Are you meeting the needs of your staff? Here are cutting-edge strategies to use
You may have tried sign-on bonuses, salary increases, and attractive benefits packages to retain and recruit staff. However, your management style should be your top priority to nurture future leaders, emphasizes Val Gokenbach, RN, MBA, CNA, director of emergency services and observation at William Beaumont Hospital in Royal Oak, MI. You’ll need to meet the needs of a newly emerging work force, which are very different from the work force of the past, Gokenbach explains. Key concerns for today’s staff are flexible work schedules and opportunity for advancement, she says.
The ED Management 2002 Salary Survey was mailed in July to 1,250 subscribers. There were 100 responses, for a response rate of 12.5%. Here are career and salary trends for ED managers, based on the survey results:
• ED managers tend not to change fields. According to the survey, 50% of respondents have worked in their present field for more than 15 years, and 76% have worked in health care for more than 15 years. According to Diana Contino, RN, MBA, CEN, CCRN, president of Emergency Management Systems, a Monarch Beach, CA-based consulting firm that specializes in staffing issues, this indicates that individuals don’t change fields once they have a degree and/or experience in health care.
She says that the survey shows that senior staff members are filling management positions. However, she notes that only 32% had bachelor’s degrees, and only 21% had a master’s degree. "Of the latter, only 7% had MBAs, and none indicated an MHA," she says. "One would have to wonder if we have the incentives to encourage leaders to obtain advanced degrees."
She recommends evaluating what training and education ED managers need to be successful. "I have been pretty aggressive in making sure our managers are current on the latest leadership theory," Gokenbach says. She points out that many ED managers have come up from the nursing ranks and may not possess business backgrounds. "So it’s important for those individuals to get the foundation that they may have missed," she says.
Gokenbach says her ED leadership team has a mandatory meeting once a week. "We discuss leadership trends, and staff are bombarded with articles," she says. "We also do a number of grand rounds and lunch and learns where people can come and learn about leadership theory."
Gokenbach stresses the importance of conferences — not only to attend, but to encourage staff to give presentations. She explains that sharing your knowledge is one of the greatest contributions you can make to your profession. "If listeners take away one tidbit of information that is helpful to them, then it is worth it," she says. Other benefits of presenting include networking with colleagues and improved self-esteem, Gokenbach adds.
• Salaries have increased but not dramatically. According to the survey, 62% of respondents reported a 1% to 6% increase in salary. Salaries are increasing at the staff and leadership levels, according to Contino. The increases depend on the facility’s financial solvency and the surrounding community economics, she adds. Gokenbach says the survey’s findings reflect salary increases at her ED. However, she adds that salary is not the No. 1 reason why staff choose to stay at a job. "The quality of leadership is usually why people stay," she says. However, Gokenbach acknowledges that with the nursing shortage, compensation has become more important. "We should be looking for ways to reward people for their contributions, such as financial incentives for developing programs," she says.
• Most EDs have increased staff in the past year. According to the survey, 64% of EDs have increased the number of employees in their ED. Over the last several years, there has been considerable publicity about the nursing shortage, ED overcrowding, and diversion, Contino says. "Nurse and physician directors who have successfully reversed this trend at their facilities often attribute it to increased nurse staffing, which decreases wait times, throughput times, and bypass times," she says. Contino reports that most of the EDs in southern California have added nursing staff, additional staff for holding units, technicians, and ancillary staff.
• ED managers are putting in long hours. A total of 69% of survey respondents reported working more than 45 hours a week. Contino says one reason for these hours is technology that allows access to rapidly changing information. "The Internet, e-mail, and listservs allow organizations to send out information and request that it be returned in very short turnaround times," she says.
Contino gives the example of continuously changing reimbursement: "There is a plethora of information that managers have to review and keep abreast of," she explains. ED managers simply may be receiving too much information and have trouble meeting deadlines, says Contino. "At times, this creates quite a bit of work stress and often longer work hours," she says. She recommends the following to improve time management:
— Always take a little work with you to meetings. "Sometimes, there will be downtime, so you can review or edit documents or give feedback on policies," she says.
— Find a way that works for you to manage paperwork and e-mail. Contino recommends using file folders to organize projects. "Many experts recommend that you touch a piece of paper just once," she says. "Be decisive and do something with it."
— Offload tasks by getting your clinical staff involved in any projects you can. "Managers are only as strong and successful as the staff who work for them," says Contino.
Gokenbach says there is a problem when a leader self-imposes work schedules that are well in excess of what anyone can achieve realistically. "I hear a lot from my managers that we feel guilty when we leave,’" she says. "If a leader is putting in [more than] 50 hours a week, they need to pay attention to exactly what is going on that is forcing them to stay." Managers may be afraid to delegate, and this is especially important because today’s staff are looking for autonomy, Gokenbach says. She recommends singling out staff members who are experts in various areas and delegating work to them. "You should consider each staff member a leader," she says.
• A significant number of ED managers are nearing retirement age. According to the survey, 49% of respondents were older than age 45. This trend is consistent with nursing in general, Contino says, and it underscores the need to recruit young women and men into the profession.
Every good manager has a "farm club" of individuals who are up and coming in the department, Gokenbach says. "Even if there is no management position available, there are still ways to groom those individuals for leadership." She recommends getting staff involved in key projects. "We actually have staff managing our committees," she says. "We have an active nurse practice council, and every single nurse on that council could be a leader in the department."
Turnover of men in nursing is higher, and the turnover of younger nurses is higher than rates of older nurses, says Contino.1 She says that higher salaries and opportunities to travel have increased enrollment and graduates, but cautions that work environment still will dictate whether they will stay.
The most successful strategy, Contino says, is to hire managers that are willing to act as mentors and use creative ways to reach individual nurses. "It’s all about knowing your employees, and getting them involved in things they excel in and are motivated to participate in," she stresses.
Contino gives these examples:
- For nurses who love to travel: Ask them to present an inservice about nursing roles and responsibilities in another country.
- For nurses who are fitness experts: Ask them to keep an information board updated with exercise and fitness research updates.
- For nurses who love to cook: Have them post healthy recipes and research articles on health and nutrition.
- For detail-oriented nurses: Have them help you with chart audits and data analysis.
- For nurses who are enthusiastic speakers: Ask them to give lectures at local schools.
Leadership training is important for upcoming leaders and current leaders, she stresses. Many nursing leaders need education in human resource management, including how to motivate staff and how to identify who is the best fit for a job. "Learning these things will also help to decrease turnover," she says. (For more information, see EDM, October 2002, p. 109.)
Contino suggests bringing in experts for education sessions, and presenting case studies at staff meetings on ways to resolve conflict and how to identify the right people for different positions. "We are in the service business, and we need to train staff how to provide excellent service — not just to patients but to their employees," she says.
Contino recommends financial incentives to encourage leaders to obtain advanced degrees. If pay scales increase in step with increased education and certification, then more staff will strive to reach these goals, she says. "Continual learning helps people keep informed of new trends, new research, and new solutions to old problems," she says.
1. Sochalski J. Nursing shortage redux: Turning the corner on an enduring problem. Health Affairs 2002; 21:157-164.