September 2004
 Reorganization Lowers Vacancy and
Turnover Rates at Washington County
In one of the few industries in the nation where positions
outnumber applicants, health care managers have to sell their organizations
Donald Trump-style. With little of the glitz and glamour of casinos and hotels,
hospitals need managers with tremendous creativity to attract and keep a corps
of experienced staffers.
Enter Mary Towe, RN, MBA, executive for nursing services at
Washington County Hospital in Hagerstown-the brainchild behind a massive
organizational overhaul that has decreased her hospital turnover and vacancy
rates by almost 40 percent and 60 percent, respectively, over the last three
years.
Washington County's results may be a sign that things are
improving in the arena of hospital retention. Vacancy rates for RNs in Maryland
declined to 10.8 percent in 2003, down from 12.6 percent in 2002, and a
historic high in 2001 of 15.6 percent, according to the Maryland Hospital
Association Annual Personnel Survey.
"The needs of our staff weren't being met, and we knew we
had to change that," said Towe, who, along with the human resources department,
the nursing executive and the Advisory Board, and the senior administration
four years ago helped sculpt a three-tiered solution to a constant exodus of
nurses and allied health professionals.
First, Towe went straight to the source.
When she asked nurses why they were leaving, they often
cited poor relationships with their managers.
"Nurses told us that the managers were not available to them
and weren't acting as their advocates," Towe said, noting that the management
team was spread too thin, with some managers covering multiple patient units
and weighed down by paperwork. "The new nurses were missing out on the valuable
day-to-day instruction that a manager should be there to provide," she
said.
As a solution, the 300 bed community hospital created the
position of Clinical Director charged with planning operations, financial,
budget - freeing up the nurse managers to spend more time with their staff. The
hospital also hired more secondary assistants to help with creating time cards,
performance appraisals and other clerical duties. In order to retain new nurses
and give them the training they need, the hospital hired a nurse educator who
worked only nights and evening shifts when a lot of the newer nurses were on
duty.
Clinical Manager Veffa Devers, BSN, CCRN, has worked at
Washington County since 1999, overseeing an 86-member staff medical unit.
Previously serving as her own secretary, she had piles of work on top of her
daily management routines. "I was on my unit, but I was in my office a lot,"
said Devers. "I would spend hours filing things, but now I'm out there on the
floor."
After restructuring the management, Towe and the team looked
toward incentivizing the staff.
Nurses and nursing assistants said they were unhappy working
weekend, night, and evening shifts, so the hospital created significant pay
differentials to reduce the shift rotation of the staff. Now, hospital staff
get a 15 percent pay differential for working a weekend day, 20 percent for
working an evening and night, and 30 percent for working a weekend evening and
night.
"We wanted to make those shifts more attractive in an effort
to hire staff who really wanted those shifts and would work there permanently,"
said Towe.
Lastly, Towe rewrote the job description for the management
staff.
"Overall, the most important thing for us is to keep the
staff that we have and avoid backfilling with new staff," said Towe. Every time
the hospital lost a staff member it cost the organization $60,000-$70,000 in
lost productivity, overtime, and new hiring orientation fees, she said.
To remedy the situation, management job performance
evaluations are weighed on their ability to retain qualified staff.
"This was a huge shift in the department - the managers
needed to be creative," Towe said.
Now, nurse managers are required to list yearly those staff
members they deem most at risk to leave. Managers also take it upon themselves
to discuss personal ambitions, goals, and professional issues with their staffs
of nurses, nursing assistants and unit secretaries.
"We usually note people with ongoing attendance problems as
the most at risk," said Judy Abrams, RN, a medical surgical clinical manager.
If a staff member's needs aren't being met in their
department, a manager assists the staff member in relocating to another unit,
which may be better suited for the individual.
"We reward our managers for helping staff pursue their
professional goals within the organization," said Towe.
Devers lost only two nurses from her team last year by
helping them advance their roles to a different department. The
medical-surgical unit is often a growing-ground for nurses who then wish to
advance in other areas.
"If their goal is to stay on med surg great, if their goal
is to be a critical care nurse, great, it's our job to work with them to meet
their goals," said Devers. We want them to advance their careers and also keep
them in house."
Although the changes are rather new, the hospital has seen
substantial results.
In fiscal year 2002, the hospital's RN turnover rate was
10.2 percent, in 2003, 9.8 percent, and in 2004 it was down to 6.6 percent. The
hospital's RN vacancy rate was about 8-9 percent prior to 2003 and has
stabilized between 2.5 and 3 percent in fiscal year 2004, according to Towe.
Aside from the numbers, the overall satisfaction of nurses
is at an all-time high.
"We're committed to our staff; hopefully this trend will
continue," she said.
Contact:
Mary Towe, RN, MBA
Executive for
Nursing Services
Washington County Hospital
(301) 790-8215
towem@wchsys.org (Back to the top)
 "R.N.-On -Loan" Program Eases Faculty
Shortage
At a time when hospital R.N. positions are hard to fill, it
may seem a bit strange that Union Hospital in Elkton would encourage a veteran
ICU nurse to leave the premises and work elsewhere. But hospital officials say
that by having an R.N. spend part of her week as a clinical instructor for
local college students, they are helping to secure the future of health care in
Cecil County.
Cecil Community College, like other nursing schools across
the state, consistently turns away qualified applicants from its R.N. program
because it doesn't have enough clinical faculty to accommodate them. In order
to help ease the shortage, officials at Union last fall entered into a
"nurse-faculty partnership" with the college, agreeing to provide a nurse from
its own staff as a part-time adjunct professor.
What thrills Robyn Otwell, R.N., about her new position is
the fact that she can experience teaching 24 hours a week during a semester and
still spend the remaining 12 hours of the week at her regular post in the ICU,
the place where she has spent the past 17 years.
