Creating Solutions to the Nursing Shortage

A hospital in Macon, Georgia is offering free sodas to nurses who have done particularly good work or gone beyond the call of duty. Meanwhile, a hospital in Buffalo, New York is partnering with an international corporation with local headquarters to pay for people to attend nursing school if they promise to work at the hospital after graduation.

These are unusual solutions to the shortage of nurses, but creative solutions seem to be growing in popularity as hospitals realize that they must find new ways to recruit and retain nurses.

The national nursing vacancy rate is hovering around 13 percent. Hospitals around the United States are so desperate for nurses that they’re promising sign-on bonuses of $1,500, $2,000, or even as much as $5,000.

But that’s just not enough to make a significant long-term difference in the nursing shortage, many nurses say. It’s not about the bonus check; it’s about respect, better working conditions and job satisfaction.

Realizing that desperate promises and sign-on bonuses aren’t working to keep nurses in the acute care setting, some hospital administrators have decided to fall back and punt. They’ve put their energy into creative solutions to the nursing shortage in the hopes that their new strategies will be more effective.

Hospitals have typically responded to past nursing shortages by offering bonuses to nurses who sign up to work there. Some hospitals, like Regions Hospital in St. Paul, Minnesota, are still offering them, including “sky-high” bonuses of $8,000 and $10,000 for some nurses with critical care experience.

That strategy has helped that particular hospital, said Jan Rabbens, spokeswoman for the Minnesota Nurses Association, but it’s just succeeded in moving nurses around, not creating or recruiting new ones.

“They’re just robbing Peter to pay Paul,” Rabbens said.

Why aren’t the sign-on bonuses effective at recruiting and retaining nurses in U.S. hospitals? According to the National Council of State Boards of Nursing, the current shortage is different from past shortages. This one is worse, and the traditional solutions aren’t likely to work when it gets worse as the nursing workforce continues to age over the next decade.

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“This time, it’s not working really well,” said Brenda Nevidjon, RN, MSN, an associate clinical professor at the Duke University School of Nursing and a member of the international nursing honor society Sigma Theta Tau. “They’re finding that they’re not getting the same responsiveness that they got 10 years ago. Nurses are not necessarily getting lured back into the workplace with a sign-on bonus when…they know it’s a very stressful workplace.”

Instead, today’s nurses know they have other options, like home care or ambulatory surgery centers, and a sign-on bonus won’t compensate for what many feel is a better job situation, she added. “I’m not going to compromise my quality of life for $5,000 or $10,000” is what many nurses feel, she said.

Liz Jacobs, RN, spokeswoman for the California Nurses Association agreed. She said that nurses need the profession to “return to a place where we can do the things that give us job satisfaction, like patient education and basically feeling like you’re not jeopardizing patient care and your license every day.”

Jeanette Ives Erickson, RN, MS, also agreed that hiring bonuses aren’t effective because they are a symptomatic solution that does not address the fundamental nursing shortage. Erickson is senior vice president for patient care and chief nurse at Massachusetts General Hospital and a faculty member of the Institute for Nursing Healthcare Leadership.

There are many theories as to the best strategies to address the shortage, but the strategies that focus on truly improving the workplace have the best potential, according to Jacobs and Rabbens.

Many hospitals are already struggling to provide enough nurses to cope with the numbers of patients. Nursing needs money, social commitment, and efforts to improve working conditions, Rabbens said, or patients will suffer the consequences. And nurses do not want to feel that they are compromising patient safety, she added.

“It has to be a concerted effort,” Rabbens continued. “I think we have to wake up and go to public debate about the patient flow problem we have right now. We do not have enough resources to meet the demand, and we have to do something about it now.”

Houston Healthcare Complex’s “Cokes for Caring” program is a nice bonus for nurses, but such strategies are not enough to make a long-term difference, she said.

“There are few quick fixes to the problem and attracting more women and men into nursing and the other health care professions will take years, if not decades,” Erickson said. “We need to employ new approaches to attracting more interest in health care careers.”

The nursing shortage is so critical in Florida that the Florida Hospital Association has predicted the state will need 34,000 additional nurses by 2006. One hospital in Tallahassee, Florida, has decided to put some money towards improving the work environment, retention and recruitment efforts in the hopes that it can staunch the flow of nurses away from the critical care setting.

“I think nurses want to be paid adequately and recognized for their performance,” said Ann Evans, RN, senior vice president for nursing for Tallahassee Memorial Hospital. “I think they want to work in a place with good outcomes. People want to work where they’re respected.”

With that in mind, Tallahassee Memorial Hospital officials decided to earmark part of a $1.9 million Robert Woods Johnson Foundation grant toward this goal. The hospital is creating a workforce development program and working to apply for magnet hospital status.

Magnet hospital status is a relatively new designation, but many hospitals hope that becoming a magnet hospital, which is designed to be nurse-friendly, will help them keep and recruit nurses. Nevidjon said she hopes that magnet hospital status does not become a purely symbolic designation and that hospitals that apply for it truly change the workplace to make it better for nurses.

“I think the jury’s out on this,” she said. “I think that if people say, ‘This is really important to our organization’…and truly transform their organization, it’s going to be great.”

Tallahassee Memorial Hospital also is adjusting its pay strategies to better suit its employees’ needs and has instituted a tuition reimbursement program as an incentive for its nurses to continue their education. The hospital is now using a market-based pay strategy to remain competitive and will regularly re-evaluate. It’s also using a new 15-step compensation program, where employees can get a pay raise for each new level to recognize their gains in experience.

Like some other nurses, Evans hopes these programs will be more effective than sign-on bonuses. “It’s sort of a bad cycle,” she said of bonuses. “If you don’t, and your competitor does, it makes you look bad.”

The California Nurses Association’s Jacobs suggests that mandatory nurse-to-patient ratios, which California recently announced, may also improve the work environment for nurses enough to draw more nurses back into hospitals. Jacobs said the association also has high hopes for California Governor Gray Davis’ $60 million, three-year Nurse Workforce Initiative plan, which funds the training and eventual hiring of 5,000 additional nurses in the state.

Erickson said she tries to use the following principles to guide her when working with the nurses at her hospital: Nurses want to feel the importance of their work, nurses want to feel valued for their work, and nurses must feel they have a voice in decision-making that impacts their practice and work life.

Her hospital has implemented strategies like a clinical recognition program and nurse participation in collaborative governance committees. These initiatives are two major factors in making nurses feel they are receiving recognition and making their voices heard, she said.

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