10 Ways Hospitals Can Position Nurses to Succeed

[FRAN]

As the country moves toward a value-oriented healthcare system, there is a growing need to devise methods for better understanding how nursing costs and resources are expended for each patient and how these relate to the quality and outcomes of care. When hospital leaders empower nurses with a value-based nursing care framework, they see better patient outcomes and a more satisfied staff. Getting there is the hard part. Hospital training programs that help nurses relieve their stress and deal with ethical dilemmas are a good start. Here are 10 ways hospitals can help administrators pay more attention to what nurses have to say about their work environment, support nurses in striking a work/life balance, and help nurses in the pursuit of advanced education and career advancement.

1. Shared Governance

In today's healthcare market, hospital leaders strive to meet the challenges of maintaining a professional practice in a cost and resource constrained environment while focusing on achieving positive outcomes for patients, nursing staff, and the organization.

Facing a competitive, value-based purchasing (VBP) environment and potential staffing shortages, hospitals endeavor to promote a culture of engagement among nursing staff. One strategy to increase nurse engagement is through shared governance (SG). This is a participatory decision-making model that empowers nursing staff to make decisions about clinical practice standards, research, quality improvement, and staff and professional development.

Hospitals can create a nursing council to act as a decision-making body for hospital nurses. SG recognizes that the primary focus of nursing is at the unit level where direct patient care is provided. Ideas and recommendations generated at the unit level flow inward via unit representatives to the councils empowered to act on these issues. Councils consult and collaborate with each other to achieve the best decisions to successfully facilitate and ensure quality patient care and outcomes. All nursing council participants can be invited to attend a boot camp to learn decision-making skills and the meaning of shared governance.

With the current focus on VBP and cost-containment, increasing nurse engagement is an organizational-level approach. The knowledge and insights of staff nurses are critical to hospital administrators trying to optimize efficiency and resources to promote safe, quality care that meets patient needs. Higher levels of nurse engagement are associated with higher Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores which are tied to hospital reimbursement. Improving nurse engagement also affects nurse retention. Nurses employed hospitals with higher levels of engagement are less apt to report job dissatisfaction, burnout and intent to leave, causing turnover.

2. Offer Training and Support for Dealing with Ethical Dilemmas

Nurses can find themselves in ethically questionable situations that conflict with their personal and professional morals. When unable to do what they consider the correct action, nurses may experience moral distress. It is critical hospitals find ways to successfully deal with ethical conflicts to improve outcomes, as they can adversely affect patient care. Moral distress is associated with employee burnout and job turnover. Organizational culture sets the stage for how individuals respond to unethical behavior. Hospital leaders are in a key position to defuse ethical conflicts and create an environment that allows nurses to practice ethically. Several strategies to achieve this include:

Supporting the ANA Code of Ethics

Hospitals should incorporate behavior consistent with the ANA code of ethics by adding them to job descriptions and considering professional ethics during annual performance reviews.

Offering ongoing education

This can be presented in the form of workshops on specific ethical subject matter or case presentations, role-playing activities, web-based learning modules, commercially prepared videos with a follow-up discussion led by an ethics committee member.

Creating an environment where nurses can speak up

Hospital policy that takes nurses' needs into account is imperative to enhance nurses' ability to respond appropriately to unethical behaviors. Leaders must recognize the importance of moral courage. Hospital policies should support nurses in demonstrating moral courage without fear of reprisal.

Bringing different disciplines together

Many hospitals employ ethics rounds and ethics conferences. Ethics rounds typically address a single case, either actual or hypothetical, and give participants a chance to see how ethical problems can be resolved. Ethics conferences usually address the entire hospital community while ethics rounds are intended to attract a smaller audience.

Offering employee counseling services

Nurses struggling with an ethical issue can benefit from individual sessions with a counselor from an employee assistance program (EAP).

3. Staff-to-Patient Ratios and Mitigating Staff Shortages

A recent Kronos Incorporated survey found that 90% of nurses are thinking about leaving their hospital for another employment opportunity due to poor work/life balance. Most of the survey respondents (83%) reported that hospitals are losing good nursing staff because of this issue.The financial cost of losing a single nurse has been calculated to equal approximately twice a nurse's annual salary. As hospitals across the country experience staff shortages, nurses are expected to pick up more hours and work overtime. Staff shortages result in increased patient-to-nurse ratios and evoke a whole host of negative implications.

