 Shore Health
System: From High School Counselors to Elementary and Middle School
Students — The Patient Approach to Nurse Recruitment
Shore Health System is taking the long view on nurse
recruitment: among its priority goals are “Enhance the image of nursing
for elementary and secondary school students,” and “Influence youth
to choose nursing as a career.” So it’s no surprise that before
program director Cynthia Watson can describe the health system’s youth
outreach efforts, she must first say good-bye to a high school guidance
counselor who has dropped by her office.
“That was one of my counselors,” she
explains—the “my” providing an indicator of the hard-won
progress Watson has made in positioning the health system as a good source of
information on nursing and other health care careers.
“Counselors tell us they need concrete facts when they
work with students,” Watson notes. “So we identify specific careers
and provide answers to such basic questions as ‘How much training do you
need to be a respiratory therapist; where can you go to school to get it, and
how much will it cost; and how much can you expect to be paid when you
graduate?’”
Watson uses a variety of methods to educate guidance
counselors on health care careers in general and nursing in particular. She has
visited more than 50 schools in the health system’s five-county region to
talk to counselors face to face, and all high schools and middle schools have
received a video explaining the specifics of nursing as a career as well as
annual packets of printed information. Watson has also spoken to school
district representatives in regional health career meetings and to smaller
groups of career counselors.
“We learned early that just presenting the information
once is not enough,” says Watson. “Counselors receive a lot of
information, and they may not remember that they have ours.
They need to be continually reinforced—the bottom-line
goal is to have them remember where the information can be obtained.”
Over the past two years Shore Health System has used its
five-year, $600,000 state Nurse Support Program grant from the Health Services
Cost Review Commission to launch or refurbish a whole spectrum of nurse
recruitment programs, including a number targeted at area youth. The latter
include:
- Mini-health fairs targeted to elementary and
middle-school students. This past year roughly 250 students, in batches of
50–60, came to the system’s Easton Memorial Hospital to tour service
areas (the critical care ambulance is a high point) and, fortified with such
fair-like food as hotdogs, to visit a roomful of health-related interactive
stations. There they can test their respiratory prowess and learn the “ins
and outs” of their blood pressure. Every information table also offers
specifics on how a student would prepare for a related health care career.
- A paid health career summer program for high school
students. Six students completed the program in its first year, with
placements in surgical services, maternity, skilled nursing, cardio-pulmonary
service, and the professional practice department. Two of the students are now
in nursing programs; the remaining four are seriously considering health career
programs.
- School-year job internship opportunities for high
school students. While already in place before the health system received
its state grant, the grant has allowed this program to be restructured. A
semester-long internship provides the opportunity for students to work
alongside nurses and other health career workers while exploring careers as
part of their school's curriculum. Tightened performance indicators have had
marked success; prior to restructuring, three to five students took part; this
year, a total of 50 students have participated. Of those who previously
completed the internship, five went on to nursing school and at least ten
participated in the health career club the health system supports as part of a
collaborative effort with regional educational programs. (The club serves high
school students as well as college students enrolled in health career
prerequisite courses. Each monthly meeting focuses on a particular area such as
surgical or emergency services, with nursing consistently represented.)
In summing up, Watson notes that she not only works with
local schools but also with chambers of commerce, faith-based organizations,
county social service agencies, and community groups to spread the
nursing-career word. For example, she organized a health fair for the isolated
and medically underserved population of Chesapeake Bay’s Tilghman Island;
20 health care agencies provided health care support, including giving 60 flu
shots. “It’s all part of my charge to improve the image of nursing,
not only for the young but also for the larger community,” says Watson.
Contact:
Cynthia Watson,
RN BSN
Nurse Support Program Specialist
Shore Health System
219 S.
Washington Street
Easton, MD 21601
410-822-1000 ext. 5457
cwatson@shorehealth.org
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How serious is Leslie Simmons about retaining new nurses at
Carroll County General Hospital? Very serious, judging by the vice president
for patient care’s instructions to the hospital’s mentors for new
hires: “Mother them; baby them; love them; make them feel nurtured and
looked after; and answer every question right away.”
There is a serious point behind the effusive language, says
Simmons. “New graduates haven’t worked anywhere else; they don’t
know any other environment. When an issue comes up and it is not dealt with
promptly, they may jump from hospital to hospital, looking for something they
may not find.”
