Solving nursing shortage requires imagination

Quality-of-life issues a key point

With many hospices trying to fill open positions, it’s easy to lose sight of the importance of keeping currently employed nurses from leaving. While nurse recruitment is important, remember that nurses who are already on staff are often seasoned hospice nurses. Their years of experience cannot be replaced by inexperienced nurses.

In 2000, Hospice Atlanta faced an employment crisis of its own. A significant number of nurses and social workers left, many to take jobs with other institutions — including competing hospices that paid higher salaries.

Pamela Melbourne, RN, MN, director of clinical services for Hospice Atlanta, says the hospice raised salaries to address its retention problems. That has made an impact on retention, Melbourne says. While she is unable to cite specific numbers, anecdotal evidence points to fewer nurses quitting for other opportunities.

Salary not final word

But salary is not the final word in retaining nurses. Salary combined with working conditions and quality-of-life issues will strengthen a hospice’s standing with its staff. Strategies cited by the Alexandria, VA-based National Hospice and Palliative Care Organization (NHPCO) in its monograph "Finding Answers to the Nursing Shortage" include:

  • giving nurses opportunities for professional development, including conferences and continuing education;
  • encouraging and rewarding staff who seek professional certifications;
  • investing more resources in new-hire orientation;
  • adding benefits, such as child care, transportation, and wellness programs;
  • giving nurses more participation in management decisions through quality improvement programs;
  • supporting programs that address grief and loss issues among nurses.

The overall aim of retention strategies is not only to provide programs intended to boost job satisfaction but also to gauge job satisfaction among nurses. Hospice Atlanta conducted an employee survey to determine what changes could be made to address staff concerns. Overwhelmingly, staff wanted a say in the direction of the organization, rather than having edicts handed down to them without their input.

Also, the hospice found that nurses wanted more predictable schedules. So rather than requiring nurses to take on-call shifts, Hospice Atlanta hired nurses whose specific job responsibility would be to handle after-hours and weekend calls.

Focus recruitment on job satisfaction

The reality, however, is that nurses will quit, retire, or move on no matter what you do. Hospices need to develop a strategy that attracts experienced nurses and develop training programs to train young nurses or nurses coming from other disciplines.

Experts agree that the two areas in which hospices should focus their recruiting attempts are:

  • high job satisfaction as a result of practicing hands-on medical care and the close relationship nurses develop with their patients and families;
  • flexible working hours that will attract nurses who can’t work traditional 40-hour weeks.

Job satisfaction is perhaps hospice’s greatest selling point, says the NHPCO.

Knowing that competition for hospice nurses is fierce, hospices may be compelled to broaden their pool of prospective nurses by not limiting their search to nurses with hospice experience.

For prospective nurses outside of hospice, the message of greater job satisfaction may have greater impact. Hospices can make use of those nurses’ current job dissatisfaction. Hospices should stress how hospice nurses can have a direct and immediate impact on patients and their families and recount the gratitude families have for hospice workers who helped them get through a difficult situation.

Still, money is a strong motivating factor. To help neutralize the money factor, providing employment that enhances quality of life beyond professional job satisfaction can go a long way toward persuading a nurse to join a hospice.

The NHPCO advocates offering prospective employees flexible hours and working arrangements. Some hospices, for example, allow nurses to work as many hours as they like, whether it’s 20 hours a week or 40 hours a week. This allows talented nurses, who, for example, cannot work a full-time job because of family commitments, to maintain the balance between work and family that is valued by workers.

Still, with no end to the nursing shortage in sight and growing competition for both experienced nurses and recent nursing school graduates, hospices may be faced with having to redefine the responsibilities of not only registered nurses but licensed practical nurses (LPNs) as well. According to the NHPCO, one solution might be to expand the role of the more abundant LPNs and use RNs as case managers.

In addition, hospices will need to explore how technology can help improve efficiency and lower the demand for nurses.