Five Questions

TO: CHIEF RETENTION OFFICER
FROM: CHIEF EXECUTIVE OFFICER
RE: STOPPING THE EXODUS OF NURSES

Despite international efforts to lure students into nursing programs, nurses aren’t getting any younger. The average age of a nurse today is 47, and by 2010 about 40 percent will be more than 50 years old. Although the demand for health services is expected to increase as the population gets older, hospitals may not have enough bedside caregivers to meet the need.

“This is a huge problem,” says Karen S. Hill, M.S.N., R.N., vice president and nurse executive at 325-staffed-bed Central Baptist Hospital in Lexington, Ky. “The industry faces not only losing the sheer numbers of nurses to retirement, but also the professional expertise and institutional knowledge they have acquired.”

Hospitals that don’t address this issue today face the possibility of closing beds and limiting services, says Hill, who coauthored a recent report for the Robert Wood Johnson Foundation, Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace. The study offers best practices for retaining veteran nurses, but Hill notes that health leaders should start asking questions to develop their own creative solutions.

Are our nurses happy?

Hill’s research inspired her to inquire about nurses’ attitudes at Central Baptist. “Nurse satisfaction is measured at many facilities, but are executives evaluating survey results by age?” says Hill. Look for trends that might point to discontent among seasoned nurses, and then start a dialog about how to make the environment better. Hill recently has begun conducting focus groups with nurses over age 45 to identify opportunities for improvements.

How can we make the bedside more safe?

Nursing is a physically stressful job even for the young, so nurses appreciate any help they can get. Hill had overhead patient lifts that can handle more than 300 pounds installed for 58 beds at Central Baptist. She is monitoring injuries, patient drops and patient satisfaction to make a case for purchasing more. “If you’re a nurse—no matter what your age—if you injure your back, you might have ruined your career,” she says.

Such capital investments could reap savings by retaining your most knowledgeable front-line clinicians, she adds. Hill is also considering universal patient rooms, designed to help staff locate items, and communication technology that decreases the amount of walking nurses have to do. “If we really want to keep nurses at bedside, then we need to minimize those things that cause injury and fatigue,” she says.

Are we encouraging age diversity?

Hill stresses the importance of making age diversity a strategic initiative. Knowledgeable caregivers translate to better patient outcomes, she says, so human resources staff, supervisors and managers should work toward having a mix of new and experienced nurses across all departments.

Are our employment policies too rigid?

Many healthcare workers over age 55 don’t want to suddenly walk away from the careers they’ve spent years developing, but sometimes institutional policies make staying on the job impossible. “Today’s retirees don’t look like the retirees of 10 or 15 years ago,” says Hill. “How are we going to help those people have interesting employment and financial opportunities to meet their needs and our needs, too?” She’s considering changes to the hospital’s nurse preceptor program that would allow skilled nurses to work shorter shifts when they mentor new nurses.

Are we developing our nursing talent?

Last, Hill points out that veteran nurses could be enticed to keep working—if they can develop new skills and have advancement opportunities.

Organizations should start work on these issues immediately, says Hill, who began investigating ways to improve nurse retention two years ago. Hill’s nurse vacancy rate is less than 3 percent—a sizable return on investment, considering the national average turnover rate was 21 percent in 2000, and the cost of replacing one nurse is more than $90,000, according to a study by the Scottsdale, Ariz.-based HSM Group, Ltd., a healthcare consulting company.

—Rick Johnson