Improving morale may be key to future recruitment

Safety programs become retention tools

As predictions of a pending nursing shortage grow direr, employee health professionals are finding themselves in a unique role of coping with the possible consequences. Even now, employee health professionals may see physical symptoms that arise from stress, fatigue, and low morale. By 2010, those problems may get worse. That’s when experts predict the demand for nurses will exceed the supply, and the average age of the existing population of nurses will be 45. More than 40% of nurses will be over 50.1 Work environment, including safety-related issues, will become an increasingly important aspect of recruiting and retaining quality workers, experts say.

Employee health professionals also are in a position to alert hospital administration to the signs and symptoms of what health care futurist Jeff Goldsmith, PhD, calls the "most acute problem" in health care today: low morale. "Certainly, clinical care and clinical services are stressful in the best of circumstances," he says. "But in an environment like the current one, where there has been so much change so quickly, I think it’s numbed a lot of people."

Workload concerns fuel turnover

Nursing leaders have begun sounding the alarm about the pending shortage and workload issues. A recent report by a coalition of nursing organizations detailed the surveys and studies that point to future shortages. The number of people taking the licensure exam has declined consistently since 1994, according to the National Council of State Boards of Nursing in Chicago.

"The American Organization of Nurse Executives [AONE] reports that in areas where the most acute shortages seem to exist, some hospitals are closing units, diverting patients, and canceling surgeries because there are not adequate numbers of professional nursing personnel," according to the nursing shortage policy statement of the American Association of Colleges of Nursing, the American Nurses Association, AONE, and the National League for Nursing.

A William Mercer study found "workload and staffing" are the second most cited reasons for turnover in the nursing profession. "Unless issues related to the care environment are addressed, strategies to increase the overall supply of nurses will not be successful," the nursing organizations concluded. The policy statement also includes a recommendation that hospitals "redesign work to enable an aging work force to remain active in direct care roles." That would include such issues as ergonomics programs to reduce patient handling injuries.

Addressing low morale is a more complex task, and one that would seem to have little to do with employee health. Yet employee health professionals may have valuable input as they see the effects of stress and the physical strain caused by staffing shortages, says Goldsmith. "There are health-related manifestations of stress that are signals that the work environment needs to be re-engineered," he says.

Low morale can be both a cause and effect of the nursing shortage, as some nurses leave and others are left with more work demands. The ANA is pressing for language in contracts that limits mandatory overtime to "defined emergencies."

"Mandatory overtime is one of the things fueling that accumulation of stress among nurses, which exhibits itself in low morale, absenteeism, and errors," says Karen Worthington, MS, RN, COHN-S, occupational safety and health specialist with the ANA in Washington, DC.

Stress also comes from a sense of powerlessness. Giving employees input into the goals and strategic direction of the hospital makes them feel more connected, says Goldsmith. "Shortages are a manifestation of a larger problem, and that is that people aren’t made to feel valued," he says. "I think there’s an irony now that we’re going to have critical shortages of workers at the time when baby boomers are actually going to need them [most]."

Safer workplaces attract nurses

There’s a silver lining in the pending labor shortage cloud: Safety, employee health, and other working conditions gain greater attention as hospitals seek an edge in recruitment and retention. Hospitals actually are featuring their no-lift policies or needle-safety programs in recruitment ads, says Worthington. "To me that says that health care facilities are aware that safe workplaces are important in attracting and keeping nurses," she says.

Some hospitals also are experimenting with "self-scheduling," in which nurses work with nurse managers to determine shift coverage. That allows nurses to consider their own shift rotation and hours. As researchers link worker safety to patient safety and medical errors, hospitals may have stronger reasons to address fatigue and stress, says Worthington.

Meanwhile, employee health programs are being strengthened by the growing interest of physicians in the field, says Geoff Kelafant, MD, MSPH, FACOEM, medical director of the occupational health department at the Sarah Bush Lincoln Health Center in Mattoon, IL. He is also vice chairman and communications chairman of the Medical Center Occupational Health Section of the Ameri-can College of Occupational and Environmental Medicine in Arlington Heights, IL. "There’s been an explosion of interest in medical center occupational health," says Kelafant. Physician involvement gives employee health programs additional clout and a strong champion, he says.


1. Buerhaus PI, Staiger DO, Auerbach DI. Implications of an aging registered nurse workforce. JAMA 2000; 283:2,948-2,954.