By Debra Anscombe Wood, RN
Hospitals and health systems are taking a more strategic approach to ensuring they have enough nurses with the right expertise to deliver high-quality patient care.
“The success of any hospital is going to lie largely on the success of its registered nurses and nursing departments,” said Maureen White, MBA, RN, NEA-BC, FAAN, senior vice president and CNE for North Shore-LIJ Health System in Great Neck, N.Y. “It’s the people at the bedside who make the strongest difference in our outcomes.”
The challenge for White is whether the country will have enough nurses to provide care to growing volumes of patients in a variety of settings.
Deborah K. Zastocki, DNP, RN, NEA-BC, FACHE, president at Chilton Medical Center in Pompton Plains, N.J., and vice president of Atlantic Health System, said she wonders if nurses will continue to find acute care attractive with so many opportunities in other venues.
To answer that issue, nursing leaders throughout the region work diligently with human resources on staffing strategies, including recruitment and retention. Most nursing leaders look three to five years ahead to grow future leaders and bring in new hires to meet current and future needs.
New Jersey-based HackensackUMC’s greatest challenge is recruiting to fill vacancies as the hospital expands and offers new service lines, said Karen Hanson, MHA, RNC, SPHR, CHCR, director of talent management. Candidates participate in a peer interview after meeting with human resources and the nursing manager.
“It helps the staff become invested in the new hire,” Hanson said. “Peers can pick up on little nuances, or the candidates may let their hair down.”
Atlantic Health System, in seeking experienced nurses for new program areas and to fill vacancies in specialty areas, looks for staff with clinical and teamwork skills.
“You need a collaborative attitude,” Zastocki said.
North Shore-LIJ seeks innovators, along with nurses who are creative, risk takers and committed to patient care. It seeks to bring on nurses in alignment with its vision of how care needs to be delivered, White said.
Lutheran HealthCare in Brooklyn also weighs whether the person is a good fit with the mission and vision, said Karen DeLorenzo, MSN, RN, CHCR, assistant vice president, nursing recruitment and retention, professional practice.
Lutheran offers a summer student extern program, which serves as a pipeline for new hires. Nurses and managers get to know the externs and whose values are a good match.
Onboarding often makes a difference in whether a new nurse stays, as does a rewarding practice environment. “The enculturation process is so important,” Zastocki said. “We help them understand nuances in care and evidence-based practice.”
Chilton offers new graduate residency programs and introduces new orientees to its professional advancement career track, during which they complete a learning project. They also are invited to participate in unit or other governance councils. “No matter where you are in your professional growth — early, middle or late careerist — there might be something to investigate that will advance the practice of nursing and promote better patient care,” Zastocki said.
The CEO at HackensackUMC kicks off orientation and sets the expectations. All new graduates are placed on the same unit with lower nurse-patient ratios and dedicated preceptors. Then they move to a regular unit with a buddy.
“They will get a strong foundation, working with a preceptor,” Hanson said. “In the end, [that] will make sure we have nurses comfortable being here.”
Preceptors can make a huge difference in retention, as do shared-governance councils, Hanson said, adding, “when decisions are made, nurses are part of the process.”
New nurses at Lutheran orient with nursing educators and a preceptor. The hospital invites nurses, new and experienced, to participate in unit-based councils, research and other activities, DeLorenzo said.
Maimonides Medical Center in Brooklyn uses a teaching, mentoring, coaching onboarding process. The mentors, nurse managers and educators meet weekly with the new nurses to answer any questions.
The new nurses also can participate in research and report at the hospital’s annual research day.
“Recognition is important,” said Mary Ann Radioli, MA, RN, director of nurse recruitment and retention for Maimonides, which offers several recognition programs.
Retention also requires a practice environment attractive to nurses.
“Registered nurses need to feel empowered and in an organization that respects the work they do, where they receive the proper recognition,” White said.
Additionally, North Shore-LIJ offers programs to enhance nurses’ well-being. Atlantic also focuses on employee wellness and creating a healing culture.
“Our goals are to have our employees be the healthiest in the nation,” Zastocki said.
Clinical ladders can offer an opportunity to grow, Hanson said.
North Shore-LIJ employs a clinical ladder to encourage staff engagement in the organization related to quality outcomes, research, community service or other goals.
“It helps connect the staff nurse to the organization and highlight their contributions,” White said.
Management at North Shore-LIJ continually watches for nurses with potential to move up in the organization. It seeks nurses with the right attitude who embrace the health system’s vision. Every 18 months, North Shore-LIJ requires leaders to identify who could fill their roles and whether they need additional education or training.
“We will mentor them and give them stretch assignments,” White said.
North Shore-LIJ considers itself a learning organization and provides opportunities for staff to grow within the health system, White said. Its Center for Learning and Innovation provides continuous learning opportunities to enhance staff knowledge and skills and foster a culture of excellence and innovation.
Maimonides offers a nurse manager leadership development program in conjunction with faculty from the NYU nursing administration graduate program.
“You need to always be on top of the evidence,” Radioli said. “Our nurses need to constantly learn.”
Additionally, nurse leaders interviewed for this story said their hospitals and health systems reimburse for conferences, specialty certifications and tuition for additional degrees. Atlantic offers a career guide, learning communities and an educational advisory program to help employees return to school. Managers also include a development plan in the annual review process.
“Having an academic coach helps them get into a program of continued growth,” Zastocki said.
Lutheran continually tries to grow from within by encouraging education and participation in committees, DeLorenzo said. Nursing and other departments often mention to management the names of nurses they feel have potential to grow in the organization. Then, through coaching and seeking new experiences, those nurses prepare for future job openings.
“Our philosophy is it’s never too early to develop a leader,” DeLorenzo said. “Nurses are leaders no matter what their position.”
Debra Anscombe Wood, RN, is a freelance writer.