Simmons’ approach to her own work reflects this belief
in the importance of open communications; she is constantly out on the nursing
units, staying in touch with current concerns. “Personnel at the
management level can sometimes get too disconnected,” she says. “Then
they aren’t able to fully represent the needs of their staff. My motto is,
‘Never forget from whence you came.’”
Simmons drew on her knowledge of current nursing concerns,
as well as her 15 years as a critical care nurse to defend her budget request
for a better-than-average ratio for hours of care at the bedside. Nurses at
Carroll County now have an average of five medical-surgical patients, compared
to six or seven statewide. According to Simmons, it’s a factor that has
drawn even experienced nurses working at higher pay—but also with higher
nurse-patient ratios—to Carroll County.
Mentoring is a full-time job
Simmons notes, however, that although the hospital has made
changes beyond mentoring to improve the work environment for nurses, “I
really think that the mentors have made the most difference.” Launched in
November 2001, experienced clinicians in all service lines were handpicked for
the positions, which serve as a primary contact point for a new hires’
first year. The mentor’s full-time job is to provide daily support through
coaching and answering questions.
In carrying out this and other nurse-retention changes,
Simmons has had the support of her executive management team and additional
financial resources provided by an $86,000 state Nursing Support Program grant
from the Health Services Cost Review Commission (HSCRC). The grant does not,
however, cover the costs of mentoring. “That is where other nurse
executives who want to make similar changes may have difficulty,” she
notes. “They may not be able to get permission for the up-front costs,
even if it would save their hospital money later.”
As an example she notes that recent orientation costs at
Carroll County General Hospital ran somewhat over budget, and that was hard on
her organization. “I feel, however, that orientation should not be rushed;
that it should be self-paced—some of our new hires took nearly seven
months before they were totally off orientation and into specialty areas.”
TLC yields tangible results
In the long run, says Simmons, a quality orientation also
saves the hospital money. “Providing a better ‘fit’ for the
nurse and the organization reduces turnover,” she notes. “And
turnover is more expensive than commonly recognized: replacing a
medical/surgical nurse typically runs $50,000 in hard costs.”
Simmons has solid evidence of a positive cost-benefit ratio
for her hospital’s careful nurturing of new hires: a nursing vacancy rate
that has fallen from 17 percent to just under 5 percent over the past year, and
a resulting significant drop in agency FTEs.
Contact:
Leslie Simmons, RN
Vice President, Patient Care Services
Carroll County General Hospital
200 Memorial Avenue
Westminster, MD
21157
410-871-6916
lsimmons@ccgh.com
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In the space of one year, patient satisfaction scores for
inpatient care at Western Maryland Health System have increased from the
49th percentile to the 85th percentile. Over a slightly
longer period, RN turnover has decreased by roughly half, from 11.9 percent to
4.7 percent.
What has made such a dramatic difference? “Happier and
more satisfied nurses,” says Nancy Adams, the system’s senior vice
president/chief nurse executive. A major contributor to that satisfaction, she
says, is self scheduling for nursing units, an initiative supported in part by
a $138,000 grant from the state’s Nurse Support Program.
Adams says that while the health system had previously
allowed self-scheduling for units that took on the responsibility themselves,
the informal approach was not very successful. The current effort works well,
she says, because it is grounded in a system-wide process with broad support.
The launch also benefited from good support from a consultant, says Adams,
noting that all of the nursing units have adopted it.
Accommodating School Bus Schedules
Individual units have considerable flexibility in shaping
scheduling guidelines to accommodate the particular needs and preferences of
their staff—for example, a nurse with a child whose school bus comes a
half hour after the day shift begins, or one who prefers to work three 12-hour
shifts. Unit-specific scheduling guidelines must, however, fit within two
over-arching sets of guidelines: health system policies, which include budget
parameters for overtime, and unit staffing guidelines (developed by the nurse
manager), which specify the level of staff required for patient census. The
unit-specific guidelines are developed by a Unit-Based Scheduling Council, made
up of at least three members—one each from the day, evening, and night
shifts—and based on staff input.
The on-going task of constructing the unit’s four-week
schedule belongs to a Unit Scheduling Coordinator; unit RNs rotate in the
position. In addition to considering health system policies and unit staffing
guidelines, the coordinator incorporates staff scheduling preferences and
time-off requests. The nurse manager approves the schedule and arbitrates any
conflicts.
