To get a first-hand understanding of how the nursing shortage is affecting the DFW area, the Nurses' Lounge interviewed several local professionals in a variety of positions to get their perspectives on the shortage. To read the entire magazine online click here.
Overall, the next several years will be good for nurses as hospitals, unable to make dramatic changes to the nursing shortage in the short term, instead boost their recruitment and retention efforts by catering to the needs of nurses. New and experienced nurses are seeing a variety of incentives, perks and educational opportunities presented to them in hopes of building employment loyalty. Many hospitals are also looking for ways to work around the shortage by using technology to improve productivity and by encouraging nurses to delay retirement. Collectively, these incentives and programs, in addition to a high RN per capita rate, have helped keep the DFW vacancy rate lower than state levels.
Acutely aware of the effects of the nursing faculty shortage, many hospitals are also partnering with local nursing schools to provide faculty and facilities to assist with the expansion of nursing education programs.
The CNO Perspectives
Rosemary Luquire,
RN, PhD, FAAN, CNAA
Senior Vice President and Chief Nursing Officer
Baylor Health Care System
How many nurses are you planning to recruit in 2008?
We recruited 900 nurses in 2007, but many of those were to staff our new women's hospital in Fort Worth. Usually we recruit 500-700 each year system-wide due to the usual attrition.
How many nurses did you have to recruit for the new facility?
Around 200-250. We have almost hired all of the nurses we need, and the facility doesn't even open until March.
How has the nursing shortage affected you the most?
Baylor has worked to create an environment where nurses created an environment where nurses choose to practice, which has been recognized with our magnet and nurse-friendly designations.
What changes do you expect to make within the next few years?
We have created some new positions: A vice president of professional development that looks at clinical competencies and how to orient staff across the system; and a Vice President of workforce development that reaches out to schools and communities, works with nursing schools, and also works with our new leadership academy to help our nurses develop into leaders.
Additionally, we are bringing in a manager to look at and modify our recruitment for different generations, how to groom our staff for future roles, and how we can use distance learning technology in addition to the classroom for continuing education.
How are you planning to prepare for future shortage numbers?
Right now our recruiting is focused on APNs with specialties like research and OR. OR nurses are typically older and will be retiring at a higher rate. Many schools don't offer training for the OR, so we are partnering with local schools to offer OR training.
Judy Denison
CNO
Texas Scottish Rite Hospital for Children
How many nurses are you planning to recruit in 2008?
Right now we have around 100 RNs on staff and are looking to recruit 10 more in 2008 due to new positions and regular turnover.
How has the nursing shortage affected you the most?
It takes us longer to hire nurses, and that makes a big impact on a facility our size. It's hard to recruit experienced nurses because the hospitals are working so hard to retain their people. We also feel that it's better to retain our nurses than to recruit nurses, so we work hard on our retention efforts as well. Fortunately we have a unique mission of providing world class orthopedic care to children without ever charging for that care, and most of our nurses come to us and stay with us because they identify with that mission.
How are you planning to prepare for future shortage numbers?
We realize that the shortage of faculty and clinical sites is a big part of the nursing dilemma, so we partner with several schools and are heavily involved in educating student nurses. We provide pediatric clinical experience for students from four to five nursing schools on a regular basis, and share our staff as clinical faculty and preceptors for both undergraduate and graduate students. Schools outside our area also bring students in for seminar days during which we teach them about our unique patient population. All these efforts bring hundreds of student nurses through our doors each year and serve as both a recruiting tool and a way for us to give back to the community.
For our own staff, we encourage and support nurses to go back to school to become nursing faculty. We have two nurses that are going to school right now with a commitment to become faculty members when they graduate. We currently provide faculty for Tarleton State University and have a nurse who works as a part-time clinical faculty for Baylor.
We make it a point to reach out to the community and get involved in recruiting young people into the profession of nursing. We also offer a summer externship program that usually results in us hiring 14 students each summer to work, study and develop their skills. Many of the externs stay on as nurse techs until they graduate, and 2-5 of them have joined our staff after graduation each year. Word of mouth is a strong recruiting tool for us, so we work hard to maintain a positive, supportive work environment and to be sure that the students have a good experience while they are with us. We could not do this without excellent supportive nursing staff who love to teach and who are passionate about helping to develop future nurses.
