Colo.: Skipping Gimmicks, Keeping Nurses

  1. Workforce Shortage

    Giving staff a schedule they can count on helps 'magnet' hospital achieve low vacancy rate

    This article first appeared in the September 2001 issue of Hospitals & Health Networks
    by Terese Hudson Thrall

    Across the country, hospitals struggle to find enough nurses. It's happening at Poudre Valley Health System, Fort Collins, Colo., where the vacancy rate is monitored by Margo Karsten, R.N., chief operating officer and chief nursing officer. "We hope this is the worst it's going to get," she says.

    Most hospitals would blush to have Poudre Valley's problems. Its current vacancy rate: 4.6 percent out of 650 nursing positions. That's about half the national average, even though the system must compete with hospitals in neighboring Denver and Greeley.

    Poudre Valley has accomplished the relatively low rate while avoiding the enticements some competitors offer. Don't look for signing bonuses or extra pay for weekend shifts at the system. Instead, it spends money liberally where hospital executives think it will do the most good.

    This year the board earmarked an additional $1 million annually to bolster the nurse staffing ranks. It's a small price to pay--total payroll is $67 million--to stabilize staffing, Karsten says.

    Typically, when hospitals have high admissions, they order nurses to work overtime and augment their ranks with agency nurses. Then, when patient census drops, hospitals send nurses home. But having a low patient-to-nurse ratio--about two to three medical-surgical patients per nurse during the day--Poudre Valley minimizes its need to make sudden personnel shifts. "The nurses have a schedule they can count on," Karsten says. "They are in control of their personal lives." Also, having more nurses helps keep length of stay low, she adds.

    Another way the hospital hopes to attract nurses is by promoting last year's selection as a "magnet hospital" by the American Nurses Association's credentialing center. The ANA program recognizes what it deems excellence in nursing management philosophy and practices. "Seeking that status shows an administrative commitment to keep the bar high," Karsten says.

    Poudre Valley will get lots of company on the magnet list soon. The ANA has named 36 hospitals as magnet facilities since the program's inception in 1994. Last year it certified seven new hospitals, and this year that figure will double. "The emphasis on improving quality and the impending labor shortage have generated interest," says Kammie Monarch, the program's director.

    Sixty-five percent of applicants are granted magnet status. And it's not merely a device to honor unionized hospitals: just 26 percent of magnet hospitals have collective bargaining for nurses. Monarch says magnet hospitals usually have a chief nursing officer who is a key member of high-level decision-making bodies. Also, doctors and nurses at magnet hospitals usually treat each other as colleagues, she says.

    Many nurses don't know about the program. But that's changing. Two recent hires said Poudre Valley's designation was a factor. "We are just beginning to see the program's impact on recruitment," Monarch says.

    How Poudre Valley Retains its Nurses
    Uses $1 million a year to support low patient-to-nurse ratio--two to three medical-surgical patients during day shifts, up to six patients per nurse at night.
    Donates $350,000 a year to a nearby nursing school for scholarships in an accelerated program in which students with a B.A. can become nurses in 18 months. In return, the system gets 10 new nurses a year.
    CEO and board support to discourage disruptive doctor behavior.
    Extra pay for nurses who help orient new hires for three months.
    Higher pay rates for nurses who serve as clinical coordinators or patient coordinators.
    Source: Poudre Valley Health System, 2001

    This hospital appears to be on track. Too bad across the country from my home and unable move!
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  3. by   oramar
    If I worked in a place like this I would think I died and went to heaven. Maybe it will catch on. Shows that someone actually knows how to do it right but most just do not want to.
  4. by   Zee_RN
    Excellent! I have a meeting with the CEO of our facility on Monday, my first day as the first Nurse Recruiter at our place. I'm taking a copy of this with me.

    I was told by my new boss that he wants to meet with me to share "his vision" with me. I'm trying to keep an open mind; both our CEO and VP of Patient Care Services are relatively new (CEO about a year; VP about 2 months). We've had a few positive changes so I'm hoping this will be an enlightening meeting.
  5. by   oramar
    We want to hear the reaction to the article.
  6. by   WashYaHands
    I live in Colorado Springs, which is about 150 miles south of Fort Collins. I can't speak for Denver nurses, but Poudre Valley Health System is an exception to the norm here.

    The ANA program recognizes what it deems excellence in nursing management philosophy and practices. "Seeking that status shows an administrative commitment to keep the bar high," Karsten says.
    My view is that this is a key contributor to the success of this facility. They have an RN in administration and managment who maintains a nursing philosophy rather than backing down to the bean counters. In other words, she hasn't forgotten where she came from. The success of this facility is an illustration of the positive impact that nurses in administrative and management positions can have to promote excellent patient care, staff nurse retention and satisfaction, and still maintain costs. I'd imagine that Karsten is a huge advocate for her nursing staff. It wouldn't surprise me if her management style was that of collaboration with staff nurses rather than power over them. I'm sure she fought hard to implement this program. Hat's off to this facility.

    I wonder what other magnet hospitals are like? Does anyone work for one?