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 As chief nursing officer and vice president for clinical excellence at Carondelet Health, Kansas City, MO, Karen Lee, MSN, RN, NEA-C, has a bird's-eye view of staffing trends within the nursing profession.
"I like to describe the current situation as a perfect storm caused by a combination of factors," she said. "Hospital census levels and procedure volumes dropped as people postponed elective surgery or lost their insurance coverage, many nurses stayed in the workforce rather than retiring as they had originally planned, and other nurses picked up extra shifts as other family members were losing their jobs."
Impact of the Storm
The economic climate has had a marked effect on nursing recruitment and retention. "We're definitely seeing some nurses changing their employment status in response to changes in the economy," said Lee. "It may be a per-diem (or PRN) nurse moving into a part-time position, and other nurses delaying their retirements. It's hard to evaluate the situation because at the same time the economy has changed, many hospitals have also experienced a little drop in volume."
PRN nurses are particularly hard-hit by the recession. "For many years, [they] could pick and choose their shifts; today, the situation has changed and these nurses can't be as selective," said Lee. "I was speaking with a per-diem nurse recently who let me know she was frustrated that we didn't have enough shifts available for her over the summer. She commented to me that many nurses weren't able to bring in the dollars they needed to meet their household budgets. Some took on second jobs elsewhere, and we've seen some going to part-time or full-time status."
Back in 2006, Carondelet Health implemented a Web-based workforce management system that allows nurse managers to post open shifts. Nurses log in to place requests for shifts that match their competencies and fit with their home lives. "Instead of having to look for paper schedules posted on a nursing unit, nurses can instantly view shifts available at either of our two hospitals," said Lee. "We're currently evaluating the concept of a systemwide float pool so nurses can more readily work at both facilities whenever they want to
Multitude of Factors
 Nancy Korom, MSN, RN, NEA-BC, vice president of patient care services and chief nursing officer, Children's Hospital of Wisconsin, Milwaukee, described what's going on in her area. "Our turnover rate is the lowest it's ever been, and a lot of that is related to the economy," she said. "Many nurses have spouses or significant others who have experienced work reductions or lost their jobs. It's also a scary time to leave positions of stability. Usually when nurses leave our children's hospital, it's not to go to another hospital in town. They either go back to school or move out of the area."
Korom is appreciative of the knowledge and experience seasoned nurses bring to the bedside. "We value competencies here so much, and we balance the wealth of knowledge from those seasoned nurses with hiring new grads who have yet to gain their competencies," she said. "I've heard some talk about postponing retirements, so we'll see if the nurses close to retirement age hold out much longer."
Korom noted nurses in their mid to late 50s are interested in different nursing roles that require less physical activity. "When I've talked with them, they tell me they want to maintain their work hours," she explained. "They don't want to change from 12- to 8-hour shifts and come in more days. So we have to be creative to retain those experienced nurses in the roles that they want."
Retaining Seasoned Nurses
Chris Ruder, MS, RN, vice president for patient care services at The University of Kansas Hospital in Kansas City, agreed with Korom's perspective. "There's no question that the expertise of seasoned nurses is a cornerstone for our workforce to ensure we have the range of experience needed for patient care at the bedside," he said. "When we look at nursing globally, we know the upcoming baby boomer retirement age is approaching. All the forecasts and projections around the nursing workforce tell us we need to consider flexible, creative and innovative ways to retain these nurses for the benefit of our patients."
As part of a recent grant, Ruder and his colleagues are pursuing strategies to maintain experienced nurses. "Are they looking for flexibility in shifts or do we need to be considering evolving roles that make the best use of their skills?" he asked. "We have a team looking at the roles we need to fill and determining how we can structure some of those roles to retain or attract experienced nurses who will bring added value to the workforce.
"As an example, we worked with two of our very experienced nurses in our Spine Center - one had retired and wanted to come back part time and the other was wanting to make a change in her career at the bedside," said Ruder. "They're now spending time in our Spine Resource Center working with patients who are referred to them for education about their disease process or ways to adapt their diet, exercise and daily activities. It's a less physically stressful role, but one that definitely requires their nursing knowledge and experience."
While Ruder hasn't seen an uptick in nurses coming out of retirement to seek jobs within his hospital, he noted, "We've seen some of our older nurses deferring their retirement - perhaps waiting to see if there will be a better time to leave the workforce."
While some per-diem and part-time nurses have picked up extra shifts to maintain their family income, Ruder and his colleagues are still actively engaged in surge planning. "Generating a strategy around retired or part-time nurses who could come back and work for a short period of time, whether that's days or weeks, is an important plan to have in place should a large disaster or crisis occur in our community," he explained. "That strategy allows us some flexibility to meet surge capacity and care for our patients during a crisis."
Sandy Keefe is a frequent contributor to ADVANCE.
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