St. Joseph's Hospital

Remedies for nurse shortage
Hospitals offer more authority, better working conditions.
By V. Dion Haynes
Washington Post

WASHINGTON - Nurse Jennifer Dimmick helped her 71-year-old patient, George Mulligan, struggle from a chair to his feet for his daily walk around the corridor outside his room at Inova Fairfax Hospital.
During the previous three days following Mulligan's aortic valve replacement surgery, Dimmick had been preparing him to care for himself after his discharge - demonstrating how he should gingerly lift himself when he rises for his walks so that he won't damage his incision, and playing videotapes that show him how to dress the wound to prevent infection and how to use a breathing device so that he won't get pneumonia. The Virginia hospital introduced the education program after Dimmick and other nurses discovered an unusually high readmission rate for heart patients.
Like hospitals across the country, Inova is grappling with a nursing shortage that is projected to worsen over the next two decades. Hospitals increasingly are responding with a new recruitment and retention strategy - giving nurses like Dimmick much more say in their patients' care.
Five years ago, hospitals waged intense bidding wars to fill nursing vacancies, luring nurses with signing bonuses and even sport-utility vehicles and vacations to the Bahamas. Those efforts often only served to exacerbate turnover, spurring nurses to remain in jobs just long enough to claim the prizes before moving to other hospitals with better incentives.
As it turns out, many nurses want better working conditions more than they do extra money. Hospitals now are responding by introducing technology to dramatically reduce paperwork, offering more flexible hours, reducing caseloads, paying for advanced training, and giving nurses more authority.
"Autonomy is a big thing," said Dimmick, who has been at the hospital for 71/2 years. "It's important for me to know that what I do matters."
Inova Fairfax recently introduced a state-of-the-art data system - consisting of video monitors and other equipment tracking the vital signs of intensive-care patients - to reduce the amount of time nurses spend on paperwork. It also has established a concierge offering such services as dry cleaning, movie tickets and car detailing for busy nurses trying to juggle their professional and personal lives.
Inova is part of a nationwide movement. These days, nurses at Children's Mercy Hospitals and Clinics in Kansas City, Mo., for instance, set their own schedule and have a say in what type of equipment should be purchased and whether patient-staff ratios need to be adjusted.
"Having the option to voice an opinion is amazing," said Jana Schlosser, a nursing education coordinator at the Kansas City hospital.
Hundreds of hospitals are spending millions of dollars to retool their practices, experts say, because of the high expense of losing nurses.
"It costs $50,000 to $100,000 to replace one nurse - and that's not counting salary," said Pat Rutherford, vice president of the Institute for Healthcare Improvement, a nonprofit organization based in Cambridge, Mass. The money, she said, is spent on overtime payments and temps to cover the position, as well as recruiting and training for a permanent replacement.
The number of open nursing jobs nationwide reached 116,000 in 2007. The vacancy rate has dipped slightly; for now, the dismal economy is providing some respite as nurses take on more work to make up for income lost by others in their households who were laid off.
But hospitals are bracing for 2025 when retirements and other factors are projected to push the number of open jobs to as many as 1 million, just when baby boomers will require more nursing care.
"We're in a big, big world of hurt coming up," said Peter I. Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University. Buerhaus said having fewer nurses would seriously compromise hospital care, putting patients at greater risk for pneumonia, falls, bedsores and infections. "This would be lights out for many [hospital] organizations."

 

This article was used with the permission of The Washington Post.