There is a general consensus that a sea change must occur in EDs to effectively recruit and retain emergency nursing staff. "It’s not just a nursing shortage, and it is short-sighted to view it as such," says Ann Kobs, MS, RN, president and CEO of Ann Kobs & Associates, a Goodyear, AZ-based consulting firm specializing in accreditation compliance. "In order to keep nurses, the entire culture must change," she says.
For example, there is a growing need to create a work environment to support the aging work force, says Robin Gilbert, RN, BSN, CEN, ED manager at Central Maine Medical Center in Lewiston. "We need to supply nurses with the physical design and technology that will retain them, and allow them more time for direct care giving," Gilbert says.
She gives examples of computerized patient records and high-definition information monitors to free up nurses from excessive paperwork that takes time away from patients, automatic stretchers to reduce work-related injuries, and flexible scheduling to help nurses balance home life and work.
Also, it is important for ED nurses to have a positive collegial relationship with the physicians they work with every day, says Darlene Bradley, RN, MSN, MAOM, CCRN, CEN, director of emergency and trauma services at University of California-Irvine Medical Center in Orange. She gives the following suggestions:
- Set up nurse/physician teams with regular meetings to strategize for care improvements and operational changes for any high-volume and problem-prone specialty.
- Arrange for a physician to attend nursing staff meetings and a nurse to attend medical staff meetings to discuss and resolve mutual issues.
- Have patient care rounds to review the work in progress for each discipline and plan for discharge or admission.
- Develop joint ventures such as public speaking engagements, community service events, research, and publication that involve nursing and medical staff.
Consider these creative solutions
To facilitate a culture change, many creative solutions are in progress at emergency departments (EDs) throughout the country, Bradley says. "This includes sharing educational resources among hospitals to train emergency nurses," she says. In addition to providing sign-on bonuses, improving benefits packages, and offering educational benefits, there is a lot you can do to reduce your vacancy rates, Bradley says. She points to the following recruitment and retention strategies used at her ED:
There is an annual weeklong celebration of nursing during Emergency Nurse Week in October. Here are some activities:
- "Teas for the soul": On the day and night shift, a cart of cookies and flavored teas is set up, with ED leadership serving nurses.
- "Favorite snack day": All nurses are invited to bring in their favorite food, which is shared around the clock.
- Lunch and dinner are catered for all nursing staff, and they are paid for by the emergency medicine faculty.
- A happy hour is hosted at a restaurant across the street from the hospital, and is paid for by the emergency medicine faculty.
- A nurse of the year is selected.
Each day, raffles are held with a prize for every nurse, such as publications from the American Heart Association, pen and pencil sets, body lotion and soap sets, T-shirts, and picture frames. Bradley says the costs are minimal since most of the gifts are donated by ED leadership and company vendors.
A meditation room with massage chairs and a CD player is available for nurses to relax and listen to music. The massage chairs were purchased for staff use by the facility’s chief nursing officer, says Bradley. Videoconference education is made available so nurses can obtain a bachelor of science degree in nursing. Staff are recognized on the "Star Board,"’ which is a bulletin board specifically designated for staff recognition. Compliments from peers and other departments, customer service feedback, and positive newspaper articles are posted. Paper stars are placed all over the board listing the names of nurses and a description of their achievements.
"When the board becomes crowded, we take down the recognition and place it in the employee’s employment file so we don’t forget to recognize them again during their annual performance review," she says. "The board encourages everyone to recognize the good works we do on a regular basis."
In addition, an employee of the month is selected from the ED nursing staff, says Bradley. (See nomination form, below.)
Nursing grand rounds provide free meals, continuing education, and an opportunity to network. The chief nursing officer and the department director make rounds on the units monthly to discuss nursing issues.
Staff morale is linked more closely to recognition than money, emphasizes Bradley. "Managers would do well to involve staff in decision making, in day-to-day operations, and on the development of teams," she says. "Above all, managers should strategize how best to recognize their staff for the efforts they do daily."