(Article originally published in Nursing Economics)
There are many benefits to designing recruitment and retention
efforts at the system level. The system approach shares resources, decreases
duplication and increases the number of ideas and creative approaches to
recruitment and retention.
Carilion Health System
(CHS), located in the Roanoke, VA, area has used a system approach to
recruitment and retention, with the leadership of Pat Conway-Morana, senior
vice president of nursing services and chief nursing officer (CNO) of the
system.
CHS organized a system-wide nursing recruitment and retention
committee, consisting of 38 members representing seven hospitals, nine service
lines, long-term care and home care. The service lines do not report to
nursing, but there is a dotted-line relationship. The goals and objectives of
the nursing recruitment and retention committee were to "create an awareness
of national nursing shortage issues, promote involvement of nursing staff,
managers and human resources staff to lessen shortage effects through workforce
education for staff, management and physicians, improving work environment and
nursing image, prioritizing ideas by value and cost and planning, implementing
and evaluating strategies.
The nursing recruitment and retention committee has been meeting
since fall 2000, co-chaired by the senior vice president of nursing services
and vice president for human resources. The committee only meets three to four
times per year, given that they work in many different organizations that are a
part of the system, but they receive continuous feedback on the many
recruitment and retention efforts undertaken by various work groups throughout
the system (Conway-Morana, October 2002, Personal Communication).
There have been several major CHS efforts to obtain data upon
which to base recruitment and retention activities. Focus groups were held with
nurses who had been employed five years or longer. Comprehensive exit
interviews, which had been completed at the rate of 4 percent in 1999, are now
completed on 70 percent of employees leaving or transferring within the system.
These efforts and the data gathered gave direction to CHS to focus on retention
instead of recruitment. Turnover for the fiscal year to date is 7.43 percent
compared to 11.15 percent last year. Separations from the system have decreased
by 35 percent since last year.
There are several programs that are credited with improving
retention.
This program offers administration, city, state and federal
legislators and politicians, guidance counselors and other individuals an
opportunity to spend time with a nurse. They meet at 6:30 a.m., spend five
hours with a nurse and then meet over lunch to debrief and share their
experiences and impressions. The program is offered two to three times a year.
This is an opportunity to promote health careers. Through FNA, CHS
has participated in a dinner for high school guidance counselors, a home
schooling fair, held workshops at a 4H camp and the Virginia Area Health
Education Center Camp, and has established a speaker's bureau for community
groups.
This program offers the opportunity for senior nursing students to
work with experienced RNs. In 2001, 26 students participated; in 2002, 78
students participated. The program is offered twice during the summer,
including an experience in the operating room. Students may participate in one
of two six-week sessions or in both six-week sessions. As many students as
possible are accommodated, as long as there is an RN mentor available.
A scholarship program supported by the board of directors and named
after a chief executive officer who retired from CHS after 30 years of service
was started with $30,000. Both employees and community members are eligible.
A "self-scheduling toolkit" was developed based on an
assessment of self-scheduling practices and preferences in the system. The
toolkit is available to staff so they can become involved in self-scheduling, a
known influence on retention.
This program helps both recruitment and retention. Employees in high-demand
or hard-to-fill positions who travel at least 50 miles to the facility in which
they work are eligible for this housing option. This has proven to be a
cost-effective option, saving overtime dollars and the costs of travel nurses.
The program has been in effect since summer 2000.
This council was begun to improve nurse/physician relationships
and is chaired by the senior vice president of nursing services, at the request
of the council. The purpose of the council is to create an environment of
excellent nurse/physician relations and communication, improve retention, and
improve nurse and physician satisfaction and patient outcomes. The PRC is
conducting a professional relations survey; however, no data on outcomes are
available at this time. The PRC also created a code of behavior for effective
professional relationships for all staff. The code addresses patient outcomes,
treating each other as professional colleagues with respect and dignity,
resolving issues and respecting each other as mentors and educators. The PRC
meets monthly and comprises 10 staff nurses and 10 physicians. The physicians
annually elect an outstanding nurse and nurses elect an outstanding physician.
A celebratory award dinner is held to honor the recipients.
In addition to the programs described, CHS has a nursing education
advisory council. The chief nursing officers (CNOs) of the system meet with
faculty from surrounding schools of nursing three times a year to discuss
mutual concerns and share information.
CHS also has been working with the Health Care Advisory Board to
improve nurse manager skills. As part of the work with the board, a new hire
coordinator (NHC) position was implemented. The NHC coordinates many of the
programs described in this column. The NHC also is responsible for knowing all
new graduate nurses and is the point person for retention efforts.
An application for magnet recognition has been submitted. CHS
believes it has made many improvements to the work environment and hence to
retention. Magnet recognition would be a significant reinforcement of their
efforts.
SueEllen Pinkerton, PhD, RN, FAAN, is a consultant, Creative Healthcare Management, Minneapolis.
Nurse Econ 20(6):296, 299, 2002. © 2002, Jannetti Publications, Inc. Available free on Medscape.com
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