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Rx for the Nursing Shortage
Business Journal

Rx for the Nursing Shortage

Hospitals need a dose of innovative recruiting, talent-based hiring, and great management

by Deborah A. Paller

The nursing shortage in the United States is not only a growing problem, but a complex one, too. Although the Bureau of Labor Statistics cites registered nurses among the top 10 occupations with the largest projected job growth in the next decade, the gap between supply and demand continues to widen.


Not only are registered nurses leaving the profession due to tense work environments, inadequate staffing, and inflexible work schedules, but negative press about the profession is also discouraging new nurses from entering the field. If hospitals are going to overcome the critical problem of rising nursing vacancy and turnover rates, they must understand the many factors that make up the challenge that lies ahead.

One factor is that aging baby boomers are going to make a double impact on the healthcare system in the next 10 years. As consumers, they're going to place even greater demands on a healthcare system that's already stretched thin, while the registered nurses in that age bracket will start looking for alternative jobs that offer a more relaxed pace and equivalent income.

In addition, because of the evolution of the nursing profession in the past 30 years, many nurses approaching retirement age don't meet the educational requirements to serve as educators in the nursing schools. This creates a cap on the number of new nurses that can be accepted into these schools each year.

Another factor is that fewer students are entering the nursing profession every year. Although it's a promising career that offers job security, ease of relocation, and above-average compensation, the public awareness of the demands of the job and malpractice risks drive students, both young and old, toward less challenging careers.

This creates a situation in which more aggressive, risk-accepting individuals are attracted to nursing for financial and security reasons. But they may not be well-equipped to provide the compassionate and high-quality care demanded of them. It will be more difficult for hospitals to keep employees like these engaged in the hospital's strategies and operations, and -- more importantly -- they may compromise patient quality and service.

To confront and overcome the complexities of the nursing shortage, hospitals must use an innovative, multi-level approach: recruiting new nurses to the profession, hiring nurses for talent while training them for skills, and creating an environment in which nurses thrive. Let's examine these three strategies more closely.

Recruiting new nurses to the profession

To recruit nurses more effectively, hospital leaders must become advocates of nursing as a profession. It's imperative that they identify their most talented nurses and nurse managers and send them into the community to attract people with similar qualities to the profession. Hospital leaders should also partner with secondary schools and colleges to identify students who have the characteristics to thrive in spite of the challenges as the healthcare environment slowly improves.

World-class healthcare organizations don't just sit back and wait for potential nurses to find their recruiters. "We can't rely on traditional efforts anymore," says Rick Lovering, vice president of human resources and health promotion at RWJ University Hospital at Hamilton in New Jersey.

RWJ-Hamilton offers an internship/externship program to mid-term nurses at a local nursing school. It hosts up to 20 students during the summer break and offers them an opportunity to assist nurses in their daily care of patients. "This initiates a strong relationship with the future nurses of our community, and many of them accept nursing positions with RWJ-Hamilton upon graduation," Lovering says.

Hiring for talent -- and training for skills

If you've ever been in a hospital or an emergency room, you can probably recount a story of a great nurse who calmed your fears and made sure you were cared for perfectly. Or maybe you were less fortunate and had a more negative or frustrating experience with a nurse.

Whatever the case, few would dispute that being a great nurse -- like being a great artist -- is the result of innate talent. And as the pool of potential nurses gets tighter, and perhaps more of the wrong people enter the profession, it's imperative that hospitals find people who were born with nursing talent in their DNA.

While hospitals can't teach nurses how to be empathetic, how to have a keen sense of accuracy, or how to communicate bad news, they can identify people with talents like these -- talents the very best nurses have in common. Once they find these individuals, they can teach them the skills they need to know, like scrubbing for surgery or providing glucometer instructions.

In fact, for more than three decades, Gallup has studied the talents of great nursing professionals. Gallup developed a selection tool based on that research -- the Gallup Nurse Index -- which is designed to help hospitals find and select highly talented nurses in the murky market of people who simply attended a two- or four-year nursing school. The tool, a standardized Web-based selection instrument, offers hospital or nurse managers insight into the talents of nursing candidates, such as attention to detail, empathy, and self-confidence, and whether those candidates are the right fit for the job.

Jerry McMorrow, vice president of human resources at the Medical Center of Plano, Texas, says using such a tool has helped his hospital cut turnover. "Healthcare is a tough field, especially nursing," he says. "And it's difficult to find nurses who can face the challenges of the day and still provide great patient care."

Creating an environment in which nurses can thrive

A recent Gallup study found that the extent to which nurses are engaged at work is the greatest predictor of mortality index and complication index. Mortality (death) index and complication (such as infection or adverse outcome) index represent the difference between what actually occurs in a hospital and the outcomes that are expected, based on the type of patients who were admitted to that hospital. So although mortality or complication is sometimes an inevitable outcome of hospitalization due to the acute nature of a patient's condition, engaged nurses reduce the number of unexpected deaths and adverse outcomes.

It's crucial, then, for hospitals to increase nurse engagement while reducing turnover. But how can hospitals accomplish this? Most nurses would agree that they are more likely to be engaged by a great nurse manager -- one with high visibility, good listening and team advocacy skills, and consistent follow through. And like the talents that are required to be a great nurse, management talents cannot be taught -- but important skills can be learned through effective coaching.

What's more, hospitals must tailor their policies and practices to the diverse nature of their nursing workforce. Younger nurses, for example, may thrive in an environment with flexible work schedules, advanced education funding, and childcare options. Bon Secours Health System offers on-site childcare at some locations due to the lower average age of their nursing workforce. Older nurses, on the other hand, may appreciate an environment that offers fewer hours per shift or job sharing; these flexible schedules can help ease or prolong their transition into retirement, while fixed schedules might force them into an early one.

RWJ-Hamilton offers another innovative recruitment and retention strategy: a mortgage subsidy to all nurses who use one of their partnering banks. The hospital has provided more than $5 million in mortgage subsidies in recent years, while saving more than that by improving nurse satisfaction and reducing turnover, according to hospital reports.

In addition, RWJ-Hamilton's nurses have an opportunity to secure a professional recognition bonus, which offers financial rewards for participation in community activities, hospital initiatives, and continuing education. In fact, some RWJ-Hamilton nursing units have waiting lists for positions, thanks to the work environment, flexible policies, and nursing focus.

Finally, hospitals must recognize that nurses are professionals, using a shared decision-making approach to empower nurses to make decisions that affect their work. Many hospitals have a team of nurses (often called a Shared Governance Committee), which offers nurses an opportunity to make decisions regarding patient care, workspace design, equipment selection, and human resource policies. This has a significant impact on nurses' engagement and their loyalty to the organization.

The best hospitals aren't waiting for the government, nursing schools, or recruiting firms to solve the nursing shortage; they aren't waiting for someone to create artificially intelligent robots, suited in white scrubs, that can be taught empathy and compassion, either. Instead, they're overcoming the nurse shortage by focusing on finding the best nurses even before they are nurses. Then they are driving nurse engagement by partnering them with great managers and creating innovative policies customized to their diverse workforce.


Deborah A. Paller was Global Practice Leader, Healthcare, for Gallup.

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