“Keeping a Wiser Workforce”*
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.
Notes: