Nursing Shortage Nursing Shortage and Retentionand Retention

Jacqueline Hart, BSN, Jacqueline Hart, BSN, CHPNCHPN

University of Central University of Central FloridaFlorida

DefinitionDefinition

A nursing shortage is when the A nursing shortage is when the supply of nurses willing to work is supply of nurses willing to work is less than the demand in the less than the demand in the marketplace.marketplace.

(Peterson, 2009)(Peterson, 2009)

IndicatorsIndicators

Indicators such as vacancy rates, Indicators such as vacancy rates, turnover, difficulty recruiting, work turnover, difficulty recruiting, work environment, education and staffing environment, education and staffing levels can help to determine a nursing levels can help to determine a nursing shortage. shortage.

(FCN, 2015)(FCN, 2015)

History of the Nursing History of the Nursing ShortageShortage

First noted in 1915First noted in 1915 Alternating nursing shortage and Alternating nursing shortage and

nursing surplusnursing surplus Surplus years are few in number and Surplus years are few in number and

short in durationshort in duration Since 1998, the US has been in a Since 1998, the US has been in a

serious nursing shortageserious nursing shortage

(Huber, 2014)(Huber, 2014)

Influencing Factors Influencing Factors

The aging of the nursing workforceThe aging of the nursing workforce Decline in nursing as a careerDecline in nursing as a career Shortage & aging of nursing facultyShortage & aging of nursing faculty A need for greater education A need for greater education The aging of the US populationThe aging of the US population Multiple health care delivery changesMultiple health care delivery changes

(Huber, 2014) (Huber, 2014)

(ACCN,2015)(ACCN,2015)

Nursing Turnover as it Nursing Turnover as it relates to the Nursing relates to the Nursing

ShortageShortage Loss of investment (recruiting, Loss of investment (recruiting,

orientation, organizational knowledge)orientation, organizational knowledge) Productivity lossesProductivity losses Instability created in the workplaceInstability created in the workplace Increased costs with agency staffing, Increased costs with agency staffing,

overtime, training new staff overtime, training new staff Staffing levels are increased, quality of Staffing levels are increased, quality of

care suffers, satisfaction scores declinecare suffers, satisfaction scores decline Staff become overwhelmed, burnoutStaff become overwhelmed, burnout

(Jones, 2004)(Jones, 2004)

Nursing Turnover as it Nursing Turnover as it relates to the Nursing relates to the Nursing Shortage Shortage In the present nursing shortage, health In the present nursing shortage, health

care organizations cannot afford to care organizations cannot afford to lose quality nurses.lose quality nurses.

Total turnover costs per RN:Total turnover costs per RN:

$$62,100- $67,10062,100- $67,100It is costly!It is costly!

(Jones, 2004)(Jones, 2004)

Role of the Nurse Role of the Nurse LeaderLeader

The Nurse Leader role is criticalThe Nurse Leader role is critical

Leadership style-create the culture in Leadership style-create the culture in your unit that retains staffyour unit that retains staff

Advocacy-in budget meetings for Advocacy-in budget meetings for staffing levelsstaffing levels

Orientation and effective on-boarding Orientation and effective on-boarding program-for new staff program-for new staff

Recognition and reward-for more Recognition and reward-for more experienced staffexperienced staff

(Huber, 2014) (Hinson & Spatz, (Huber, 2014) (Hinson & Spatz, 2011)2011)

Alternate SolutionsAlternate Solutions

Marketing campaigns to attract staffMarketing campaigns to attract staff Partnerships with nursing schools, high Partnerships with nursing schools, high

schools and community agenciesschools and community agencies Recruit retired nursesRecruit retired nurses Hiring nurses from other countriesHiring nurses from other countries Creating a healthy work environmentCreating a healthy work environment Nurse residency program for nurses Nurse residency program for nurses

(preceptor/mentor programs)(preceptor/mentor programs) Salary incentivesSalary incentives

(Huber, 2014)(Chan et al, (Huber, 2014)(Chan et al, 2013)2013)

Selection of the Selection of the SolutionSolution In order to In order to

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

My SolutionMy Solution

Healthy Work EnvironmentHealthy Work Environment Culture of CivilityCulture of Civility On-boarding programOn-boarding program Educational opportunitiesEducational opportunities Reward and Recognition programReward and Recognition program Professional DevelopmentProfessional Development Social NetworkingSocial Networking

Implementation PlanImplementation Plan

The Road Map to SuccessThe Road Map to Success

Implementation Plan-Implementation Plan-PlanPlan

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

Implementation Plan-Implementation Plan-PlanPlan

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

Implementation Plan-Implementation Plan-PlanPlan

Develop a kick off strategy Develop a kick off strategy and how to present the and how to present the healthy work environment healthy work environment to the entire staff and how to the entire staff and how to record the results.to record the results.

