The National Association for Health Care Recruitment (NAHCR) announced that Tuesday, June 1, 2004 is National Healthcare Recruiter Recognition Day.  In 1991, Congress declared the first Tuesday in June each year to be National Health Care Recruiter Recognition Day.

Healthcare recruiters, holds NAHCR, work tirelessly to find the best candidates and employees for their organizations. Recruiters play an integral role in the every day operation of their facility. Without these professionals and their efforts, patient care would suffer and many facilities would not be able to function. NAHCR salutes our members and healthcare recruiters across the country today and every day.

NAHCR provides leadership and support to the healthcare recruiting profession through advocacy, education and professional development. NAHCR has more than 1,000 members nationwide, serving nurse, allied health, physician recruiters and human resources professionals; working in hospitals, home care, long term care, rehabilitation facilities, HMOs, schools of nursing and the military.

Kenexa®, a global leader in innovative human resource solutions, announced that New Jersey-based East Orange General Hospital has selected its Talent Acquisition services to recruit more than 25 registered nurses.

An independent, fully accredited, acute care hospital, East Orange General Hospital has been an integral part of its served community for 101 years. The hospital is recruiting registered nurses for its in-patient psychology, telemetry, critical care and med/surg units.

Sarah Arnold, MSN, RN, ANP, the chief nurse officer for East Orange General Hospital, shared, "East Orange General Hospital is growing and making many changes. When researching the various options for recruitment, Kenexa offered an outstanding service. They have been very professional, responsive to the specific needs of the hospital and community, cost effective, and a pleasure to work with."

According to the American Association of Colleges of Nursing, the United States is in the midst of a nursing shortage that is expected to intensify, especially as baby boomers age, creating further demand for nursing services. The Bureau of Labor Statistics cites registered nurses among the 10 occupations with the largest projected job growth between 2002-2012.

Kevin Hudson, senior vice president of Healthcare Staffing for Kenexa, said, "We're pleased to welcome our new client, East Orange General Hospital, which is highly focused on the needs of its community. Kenexa's systematic canvassing of the qualified nursing population raises the awareness of their organization's unique differentiators to registered nurses. As a result, they'll receive positive return on their talent acquisition investment and build a solid talent pipeline for their future hiring needs."

National nursing issues continue to impact the healthcare environment. Facilities are challenged to provide quality patient care that the consumer expects and deserves, despite the nursing shortage.

In addition to recognizing the nursing shortage, it is important to address why nurses leave their positions. Reasons cited have included lack of flexibility in work schedules, better job opportunities and benefits, inadequate staffing, lack of managerial support, unsatisfactory work environment, no opportunity for advancement and heavy patient load of sick patients.¹

To increase the nursing numbers for the future and provide better environments for nurses to work, facilities and staff members must collaborate to find solutions.

Finding Solutions

Our hospital started ad.dressing issues surrounding the nursing shortage several years ago when we formulated the Nursing Recruitment and Retention Committee. From the recruitment standpoint, the following initiatives were implemented:

Increased management visibility with deans and faculty from area schools of nursing resulted in four of these schools now using our facility for clinical experiences as opposed to only two previously.

Management and faculty conduct a yearly, formal session to evaluate student needs.

An annual student reception is held at our facility, offering opportunities for one-on-one communication with management and staff.

Nursing administration host a yearly open house to recruit RNs and CNAs. The most recent, in February 2003, resulted in the successful recruitment of seven full-time RNs. This event is attended not only by nursing administrators, but also by the CEO, CFO and medical staff.

To promote the public image of nursing, we have at least two events per year. One centers around Nurses Week and receives local television coverage. The second includes community events, such as annual baby fairs and monthly blood pressure clinics conducted at our facility.

Retention strategies are just as important to assure quality healthcare. Several professional development programs have been added to the nursing staff's benefit package, including:

• career ladder with financial incentive;
• tuition reimbursement for nurses from all specialty areas to obtain national certification; and
• tuition reimbursement for nurses who pursue bachelor's or master's degrees in nursing.

Positive Changes

Improving conditions for nurses is an essential part of an ongoing effort to reduce medical errors, improve patient outcomes and encourage individuals to become and remain nurses.² Some initiatives have included:

• shared governance models;
• crosstraining programs for nurses, in.cluding education and clinical training; and
• financial incentives for nurses trained in three different areas.

