The current shortage of qualified, experienced nurses magnifies the level of effort required to develop and implement registered nurse recruitment and retention. The problem is expected to worsen.
The drivers are the standard ones. Demand is growing-RN job opportunities are expected to grow 21% over the next 10 years, compared with the 14% growth rate for all professions nationally. Supply is dwindling for a number of reasons, including a rapidly aging workforce; about half the nation's nurses will reach retirement age in the next 15 years.
A long-term solution is achievable only if healthcare organizations have five fundamental qualities.
1. A great reputation. People want to work for a winning organization with a good working environment and a reputation for excellence. More than 50% of the respondents to a survey of critical-care nurses indicated that the "reputation of employer as a healthcare institution" or "general working conditions for nurses at that institution" was the most influential factor in their decisions to accept employment ("Factors that influence recruitment and retention of critical-care nurses" by Alspach, Critical Care Nurse, 1992).
Healthcare organizations need to differentiate themselves by achieving a reputation for clinical excellence and a positive work environment that places a high value on trust, pride and camaraderie. We've found that factors that directly affect the quality of our company's candidate pool and retention rate include recruitment and retention of talented men and women and work-family strategies such as flexible schedules, reduced hours, spousal maternity leave and job sharing; major investments in employee education; and a culture that fosters innovation, two-way communication and high performance.
2. Strong management and quality leadership. Senior managers must be supportive and available and must participate. They must encourage communication and demonstrate a commitment to RNs, for example, by fostering nurse participation in hospital management through nurse involvement in the hospital's committee structure or other decisionmaking processes. Effective managers must actively promote the factors that lead to job satisfaction, such as career development and financial and job security.
3. Well-defined employee roles and expectations. High-performing organizations often explore creative ways to make a strong connection between their employees' goals and the organization's overall objectives. Try developing a professional practice nursing model that includes a professional salary system, skill-mix changes and a mentoring program or a well-structured appraisal system. Provide challenging work for which nurses can assume responsibility and contribute to patient outcomes and the organization's success.
4. Recognition and rewards for high performance. Organizations must develop programs that are meaningful to their employees, relevant for the culture of the organization and achievable. Successful recognition programs reward high performers in ways other than competitive salaries. Each organization must strive to understand which forms of recognition its nurses value and consistently apply the reward program, keeping it fresh to maintain its relevance.
5. Technology-enabled infrastructure and efficient processes. The best companies have policies, practices and an infrastructure that support high performance. They offer career development and enhancement (for example, tuition reimbursement and paid sabbaticals) and the opportunity for financial security (for example, stock options). They use technology in a way that supports performance. They invest in information systems to eliminate manual tasks, enhance access to information and improve patient care-such as by using electronic medical records and patient monitoring systems.
Recruitment and retention strategies. An organization should move quickly to implement a successful recruitment and retention plan, focusing on candidate sources, the interview and selection process, and incentives that draw top candidates. Referral programs that offer financial rewards, Internet-based job application practices, applicant-tracking databases, signing bonuses and educational benefits are examples of effective recruitment tactics.
Effective retention strategies include staffing models that relieve nurses of non-nursing duties, training nurses for new responsibilities and nonfinancial incentives such as flexible scheduling.
There will always be challenges to recruiting and retaining good employees. The answer to the nursing shortage is to focus on building a solid reputation for your organization and differentiating it as a place where nurses can proudly deliver top-quality care. Then invest in tactics designed to keep high performers.
Marla Hutchinson is a partner with the Houston healthcare practice of Deloitte Consulting. Sandra Mattice has more than 20 years' experience in managed healthcare. She is in the Seattle office of Deloitte Consulting.