership in medical organizations need to recognize this is a pressing issue and be proactive in keeping valuable veteran nurses.