The VA Perspectives
Sandra Griffin
Associate Director for Patient Care Services
VA North Texas Health Care System
Kris Davies
Nurse Recruiter
VA North Texas Health Care System
How many nurses are you planning to recruit in 2008?
Sandra: We just added 42 additional RNs, but we will be expanding our programs in 2008 so we will be adding more.
How has the nursing shortage affected you the most?
Sandra: Nurses with specialized skills, such as OR or ICU, are harder to find and thus the most sought after.
What changes to your recruiting program have you made due to the shortage?
Sandra: We have established a team of managers, HR staff, recruiters, and other leaders to identify new approaches to recruitment and streamline the process for getting nurses in the door.
Do you have any new or interesting programs designed to attract or help retain nurses?
Kris: We have several programs for special financing, including more scholarship money for student nurses and higher salaries. We have established a "Grow Our Own" program, and we offer paid time off while attending school to pay nurses while they are actually attending school. This is a big incentive for many of our nurses.
Is there a difference in how your hospital is affected by the nursing shortage compared to private sector hospitals?
Sandra: There is no difference between how we are affected. We are all competing for the same people. The biggest difference in how we respond, though, is that the private sector uses agencies or contract nurses, which we do not.
How are you planning to prepare for future shortage numbers?
Sandra: We are looking to identify staff with leadership potential for leadership development and training. We also offer a special OR training program that is open to the public. Our VA Learning Opportunity Program reaches out to junior- and senior-level student nurses and offers an expanding program to develop clinical skills.
The Director Perspective
Nan Richards
Director of Recruitment and Employment
HCA Medical Center of Plano and McKinney
How has the nursing shortage affected you the most?
The shortage is taking us out of our normal thinking and forcing us to be more creative and strategic in our recruitment and retention. We try to make ourselves visible and memorable to nurses. A lot of it is timing. A part of our performance evaluation for our recruiters is measuring the time from contact to hire. Changes are made to our recruitment efforts every day, so this is an exciting time.
How are you planning to prepare for future shortage numbers?
Our plan is a diverse mechanism for creating a constant flow of candidates. We have a seasoned team that is involved with the community, including Collin County Community College, the Dallas-Fort Worth Hospital Council, and are members of the board for the Texas Workforce Commission. They make our face visible in the community. HCA also has a "Grow Your Own" program that includes internal training for managers and a streamlined process for leadership development.
We develop a strategic plan every year based on the marketplace that is very targeted and strategic as opposed to clerical.
The Educator Perspective
Dr. Pat Holden-Huchton
Interim Dean
TWU College of Nursing
What type of programs are you planning for the next few years to respond to the nursing shortage?
Last September we received funding from the legislature that allowed us to create a new condensed master's program. It's a 36-hour program that is completed entirely online over three semesters through TWU's Denton, Dallas and Houston campuses, plus we have a non-online option.
We have also recently been able to offer a new doctoral degree program, the Doctor of Nursing Practice. The DNP is designed to address the need for more highly educated nurses in technological-based healthcare system. Nurses who want to pursue doctoral education will be able to choose between a Ph.D., which is research focused, and a DNP, which is the highest level of specialty clinical practice. We are seeing an increase in nurse educator enrollment with these programs.
In the summer of '08 we will be offering a weekend-only option for second-degree nurses who already have a bachelor's degree and are looking to move into a different field. Baylor is providing clinical faculty and the didactic portion is online.
We have developed several strong collaborations and partnerships with local hospitals and medical centers in DFW. They help with scholarships, faculty, preceptors, and facilities.
Our faculty is very productive with simulated learning environments. We work heavily with local hospitals to develop new strategies for clinical teaching and learning using these technologies to help alleviate the shortage.
Are you seeing a change in the ages of incoming students?
Our students range anywhere from 18 to 60, but we are seeing older students, which is why we offer accelerated programs for second-degree students.
