Retention ideas wanted (sorry long winded message)

susanmary · Dec 21, 2000

Wow, Lisa -- your staff has had salary increases, your staffing numbers are excellent, you offer perks for employees, you care about your co-workers -- what state do you work in? Sounds like you offer alot.

I was involved with a hospital-wide retention committee and believe that nurses leave their positions because of (1) work environment, and (2) benefits. Does your facility offer tuition reimbursement? Available childcare? I work in a med/surg telemetry unit in CT -- clearly there is a nursing shortage; nevertheless, there seem to be a great deal of nurses who prefer night shift. Good luck -- you sound like a caring individual.

ClariceS · Dec 21, 2000

Lisa, your situation sounds very similar to what we have here except I haven't been able to pay doubletime. My floor doesn't use agency nurses and we pay RN's tuition reimbursement. Our institution made an effort to give a year-end bonus this year which gives some credit to retention time as it is based on the staff's base pay. Have had some positive feedback since word of that was given to the staff. During severe shortages or sustained high patient census we have sometimes offered incentive bonuses to anyone willing to work extra shifts. If I have a full nursing complement, our nurse to patient ratio is similar to yours as well as having about the same number of unlicensed assistants. Right now it is not that great because of open positions.

P.s. You did not say what state you were from.

Genista, BSN, RN · Dec 21, 2000

Hi Lisa-

What you describe sounds like where I work (except not as many nurse assistants). I work tele, and w/ similar ratios. Nurses are leaving in droves. (You may wonder why- with such good staffing ratios).I think the main reason is that even w/ decent ratios- the pts on our floor are very sick, very heavy, and very complicated.It can burn you out w/ the FAST pace, when you have people going into SVT and Vtach frequently, post ops w/freq. vs, pt getting blood, unstable angina on drips, lots of unstable diabetics w/ Q2H bloodsugars, people needing 2-3 person assist to get them up to a chair, people needing total ADL assist, multiple comlicated dressing changes (many diabetic ulcers), most pts having 10-15 meds on the 9 am med pass alone (many times missing meds and having to req. from pharmacy), not to mention prns for BP/Pain,monitoring labs, the usual noting of orders, calling docs re: pt change in status, etc.RNs are responsible for LVNs pts in additon to their own. RNs do EKGs, and ABts, sometimes phleb.Many of these pts are so complicated and much time is spent coordinating discharge plans, and talking at length w/ family.It can be very very exciting, and rewarding, interesting work. But it is hard and exhausting. What seems to help...making sure each nurse gets at least their 30 min. undisturbed lunch break, having regular staff meetings (to discuss concerns & solutions), offering incentives to work overtime, and allocating extra staff sometimes when the floor is REALLY heavy & we need help. Have you tried asking the nurses at your facility what would help retention? Maybe they have some good ideas. Good luck!

JillR · Dec 21, 2000

And you have retention problems? Go figure.

Anyway the only things I can think of that might be a problem, with me anyway, would be having to work all shifts. I don't particularily care what shif I am put on as long as I don't have to work PM's one day then a couple of days then a day off and come back on nights. I won't do it, and that is one of the major reasons why I stay where I am at. Another reason why I stay is that I cannot be made to work more than I was hired for, no one can. Do you only have PT positions? This is another problem, some hospitals around here only offer PT positions so that they do not have to pay full benefits, and then expect you to work 40/wk and will make you do this. I say absolutly not to that one.

Is the pay just average or really above average?, because 1 or 2 dollars more an hour will not make me want to work more than what I am hired for, or work all shifts either. Although I would work that night shift, no problem. How about a really good weekend differential? If you offered that, I would bet you would have less call outs on weekends too.

Continuing educations assistance and/or tuition reimbursements programs are a must now days.

One more thing is floating. Ig people are required to float to units that they do not like or are not comfortable, then I see people leaving. How are new people treated, this may not be obvious, you may have to do some detective work on that one because many times people are afraid to say something about someone who has been around for a long time.

You facility sounds great. I hope some of this nay help you. Good luck.

fizzie · Dec 21, 2000

In my experience the best way to retain staff is through flexible shift patterns. This can take quite a bit of work for whoever is responsible for the rostering, but it is well worth it. Staff in my area of work have the option of working 12 hour shifts. Staff who choose to wrk these shifts love the benefits of having 4 days off per week. It also gives patients throughout the day a little continuity in care.

[This message has been edited by fizzie (edited December 21, 2000).]

