September 2000

Retention Key to Addressing the Shortage of Nurses


The current shortage of nurses, which has already created nursing position vacancy rates of 10 percent or more in some areas, will only get worse before it gets better, according to Bobbie Ingram, RN, chief nursing officer for Catholic Health Initiatives. "We have to do all that we can to recruit and retain nurses during the next two years, because after that the shortage will become more severe," she said. "Within the next few years hospitals may have waiting lists for critical case services due to a lack of registered nurses." Many market-based organizations have already taken steps to address the issue. "We’re working to develop short- and long-term recruiting and retention initiatives," said Beth Eagleton, RN, PhD, vice president of patient care services at St. John’s Regional Medical Center in Joplin, Mo. St. John’s has four nursing schools in the area, but the competition for graduates is fierce. To establish relationships with nursing students, St. John’s created a summer internship program that provided eight weeks of classroom training, clinical experience and a student nurse wage. "All ten of this summer’s interns have already ccepted patient care positions with us for next year," said Eagleton. "We plan to expand the program to 20 participants next summer." Mercy Hospital in Valley City, N.D., uses the advantages of small-town living to help recruit and retain nurses. "We can’t always compete with larger cities on salaries, so we emphasize the benefits a smaller community and hospital provide," said Ann Sherlock, RN, director of patient services. "We promote our ability to care for the whole employee by being supportive of personal and family needs, which is something that large urban hospitals can’t always do." Multiple factors contribute to shortage While there have been cyclical shortages of nurses in the past, the current shortage is so severe because it results from multiple demographic, education and socioeconomic factors:
  • The average age of practicing nurses is 46 — six years older than in 1980 — and 50 percent of the current nursing workforce will retire during the next 15 years.
  • Enrollment in bachelor’s degree nursing programs fell 4.6 percent in 1999, the fifth decline in as many years, according to the American Association of Colleges of Nursing.
  • Today’s vast array of job opportunities for women, who account for more than 90 percent of nurses, means that some who might have selected nursing in the past are choosing other careers. In addition, nurses are leaving the profession for better-paying opportunities.
Implications for quality of care The nursing shortage has a financial effect, increasing staffing costs for nursing at a time when health care providers are dealing with reduced reimbursements. "It also has huge implications for quality of care, which is becoming the differentiating factor for health care consumers," said Ingram. To help market-based organizations deal with the shortage of nurses, Catholic Health Initiatives is creating a Nurse Recruitment and Retention Manual. "We invite all market-based organizations to submit their successful policies and procedures in nurse recruitment and retention so we can share them with our entire organization," said Ingram. "We’re also looking at different models of care that can help mitigate the shortage." Ingram also noted that retention strategies need to take into account the significant differences in work habits and attitudes between nurses from the baby boom generation, who are now in their late 30s to early 50s, and members of generation X, who are in their 0s. "To put it in simple terms, boomers tend to be career-oriented team players, while generation Xers tend to emphasize a balance between their work and personal lives," she said. Generation gap This has implications for nursing management: for example, while experienced nurses may volunteer to work unscheduled overtime, younger nurses may agree to work extra hours only if they know about it in advance. We need to understand the different values that drive the different generations of nurses, and to consider those values in creating a cohesive workplace that will benefit all nurses and their patients." Eagleton agrees that there are differences between the generations of nurses. "Our younger nurses are very up front about their priorities," she said. "They have a different attitude than our established nurses. But, we need to appreciate those differences and the strengths that all of our nurses bring to their work."