It can be tough for practices to compete for nurses when desperate hospitals are shelling out high wages and signing bonuses, but doctors still have some recruiting tricks in their bag to beat the nursing shortage.
Recruiting and retaining nurses is all about work environment, says Marilyn Lang, a nurse and editor of the Patient Care Staffing Report, published by Santa Barbara, Calif.-based health information company COR Health. And the medical office work setting offers several advantages that should be trumpeted.
Three key incentives that keep a nurse on the job are opportunity for growth, control of work-life environment and mutual respect with his or her employer, Lang says. Money is important, and practices should be aware of benchmark salaries to stay competitive, but pay is not the top factor.
"A lot of hospitals are striving to be 'best in class' employers, and medical groups should be doing the same thing," she says. "The group doesn't have to be huge (to compete). It boils down to creating an environment that is going to attract nurses because they're out kicking the tires."
"Parent time hours" that allow nurses to deliver and pick up children from school and opportunities for job sharing among part-time RNs are just some of the hospital practices that medical groups can mirror. Another is knowledge of patient workload and scheduling around the most intensive times so nurses are not overwhelmed. Lang also suggests looking at technology resources, which help the staff maximize productivity. Efficiency attracts employees, she says.
Many nurses also want to expand their scope of practice through innovative programs, such as running a diabetes care management program. Medical groups could adopt such initiatives to give nurses more autonomy in directing care and patient education, Lang says. The fact that a lot of these services aren't reimbursable can be a problem, but if included as a component of the job, the result is likely to be long-term retention and subsequent savings on the money spent to replace unhappy nurses.
The current shortage is reflected in the 126,000 unfilled nursing positions reported in June by the American Hospital Association. Similar statistics are not available for physician practices, but other recent reports paint a grim future for all providers.
The average age of registered nurses in March 2000 was 45.2, almost one year older than in 1996, according to a study released in February by the Bureau of Health Professions, a division of the Health Resources and Services Administration. By 2020, retirements coupled with a 22% decrease since 1993 in the number of nursing school enrollees, will result in a nursing workforce 20% below the projected need, the AHA reports.
The role of the physician is pivotal, whether as boss, department leader or, perhaps most importantly, as one who sets the tone for the culture of the practice. Ultimately, even if an office administrator does most of the interviewing and hiring, it is up to the physician to make sure that candidates have a realistic understanding of what it is like to work at his or her particular practice.
One way the 162-physician, multispecialty Wichita (Kan.) Clinic has improved its physician exposure is by partnering with area nursing and technical school programs to create rotations for students.
"I hear from people we hire why they choose our clinic over someplace else, and often it is their perception that they will have closer proximity to the physicians," says William Stricker, director of human resources. "We don't promote that as a recruitment tool, but I know we benefit through our wide participation in rotations."
Wichita Clinic physicians work closely with managers to detail their practice needs, compose job descriptions and conduct interviews to select the right person.
Stricker says the Wichita nursing market is dire for employers, with five hospitals serving a population of 300,000. Yet the clinic, he says, does not have much difficulty filling openings. Even though its pay for nurses is 5% to 10% less, the clinic's primary supply of RNs comes from local hospitals, where physicians help identify and recruit those who may be dissatisfied and ready for a change.
"We don't have the three-shift, seven-day-per-week scenarios or all the heavy work," Stricker says. Some new nursing graduates want that kind of excitement, but many seasoned nurses are eager for the stability and flexibility of an office setting.
According to Don DeCamp, chief operating officer of CompHealth, a Salt Lake City-based healthcare recruiting and staffing firm, practices must highlight their competitive advantages to attract the best people.
The majority of classified ads, he says, focus on what the practice wants, not what it offers.
When there are 10,000 openings for nurses, "you need to treat your candidates as customers, not as subordinates," DeCamp says. "Tell them what you can give them. What are the advantages of your area? (If I'm a nurse) I want you to sell me on why I should quit where I am and come to work for you."
Physicians don't want the tail wagging the dog, but they can change the culture simply by treating people properly, he says, which is more valuable than money.
Make sure to maintain that mindset through the entire advertising, interviewing and hiring process, DeCamp continues. And follow through when a new nurse comes on board.
When employees like their job, they'll talk about how great it is to work there, and DeCamp says the best and most affordable way to recruit nurses is through personal referrals.
It is important to stay abreast of national trends, but more crucial to staff planning is a familiarity with the nursing supply and demand in your local market.
For example, as California prepares to implement mandatory hospital nurse staffing ratios, many nurses may be sucked away from other settings, including the medical office. Lang says knowing the demographics of your own region, such as how many nurses are graduating from local colleges, will help better prepare your group.
As supply continues to tighten, the Wichita Clinic has followed a growing trend among practices to become less dependent on RNs by shifting to the use of medical assistants for duties that don't require licensure.
Registered nurses are still preferable for phone triage and other areas involving medical decisionmaking, says Crystal Reeves, a principal with the Coker Group, a national healthcare consulting company based in Roswell, Ga.
But Reeves says if RNs are spending more time taking vital signs or assisting with patient flow and minor procedures, it can make sense to use MAs to distribute duties more efficiently.
One system-based model that might prove useful to medical groups--especially large or hospital affiliated physician networks--is the Patient Care Assistant Program being implemented by the Madison, Wis.-based Dean Health System.
"We're creating our own supplemental staff to make up for our nurse shortage," says Glen Kielley, employment services manager.
Characterized as a "system redesign," Dean Health is working with a Madison-area technical college to hire recruits for classes that will train patient care assistants with skills tailored directly to the needs of the Dean system.
The program, paid for out of the recruitment budget, provided about 30 new hires in 2001. Kielley says he hopes to double that success in 2002.
On the whole, he says nurses are pleased with the program because it frees them to focus on the more complex patient care issues they were trained for.