Similar to most medical facilities across the country, Norwalk (CT) Hospital, a 366-bed nonprofit community hospital, is feeling the effects of the nationwide nursing shortage.
Even though the administration strives to address nurses' concerns about long hours, overtime and the amount of time they can spend with patients, some nurses are leaving the bedside to pursue other careers.
Something had to be done to address this issue to ensure a positive future for patients and nurses alike.
With that in mind, Norwalk Hospital has moved into high gear to reinforce and expand its recruitment and retention (R&R) efforts. Leading those efforts is Jan Mola, MS, RN, Norwalk's newly appointed director of R&R.
Excited about her new role, Mola said she's looking forward to working with the staff and making the program a success. She is no stranger to the management team at Norwalk and has held various leadership positions. Her most recent role was as executive director of ambulatory services and the ED a position she will continue in, despite the additional R&R responsibilities.
Mola began her career at Norwalk in 1976 as a staff nurse.
"Norwalk Hospital is very family-oriented," Mola explained, "and I enjoy working here. The hospital is letting me grow in my profession as well as giving me various opportunities. My job is to make sure all nurses here feel that way and are given similar opportunities."
Diana Karish, MA, RN, vice president of nursing/patient care services, also is enthusiastic about the rejuvenated R&R program.
The administration fully supports the program's initiatives, she said, and will help assure that they reinforce the core values of the division: to encourage clinical and personal excellence, to support lifelong learning efforts, health and wellness, and to enhance customer service and satisfaction.
Karish said creating an environment that fosters R&R is fundamental to maintaining a healthy and vital level of staffing.
"You have to be sensitive to the issues of limited RN resources and their effects on patient care and staff dissatisfaction," she explained. "That's why we are making recruitment and retention programs a priority."
Finding Tomorrow's Stars
Norwalk Hospital's hiring initiatives include both national and international recruitment efforts.
Stateside efforts include:
- establishing relationships with academic institutions through recruiting and internships; resulting in some GNs accepting positions at the hospital;
- nursing scholarships and tuition reimbursement programs;
- high school recruitment programs such as adopt-a-school, school-to-work and internship programs;
- job fairs (local and national);
- open houses/receptions;
- community involvement/activities;
- nursing magazine article and ambassador program/advertisements; and
- proactive recruitment department in collaboration with human resources.
High school recruitment programs are of particular note. Recruiting kids into the profession at an early age is a priority nationwide. At Norwalk, students who showed interest were provided a unique educational opportunity to observe hospital situations while shadowing a nurse. Eighteen students participated last year.
The hospital also is pursuing Magnet recognition from the American Nurses Credentialing Center. This will allow the institution to showcase various initiatives and programs that support our core values and professional practice as outlined earlier.
In addition, studies show that nurses are more likely to join a hospital with Magnet status.
Plans to attract nurses from other countries are also underway. Last summer Mola led a team to India, which has one of the largest pools of English-speaking foreign nurses in the world. These nurses not only show clinical competence, but also are caring and very committed to their profession, Mola said.
Forty-five Indian nurses will be arriving at the hospital between April and December 2004. These nurses were recruited from an agency and were required to pass the TOEFL (Test of English as a Foreign Language), CGFNS (Commission of Graduates from Foreign Nursing Schools) and NCLEX. Plans to recruit nurses from Canada and Ireland also are being considered since the hospital successfully hired RNs from these countries in the past.
Nurse retention today is a juggling act of sorts, requiring managers to address many personal and professional needs among the staff members.
As a result, Norwalk Hospital's accelerated retention efforts are multifaceted.
Perhaps first and foremost, at least chronologically speaking, is an extensive and individualized orientation program. Creativeness is encouraged to ensure the needs of new RNs are met. For example the ortho/neuro unit recently included observed orthopedic and neurosurgical procedures in the OR as part of the unit's orientation curriculum. This was received positively from both the new and seasoned nurses.
A specialized preceptor program also has proven effective. Preceptor training not only ensures new RNs will be clinically competent but also provides an atmosphere of acceptance keeping in mind diversity and cultural differences.
An adjunct to the preceptor program is our "buddy system" for foreign nurses. Designated nurses act as the "welcome wagon" to help acclimate and show them around.
Robust educational opportunities are a must in today's competitive nurse market. Tuition reimbursements for those wanting to advance their careers to the BSN, APRN or master's level are offered at Norwalk.
In addition, relationships with local institutions allow the hospital to offer degree achievement on- and off-site. Currently, an MHA program is being offered on-site.
Equipment analysis and upgrade has helped make Norwalk Hospital an easier, more efficient place to do nursing. The recent purchase of new beds and transfer devices is meant to prevent staff injuries caused by lifting, turning and transferring patients. This will accommodate the aging workforce by decreasing manual effort in patient movement and transfer.
Other retention efforts are listed in the Table.
Acknowledging that an active R&R program is vital in every healthcare institution, Mola reflected a recent experience she had with a nurse who was ready to leave the hospital for numerous reasons.
Mola, along with the unit's director, sat down and talked with the nurse, who subsequently decided she was going to stay. Sometimes, Mola surmised, listening is all that is needed - but what a world of difference it makes.
"This is what the program is all about - keeping our staff members and letting them know they are valued," Mola said.
Nimfa B. Orpeza is patient care manager for the ortho/neuro unit at Norwalk (CT) Hospital. She is an active member of the recruitment and retention committee and the nursing recognition committee.
Table: Retention Efforts
In addition to the programs mentioned in the main story, retention efforts at Norwalk Hospital include the following:
- A revamped staff development department that puts an emphasis on CEUs and various educational enrichment programs.
- A nursing leadership program that empowers nurses to improve teamwork and communication while providing a forum to voice their issues and concerns.
- A nursing leadership "academy" to enhance leadership skills at all levels.
- Opportunities for career growth and development of nursing support personnel by enhancing PCTs' relationship with RNs. An in-house survey showed that this is integral in retention efforts. For example, a PCT development group that started in the ortho/neuro unit proved so successful, plans are in the works to make it a hospital-wide initiative.
- Development of an R&R committee comprised mostly of staff nurses which meets monthly to identify nurse dissatisfiers and improve communication.
- R&R boards in every unit to post program updates, as well as new and ongoing initiatives.
- Exit interview tools/analysis to identify why nurses are leaving.
- Routine monitoring of vacancy/turnover rates, use of staffing agencies and OT use.
- Continuous assessment of patient/family satisfaction.
- Active recognition programs, including annual clinical excellence awards, nursing philanthropy awards, performance improvement awards, preceptor awards and Nurses Week celebrations. In-house staff surveys show that recognition is on the top of the list in retaining staff.