Workplace/environment issues also have been addressed to focus on retention. Some examples have included the following initiatives:

Flexible scheduling, considering ergonomic issues, was implemented. For example, a more experienced nurse now functions as an admission day nurse during high-peak admission hours of 10 a.m.- 7 p.m., Monday-Friday. The 8-hour, as opposed to 12-hour shifts, meet the needs of the nurses and hospital operations. The role is designated for the nurse to perform the admission and assessment requirements and eliminates the physical nature of a full patient assignment.

Bed disaster protocol was developed and implemented, in conjunction with the ED medical director, to address operational placement of patients during periods of high volumes.³

Staffing guidelines are followed through the American Association of Critical-Care Nurses' Staffing Blueprint, the Association of periOperative Registered Nurses, standards of the American Society of PeriAnesthesia Nurses and guidelines of the Association of Women's Health, Obstetric and Neonatal Nurses.

From JCAHO's recommendations, staff.ing effectiveness patterns are monitored daily, reported, and process changes implemented.⁴ For example, based on monitoring medication errors, falls, staff injuries and turnover rates, a medication nurse has been implemented on a nursing unit to correspond to decreased acuities and admissions with the day of week.

Clinical information systems have been shown to help nurses prevent errors, enhance communications and optimize care processes.⁵ As a result, we implemented a medication system, computerized charting system in the ED and computer terminals in the nursing pods.

Communication between management and staff has been greatly enhanced. Management communicates one-on-one daily. Scheduled staff meetings and quarterly nursing forums with the chief nursing officer are provided for all staff. In addition, the CEO has monthly roundtable lunch discussion groups with staff. Written communication, in the form of nursing, hospital and corporate newsletters, is distributed to all staff.

Partnering for Success

Respect, recognition and professional growth have been three elements for improving nursing success at our facility. The turnover rate has decreased by 7-10 percent over the last 4 years. We have successfully staffed without agency or travel nurses for 7 years.

Collaboration and partnership with the medical staff, human resource director, marketing director and CEO have been essential for our outcomes.

References

1. Strachota. E., et. al. (2003). Reasons registered nurses leave or change employment. Journal of Nursing Administration, 33(2), 111-117.

2. Fong, T. (2003). Reinvesting again. Modern Healthcare, 33(7), 11.

3. Mason, T., & Rudisill, P. (2001, March). Bed disaster plan. 2003 Nursing administration policy and procedure manual (pp. 1-3). Mooresville, NC: Lake Norman Regional Medical Center.

4. 2003 Hospital Accreditation Standards. Accreditation policies, standards, intent statements. Oakbrook Terrace, IL: JCAHO.

5. Meadows, G. (2002). The nursing shortage: Can information technology help? Nursing Economics, 20(1), 46-48.

Written by Pamela T. Rudisill, MSN, RN, CCRN, associate executive director and chief nursing officer, Lake Norman Regional Medical Center, Mooresville, NC.

It's definitely a sign of the times. When the Virginia Nurses Association (VNA) met Oct. 17-18 in Lynchburg, VA, two local television news stations and the local newspaper covered the biennial meeting - demonstrating how significant the nursing shortage has become in every state, including Virginia.

VNA president Florence Jones-Clarke, MS, BSN, RN, and American Nurses Association (ANA) president Barbara Blakeney, MS, APRN,BC, ANP, fielded questions from reporters periodically during the 2-day meeting on the depth of the shortage and what organizations such as the VNA and ANA are doing to alleviate the pinch.

Covered Lots of Ground

Besides the nursing shortage, speakers at the conference covered issues such as good communication and strategies for nursing recruitment and retention. JoAnne Henry, EdD, RN, CS, professor, Virginia Commonwealth University School of Nursing, Richmond, and co-chair of the Virginia Partnership for Nursing, provided an update on the partnership, a state initiative of nursing educators formed to attract more people into nursing.

Nurses learned what three hospitals/ health systems are doing to recruit and keep their nurses during a lively panel discussion that included Golden H. Bethune, MSN, RN, CNAA,BC, at Centra Health, Lynchburg; Carolyn M. Webster, vice president of nursing services, Carilion Medical Center, Roanoke; and Pamela F. Cipriano, PhD, RN, FAAN, chief clinical officer/chief nursing officer at the University of Virginia (UVA) Medical Center, Charlottesville.

Bethune shared that since Centra Health ceased "pulling" nurses 3 years ago, its turnover rate has dropped from 14.3 percent-8 percent.

"Once we stopped floating, unless it was voluntary, we noticed a drop in sick call-outs as well," Bethune told nurses gathered for the plenary session. She also provided a list of 101 ways to recognize and thank staff.

