Shortage of hospice nurses continues to worsen
Shortage of hospice nurses continues to worsen
Focus on retention strategy
Just when many thought the nursing shortage couldn’t get much worse, there is unsettling evidence that it is far from over. According to a national survey prepared by the Federation of Nurses and Health Professionals (FNHP), one in five nurses plans to leave the profession within five years because of unsatisfactory working conditions.
The survey, the results of which were released in April, included interviews of 700 current nurses and 207 former nurses, the FNHP said. Half of the current nurses said they have thought about leaving nursing. With nurses contemplating leaving the profession at such an alarming rate and a scant number of nursing school graduates on the horizon, the Bureau of Labor Statistics says 450,000 additional registered nurses will be needed to fill the present demand through the year 2008.
Of the nurses who told researchers they plan to leave, 75% said they could be persuaded to stay if certain improvements were made, including better staffing levels, more flexible schedules, and higher salaries, the nurses’ group said.
The implied message is for hospices to find ways to pay nurses more, improve working conditions, and offer them a higher quality of life — both in the workplace and out of it — if they expect to compete in the labor marketplace. With hospitals having greater access to money compared to smaller, independently owned hospices, hospices are at a disadvantage if they cannot offer competitive salaries and higher staffing levels to attract a limited pool of prospective nurses and keep those already on staff.
Hospices don’t face competition just from hospitals and other segments of health care. They also run the risk of losing out to competing hospices that either have more resources or make the necessary sacrifices in order pay nurses more and offer them better benefits.
The National Hospice and Palliative Care Organization says hospices must implement innovative programs such as training student nurses in end-of-life care by affiliating with nursing programs. In this way, hospices can help to expose more nurses to the rewards of hospice nursing as well as providing an end-of-life care knowledge base for nurses, regardless of the health care segment in which they work.
But those kinds of programs will have little immediate impact and are certainly no help to hospices that find themselves cutting back on admissions or stretching their staffs to their limits in order to meet patient demand.
Surviving the nursing shortage requires a two-pronged focus: nurse retention and nurse recruitment.
With many hospices trying to fill open positions, it’s easy to lose sight of the importance of keeping nurses from leaving. While recruiting nurses is important, remember that nurses who are already on staff are often seasoned hospice nurses who possess on-the-job experience that cannot be replaced by new nurses who undergo a few hours of orientation training.
"We are in an all-out blitz to retain our nurses," says Susan Lowell Butler, vice president of communications and public engagement at the Hospice of Northern Virginia in Falls Church.
The Hospice of Northern Virginia is part of the competitive Washington, DC-area market. It must compete with a myriad of hospitals, physician offices, nursing homes, home health agencies, and hospices, to name a few.
Because of this situation, officials there do not harbor any illusions that any effort to retain nurses will be successful without a financial commitment. Butler says the hospice has made an effort to raise its salaries to be competitive with any institution in the Washington, DC-area.
"If hospices want to keep their staff and attract talented candidates, they are going to have to make a financial commitment," Butler says.
Last year, Hospice Atlanta faced an employment crisis of its own. A significant number of nurses and social workers left to take jobs with other institutions, including competing hospices that paid higher salaries.
"We are trying to address the salary issue," says Pamela Melbourne, RN, MN, director of clinical services for Hospice Atlanta. "But it is quite a challenge. The work that hospices nurses do should not be undervalued."
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.
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, Hospice Atlanta found that nurses wanted more predictable schedules. So rather than requiring nurses to take on-call shifts, Hospice Atlanta is the process of hiring nurses whose specific job responsibility would be to handle after-hours and weekend calls.
At the Hospice of Northern Virginia, administrators are cognizant of the dangers of overloading their nursing staff. Administration emphasizes quality over quantity and supports the desire of nurses to spend more time with patients rather than cutting patient time short in order to make the next visit.
"They know that quality is as important as the number of patients that you see," says Butler. "A lot of nurses have come here because this is a return to real nursing, where you can build relationships with their patients. If you take that away from them, you’ll lose those nurses."
Give nurses real support
In addition, nurses at the Hospice of Northern Virginia are showered with gestures of support, ranging from time off to attend nursing conferences to the use of laptop computers to reduce the burden of time spent performing tedious documentation tasks.
The Hospice of Northern Virginia also provides emotional support for its staff, recognizing that their professional caregivers need care too sometimes.
For example, the Hospice of Northern Virginia requires its workers to attend a support group twice a month. The support group is facilitated by an outside psychologist, and management personnel are not allowed to attend, which helps promote frank conversation without fear of reprisal.
Yet, some hospices find it impossible to require their busy nurses to attend support groups. Rather than making attendance a requirement, they place a priority on providing a formal outlet for nurses to express their emotions.
Other venues in which nurses can share their feelings include:
• Interdisciplinary team meetings. A great deal is discussed during team meetings, everything from the patient’s progress to spiritual matters. The team meeting can also serve as a platform for nurses and others to share their feelings, especially following a difficult case. This allows a nurse to share his or her feelings with peers who can empathize with the emotions a troubled nurse is going through.
• Patient memorial services. Most hospices hold these services on a monthly basis to allow staff to recall patients who have died that month. The event gives staff a chance to share their feelings about their patients with colleagues (and sometimes family) of the deceased.
Experts agree that hospices should focus their recruiting attempts on the following two areas:
• Tout the high job satisfaction nurses will experience as a result of practicing hands-on medical care and developing close relationships with patients and families.
• Offer flexible working hours that will attract nurses who can’t or don’t want to work a traditional 40-hour week.
Job satisfaction can be the greatest selling point for a hospice, says Metta G. Johnson, RN, BSN, OCN, ACRN, executive director and owner of Haven House, an Atlanta-area hospice. Johnson and the directors of other Atlanta-area hospices would know. Because Georgia does not require a certificate of need to start a hospice program, competition is strong in Atlanta and surrounding counties. Not only are Atlanta-area hospices competing for patients, they are also competing for nurses.
Be willing to look outside hospice
Knowing that competition for hospice nurses
is fierce, Johnson says she broadens her pool of prospective nurses by not limiting her search to those with hospice experience. Instead, her search includes all experienced nurses from a variety of disciplines.
To attract prospective nurses from outside hospice, the message of higher job satisfaction may have greater impact. 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.
"I feel that an employer that is meeting an employee’s personal and professional goals is the one with the most satisfied workers," says Johnson.
The best way to do that, says Johnson, is to offer a flexible hour and working arrangements.
At Haven House, Johnson allows nurses to work as many hours as they like, whether it’s 20 hours a week or 40 hours a week. This attracts talented nurses, who, for example, cannot work a full-time job because they want to be home with children after school. Instead, hospice can offer that same nurse an opportunity to pursue her professional interests while still being able to fulfill family obligations.
"You need to come up with creative scheduling," says Johnson. "Try to come up with a more flexible schedule that allows nurses to have a better quality of life and reduce burnout."
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