Medical center grapples with national nursing shortage
Health System Marketing and Communications
By Dan Heuchert
School of Nursing dean Jeanette Lancaster calls the looming national nursing shortage a “perfect storm,” a confluence of several factors that threatens to swamp the nation’s health care system.
Weathering that storm will take some creativity and a lot of focused attention, say those who are leading the U.Va. Medical Center’s nursing
recruitment and retention efforts.
The demand for nursing is rising. As the Baby Boomers age, they will require more care — both in the increased quantity of patients and the complexity of their conditions — from a statewide nursing corps that already is stretched thin.
“Nurses are getting older, too,” Lancaster said; by 2010, it is projected that 40 percent of registered nurses will be older than age 50.
Just as the demand on nurses from patients is increasing, their supply is decreasing. Lancaster cites surveys that show that between one-fifth and one-third of working nurses expect to leave the profession in the next five years because they are dissatisfied with their jobs.
“They’re burning out from the burden of extra unexpected shifts as they care for greater numbers of sicker patients,” Lancaster said.
According to a February study from the U.S. Bureau of Labor Statistics, more than 1.1 million new and replacement nurses will be needed by 2010.
And completing nursing’s terrible triangle: the pipeline of new nurses is lagging. Nursing schools nationwide turned away nearly 16,000 qualified applicants last year because they lacked the faculty and facilities to train them. The average age of nursing professors is higher than that of frontline nurses, with a wave of retirements expected during the next decade and an insufficient number of nurses seeking advanced degrees.
So what is a busy academic medical center to do?
The first focus is keeping the 1,500 nurses already here, said Pamela F. Cipriano, U.Va.’s chief clinical officer.
“The best reference is good word-of-mouth,” she said. “The most important thing to do is to have a good working environment and retain the nurses we have.”
To that end, Medical Center officials are striving to improve worker safety, including purchasing $700,000 worth of equipment to help lift and move patients — tasks that can be a major physical strain on nurses. Nurses also participate in Medical Center governance through the Professional Nursing Staff Organization, and are
offered plenty of career-enhancing education and research opportunities, Cipriano said.
The retention efforts seem to be paying off. The University’s 14.5 percent annual turnover rate is at or below figures cited in national surveys, said Patricia Van Hook, director of employment for the Health System.
“Time and time again, what we hear from nurses is that U.Va. is a good place to work because of teamwork, autonomy and the ability to work in specialty care areas,” said Beth Dierdorf, president of the Professional Nursing Staff Organization, citing annual surveys. “Also, they value working side-by-side with very qualified nurses.”
Vacancies do occur, though. Some are filled by so-called “traveling nurses,” or nurses provided by temporary staffing agencies. There are also “wage nurses,” who are paid hourly and fill empty shifts when they choose, and “flex nurses,” who regularly work 32 hours per week, but can work full-time as needed.
The U.Va. Medical Center generally hires about 250 nurses per year, and is attempting to push that number above 300 this year, with an emphasis on full-time staff, Cipriano said. The hospital has opened 33 new beds since June 2003, and expects to open two new operating rooms in mid-November and have all of its beds available by January.
The first hires are usually relatively easy, Cipriano said. The hospital generally hires about 60 freshly minted nursing graduates each year — including 36 last year from U.Va. and Piedmont Virginia Community College — while experienced nurses seek out the University for other reasons. An Oct. 27 open house drew some 52 nurses from as far away as Florida, Dierdorf said.
But filling the last hundred or so positions requires a larger recruitment effort, particularly for positions requiring greater specialization. “The more specialized the area, the harder they are to find,” Cipriano said, adding that certified registered nurse anesthetists and nurses with neuroscience backgrounds are particularly prized.
Van Hook has three staff members focused on nurse recruiting. They travel to job fairs nationwide, often accompanied by a frontline nurse who “can talk the language,” she said.
They also visit nursing schools, touting their mentorship program that pairs a new nurse with a more seasoned mentor for four to six months after they are hired.
The Health System also offers its employees incentives — cash bonuses or eligibility for trip giveaways — for referring successful applicants to the University. One person who benefited from such an incentive was Alonzo Bell, an operating room support tech. In August, Bell received $2,000 for referring a nurse candidate who was hired to work in the operating room. He will get another $2,000 on the first anniversary of her hire.
Officials currently are considering expanding the incentive program to alumni of the schools of Nursing and Medicine, Van Hook said. Word that the University was seeking to recruit approximately 12 nurses from overseas during the next two years recently raised a few eyebrows, but such efforts are not unusual in a tight nationwide labor market, Cipriano said. In a letter to Medical Center employees, she noted that the hospital already employs more than 50 foreign nurses who moved to Charlottesville without any special recruitment efforts.
“We have built an environment that supports diversity and welcomes staff from around the world,” she wrote.
With nursing supply and demand projected to move further apart in the future, another avenue helping close the gap is technology.
“Our challenge is to figure out how to use technology to make nonessential tasks go away so nurses can spend more time with patients,” Cipriano said. Cutting down on paperwork and telephone time by streamlining the processes electronically, for instance, can improve work flow, she said.
All in all, the University has fared pretty well so far, Cipriano said.
Still, the shortage “is ever looming out there,” she said. “We can’t turn our backs and say we have solved the problem.”