HHS says the coming nursing shortage could mean a deficit of 1 million nationwide. Are you prepared to do a better job keeping quality nurses in place?

Hospital executives realize that nurse turnover is a problem—just not in their institutions. According to research from PricewaterhouseCoopers’ Health Research Institute Survey, three-quarters of respondents indicated that workforce shortages were real. But when asked to list priorities for their hospitals, those same executives ranked nursing shortages seventh, just behind physician shortages, and behind such competing priorities as reimbursement concerns, uncompensated care, clinical quality, and government regulations.

Every percentage point increase in nurse turnover costs a hospital about $300,000, according to findings in PwC’s “What Works: Healing the Healthcare Staffing Shortage.” Hospitals with high turnover spend an average of $3.6 million more per year on staffing than institutions with low turnover.

“Trained, quality nurses will directly impact the bottom line,” said Janet Hinchcliff, director of the healthcare advisory practice at PricewaterhouseCoopers, based in McLean, Va. “Hospital margins are not that big, so a 1% or 2% swing in profit is huge for them.” Although figures vary widely, the cost for replacing a single nurse has been pegged at $65,000, so keeping quality nurses should be a priority for any institution.

Hospital executives also realize that a nursing shortage is coming. The US Department of Health and Human Services believes the deficit could reach 1 million nationwide, and Hinchcliff said that hospitals, especially in metro and suburban areas, have had to reduce the scope of expansion efforts or shelve them altogether because of the potential inability to staff them. She added that nearly one-third of licensed nurses are either working part-time or have left the profession, making efforts to retain quality nurses more important than ever.

Great expectations
Children’s Healthcare of Atlanta, which encompasses three pediatric hospitals and 16 satellite care centers, has retained nurses at a rate between 88% and 90% over the past four years, said Linda Matzigkeit, senior vice president of human resources. Metro Atlanta hospitals have an average retention rate of 86%, so Children’s performance has eclipsed that mark, as well as the national average of between 80% and 85%.

Despite its success, the institution has initiated several programs over the past few years aimed at keeping its 2,100 nurses on the job longer. Overall, Children’s spends about 1.5% of payroll on work/life initiatives to help all employees achieve success in the professional and personal aspects of their lives.

The most successful program has been the Great Expectations baby showers, held quarterly since 2004 for employees who are expecting or adopting. Along with cake, punch, and prizes, expectant mothers are given information about benefits during maternity leave, how to return to the organization, full- and part-time flex working options, daycare choices, and other issues. The event generally is held at a near-site daycare center, so moms can tour the facility.

“We want nurses to come back,” Matzigkeit said. “Our goal is to take the stress out of having a baby and returning to work.” She estimates Children’s spends $5,000 on each event, which has helped the hospital system increase the percentage of nurses returning from maternity leave from 64% to 96%.

Children’s has several other programs designed to reduce turnover, including the Career Advancement for Nursing (CAN) program, which debuted in 2005. The career development program helps nurses gain proficiency at the bedside or prepare for an administrative role. The clinical progressions are novice, colleague, resource, leader, and expert. After reaching the resource level, a nurse can branch off into the administrative track and progress through clinical educator, assistant manager, and nurse manager. Each track works on a point system, with prescribed studies and demonstrable skills necessary before a nurse can move to the next level.

In addition to the preceptor that new nurses are assigned to for 12 weeks, they are also appointed a mentor for their first year to help them navigate through the institution and provide valuable insights about working at Children’s.

Matzigkeit also points to the recent purchase of baby, toddler, and child simulators so nurses can hone their clinical skills, a working mothers network through the company intranet, and informative e-mails as other ways to increase retention. “We want good nurses to come here and stay,” Matzigkeit said. “We want lifers.”
          
From day one
Helping new nurses assimilate to their new careers and remain in nursing is the focus of the Wisconsin Nurse Residency Program, which has received two grants from the Health Resources and Services Administration since 2004.

The year-long residency program, which begins when the three-month preceptor program ends, has lifted nurse retention to 85% for the first two years, compared with a 50% national average for new nurses said Marilyn Meyer Bratt, project director. Nearly 40 hospitals and more than 300 nurses have been involved in the program.

“We’re looking for retention as new nurses make a successful transition to a career, provide evidence-based care, use critical thinking skills, and engage in lifelong learning and clinical leadership,” said Bratt, a registered nurse and assistant professor at Marquette University. “Nurses commit to a once-a-month learning session and are assigned a clinical coach to help them create their own professional development plan and provide an ongoing support system.”

Running the residency program for 10 nurses costs about $52,000, significantly less than hiring and training one new nurse. A new grant will examine the preceptor model, with the aim of supporting new nurses from day one, Bratt said.

Even at hospitals with success in retaining nurses, this area remains a focus. The three-hospital Swedish Medical Center in the Seattle area has a nurse vacancy rate that ranges between 5% and 5.6%, but it still wants to attract and retain the best nurses, said Pamela Smith, RN and director of clinical education and nurse integration in the system’s Center for Nursing Excellence (CNE). The 40-plus employee department was established to “focus on staff who take care of patients in all clinical settings,” said Smith, which includes the system’s 2,300 nurses.

Swedish recognizes that the nursing pool is becoming more shallow, even though the system has five qualified applicants for each job opening. Smith, who joined Swedish in 2006, has created a pipeline plan that begins at the student stage, using an assimilation coordinator to greet students and become a point of contact. New graduate hires are assigned a professional development specialist to map out growth opportunities and help nurses fit into hospital culture with colleagues and managers.

“The real prize is that the patient gets better care,” Smith said. “Our mortality rates are at or below the national average, and we know there is a competent nurse at the bedside doing the right things at the right time.”

Matt Bolch, This e-mail address is being protected from spam bots, you need JavaScript enabled to view it , is a freelance writer based in Atlanta.