Nursing Shortage and Retention

1. Nursing Shortage and Retention Jacqueline Hart, BSN, CHPN University of Central Florida

2. Definition A nursing shortage is when the supply of nurses willing to work is less than the demand in the marketplace. (Peterson, 2009)

3. Indicators • Indicators such as vacancy rates, turnover, difficulty recruiting, work environment, education and staffing levels can help to determine a nursing shortage. (FCN, 2015)

4. History of the Nursing Shortage • First noted in 1915 • Alternating nursing shortage and nursing surplus • Surplus years are few in number and short in duration • Since 1998, the US has been in a serious nursing shortage (Huber, 2014)

5. Influencing Factors • The aging of the nursing workforce • Decline in nursing as a career • Shortage & aging of nursing faculty • A need for greater education • The aging of the US population • Multiple health care delivery changes (Huber, 2014) (ACCN,2015)

6. Nursing Turnover as it relates to the Nursing Shortage • Loss of investment (recruiting, orientation, organizational knowledge) • Productivity losses • Instability created in the workplace • Increased costs with agency staffing, overtime, training new staff • Staffing levels are increased, quality of care suffers, satisfaction scores decline • Staff become overwhelmed, burnout (Jones, 2004)

7. Nursing Turnover as it relates to the Nursing Shortage In the present nursing shortage, health care organizations cannot afford to lose quality nurses. Total turnover costs per RN: $62,100- $67,100 It is costly! (Jones, 2004)

8. Role of the Nurse Leader The Nurse Leader role is critical • Leadership style-create the culture in your unit that retains staff • Advocacy-in budget meetings for staffing levels • Orientation and effective on-boarding program-for new staff • Recognition and reward-for more experienced staff (Huber, 2014) (Hinson & Spatz, 2011)

9. Alternate Solutions • Marketing campaigns to attract staff • Partnerships with nursing schools, high schools and community agencies • Recruit retired nurses • Hiring nurses from other countries • Creating a healthy work environment • Nurse residency program for nurses (preceptor/mentor programs) • Salary incentives (Huber, 2014)(Chan et al, 2013)

10. Selection of the Solution In order to decrease the nursing shortage, all of these options will need to be employed. The solution to this issue is complex and multifaceted.

11. My Solution Healthy Work Environment • Culture of Civility • On-boarding program • Educational opportunities • Reward and Recognition program • Professional Development • Social Networking

12. Implementation Plan The Road Map to Success

13. Implementation Plan-Plan • Create a work group for each component of the healthy work environment (6). Enlist nursing staff from different units to serve on a group with one or two management advisers.

14. Implementation Plan-Plan • Allow a set time for each group to research the issues and find solutions that will work in their setting.

15. Implementation Plan-Plan • Develop a kick off strategy and how to present the healthy work environment to the entire staff and how to record the results.

16. Implementation Plan-Do • Create positive momentum across the organization with a kick off Options: -Pilot study in one department -Staggered roll out to all departments

17. Implementation Plan-Do • Create quality reports to track the data you want to measure • Report the data to each work group and they will be responsible to analyze the progress

18. Implementation Plan-Study • Set up monthly meetings (in person or conference call) for each work group to check the results. -What is working? -What is not working? -What could be better? -What needs to change?

19. Implementation Plan-Act • If your results are successful and the data shows the improvement you were looking for, continue the plan and the PDSA cycle for continuous improvement • If your results are not successful: -Adjust the plan -Abandon the plan and restart the PDSA process

20. Plan for Evaluation • The PDSA process will be followed by the work groups to monitor the results of the healthy work environment plan • The Human Resources department will collect annual turnover data and compare to the previous year’s data • Surveys will be sent to staff quarterly to obtain their feedback to the programs • The Leadership Team will gather data from all groups to determine the effectiveness of the program

21. Nursing Shortage and Retention • This is a complex problem and will require a multifaceted response • Creating a healthy work environment is one option that healthcare organizations can implement internally

22. Resources AACN. (2015). Nursing shortage. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage Chan, Z., Tam, W., Lung, M., Wong, W., & Chau, C. (2013). A systematic literature review of nurse shortage and the intention to leave. Journal of Nursing Management. 21(4), 605-613. doi:10.1111/j.1365-2834.2012.01437.x Florida Center for Nursing. (2015). Trends in Average Turnover Rates 2007-2013. Retrieved from http://www.flcenterfornursing.org/GraphsCharts/AllGraphsCharts.aspx Hinson, T. & Spatz, D. (2011). Improving nurse retention in a large tertiary acute-care hospital. The Journal of Nursing Administration. 41(30), pp.103-108. Huber, D.L. (2014). Leadership & Nursing Care Management (5th Ed.). St Louis, MO: Elsevier. Jones, C. (2005). The costs of nurse turnover, part 2. The Journal of Nursing Administration. 35(1) pp. 41-19. Peterson, C. (2002). Projected supply, demand and shortages of registered nurses: 2000-2020. Tar Heel Nurse, 64(5), 19. 2010.