The Missouri Hospital Association 2015 Workforce survey revealed that RN employee turnover has increased over the last 3 years from 10.2% to 15.7% while vacancy rates rose from 3.4% to almost 10% in 2015. The annual average openings for a registered nurse in Missouri are 886 (Missouri Hospital Association, 2015 Workforce survey).
With a large and complex health system situated primarily in the Midwest all facing a shortage of nurses the Chief Nursing Officers (CNO) from across the Mercy system came together to share best practices related to recruitment and retention. In an attempt to place effort on each hospital’s best opportunities, it was decided to format key initiatives related to recruitment and retention by using the key concepts of the AACN Healthy Work Environment (HWE) . The HWE assessment had previously been used to assist individual units in assessing culture and creating positive change. This would be the first time an entire system would participate in one large exercise around the HWEs.
The AACN’s HWE standards align with the core competencies for health professionals by the Institute of Medicine (IOM). They are indeed designed to be used as a guide for prioritization and reflection by units, hospitals and systems. HWE measures the current realities of the work environment, and aligning with the standards reaffirms safe and respectful work teams.
After identifying any and all recruitment and retention strategies from each hospital, the best practices were placed under the HWE standard that best represented its intended goal or outcome. Once the identified strategies were paired with a HWE standard, each opportunity was numbered using Benner’s novice to expert model related to maturity of each hospitals efforts. After ranking each best practice, CNOs rated the HWE standards based on most opportunity to least opportunity (novice work to expert work). This allowed each hospital to pick the top 1-2 areas for which to devote the greatest effort related to recruitment and retention strategies. It also allowed for a great deal of sharing between hospitals
Mercy Hospital Saint Louis identified appropriate staffing and meaningful recognition as the top two priorities. The CNO and Chief Executive Officer (CEO) worked collaboratively to understand best practices that linked these two standards and developed strong teams to design and implement changes that would move these two standards to maturity. Four primary focus areas were evaluated and implemented over a six month period ; Base rate pay increase to market comparability, increase in night shift differential where staffing is hardest to recruit, loan forgiveness programs and career ladder. These recruitment and retention strategies were communicated in August with immediate positive reaction from our bedside staff.
One of the many avenues that we currently use is to offer flexible staffing options. Mercy facilities offer weekend option position in two different formats. Weekend option 1.0 offers the coworker the opportunity to work every weekend with a higher differential and the ability to have three weekends off per year. .Weekend option 0.75 offers the coworker the opportunity to work every weekend with a lower differential rate and only working three out of the four weekends per schedule. This provides the coworker opportunities of home-life and work balance.
Shift incentives are regularly offered when a coworker picks up a shift for a priority need prior to the actual scheduled shift. Incentives shifts are placed into a scheduling system accessible online where the dollar amount changes based on the units need. Incentives can be higher if the RN commits to it early.
Patient care technicians are included in the staffing grid. These grids are modified based on unit needs. Some units chose to go with lower nurse to patient ratios in lieu of using a patient care technician.
Our facility offers a structured on boarding process for nursing. Each new nurse attends seven days of orientation to the facility. This includes a new co-worker orientation, computer training, registered nurse orientation, safe patient handling and coworker protection training. This provides a solid foundation before moving to the specialized training.
Fellowships are offered throughout each service line in order to prepare the registered nurse for specialized training. Nursing Fellowships range in length of time determined by each area and based on the expected progression of the novice nurse.
Nursing school senior practicum's are offered in all of our facilities. This provides the nursing student an opportunity to learn in an environment where they eventually would like to practice. Not only does this provide a great platform for the future fellowship nurses but gives the nursing student the opportunity to decide if this is truly where they may want to work.
In order to address vacillation in staffing needs on our units a program was created to cross train from lower levels of acuity to the higher levels of acuity with additional fellowship classes, preceptored shifts and didactic information related to the new area. This provides relief to the unit and allowing the nurses to broaden their knowledge base.