Companies are always striving to make employment at their work places attractive to staff especially nurses. Chief nurses from health systems and hospitals around New York and New Jersey share their strategies to maintain what they believe are their most important tools for recruitment and retention. From innovative, empowering atmospheres to getting staff excited about change, hospitals work to keep nurses content and on their payrolls. Find out what health systems in your area have to offer.
Teamwork, Communication Keep Nurses on Right TrackMargaret Cusumano, RN
Most of the nurses at Vassar Brothers Medical Center in Poughkeepsie, N.Y., live near the hospital, which gives them an extra incentive for excellence, says CNO Margaret Cusumano, RN, MSN. This is their community hospital, Cusumano says. This is where they had their babies, their surgeries. Their families and friends come, so they really have a strong investment in making it the best.
Vassar Brothers is the largest hospital in the Health Quest system, which includes Northern Dutchess Hospital in Rhinebeck, N.Y., and Putnam Hospital Center in Carmel, N.Y. There is no overarching CNO, but one for each hospital.
Good communication has been essential between hospitals, Cusumano says, so staff can learn from each other in terms of best practices and technology. Nurses sharing best practices has led to improvements such as the systemwide implementation of lift equipment, a hands-free communication system so nurses can call for assistance through a device around their necks rather than leaving patient care and smart technology for IV medication safety.
Most recently, the three hospitals worked together to launch the systems electronic medical records system. Nurses helped select the system and their high-profile role in implementing it is testament to the support the system puts behind the nursing staff, Cusumano says.
Many of our nurses were involved in designing, testing and decision-making and now much of the training, she says.
The nursing vacancy rate for the three hospitals combined is 1.75%. Among the reasons for that low rate, Cusumano says, are competitive salaries and staffing levels and that nurses feel they can do their best work in a place where they can challenge practices based on the evidence.
Anything they have identified or are concerned about that could lead to a problem with patient safety they are not only encouraged but expected to bring that forward, Cusumano says. Very often they are rewarded and recognized for bringing that forward.
Nurses Take the Lead to Improve CarePatricia Hogan, RN
In the next few months, Good Samaritan Hospital Medical Center and St. Francis Hospital, both part of Catholic Health Services of Long Island, will find out whether they have again attained the gold standard of nursing excellence Magnet.
While Magnet efforts are launched on a grand scale, an expectation of developing evidence-based best practices has led to improvements on a small scale. Nurse-driven innovations, for instance, have led to communication improvements, such as having separate websites for different units.
Nurses also developed a policy called the caring moment for each patient on each shift, a practice that gets great reviews from patients and nurses, says Patricia Hogan, RN, MA, NEA-BC, CNO for Good Samaritan, the largest hospital in the system.
Its a two- to five-minute interaction with a patient where we sit down next to them and talk about what’s important to the patient, Hogan says. Not so much this is your pill or Im going to change your dressing. Its a moment when we ask what would make their experience better here, how many grandchildren do you have, or what are you most fearful of? It gives the patient a sense that they are important to us.
The standards that helped the hospitals win Magnet are shared throughout the six-hospital system, Hogan says. Good Samaritan nurses have served as leaders, to the point of learning to read blueprints to ensure a modernized surgical ICU had the best evidence-based improvements, such as decentralized nursing stations, state-of-the-art lighting, private rooms with room for family and ceiling lifts.
Only about 7% of U.S. hospitals meet the standards for American Nurses Credentialing Center designation. Both hospitals first achieved it in 2006. Requirements for a Magnet environment include high levels of empowerment, autonomy, accountability and opportunities for professional development with proven outcomes in patient care.
Staff Embrace Change, InnovationMary Pat Sullivan, RN
Caught in the upheaval of closing and merging hospitals, nurses at Atlantic Health System have become experts at managing change.
In the last three years, weve had four hospitals within a 15-mile radius close, says Mary Pat Sullivan, RN, MSN, CNS. She is CNO for Overlook Hospital in Summit, N.J., part of the Atlantic system. That has posed interesting problems for our staff in terms of capacity management, work flow and enculturation issues when weve brought on large, large numbers of new nurses.
Many had been through a fairly traumatic event, Sullivan says. They had worked at these other hospitals for 10, 20, 30 years and thought they would retire there.
To soothe the transition, Atlantic started peer interviewing. Seasoned nurses were included in the interviewing to take new nurses on tours, offer shadowing experiences and provide insight into the practice environment. Overlook and Morristown (N.J.) Memorial Hospital, the other hospital in the system, had to tailor orientation on a one-on-one basis because nurses were coming in with very precise areas of clinical expertise. A third hospital, Newton (N.J.) Memorial, is merging into the system by the end of March.
Among changes that have bolstered support for nurses is the daily briefing. All nursing units have them. Every nurse comes in with her team, which could include anyone helping with the care of a patient, to share whether their patients are progressing on target. If staff are having trouble meeting goals, Sullivan says the team is there to help.
