Chattanooga Columnist's Controversial Recommendations For Area Nursing Shortage
Healthcare leaders cite widely known reasons for the current nursing shortage. Most likely, at least 3 immediately popped into your own head. One Chattanooga opinion columnist challenges hospital administrators to examine their treatment of nurses and rethink sign-on bonuses.
NursesHeadlinesNews
A Chattanooga, Tennessee newspaper recently published an editorial analyzing the root cause of the area’s nursing shortage. Roy Exum, a local controversial opinion columnist, offered an alternative explanation that contrasted the underlying problems identified by area hospital leaders. The op-ed was written in response to a news article highlighting Chattanooga’s nursing crisis and recent events surrounding Erlanger Health Systems.
Erlanger Events
In May 2019, the physicians making up Erlanger’s 11 member Medical Executive Committee unanimously approved a no-confidence vote “in the structure of the current executive leadership”. The letter raised concerns about the quality of care and patient safety within Erlanger Health Systems, specifically understaffing, poor morale and policies that cause overcrowding in the emergency department and operating rooms.
Chattanooga’s Nursing Shortage
According to the Times Free Press, there are six different nursing programs in the Chattanooga region. Nearly 500 students graduate each year and more than 6,500 nurses live in Chattanooga’s Hamilton County. However, local hospitals are still challenged to fill critical positions. Rhonda Hatfield, chief nursing officer at the area’s CHI Memorial acknowledges Chattanooga’s supply of nurses is better than many areas. However, city is experiencing the same staffing challenges that are faced nationwide. Hospitals, insurance companies, ambulatory centers and physician practices all compete for nurses not only locally, but also in nearby Nashville and Atlanta.
Local leaders attribute the challenge of recruiting and retaining nurses is related to several factors, including:
Aging nurse workforce
Low unemployment rates
Lack of nursing faculty
Patient acuity increase on hospital floors
Nurses entering nurse practitioner programs
Unable to maintain work-life balance
Demands of nursing
The greatest need is for medical-surgical bedside nurses, however, increasing patient acuity often steers nurses away from this area.
Strategies for Recruitment and Retention
Chattanooga hospitals have implemented a variety of strategies to attract and retain nurses. These include:
Sign-on bonuses
Tuition reimbursement
Scholarships
Student loan assistance
Retention bonuses
Funding of faculty positions
Partnering with area nursing programs
Roy Exum’s Recommendations
In "Roy Exum: A Nursing Shortage?", published July 15, 2019 in the Chattanoogan, Exum shares his own controversial reasons for the shortage in Chattanooga hospitals. I admit, his reasoning does provide food for thought when considering the nation’s nursing crisis. According to Exum, the real root cause of the nursing shortage in Chattanooga is “gross mismanagement at the middle and upper levels of nursing” in the top 3 area hospitals. Other contributing factors expressed include:
Poor treatment of nurses
Forced overtime
Off day call-in
Verbal “bashings”
Poor staffing and overworked
No merit system for raises
Lack of reward for individual excellence
The Darkside of Sign-On Bonuses?
Exum takes aim at a popular recruitment strategy, sign-on bonuses. After signing the contract and receiving the bonus money, Exum claims nurses are assigned to floors with “1 nurse for 24 beds”. And with the bonus money spent, the nurse is unable to pay it back and trapped working in miserable conditions.
The article proposes doing away with sign-on bonuses, and instead, implement retention bonuses. Without sign-on bonuses, nurses will have a “no strings arrangement” and be in control of if and when they seek other employment opportunities. Without a sign-on bonus contract, Exum predicts hospital administrators will be forced to take “gigantic steps” in retaining nurses.
Conclusion
The nursing shortage in Chattanooga is not unique. And, the events at Erlanger Health Systems most likely parallel other U.S. hospitals. Factors contributing to the nursing shortage identified by Chattanooga’s hospital administrators are familiar and widely accepted. These factors are much “cleaner” and broadly brush over the harsh reality of the opinion article. Does Exum’s analysis of contributing factors have teeth and legitimacy?