Webster said besides educating non-nursing staff about the nursing shortage, Carilion worked out strategies for short- and long-term recruitment. Before the system began its efforts, it had 80 travel nurses and a high nurse vacancy rate. Since January, after initiating several measures, including help with child care costs and providing short-term housing, Carilion has not used travel nurses.

Dr. Cipriano said UVA Medical Center is a large facility, with 1,600 nurses ranging in age from 21-80. "Yes, we have an 80-year-old nurse who does discharge and teaching," she noted.

After asking staff what they feel is necessary to maintain a good work environment, the system learned that having competent co-workers and the ability to work in a highly specialized area is important. Also better recognition, allocating time for education of nurses, a responsive administration and initiating an expanded shared governance cabinet have helped with retention.

Good Communication

Another way to retain nurses is to communicate well with them and listen carefully, offered Susanne Gaddis, PhD, "The Communications Doctor." Dr. Gaddis' lively delivery and excellent tips included improving non-verbal communication, how not to show anger, and how to make patients and fellow nurses feel accepted, valued, worthwhile and supported.

"Your gait, body language, facial expressions, they all say a lot about you and your attitude toward others," Dr. Gaddis said. "Your face is an instrument of communication. It has the highest nerve-to-muscle ratio of any part of the body."

Listening well and acknowledging that you know what the speaker is going through, are critical to letting people know you care.

Gail O. Guterl is editor of ADVANCE.

In spite of a growing nationwide shortage of nurses, 62 percent of nurse executives and managers responding to a poll at the 2002 VHA Leadership Conference in Irving, TX, last month said they'll remain in the profession for at least another 10 years.

"It is encouraging that so many nurse executives and managers are committed to the profession, as they have an important role in mentoring the next generation of nurses who are delivering care," said Lillee Gelinas, MSN, RN, vice president and chief nursing officer at VHA Inc.  "The challenge will be to provide the kinds of benefits and opportunities for professional development that will continue to attract nurses to leadership roles."

Fifty-four percent of poll participants reported seeing the nursing work force shortage worsen over the past three months. While convinced of their own tenure, nursing leaders still showed great concern about the departures of the nurses they manage. To retain nurses who deliver patient care, 35 percent of nurse executives and managers polled said hospitalsneed to increase compensation and lower nurse/patient ratios. 

"Nurses involved in the delivery of patient care today want to know that their work is important," said Gelinas. "These professionals need to be validated and recognized as decision-making members of the team whose voices need to be heard."

Hospitals are addressing the work force issue in a positive way, according to poll respondents. To recruit and retain nurses at the patient bedside, 35 percent of poll respondents cited aggressive attempts by their organizations to improve compensation.  Another 10 percent of respondents said their organizations have offered more flexibility in scheduling,

Nearly 600 registered nurses and nursing students attended the 21st Annual Nurse Legislative Day on Feb. 10 in Olympia, WA, reported PR Newswire. Strategies to address both the recruitment and retention of registered nurses were the focus of the event.

"Our record turnout of nurses and nursing students from every part of the state demonstrates the critical nature of the nursing shortage and its effect on every facet of health care," said Louise Kaplan, PhD, ARNP, president of the Washington State Nurses Association (WSNA). "Legislators and the governor must act to increase nursing education programs at every state college and university,"

To attract more people into the profession and increase diversity, the Washington State higher education system must expand capacity of programs so that qualified applicants to nursing programs are not turned away, Dr. Kaplan said. The state must also establish safe staffing standards to ensure safe patient care during the shortage.

WSNA's legislative recommendations for addressing the nursing shortage include:

1. Designating at least 500 fully funded RN slots in the 1,550 high-demand FTE enrollment slots proposed by the governor.

2. An increase for RN faculty salaries at community colleges and 4-year universities by funding increments in the operating budget and recruitment and retention funding designated specifically for RN faculty.

3. Investing money in schools to expand labs and classrooms and provide appropriate support of new nursing programs.

4. An increase in Higher Education Coordinating Board Health Professions Scholarship & Loan Repayment program funding by $1 million in the operating budget. 

5. The Patient Safety Act (HB 1602/SB 5598) provides nurses with an opportunity to give meaningful input toward nurse staffing in order to ensure quality patient care and increased job satisfaction.

6. Extend protection from mandatory overtime for nurses to additional settings such as jails, state hospitals and state veteran's homes.