Implementation Plan-Implementation Plan-DoDo

Create positive momentum across Create positive momentum across the organization with a kick off the organization with a kick off

Options:Options:

-Pilot study in one department-Pilot study in one department

-Staggered roll out to all -Staggered roll out to all departmentsdepartments

Implementation Plan-Implementation Plan-DoDo

Create quality Create quality reports to track reports to track the data you the data you want to measurewant to measure

Report the data Report the data to each work to each work group and they group and they will be will be responsible to responsible to analyze the analyze the progressprogress

Implementation Plan-Implementation Plan-StudyStudy

Set up monthly meetings (in Set up monthly meetings (in person or conference call) for each person or conference call) for each work group to check the results. work group to check the results.

-What is working?-What is working?

-What is not working?-What is not working?

-What could be better?-What could be better?

-What needs to change?-What needs to change?

Implementation Plan-Implementation Plan-ActAct

If your results are successful and the If your results are successful and the data shows the improvement you were data shows the improvement you were looking for, continue the plan and the looking for, continue the plan and the PDSA cycle for continuous PDSA cycle for continuous improvementimprovement

If your results are not successful:If your results are not successful:

-Adjust the plan -Adjust the plan

-Abandon the plan and restart the -Abandon the plan and restart the PDSA processPDSA process

Plan for EvaluationPlan for Evaluation

The PDSA process will be followed by The PDSA process will be followed by the work groups to monitor the results the work groups to monitor the results of the healthy work environment planof the healthy work environment plan

The Human Resources department will The Human Resources department will collect annual turnover data and collect annual turnover data and compare to the previous year’s datacompare to the previous year’s data

Surveys will be sent to staff quarterly to Surveys will be sent to staff quarterly to obtain their feedback to the programs obtain their feedback to the programs

The Leadership Team will gather data The Leadership Team will gather data from all groups to determine the from all groups to determine the effectiveness of the programeffectiveness of the program

Nursing Shortage and Nursing Shortage and RetentionRetention

This is a complex This is a complex problem and will problem and will require a require a multifaceted multifaceted responseresponse

Creating a healthy Creating a healthy work environment is work environment is one option that one option that healthcare healthcare organizations can organizations can implement implement internallyinternally

ResourcesResources

AACN. (2015). Nursing shortage. Retrieved from AACN. (2015). Nursing shortage. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shorthttp://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortageage

Chan, Z., Tam, W., Lung, M., Wong, W., & Chau, C. (2013). A systematic Chan, Z., Tam, W., Lung, M., Wong, W., & Chau, C. (2013). A systematic literature review of nurse shortage and the intention to leave. literature review of nurse shortage and the intention to leave. Journal of Nursing ManagementJournal of Nursing Management. 21(4), 605-613. doi:10.1111/j.1365-. 21(4), 605-613. doi:10.1111/j.1365-2834.2012.01437.x2834.2012.01437.x

Florida Center for Nursing. (2015). Trends in Average Turnover Rates Florida Center for Nursing. (2015). Trends in Average Turnover Rates 2007-2013. Retrieved from 2007-2013. Retrieved from http://www.flcenterfornursing.org/GraphsCharts/AllGraphsCharts.asphttp://www.flcenterfornursing.org/GraphsCharts/AllGraphsCharts.aspxx

Hinson, T. & Spatz, D. (2011). Improving nurse retention in a large Hinson, T. & Spatz, D. (2011). Improving nurse retention in a large tertiary acute-care hospital. tertiary acute-care hospital. The Journal of Nursing AdministrationThe Journal of Nursing Administration. . 41(30), pp.103-108.41(30), pp.103-108.

Huber, D.L. (2014). Huber, D.L. (2014). Leadership & Nursing Care Management (5th EdLeadership & Nursing Care Management (5th Ed.). .). St Louis, MO: Elsevier. St Louis, MO: Elsevier.

Jones, C. (2005). The costs of nurse turnover, part 2. Jones, C. (2005). The costs of nurse turnover, part 2. The Journal of The Journal of Nursing AdministrationNursing Administration. 35(1) pp. 41-19.. 35(1) pp. 41-19.

Peterson, C. (2002). Projected supply, demand and shortages of Peterson, C. (2002). Projected supply, demand and shortages of registered nurses: 2000-2020. Tar Heel Nurse, 64(5), 19. 2010.registered nurses: 2000-2020. Tar Heel Nurse, 64(5), 19. 2010.