Preaching from the Pulpit: Desperately Seeking Nurses

[NRSKarenRN, BSN, RN]

Legislation

Desperately Seeking Nurses

April 25, 2002

http://www.healthleaders.com/magazine/feature1.php?contentid=33939&categoryid=153

Because Karen Soehner serves on staffing shortage task forces in Florida and at the national level, her nursing home jumped into action as soon as she learned the state's legislature would likely pass a bill requiring Florida nursing homes to boost the sizes of their nursing staffs.

"We started very early. We didn't wait until the last minute," recalls Soehner, administrator of the 133-bed Ormond Beach, Fla.-based Avante at Ormond Beach nursing home and secretary of the Florida Health Care Association, which represents nearly 1,200 nursing homes and assisted-living facilities in the state. "We started even before the law passed and began to build those nursing-staff numbers," she says. "When the new year started, we were there."

Soehner says the Hollywood, Fla.-based Avante Group, with nursing home facilities in four states, tends to pay the highest wages in its markets, which helped in the recruitment process. Even so, it took an intensive effort-including participation in job fairs, advertising in nursing trade magazines and creating a recruitment section on the Avante Group Web site-to fill the required positions. "We only have two or three positions now open, which we're filling through overtime," she says. "Our facility is probably unique, compared with others in the state, but even we have struggled."

The staffing law, passed by the Florida legislature a year ago, requires nursing homes to boost daily staffing ratios for licensed nursing staff and certified nursing assistants. The increases are scheduled to take place over a three-year period. Beginning Jan. 1, each state facility had to begin providing one hour per patient per day of RN/LPN care, up from the previously required minimum of 0.6 hours per day; at the same time, minimum certified nursing assistants' standards jumped from 1.7 hours per day to 2.3 hours. More staffing ratio increases will take effect over the next two years.

The new requirements were inspired by complex political battles over tort reform and Liability Insurance, and came as nursing homes and other healthcare facilities in Florida, as elsewhere in the nation, were already facing a severe shortage of trained nurses. In fact, officials at the Florida Hospital Association estimate that Florida will need 34,000 additional nurses by 2006 to serve its growing population, particularly its huge number of senior citizens.

The state has about 700 nursing homes and 82,000 licensed nursing home beds. On a typical day, nearly nine in 10 of those beds are filled, according to the Florida Health Care Association.

Last summer, the FHCA projected that the state would need at least an additional 3,500 CNAs and 800 more RNs and LPNs to comply with the new staffing standards. "That was an extremely conservative estimate," says Ed Towey, a spokesman for the Tallahassee-based trade group.

By the time the staffing law took effect, Towey says, the vast majority of nursing homes had met the standards. Others hired extra staffers to match the mandated ratios, or were forced to take beds "off-line" to comply. Nursing home facilities must now stop admitting new patients within two days if they fail to meet the staffing standards, and violations can result in exposure on state regulators' quarterly "watch list."

But filling those positions was a daunting task that involved a statewide recruitment effort, including a PR tour last year of many of the state's leading markets and a continuing radio and TV ad campaign to recruit new staffers. The ads, which have been running since last October in English, Spanish and Creole, have cost the association about $100,000.

FHCA leaders and local nursing home executives also canvassed the state last summer, generating publicity for their cause and imploring unemployed workers to consider jobs as certified nursing assistants. They specifically targeted members of faith-based organizations and people laid off from jobs in the state's beleaguered hospitality industry. In many cases, free training classes are available, and some facilities even pay prospective employees to take those classes or offer scholarships to nurse assistants who want to become LPNs.

Even facilities that are currently in compliance with the staffing edicts can't relax. Mary Ellen Early, senior vice president of public policy for the Florida Association of Homes for the Aging, a Tallahassee-based association that primarily represents nonprofit and church-based nursing homes, says staffing issues are paramount. "The way the law is written you always have to be in compliance," Early explains. "If a nurse has to leave work early, you can be out of compliance, and there's no exception for hardships."

Filling low-paid certified nursing assistant jobs is particularly difficult, experts say, since such positions tend to have high turnover rates. CNAs are required to do backbreaking work that many prefer to avoid, such as bathing elderly nursing home residents and helping them dress.

So nursing homes are trying all sorts of innovative approaches to keep their staffing ratios intact. "We've even asked preachers to preach it from the pulpit," says Soehner, "asking if they have members of their congregations that want to do something worthwhile."

-Chris Rauber