The Next Nursing Shortage

We all know the numbers around the projected nursing shortage. Organizations, including the American Nurses Association and the American Association of Colleges of Nursing, among others, have been very successful getting this issue out in front of the public.

The facts are pretty clear:

More Americans with insurance coverage: As the second enrollment period for coverage under trhe Affordable Care Act is upon us (November 15, 2014 – February 15, 2015) it is estimated that between nine million (Health and Human Services estimate) and 13 million (Congressional Budget Office estimate) more people will have health coverage through the federal and state insurance exchanges. This is in addition to the 7.1 million Americans who signed up for coverage and still have it from the first enrollment period.

Aging nursing workforce: Currently 55% of the RN workforce is age 50 or older, per the 2013 National Workforce Survey of Registered Nurses, published in the Journal of Nursing Regulation.

Projected growth: The Bureau of Labor Statistics’ Employment Projections for 2012-2022 show the RN workforce is expected to grow by 526,800. However, they also predict the need for an additional 525,000 nurses to replace those that will be retiring.

This is all supposed to hit by 2022, but many nursing leaders I’ve spoken with say they are experiencing a nursing shortage today. They point to dozens – if not a hundred or more – open positions they cannot fill. And this is happening as they are under pressure to reduce costs.

When I speak with my colleagues who are dealing with this I ask them to consider three things:

  1. You might actually have all the RNs you need.
  2. You might be making the situation worse through inconsistent practices unit to unit.
  3. You may not be doing a lot of the “little things” needed to retain and motivate your staff.

Once they reflect and let me elaborate, most agree that there’s sense in my blunt statements.

You might actually have all the RNs you need.

If you were to analyze both staffing and punch data you would probably find two things without exception. First, you’ll find many of your RNs are not being scheduled to their full-time equivalency (FTE) commitment initially and others not meeting their hours in actuality do to various reasons. This is called FTE leakage. Second, you very likely have an issue with incidental worked time (time on the clock before or after a shift or on a scheduled break). These are two basic things that are easy to tackle. First, submitted schedules must have every individual scheduled to their FTE. There should be a simple check and approval protocol in place for this. Relative to incidental worked time, simple monitoring of punches verses schedule data will identify those who might be consistently clocking in early or skipping lunches. These are learning opportunities nurse managers can take advantage of to identify which staff members might need more coaching. There are also a number of strategies to ensure that staff are able to wrap up their shifts on time. For example, Penn State Hershey has instituted what they call “Power Hour.” During the final hour of the shift the care staff team up and see what each nurse might need or be willing to help with to ensure everyone can leave on time. Reducing FTE leakage means more hours devoted to patient care. Reducing incidental worked time reduces costs and improves morale by creating a little more work-life balance.

You might be making the situation worse though inconsistent practices unit to unit.

It’d be a safe bet to say that 90% of the nursing leaders I work with think their policies are clearly understood and that they are consistently applied across their nursing departments. When we dig into this through staff interviews and the examination of data, the level of variance revealed often leaves them speechless. I am mostly referring to policies such as floating, cancelation order, recruitment order, paid-time off and time off requests, and extra shift and OT approval. Much like FTE leakage and incidental worked time, a little inconsistency amounts to a lot when rolled together. One example is the cancellation order. In instances of overstaffing, the best practice would be to cancel expensive staffing sources and/or staff without FTE commitments before a core staff member not in overtime. Many departments have this as a policy but it’s inconsistently applied shift to shift and dependent upon who the manager is that day.

You may not be doing a lot of the “little things” needed to retain and motivate your staff.

Consistency is one of those “little things” mentioned above. Staff appreciate consistency with the application of policies. Even if they don’t necessarily like a policy, they appreciate the fact that the rules are the same for everyone. The sensing of favoritism or exceptions to rules is a morale killer. Staffing is typically the number one staff dissatisfier in nursing. Being short staffed, floating excessively, constantly recruiting staff to pick up more hours, and on the other hand, having shifts cancelled, continually working with staff floated into your department, and/or working with a revolving door of agency staff and travelers also wear on nurses, not to mention adds considerable expense to your organization’s budget.

What does this have to do with the nursing shortage?

Everything I mentioned above has a role in both reducing costs and decreasing turnover. Additionally, what I’ve talked about here are basic things organizations can implement that have an immediate benefit. The first step to combating a nursing shortage is to take stock of the resources you have. Engage and optimize them by focusing on: staff mentoring, consistent and positive work environments, scheduling to commitments, and reducing the dissatisfiers that drag down morale and increase absences and turnover. As nurse leaders you are challenged with not only recruiting nursing resources but mentoring, developing and retaining them. Adhering to the above mentioned steps will allow you to be successful in retaining your most valuable nursing resources.

Patsy Gleim is Chief Nursing Officer and a Senior Consultant at Avantas.

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