"Some semesters I spend more of my time at the hospital,
other times at the college-it depends on how much Cecil [Community College]
needs me," said Otwell, who plans to continue her unique dual role in the
2004-2005 school year. "The neat thing is, I'm still considered full-time at
the hospital so I don't lose my seniority or my benefits," she said.
A hospital e-mail describing the position piqued Otwell's
interest last summer, and - although she never had a lifelong yearning to be a
professor - the opportunity to add a new dimension to her nursing experience
sounded too good to pass up.
"The position was presented as a 'Trial Position: If you
like it, great, stay - If not, you can always go back to full-time nurse.' I
was one of the few people who had the required B.S.N. degree and I just decided
to give it a try, but it's absolutely wonderful....I enjoy it a lot." she said.
Last year, Otwell taught the college's Level I clinical
classes at a local long-term care facility. She also taught Level IV clinical
classes in the Progressive Care Unit at Union Hospital. With an additional
part-time instructor, Cecil Community College was able to expand its R.N. class
by eight students.
Not only will Cecil County gain eight additional nurses, but
officials say Union Hospital will reap long-term rewards from the partnership.
"It costs the hospital $25,000 a year per nurse who
participates in this program, but for each of those nurses, we're gaining eight
new nurses coming out of Cecil Community," said Tom Sweeney, the hospital's
vice president and chief clinical operations officer.
"If the college is able to expand, then so will our internal
career development program. A lot of the nursing students who get the chance to
work in our hospital will end up working with us after graduation," he said.
With the demand for nursing faculty so high, a partnership
also prevents an exodus of nurses from hospital settings to academic
institutions, said Sweeney. "This lets us keep members of our staff, but also
lets them experience teaching," he said, adding that during the summer and over
the holidays, nurse partners go back to being full-time hospital nurses.
Since the 2003-2004 program was hailed as a success with a
single nurse, the partnership will probably be expanded this fall to include
additional nurse-instructors.
"The second nursing partner position will most likely be a
shared responsibility between two nurses," Sweeney said, adding that several
staff members are interested, but nothing is official at the moment. This would
enable the college to enroll another eight additional students into a program
of L.P.N.'s studying to receive their R.N. licensures.
"Overall the partnership is a nice bridge between our
institution and the college," said Sweeney. "It helps our staff build stronger
relationships with the college and its students," he said.
Contact:
Robyn Otwell, B.S.N., R.N.
Intensive
Care Unit
Union Hospital
Phone: (410) 920-2764
E-mail: otw@dmv.com
(Back to the top)
 Early Clinical Scheduling Helps
Pediatric Hospital
"When can we get in our clinical instruction?"
This question is part of a yearly headache for many nursing
program coordinators—finding where and when their nursing students can get
that essential hands-on experience they need to enter into the profession.
Waiting until the last minute may be the problem, but Mt. Washington Pediatric
in Baltimore has a surprisingly simple solution.
"We schedule all of our pediatric clinical training for the
year over the summer and we're done," said Barbara Scharf, M.S.N., M.P.H.,
R.N., Director of Education & Nursing Research at Mt. Washington.
Scharf says that being proactive is the key to accommodating
everyone.
"We send out a letter in May or June to all of the Maryland
nursing schools requesting that they put in their clinical requests for the
entire year. We then take all of these requests at once, fit them all together,
and make a calendar," said Scharf, emphasizing that many factors are taken into
account. "We can't have duplicate schools on the same floors at the same time,
we utilize weekdays and weekends, and we squeeze everyone in - at least for
some of the time they want," she said.
Offering a multitude of rehabilitation and complex medical
services for infants and children, the 102-bed Mt. Washington has eight schools
of nursing and 180 students doing their pediatric clinical rotations at the
facility. With 2 patient care areas (in Baltimore and in Cheverly), and with
advanced planning, Scharf says the hospital can be flexible when it needs to
be.
"Our hospital philosophy is that we want to accept any
nursing school we possibly can and try to fit in all of the schools," she said.
The extra clinical instruction serves as a recruitment tool.
The more students trained at Mt. Washington, the more they get to know the
place and want to work there after graduation, said Scharf.
In addition to helping the hospital, the advanced scheduling
is designed to benefit Maryland nursing programs, many of which have to turn
students away for lack of faculty and clinical sites.
As a result of the hospital's program, two degree tracks at
the Community College of Baltimore County - L.P.N. and R.N. - were able to
increase their enrollment because the hospital had more time to schedule their
pediatric clinical. Simple planning measures like Mt. Washington's may become
part of a larger solution to alleviate a statewide nursing shortage and Scharf
hopes that other hospitals will jump on board.
"We've always taken a proactive approach by asking colleges
to put in their clinical times early, and it's helped us," she said, noting
that other hospitals tend to wait until they receive requests to schedule their
clinical instruction, allowing for a barrage of frantic phone calls at the
beginning of the semester.
For the present, Mt. Washington employees welcome as many
clinical students as they can. "Constant clinical instruction is very time
consuming," said Scharf, "but here we are really committed to students. Our
nursing staff are excellent and very welcoming, so the students get to see a
lot."
Editor's Note: At an Aug. 3 meeting hosted by the Maryland
Hospital Association, hospital and nursing school representatives from across
the state began to develop strategies to assure that student nurses have access
to clinical practice sites. The group came up with several recommendations
including creating a regionalized approach to clinical placements. A summary of
the group's recommendations has been distributed to MHA member hospitals for
future implementation.
Contact:
Barbara Scharf, M.S.N., M.P.H.,
R.N.
Director of Education & Nursing Research
Mt. Washington
Pediatric Hospital
Phone: (410) 578-5020
E-mail: bscharf@mwph.org
(Back to the top)
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