Nurses helped design a new $92 million patient tower that opened last year at Monongalia General Hospital in Morgantown, WV.
At Carondelet Health Network in Tucson, AZ, nurses have access to on-site bachelor's of science in nursing and master's of science in nursing education, through collaboration with a local university.
And at Scripps Health in San Diego, CA, experienced and mature nurses are encouraged to stay on the job through a multitude of flexible work arrangements and phased retirement options.
These are three success stories highlighted in a recent report, "Wisdom at Work: Retaining Experienced Nurses" by the Lewin Group and commissioned by the Robert Wood Johnson Foundation.
While seven case studies describe projects that work, the report also details the outcomes of 13 selected research projects designed to test positive and negative outcomes of strategies to retain experienced nurses who otherwise might quit for less demanding jobs.
Healthcare executives are well aware of the problem. According to a January report by the Lewin Group, the average replacement cost for a full-time equivalent RN is about $36,567. About two-thirds comes from the added termination expenses, such as paying the departing nurse for unused vacation time, as well as finding temporary replacement and conducting new RN training and orientation.
By next year, more than half of the nation's registered nurses will be over age 50 and many will be considering retirement.
Surveys reveal that 116,000 registered nurse positions are now unfilled in U.S hospitals; another 100,000 job vacancies exist in nursing homes. Although the recession has caused some nurses to delay retirement, the aging demographic means an increasing demand for nurses looms, and may outpace the supply of nursing school graduates.
"We know that there is no quick fix to the crisis in healthcare," said Susan B. Hassmiller, the Robert Wood Johnson Foundation's senior advisor for nursing. "But initiatives explored in our Wisdom at Work are pieces of a larger puzzle that will help healthcare organizations keep experienced nurses from walking out the door–and taking their expertise with them–just when we need them most."
The recent report focused on efforts in three key areas to retain nurses:
- Ergonomic initiatives to help nurses better manage the demand for strength
- Human resource-related strategies and employee wellness
- Technology and leadership development
For example, Cedars Sinai Medical Center in Los Angeles, a 952-bed facility, launched a lift-team initiative to decrease the number of back injuries, lost work days and costs related to injuries while handling patients. Since the program started, the number of days of work lost due to patient handling injuries and disability costs declined. Challenges, however, included uneven use of the teams by some inpatient units and the lengthened time to respond to some parts of the large hospital.
At Florida Health Science Center in Tampa, FL, an 877-bed facility, a similar initiative was not as successful. The system saw a large drop in the number of days lost by experienced RNs because of patient handling injuries. Also, "experienced RN turnover trended upward," in part because of competition from non-bedside nursing opportunities as well as the hospital's staffing policy that required 12-hour shifts in some units.
The report found that overall, such ergonomic initiatives did not contribute to an overall drop in turnover, although they did improve morale and cut expenses associated with injuries.
On general staffing issues, Centra Health's Lynchburg General Hospital and Virginia Baptist Hospital, a 526-bed system, realized that nurses were often calling in sick when scheduled to work outside their home units because many did not feel "comfortable or confident being pulled from one medical center to another." The resulting launch of a "closed staffing" policy, in which nurses who volunteer for the program can work outside their home unit, was credited with reducing turnover of experienced staff.
At Froedtert Memorial Lutheran Hospital in Milwaukee, a 434-bed facility, experienced nurses were employed to staff a virtual intensive care unit that monitors intensive care at a number of sites. Since the setting is less physically demanding, it was credited with reducing physical strains on older nursing staff.
Kay McVay, president emeritus of the California Nurses Association, which represents 85,000 of the state's 200,000 nurses, says these techniques are all well and good, and it's laudable that hospitals are using better ergonomic equipment to ease strain on older nurses.
But to some extent, she said, "that's a gimmick, something that hospitals can use to say, in effect, 'We're going to change things and you're going to like this.' "
"But what we really want is respect, and to be assured that we really will have the time we need to take care of our patients," says McVay, former critical care nurse with Kaiser Permanente Medical Center in Martinez, CA.
What helped achieve better working conditions in California was a court room victory several years ago to uphold nurse staffing ratios set by former Gov. Gray Davis in 1999, but which Gov. Arnold Schwarzenegger attempted to overturn.
In medical surgery and telemetry units before the ratio limits were upheld, hospitals could staff nurses any way they liked, says McVay. Now the ratio is set at 1 nurse to 5 patients for med-surge units and 1 to 3 in telemetry.