What are your current enrollment numbers and are you expecting them to change over the next few years?
We produce over 300 graduates each year in our program, and our enrollment is growing 4 percent per year.
Elizabeth C. Poster, PhD, RN, FAAN
Dean
UTA School of Nursing
How are your current enrollment numbers being affected by the nursing shortage?
We have a high demand for all our programs, BSN, MSN and PhD, however, unfortunately we can only admit 100 students each semester into our large 400 student BSN program. We don't have the number of faculty needed to increase this number. A major limitation is that faculty salaries that are not comparable to those in health care settings.
Do you expect them to change in the next few years?
We hope to establish some innovative new options for students; such as an accelerated BSN program using a hospital partnership model. It will be the same curriculum as in the current BSN program but students will be able to complete it in 15 months.
How are your instructors affected by the nursing shortage?
The nursing faculty shortage will increase in the future, since the current average age of faculty nationally is about 56 years. We know that about 70 percent will be retired in the next decade.
Our goal is to have younger nurses become faculty. One of the ways we are doing this is by encouraging BSN prepared nurses to enter our BSN- PhD program. This program prepares nurses to be scholars and faculty. Flexibility is important. We also hire MSN and PhD prepared nurses both full and part time on either our clinical or our tenure tracks. Faculty development strategies , support for faculty to do their scholarship, a very collegial environment and many resources that allow faculty to meet their career goals make our setting a very positive one that results in retention.
What type of programs are you planning for the next few years to respond to the nursing shortage?
I believe that collaboration with our service partners is vital to ensure the success of innovative programs as well as ensuring a vibrant nursing education program for our future RNs and advanced practice nurses
One successful strategy has been for hospitals to "loan" a member of their nursing staff to us for the nine month academic year. Students have their clinical placements within that setting and often will be hired by that setting upon graduation. There are benefits for both partners of working closely together.
What change or growth do you foresee over the next few years and what plans do you have to address these changes?
We have a number of new initiatives planned to better meet the community's needs. We have three programs pending for 2008: a post MSN NP Doctorate of Nursing Practice program, a Neonatal Nurse Practitioner MSN option and an MSN Nurse Educator program.
Having new programs at the post BSN level, will enable BSN prepared RN's to increase their knowledge and skill and ensure that the multiple needs of our patients and our students are being met.
The VP Perspectives
Mark Morales
Vice President of Workforce Planning
THR
How many nurses are you planning to recruit in 2008?
We hired 800 RNs in 2007 for the traditional turnover reasons, which is usually the same each year.
How has the nursing shortage affected you the most?
It's getting more difficult to find experienced RNs. We have to see more candidates for each position to find the person who is the right fit.
Do you have any new or interesting programs designed to attract or help retain nurses?
For retention, we have several new programs that provide a structured approach to engaging our nurses, and we are looking at how we can create flexibility for our veteran nurses, such as shorter shifts. We also offer a two-year residency program for nurses.
We have several recruiting channels, including our "Grow Our Own" program where we have partnered with El Centro College who provides distance learning for educating our employees. We have close to a 100 percent pass rate and have produced 129 who have graduated with an associate's degree in nursing, five with a BSN and three with an MSN.
Beyond our employees, we reach out to the community and partner with local high schools, junior highs, chambers of commerce, career development centers, and outreach programs designed to drive people into the pipeline. We have also partnered with UTA to create programs to move nurses from their ADN to BSN or MSN.
John Lacy
Senior Vice President, Human Resources
Methodist Health System
How many nurses are you planning to recruit in 2008?
It is challenging to predict the exact number as our nurse turnover rates are trending down. Instead of focusing only on recruitment, however, Methodist has chosen to focus on both recruitment and retention. We not only want to build our staff, but also retain the staff we currently have by providing a fulfilling and appealing work environment.
What changes to your recruiting program do you expect to make within the next few years?
Any recruitment program is only as strong as the hospital's work environment...Over the next few years, we will continue to strength our working environment with programs that assure a meaningful work experience filled with professional growth and development.
Do you have any new or interesting programs designed to attract or help retain nurses?