I try to go to one or two a day, Sullivan says. It really helps me to share in the successes these nurses are having and see where the barriers are.
Even with the upheaval, satisfaction remains high. Sullivan says Overlook nurses scored significantly higher than the national average for all hospitals in all seven areas of nurse satisfaction measured in the latest National Database of Nursing Quality Indicators survey.
Training, Less Per-Diem Staff Improve RetentionSusan Cummins Caputo, RN
MJHS was the first home health agency in the nation to achieve Joint Commission certification for heart failure disease management.
A big part of that was the competence of the systems nurses who receive intensive and ongoing training through physicians and other practitioners in the pharmacology, physiology and latest interventions surrounding the disease, says Susan Cummins Caputo, RN, BSN, president of MJHS Home Care, Hospice and Palliative Care. The health system also has intensive nurse-training programs for areas such as stroke, diabetes and kidney transplants.
Its not like the old days where you had a med/surg background. You come out of a hospital being an expert in a certain area, and then you come into home care and its a surprise behind every door, Caputo says. You have to know something about everything. Equipping nurses with the skills they need has boosted confidence and retention, she says.
A sophisticated IT system also has provided the electronic tools to help nurses focus on their clinical skills and has removed much of the labor-intensive documentation, Caputo says. Nurses now have access to the hospitals records and policy manual, and even videos of procedures, in real time from the home setting.
MJHS also has changed the staffing structure during the past few years to go more toward full-time staff and less per-diem. In four years, the percentage of full-time staff nurses has grown from 30% to 70%, Caputo says. That has helped raise the skill level of the facility because the job was a secondary job for many of the per-diems, she says. Nurses also feel more confident handing off their patients to the next nurses because they know colleagues are there for the long haul.
A nurse satisfaction score of 79% from the most recent HR Solutions survey reflects that confidence. Turnover was 19% last year, a 16% decrease from 2009.
Nurses Improve Skills With Practice, CouncilsMaureen White, RN
With tools such as simulation labs and Collaborative Care Councils, nurses focus on improving their skills through practice and review.
Suppose a routine birth suddenly has gone wrong, and the nurse is told to prepare for a C-section. Such a scenario might be thrown at a nurse going through the simulation center at North Shore-Long Island Jewish Health Centers Center for Learning and Innovation. The nurse reacts with the mannequin patient as a supervisor watches behind glass and records the session. Afterward, they critique what could have gone better.
All new employees and many seasoned nurses go through the simulation center to perfect a skill. Its among the opportunities that keep nurses challenged in a hospital system heavily focused on education, says CNO Maureen White, RN, MBA, CNNA. Feedback from nurses on the benefit of simulation is good, White says, and 82% of the systems nursing staff reported high levels of engagement in a 2009-10 survey.
Another focus is the Collaborative Care Councils, which are teams of about 12 that include physicians, nurses, receptionists anyone who helps with patient care. They meet monthly and each member must communicate with five members not on the council to relate the work of the committee and get feedback on whether the council is going in the right direction.
The councils were developed to build agile work forces, White says, so if we need to solve a problem we can tweet, text or blast an e-mail to the chairs of these councils and say this needs to get done in 60 days. How can we get it done? The councils also empower the staff to make decisions in patient care. Administrators are there to help remove the barriers to achieving the goals, she says.
Were never going to come up with the right solutions in the C-suite, White says. The real answers are at the bedside.
Investing in Nurses Reduces Turnover RatesWilhelmina Manzano, RN
Since a new nurse residency program was instituted in 2006, the turnover rate for nurses at NewYork-Presbyterian Hospital, which had been 45% in the first year of hire has dropped to 4% in the first year.
The program, designed by University HealthSystem Consortium, helps nurses when they are at their most vulnerable point, says Wilhelmina Manzano, RN, MA, who is CNO for the hospital and NewYork-Presbyterian Healthcare System.
Some people burn out very quickly or they feel that its not the right fit for them, Manzano says. We have invested a lot of time and energy in preceptorship and in mentoring new hires. You cant know everything when you come out of school.
Investment in nurses also comes in supporting continuing education and in growing the next leaders, Manzano says. To that end, the hospital has partnered with schools such as Hunter-Bellevue School of Nursing.
Some of the Hunter RN-to-BSN classes are held on the NYP site to ease access and increase the number of BSN nurses. Another two-year nurse leadership program with the New York University Wagner Graduate School of Public Service is fully funded by the hospital. NYP pays full tuition for nurses accepted into the masters program.
Overall nursing satisfaction scores for NewYork-Presbyterian Hospital have gone up at each site steadily in the past three years from 75% in 2008 to 83% in 2010.
Clear, consistent communication is among the reasons nurses feel engaged in the system, Manzano says. All nurses have their own e-mails and they get regular broadcast e-mails and a quarterly newsletter. Manzano also sends personal letters to nurses homes with significant news. Managers visit sites during the day and night, so nurses arent left out because of the shift they work.
I want them to feel good about coming in to work, Manzano says. The work is hard enough.