HOSPITAL, NURSES RISE TO THE CHALLENGE
Friday, August 9, 2002 5:12AM EDT
By ANITA BOWLESAND SARAH AVERY, Staff Writers
RALEIGH - Nursing staff levels are at the highest they've been in recent years at Dorothea Dix Hospital, and hospital administrators said the gains signal an end to more than two years of shortages that put patient care at risk and the mental hospital's operations in jeopardy.
Dix now has about a 6 percent vacancy rate for registered nurses and licensed practical nurses -- about on par with other area hospitals and a significant improvement since 1999, when 40 percent of its nursing positions were vacant. Additionally, overtime shifts have been greatly reduced, addressing a key issue that fed low morale.
The hospital's nursing force has been a matter of concern for years. Nurses are on the front line of care at the 435-bed hospital, and the quality of patient care is directly tied to the number of nurses on duty.
"Clearly, when there is rapid changeover in nurses, or if you are forcing overtime and nurses are tired, the quality of care is going to be compromised," said Terry Stelle, director of Dix. "When you have fewer agency nurses or part-time people coming in, you also decrease the errors. Overall, there is a better sense that things are OK, things are better organized, morale is improved."
Low nursing staff levels put the hospital in regulatory peril in February 2000 after a state inspection pointed out patient care problems. The deficiencies were so serious that the federal government threatened to withhold $42 million in support. Dix administrators scrambled to make improvements and, despite a setback in early 2001 when a patient died from a medication overdose, cleared regulatory hurdles and passed the inspection for accreditation renewal.
Still, there were lingering complaints from nurses about exhaustion from working overtime shifts and of administrators unresponsive to scheduling needs.
"Morale was just spiraling downward," said Cheryl Hutten, a registered nurse who left Dix for a job at another local hospital. Hutten returned to Dix eight months ago as a registered nurse in the hospital's medical unit. "I'm very happy to be back," she said. "It is much better."
Paula Bird, who was named nursing director two years ago, attributes the hospital's turnaround to a reorganized administrative structure and increased recruitment efforts.
Stelle said the hospital also has hired a corps of highly qualified doctors, which in turn has drawn nurses.
"I think that you can attract good nurses who will stay if they feel like they are working with good doctors," Stelle said. "All of this translates into better patient care and a sense that we are no longer in crisis."
Hospital administrators also examined scheduling issues raised by the nursing force. They assembled a temporary pool of nurses who could fill in for sick or vacationing people, cutting the number of unplanned overtime shifts of full-time nurses. That created another kind of job, with its own incentives.
"A lot of people who resign actually come back in our temporary nurse pool and work part time," said Jo Ann Barbour, who became Dix's nurse recruiter in February after 20 years as a nurse there. "That's been a big advantage. It's almost like a test job for them and us -- it's a chance to try a new job without a full-time commitment."
Making such changes was necessary for Dix to compete for new nursing recruits against the area's well-heeled general hospitals and university teaching hospitals. Unlike some competitors, Dix has not offered signing bonuses to new recruits. But its registered and licensed practical nurses received a 10 percent pay raise this year, and the hospital offers benefits for nurses including educational leave and on-site child care.
Still, nurses don't work at Dix for the pay, said Billie Hanrahan, a registered nurse who has worked at the hospital for more than 16 years.
"They are here because they love their job, they love the patients that they work with -- although some of them are surely difficult -- and they enjoy helping the families," Hanrahan said.
In addition to the tough market competition, Dix has had to fight a public impression that the hospital is all but dead. Just this year, another proposal arose calling for Dix to be closed and a new facility built elsewhere, but no definite plans have emerged.
"Every school or job fair we go to, somebody will say, 'Well, I thought Dix had closed,' " Barbour said.
Barbour said the hospital serves 350 to 400 patients with a staff of 177 registered nurses, 35 licensed practical nurses and about 300 health-care technicians. Currently, the hospital has only 10 registered nurse vacancies and four open licensed practical nurse positions. Stelle said reduced turnover rate has saved money on training and overtime expenses.
"And you end up with staff that feels more dedicated to an institution," Stelle said.
That quality is critical, Stelle and other administrators said, because the hospital treats patients who are in psychological distress -- often volatile and sometimes violent. That sort of environment takes a certain sort of nurse.
"It's like the Peace Corps," Bird said. "They come here because it's the right place to be. We get the patients that no one else can care for."
© Copyright 2002, The News & Observer Publishing Company