We have recently added flexible staffing options for nurses, such as a Weekender Plan. We also have doubled our tuition assistance for nurses or other employees pursing nursing degrees. We also now provide reimbursement for nurses obtaining advanced certification.
How are you planning to prepare for future shortage numbers?
According to the American Association of Colleges of Nursing, a shortage of nursing school faculty is restricting nursing program enrollments. Methodist has a proud history of partnering with local nursing schools to enhance enrollment and graduation of new nurses. One such program is the Methodist Health System/El Centro College nursing program. Methodist, in partnership with El Centro Community College of Nursing, offers the two-year nursing programs on the Methodist Dallas Medical Center campus. Methodist's Department of Education instructors oversee the clinical and skills labs. Lectures are shown via teleconference. We also present nursing as an attractive and rewarding first or second career.
The Recruiter Perspective
Doreen Foy
Senior Recruiter, Northeast and Texas Regions
VITAS Innovative Hospice Care®
How many nurses are you planning to recruit in 2008?
In the Dallas/Fort Worth metroplex alone, we hired more than 40 RNs, 20 LVNs and 40 CNAs in 2007. We recently initiated bilingual Spanish teams to better serve the local Hispanic population. As our home care and long term care censuses grow, we will be hiring RN field case managers, admissions RNs, RN team managers, triage/on-call RNs, inpatient hospice unit nurses, Continuous Care LVNs, and more.
What changes to your recruiting program do you expect to make within the next few years?
Our organization strategically focused on retention throughout 2007, and retention continues to be our focus: Helping employees balance work and family issues, offering a benefits plan designed to meet the needs of varying individuals and maintaining a financially stable work environment are just a few strategies we use.
How is your current staff affected by the nursing shortage?
Like most healthcare employers, we recognize the issues surrounding the nursing shortage. We focus our efforts on communication, education, referral programs and retention initiatives.
How are you planning to prepare for future shortage numbers?
We stay keenly aware of workforce trends and develop programs to address anticipated needs, such as providing financial incentives for team members to pursue additional levels of nursing education. Most importantly, we really listen to the suggestions, concerns and ideas presented by our current team members and act on them whenever possible.
Jim Heinemann
Recruiter
Management Resources
How has the nursing shortage affected you the most?
I have stopped trying to compete with bidding wars by focusing on nurse managers and up. Until they get into management, most of the nurses I see are strictly looking at pay rates, shift differentials, and closer locations. Many nurses are overworked, so many are focused on who has the best hours with the best money.
What changes have you seen in recruiting programs over the last few years?
Many systems are heavily recruiting internationally. South Africa, the Philippines, England, and more are popular recruitment destinations. One local hospital system just spent millions of dollars recruiting in Scotland.
The Agency Perspective
Julie Norris
PRN Surgical Services staffing agency
Do you have any new or interesting programs designed to attract or help retain nurses?
We sought out Joint Commission Certification because nurses want to be associated with high-quality companies and they don't have to tolerate facilities that have chronic troubles.
As a staffing agency for surgical nurses, how has the nursing shortage affected you the most?
We assess each of our nurses for cross-training to broaden their practice areas. There is a high-demand recently for OR nurses who can handle pre-op, recovery, work cases, and more.
Since you have been an OR nurse for 24 years, what changes have you seen that are a result of the current nursing shortage?
We get more calls because the hospitals don't have a backup available. Almost every day we have positions we can't fill because all of our staff are working or hospitals need someone specialized.
The clinical directors and charge nurses who are on salary are more overworked. They often work 10-12 hours a day with no overtime.
What differences are seeing between recruiting floor nurses and surgical nurses due to the shortage?
Floor nurses are not getting the $10,000 sign-on bonuses or other recruiting incentives that OR nurses get. It's much easier to find a nurse to float floor-to-floor than it is to find an OR nurse.
Hospitals are getting more flexible because nurses need family time or they simply cannot work 12 hour shifts, especially since the average nurse is close to 50 years old. I see a lot more nurses dictating their hours as the hospitals will just take what they can get.
NL