The Appeal of Closed Units
Adams cites another contributor to nurse satisfaction at the
health system: the opportunity to adopt the closed unit concept. Under this
arrangement, nurses agree to staff the unit from within, rather than seek help
from nurses on other units who “float” or are “pulled” from
their own units to provide extra help. By committing to meet unit needs under
all circumstances (either working overtime if needed or not working if not
needed), unit nurses cannot be pulled to another unit. “When you talk to
nurses,” notes Adams,” being pulled from one unit to another is one
of the things they dislike the most.”
Adams says that while arranging coverage under the concept
is easier in a large unit, Western Maryland has a 10-bed ICU where it is
working well. She cites a flexible and cohesive staff as a requirement for
success.
While the closed unit approach is not part of the health
system’s state grant, it does dovetail with grant goals. “Our number
one goal is nurse satisfaction,” says Adams. “The happier and more
satisfied the nurses are, the more satisfied patients are. Since we’re
here to give patient care, the focus of these programs is on nurses.”
Contact:
Theresa Hershberger, RN, MS
System
Director, Education & Project Management
Western Maryland Health System
P. O. Box 539
Cumberland, MD 21501-0539
Phone: (301) 723 1431
thershberger@wmhs.com
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In talking to Vice President for Patient Care Services Diane
Johnson about Sinai Hospital’s foreign nurse recruitment effort, you get
the distinct impression that she is a resilient person. That’s because
after a conversation about her Philippine recruitment experience—a
conversation that describes “aggravation, pain, and heartache” and an
“emotional roller coaster”—she ends on an upbeat note: “For
us, it was time well spent.”
Johnson explains that she suggested her hospital try
recruiting foreign nurses because she got tired of the competitive
“how-can-I-make-my-opportunity-more-attractive” strategy that
hospitals were using to steal nurses from the next facility—a strategy
Johnson candidly admits she has used herself. With executive management
support, she identified a small recruitment agency and assembled a team of
three directors and a Human Resources nurse recruiter to go to the Philippines
in December 2000. The team consulted both clinical and administrative experts
to craft a list of screening questions for interviews—for example,
“If you had a patient that presented with xyz symptoms, how would you
handle it?”
An abundant supply—and a lengthy process
The recruiting team found the Philippine nurses well
prepared and the number wanting to come to the U.S. abundant—driven partly
by a Philippine over-supply of nurses. The team contracted with just over 160
nurses, with a three-year term of commitment contingent on obtaining a visa and
license, and subject to hospital employee rules and regulations.
While the original plan was to have the nurses obtain their
license before coming to the U.S., that did not always work out in practice;
Sinai now allows those that need to, to take the test here. Nurses must pass
the Test of Spoken English before obtaining a visa and their Maryland license:
a tough hurdle, with a 50 percent failure rate.
The first Philippine nurses started arriving in small groups
early in 2002; so far 56 are working at Sinai, and, with a switch to a larger
recruiting agency, the hospital is committed to speeding up the process and
bringing the remaining 50 here (the lengthy wait has had an attrition rate).
Johnson and her staff used the time before the nurses’
arrival to lay groundwork: among other steps, they conducted the equivalent of
an in-service program for front-line staff to educate them on Philippine
culture. Johnson made a particular point of educating herself on training for
nurses in the Philippines—all bachelor’s prepared, their education is
similar to that in the U.S.—and then meeting with small groups of
physicians to describe competency level and hear concerns. At the same time,
Sinai kept in touch with their Philippine recruits, supplying background
information on the U.S. and Baltimore as well as clinical and cultural
information about the hospital.
Sinai’s Director of Patient Care Services for
Medical-Surgical Services, Linda LaHart, and Director of Patient Care Services
for Cardiac Services, Valerie Allen, took on key roles in helping the nurses
adjust once they had arrived. LaHart watches over their cultural and clinical
needs and Allen helps them settle into (and move on from) the apartments the
hospital provides for their first three months.
Meeting objectives—including physician approval
With only a few bumps, the Philippine nurses are melding
smoothly into the staff. “They are pleasant and competent,” notes
Johnson. “The one over-arching issue is they need more coaching in
technology than U.S.-trained nurses; Philippine hospital technology is
typically several generations back.”
There are early signs that Sinai’s foreign recruitment
effort is meeting its objectives: vacancy, turnover, and agency use rates are
all declining. And there are signs of physician satisfaction, says Johnson,
citing a recent encounter with a surgeon, who told her: “Diane,
that’s one of the best things Sinai has ever done.”
Of course, being a resilient and realistic person, Johnson
knows that physicians will move on to other issues.
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