The most frequently cited factor causing nurses to quit is feeling overworked and not being able to manage the workload. Staffing shortages caused by nurse turnover can lead to an increase in accident rates and higher absenteeism levels. As nurses work with a higher patient-to-nurse ratio, the chances of patients getting infections, being injured, receiving delayed care, or being sent home without adequate at-home care instructions increases. This can result in extended hospital stays and rehospitalizations due to complications.

Hospitals can reduce nurses' stress levels while improving patient care by enacting lower nurse-to-patient ratios. Establishing a staffing committee allows a hospital to take a collaborative approach to staffing. The committee provides input on scheduling procedures as well as staffing guidelines. This helps lower the chances of an unsafe nurse-to-patient ratio.

4. Encourage and Support Nurse Wellness

Promoting health and reducing costs related to acute and chronic illness is of great concern to all healthcare organizations. Systemwide solutions are required to address issues such as absenteeism and presenteeism, which occurs when employees report to work impaired by illness and unable to work to their full ability. Presenteeism costs hospitals more than absenteeism. One solution is the implementation of a positive wellness program to encourage work-life balance. Popular wellness solutions include exercise incentives, food and snack programs, counseling groups, and team building activities. On-site wellness programs have been successful in increasing compliance with evidence-based wellness guidelines for care. This compliance has been ascribed to an effective patient-provider relationship and timely follow-up.

Another method to encourage and support nurse wellness is the placement of on-site, workplace clinics that provide cost-effective, quality healthcare to employees. Providing preventive care and treatment to employees at their place of employment increases their work attendance. Prevention activities, including immunization and management of chronic conditions, result in fewer acute episodes of disease. By promoting wellness, hospital leaders may affect employee-associated costs by reducing the costs of sick leave and presenteeism.

5. Teach Self-Care Strategies and Compassion Practices

Nurse burnout refers to the emotional, mental, and physical exhaustion caused by excessive and prolonged stress. Nurses experiencing burnout are more likely to make poor decisions and experience poor patient engagement. Patients and their families can sense when a nurse is burned out, which leads to lower patient satisfaction. In addition to hindering job performance, burnout can change how nurses view their role and put patients in danger. The Occupational Safety and Health Administration (OSHA) has found that caregiver fatigue and stress are linked to a higher risk of medication errors and patient infections. Job satisfaction is always about the individual nurse and how he or she responds to the work experience.

Compassion practices refer to organizational practices that recognize and reward caregiving work. They incorporate resources to cope with stress and provide pastoral care. In healthcare organizations where compassion practices are the norm, nurses report less emotional exhaustion and more psychological vitality. Patients report better interactions with nurses and gave higher evaluations of their patient care experience. Hospital management must watch for signs of stress such as changes in engagement and attendance, then develop initiatives that directly address areas of concern and most effectively enhance well-being. This is achieved when hospitals offer in-service education that emphasizes self-care as a priority and teaches various self-care activities. Programs can assist employees in developing a personalized wellness plan that they will use to practice positive self-care.

Systematic efforts should support the development of positive, proactive health care behaviors and coping strategies. The importance of positive self-care must be at the forefront of discourse within the healthcare organization. When a hospital provides a dedicated space to reduce and alleviate the consequences of stress, it sets the tone of management's intention to reward self-care. Leaders could utilize creativity to introduce self-care and self-healing and to make it a daily focus. Examples to raise awareness about self-care and self-healing include:

• Acknowledge people at each shift change, team meeting, or huddle when they have done something to promote self-care
• Reference self-care and self-nurturing daily in all appropriate conversations
• Cultivating an attitude of gratitude by starting a gratitude-a-day practice among coworkers or creating a gratitude journal for the work unit
• Rewarding self-care and self-healing behavior
• Ensuring nurses receive their scheduled breaks each shift
• Creating a comfortable space dedicated to peace and quiet where nurses can get away from the stress during their shifts

6. Tuition Reimbursement and Assistance

Many healthcare organizations offer some form of tuition reimbursement or assistance. Tuition reimbursement, also known as tuition assistance, is an employer-provided employee benefit that is a win-win for both hospital and employee. In a hospital-based tuition assistance program, the hospital pays all or part of an employee's cost to attend college classes. Tuition reimbursement helps further employee empowerment, loyalty, and longevity. It serves as an employee retention tool as well as a recruiting tool that benefits employers with high potential employees who are focused on growth and learning. Tuition reimbursement makes sense for hospitals because it enables employees to continue to develop their knowledge and skills.

