Roberta Abrams:Retain, recycle, replenish, and recruit

  1. a nurse's viewpoint

    retain, recycle, replenish, and recruit

    by roberta b. abrams, rnc, ma, lcce, for, march 11, 2002 (free registration required.)

    it must be about the same where you live. the newspapers, news magazines, radio, and television news report almost daily on some aspect of the current nursing crisis, or on its sequelae in the world of healthcare delivery. that's the good news. we need to keep this situation in the public focus.

    we also need to ensure that our healthcare administrators, educators (of every level), and legislators are tuned in to the problem. we have begun to see some results of the swath of attention. but it's just the beginning. the situation has been building for years. solutions will not occur overnight. let's look at current events and future needs from a nurse's viewpoint.

    some wonderful "works in process" are revolving around recruitment of nurses. federal and state legislative initiatives are providing scholarships and other forms of financial support for nursing education. programs that reach out to guidance counselors in elementary and high schools help them promote careers in nursing for their students. multiple media promotions focus on the benefits of nursing as a career.

    these are all well and good. however, they are not enough. first of all, recruitment efforts focused on elementary or high school students have a built-in time lapse of at least eight to 10 years. that does not mean that it should not be done. it should be done, and it must be done if we are to attract sufficient people into healthcare occupations. it's just not enough to fix the problem before the collapse of the healthcare system. geri dickson, r.n., ph.d., the new jersey project director for colleagues in caring, is part of a large group of nurses who believe that nursing needs a major restructuring to deal with the current crisis - and, hopefully, to prevent repetitions. in nursing spectrum she says: "we hear a lot about the issues of recruitment and retention (the current morale and status of the work environment). these are very closely related. just making an effort to change the image of nursing and recruit college students into nursing won't solve the problem. if the reality of the everyday work life changes, then you will have people wanting to go into nursing. we need to make it an attractive career."

    long-term recruitment efforts must be coupled with reparations to the current system. if we don't deal with the issues that have caused nurses to leave, and that have prevented others from choosing a career in nursing, the young people currently being recruited will become part of nursing's revolving door.

    the newspapers are replete with stories about nurses leaving hospitals because of long hours, mandatory overtime, and inadequate staffing. there are horror stories about errors in patient care, medication errors, surgical errors, and all the misadventures that can be imagined.

    those stories are akin to an infectious disease. they spread their miasma of misery. current nurses, reading them, feel worse about their workplace, their position, and nursing in general. potential nurses, reading them, begin to question their choice of careers. for that reason, among others, recruitment alone will not improve nursing. it will certainly not improve patient care. equal emphasis must be placed on changing the work environment so that nurses choose to remain at the bedside. our efforts need to be of a magnitude that licensed, experienced nurses will choose to return to the bedside from the doctors' offices, ambulatory surgery centers, or insurance companies.

    it is easy to say: "make nursing better." doing it is complex, initially expensive, and fraught with the potential for disaster. we need to begin by gathering evidence about what works.

    in 1982 the american academy of nursing created a task force on hospital nursing practice. the academy's goal (according to the american nurses credentialing center) was to "identify and describe variables that created an environment that attracted and retained well-qualified nurses who promoted quality patient care through providing excellence in nursing services." in the years since, the qualifications for magnet hospital certification have provided guidelines for nurses and nursing administrators who seek to create a magnet atmosphere.

    magnet hospitals are few in number. only 42 facilities in the country are entitled to use that designation. according to the ancc: "this program provides a framework to recognize excellence in:

    1. the management [leadership] philosophy and practices of nursing service;

    2. adherence to standards for improving the quality of patient care;

    3. leadership of the chief nurse executive in supporting professional practice and continued competence of nursing personnel;

    4. attention to the cultural and ethnic diversity of patients and their significant others, as well as the care providers in the system.

    it is appropriate to study the institutions, such as those with the magnet designation, to see how well they succeed in their stipulated goals. if they are truly places of excellence for both patients and caregivers, if their ability to retain nursing staff is better than comparable institutions, as it is reputed to be, then we need to use them as a template for successful nursing practice.

    we need to ask their leaders to consult, to help other facilities replicate their successes. we need to hear from their staff about the factors that create the dynamic in their patient care. we need to recycle other nurses - to equip them with the skills, knowledge, and abilities of the magnet nurses. we need to "recycle" their facilities, and their administrators in a manner that will support excellence in practice and pride in position. we need to practice inclusive governance, where the clinical staff have as much to say about the workings of the facility as do the appointed administrators.

    we need to examine places such as clark memorial hospital, in jeffersonville, tenn., where senior management looks not only to motivate its frontline staff, but also to create an environment in which the employees take responsibility for the hospital's reputation. in this facility, senior administrators shadow clinical staff, seeking better understanding of what they do and how they do it. staff are included in identifying and solving problems in the facility. other hospitals in the area have similar programs where administrative team members rotate shifts, listen to and observe staff and interview patients. their goal is to work with the caregivers to identify problems in delivery of patient care.

    we need to increase the supply of professional nurses who provide patient care. in some areas, this may mean closing beds until there are enough nurses to staff them. the u.s. department of health and human services released a report indicating that there were 2.7 million registered nurses in the united states, but only 2.2 million were employed in nursing. perhaps some of these nurses can be persuaded to return to nursing, to replenish the work force. several hospitals are working on development of refresher courses to restore the knowledge and skills that have atrophied for lack of use. while this is not an overnight solution, it has significant temporal and perhaps professional advantages over importing nurses from other countries. a two-fold caveat in this type of endeavor: the conditions that drove these nurses away must be fixed. meanwhile, the refresher course given them, with supported clinical practice, must be structured to facilitate success.

