The worsening shortage of qualified nurses has changed the employer-employee dynamic within healthcare organizations, says K. Lynn Wieck, RN, PhD, FAAN.
“The issue today is retention, retention, retention in hospitals,” says Wieck, who is CEO of Management Solutions for Healthcare and a professor at the University of Texas at Tyler. “It used to be recruit, recruit, recruit. But there’s not anyone out there to recruit.”
One-third of nurses older than 40 are expected to retire between 2015 and 2020. It costs $45,000 to $60,000 to replace one nurse, and that figure goes up to $80,000 for an intensive care unit nurse, Wieck says.
Human resources departments have to shift from asking how to attract new nurses to looking at the nurses they have and asking, “What do nurses want?” – the title of Wieck’s presentation to faculty members who attended the National Student Nurses Association (NSNA) 25th Annual Midyear Career Planning Conference in Kansas City, Mo., Nov. 15-18.
“The fact that we’re even asking these questions shows it’s a great time to be a nurse,” she says.
The most difficult part of creating a retention plan is satisfying nurses of all ages. “How do we create an environment where they all want to stay and all feel like they’re productive?” Wieck asks.
Wieck suggests facilities adopt a “cafeteria-style” incentive package that allows nurses to choose their perks, such as flexible scheduling and tuition reimbursement. “Develop a menu that’s consistent and transparent to all,” she says.
Nurses over age 60 have the strongest work ethic and loyalty to their employers, according to Wieck’s research for the 2007 Nurse Incentive Project. They respect rules and expect authority to come from the top down, she says.
“What we want to do is prevent early retirement, or at least delay it for a while. Or if they’ve already retired, bring them back for a while,” Wieck says.
One way to keep this age group is to shorten 12-hour workdays, Wieck suggests. In her research, she found 31% of nurses over age 50 are working 12-hour or longer shifts.
“How many [of this age group] are doing caregiving after work?” Wieck says, referring to aging parents and spouses. “This can really affect their ability to be effective at work.”
Offering long-term care insurance for family members is a strategy management might consider to keep these nurses, Wieck suggests.
Do-not-lift policies are important for keeping this generation and others from common on-the-job injuries, Wieck says.
Debt is an outside factor keeping this age group on the job, Wieck says. Overall, 60% of nurses she surveyed have done nothing to prepare for retirement financially. So financial planning services would be a valuable perk.
Wieck found those ages 41 to 60 are generally overachievers and seek respect and recognition. And loyalty to an employer falls off drastically in nurses age 40 and younger.
Members of the 18-to-26 age bracket, the mention of which drew an audible moan from the audience, are accustomed to making their own decisions, Wieck says. They are collaborative in nature.
The younger generation is entrepreneurial, so offering them a stake in patient care is a good incentive, even allowing them to form their own corporation so they are essentially outsourced, she says.
For example, a hospital could offer a group of outsourced night nurses half of the savings realized by decreasing hospital-acquired conditions not covered by Medicare, such as falls and bedsores, Wieck says. “If we can save $1 million, why do we care how we get that done?”
One challenge with this group is keeping them from going into other fields, Wieck says. “Everybody values the skill set we’re giving our students and they’ve got more money than we do,” she says.
Members of this age group and those younger are heavily oriented toward computer and mobile phone text messages. “We’re going to have to adapt,” Wieck says. Future perks could include charting remotely from hand-held devices while on rounds and offering classes online.
Wieck researched the reasons nurses want to leave their jobs and found that stress, restrictive corporate policies, and unpleasant relationships with managers top the list.
The younger generation values people skills most in a manager, Wieck found. They want their managers to be team players who are approachable. “Caring environments don’t just happen -you have to build them,” Wieck says.
Risk taking and businesss savvy are least valued, Wieck found.
A shift in focus from the well-being of the patients to financial considerations was the next biggest turnoff.
Wieck urges adminstrators to “listen, listen, listen” to employees when they create incentives. “If they don’t want it, it doesn’t matter if you have it or not.”
Wieck was the endnote speaker at the NSNA 56th Annual Convention, March 26-30, 2008, in Grapevine, Texas. Gen. Gale S. Pollock, 22nd chief of the U.S. Army Nurse Corps, gave the keynote speech.