Tuition assistance can be offered in several different formats. Some hospitals cover the cost of any class an employee takes even if the class is unrelated to the employee's job. Other hospitals cover only the cost of classes that are directly related to their positions or to prospective positions.

7. Employer Partnerships with BSN Programs

Healthcare organizations are partnering with online RN to BSN degree programs more frequently as respectable nursing schools launch online options. Through partnerships, nursing schools may offer discounted tuition and a simplified application process to hospital employees in return for the hospital hosting virtual networking and recruiting events. Sometimes hospitals even provide input on the curriculum to ensure the program is current and aligned with the organization's needs. When healthcare organizations partner with colleges they offer special benefits that can make furthering education easier while employees remain on the job. Online classes allow nurses to complete their program without travel or having to rearrange work schedules. Hospital partners provide students with support services such as mentors and flexible scheduling options.

Forward-looking hospitals realize advancing the education of their staff is a competitive advantage for them. With hospitals facing a critical nursing shortage, partnership programs can provide a pathway to fill specific workforce demand by producing more registered nurses from within the hospitals' own employee base. In return for financial support covering tuition, books, and fees, the employee signs a contract to work as a nurse within the sponsoring hospital for a set length of time. This effort results in loyal employees who are familiar with the hospital's culture and work environment.

8. Nurse Residency Programs

The ever-changing healthcare environment presents challenges to new nursing graduates, as well as those changing specialties or worksites, regardless of their clinical background. These include a lack of confidence, difficulty with work relationships, frustrations relating to the work environment, high levels of stress, lack of time and guidance for developing organizational and priority-setting abilities. These factors likely contribute to the high turnover rate among new nurses, estimated at 35-60% within the first year. Hospitals have the opportunity to implement appropriate training that will benefit nurses and the patients who depend on their care, as well as the hospital itself. Nurse residency programs can transform nurses' professional development and improve healthcare quality and affordability. Residency programs put qualified nurses through an intense training that accelerates their transition into specialty practice. Organizations should strive to improve nurses' work experiences, to increase retention of new nurses, and to show financial return for organizations investing in nurses as resources. Residency evaluations show increases in leadership and communication skills, increases in core competencies resulting in higher levels of patient-centered care, and decreases in stress levels and turnover rates.

9. Reimbursement for Certification

Some hospitals offer reimbursement for certification courses and exams as well as offering higher pay and incentives to specialty certified nurses. Certification, and the continuing education required to maintain it, serve as a benchmark for success and excellence. Certification is a way for nurses to validate their mastery of skills, knowledge, and abilities. Patients, employers, and nurses all benefit when nurses attain specialty certification. Three-quarters of Americans prefer hospitals that employ a high percentage of nurses with specialty certification. In today's complex healthcare environment, it's essential that facilities assure the public that their healthcare professionals are competent. A growing body of research shows certification contributes to better patient care.

Nurse certification also benefits hospitals by creating a positive work environment, one that embraces professionalism and promotes a culture of retention. Nurses who derive high job satisfaction from a supportive and professional work environment are less likely to change jobs. By becoming certified, nurses are positioned for recognition and advancement. They experience an increased sense of pride, fulfillment, and empowerment. Nurses whose clinical judgment has been validated through certification make decisions with greater confidence and feel more satisfied with their work.

10. Job Perks and Incentives

Sometimes it's the little things that make nurses feel like valued employees. Nurses appreciate perks and incentives that can make life easier and help improve their work environment. These benefits can range from time-saving conveniences to investments in employees' education and/or home life. Perks include, but aren't limited to:

• Self-scheduling and a compressed workweek
• Extended sick leave
• Classes and seminars
• Leadership programs
• Education awards to attend national and international conferences
• Free concierge service
• Shuttle service and parking
• Rideshare incentives
• On-site child care and back-up childcare for emergency situations
• Employee health club on campus or subsidized gym membership
• On-site credit union
• Legal assistance
• Weekly farmer's market on campus
• Discounted tickets to movies, theme parks, sporting events, and local attractions
• College scholarship for children
• Adoption assistance
• Relocation expenses

(FranU provides online education opportunities for nurses who want to do more with their drive to make a difference. Contact us to find out more about our online RN-BSN. Learn more here.)

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