    thus we have at least a fourfold effort needed to rectify the nursing situation. we must retain, recycle, replenish, & recruit existing and potential nurses. the keys to doing that focus on a multi-disciplinary effort. guidance counselors need to be aware of what nurses do, of the rewards of professional practice, to recruit students with the potential for careers in nursing. hospital leaders need to work with their nursing staff to restructure an environment that attracts and retains nurses. nurses and others need to seek colleagues who can return to nursing to replenish the cadre of professional staff. and we need a concerted effort to recycle, restore, or replace working conditions within the hospital so that we become magnets for nurses and nursing.

    roberta b. abrams, rnc, ma, lcce is principal of rba consults, in farmington hills, mich., and is on the adjunct nursing faculty at madonna university. she may be contacted at
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  3. by   -jt
    <Long-term recruitment efforts must be coupled with reparations to the current system. If we don't deal with the issues that have caused nurses to leave, and that have prevented others from choosing a career in nursing, the young people currently being recruited will become part of nursing's revolving door. >

    Roberta finally hits the nail on the head.

    Last edit by -jt on Mar 13, '02
  4. by   prmenrs
    I have 2 questions:

    1. How do you "replenish" a nurse?

    2. Where would I find a list of the Magnet hospitals?


    A nurse in need of replenishing.
  5. by   NRSKarenRN
    How to replenish a nurse---send to educational programs outside work setting where you can colaborate with other---has worked for me for years along with participation in specialty organization and ANA.

    Magnet Nursing Services Recognition Program:
  6. by   prmenrs
    Thanks, Karen. It says 42 facilities have rec'd this designation. The link just gave the criteria and purpose of the award. Did I just not look far enough at the site?
  7. by   prmenrs
    Never mind, I found it.
  8. by   lever5
    When you post articles on the site like this, is it an infrignment on copyright?
  9. by   NRSKarenRN
    lever 5, that is a good question. this is a nursing bulletin board the purpose of which is discussion and dialogue of nursing issues. "this forum is for constructive networking, discussion about activism efforts, nursing shortage, mandatory overtime and other political topics" per forum entrance description.

    ideas are not presented as being my own if they are from an other source. any material obtained from another source is fully credited with site link to material, authors name if known, title and material quoted in enterity; brief description with link; or quotation marks. i try to include author contact link if known.

    found this re copyright infringement on the net. the internet's purpose is to share information worldwide.

    [b]from copyright agency limited (cal) --licensed copying and communications-{/b]

    under the copyright act 1968 (the act), copyright owners have certain rights. reproducing copyright material without the copyright owner's permission will usually be an infringement of copyright. dealing with part of a work may also infringe copyright if that part is important to the work - it need not be a proportionally large part.

    copyright may also be infringed by authorising or facilitating the infringing act of another party; importing articles containing infringing copyright material; and by selling infringing articles.

    exceptions to infringement

    under the act there are exceptions to infringement that allow some uses of copyright material without permission. these exceptions can be split into two categories, free of charge copying, and copying that requires payment.

    the major areas of free of charge copying are:

    fair dealing for the purpose of research or study:
    allows a student or researcher to copy protected material. copying 10% or one chapter of a published literary, dramatic or musical work of 10 pages or more, and one article from a periodical, is deemed to be fair,

    fair dealing for the purpose of criticism or review:
    allows reviewers to make a fair use of copyright material provided they acknowledge the work; or

    library provisions:
    generally non-profit libraries and archives have the right to:

    reproduce or communicate copyright work for a client;
    reproduce or communicate copyright work for inclusion in the collection of another library; and
    reproduce and communicate original material for the purpose of preservation. libraries are also able to replace copyright works lost from their collection as long as the work is not available within a reasonable period of time at an ordinary commercial price.

    copying that requires payment

    statutory licences allow educational institutions, institutions assisting people with disabilities, and federal, state and territory governments to copy protected material for defined purposes, without the need to obtain the copyright owner's permission. cal has been declared by the attorney general as the official collecting society to administer these licences.

    of course these aren't the only times where copyright material may be used by other parties. rightsholders are free to directly negotiate an agreement that will allow their material to be used. many rightsholders also choose to use a copyright collection agency to ensure their rights are enforced. cal, for example, also operates voluntary licences with a range of organisations and corporations allowing them to use copyright material.

    " free of charge copying...fair dealing for the purpose of criticism or review:
    allows reviewers to make a fair use of copyright material provided they acknowledge the work"
    that is what is occuring at this site. thanks for asking.
  10. by   -jt
    <<" Free of charge copying...fair dealing for the purpose of criticism or review:
    allows reviewers to make a fair use of copyright material provided they acknowledge the work"
    That is what is occuring at this site. Thanks for asking.>>

    Agreed. Also, many of the articles we find on the internet clearly state:
    "fair use - may be used for discussion and educational purposes",
    "for immediate release",
    "press release",
    "may be used with a link back to this site included".

    We always include the link to the original article & we post the credit and website with it and are using the articles for the purposes of criticism, review, discussion and education.
    Last edit by -jt on Mar 14, '02