ClariceS · Dec 21, 2000

What I don't understand is why people like Lisa and I have problems keeping people! I bend over myself trying to be flexible with school, childcare issues, 8 hour shifts, 12 hour shifts (and the nightmare scheduling for a mix of both), full time, part time, can't work weekends, can't work Fridays, very rare mandatory overtime (never more than 8 hours in a month). We have permanent shifts meaning you don't have to do days one week then switch to nights--for example, if you work days normally, you are NEVER scheduled for evenings or nights unless you sign up for extra. We have made odd shifts for those with unique time constraints or who want to commute for a week at a time. With all those acrobatics, we can't seem to keep nurses or gain new ones!!!

Yes, I'm venting. Thanks for listening.

Mijourney · Dec 22, 2000

Hi Lisa, et al. I agree with previous posters on possible resolutions for staff retention problems. Some of my observations that affect retention are:

1. Graduation rates of young people entering the field have significantly decreased over the years to the point where most of the practicing nurses are boomers or older and have been in practice over 5 years.

2. Because of #1, nurses either don't have the time, desire, physical ability to work the employer's needs.

3. Family commitments in this age group make personal obligations an overriding concern.

4. There is no employer loyalty to employees any longer, so employees don't feel the need to be loyal to employers. Even typically workaholic experienced bedside nurses, who have been "burned" once too often, now feel in a position to stand up for themselves in one way or another.

5. The reported nursing shortage has given bedside nurses new found power in some cases.

6. Many experienced nurses have left the bedside for greener pastures.

7. There is still a problem with the pyramid approach to direct patient care and nurses along with patients in many cases are low on the food chain when it comes to authority and respect.

I feel for our patients and families when they are hospitalized and need attention for an acute problem. As a home health nurse, I can attest to the fact that the shortage of hospital staff is one of the major reasons that home health is, after some years of draught in certain localities, increasingly recommended as the outpatient service of choice after a hospital stay.

sunnybrook83 · Dec 22, 2000

Hi,

Something I've found from experience on both sides-management and staff - is what is your nursing administration like? Are they supportive? Do they back up the nurses or the physicians? Are they willing to listen to ideas and implement good ones? Do they involve the staff in new changes- and not just as a front? Do they tell nurses-hey good job with that code, hemorrhage, whatever the other night? Staff nurses feel as if administration has no clue ( and there are a lot of administrators out there who don't!) and would love to see their managers, directors, VP's out on the floor working beside them in the trenches. This increases communication between administration and staff, and lets the management see what it is really like shift to shift.

I also agree with the person above who said how are the new people being treated? Are there difficult cliques on the night shift that make the newcomer feel like an outcast?

Just some ideas, hope they help.

By the way, what state are you in? I like the pt ratio and pay increases!!

mustangsheba · Dec 22, 2000

If you can't be long winded here, where can you be? Good suggestions posted. Note the comment on the multiple a.m. medications plus the frequent diabetic checks. (I won't offer my opinion on the number of meds). There have been many comments under other topics about the burden of passing so many many meds as well as the other chores that crop up for the primary nurse. One thing that I have seen offered that seems to work well is 16 hour shifts weekends. These nurses work only weekends, 16 hour shifts 1500 - 0700 and get full time benefits. This helps with child care and frees them up to be with family the rest of the week. It also alleviates the need for regular shift nurses to work every other weekend, although you would still need coverage for days. Sounds like you're really trying. Where are you?

DHB · Dec 22, 2000

Asking nurses to work in areas where they have no training or expertise is the demise of the professional nature of our job. The hospital is setting the RN up for failure, or at least for error.

lisagh · Dec 22, 2000

Thanks to you all for your ideas!

I am in Georgia- South Metro Atlanta (I don't do interstate driving- my hospital is just south of the airport off the interstate- about an hour from Macon).

I have a personal website that links to my facility. www.georgianurse.com

I don't make folks rotate shifts--Some nurses have volunteered to help & make the extra pay.

Administration is very supportive to me& staff. I am a nursing director at this point (started here as a clinical nurse specialist- told you all I go back and forth in roles- don't want to get too far from clinical if the truth be known!.) I am recruiting to get a good clinical manager in place to work with me (I am over med/surg; tele; and critical care.)Prior administration (2 yrs ago) was not supportive- we have a pretty new admin team & they are supportive now- I think we are in the rebuilding phase.

Appreciate everyone's ideas!

I offer flexible shifts for anyone except those only open to 7a-3p. I have too many folks already- other than that I'll do 6 hr; day/night combo (some nurses want to work 1 or 2 days then work a night to get their 36 hours in.); or 3-11;11-7 or p-a.

I am not giving up on this! I am determined.

We are starting a professional nursing model nursing wide to implement staff based practice councils in January.