The complicated truth behind a nursing shortage

Elizabeth Newman
Elizabeth Newman

Conventional wisdom often leads us to incorrect conclusions, whether it's in politics or healthcare. Nowhere is this more true than when we discuss our nursing shortage.

At first glance, a story we ran this week on how long it takes to fill nursing positions would appear correlated to a lack of nurses. In response to the article, a commenter wrote it was wrong because of a huge number of LPNs and RNs in Texas. “The competition to get a job is fierce in Texas. Many new students do not even get hired for months,” the commenter wrote.

Unwittingly or not, that person stumbled onto the starker truth within the report: The industry may actually have enough nurses. But they aren't the nurses you want.

That's because most healthcare organizations, long-term care included, want to hire people with some experience. This is not unreasonable. Long-term care is becoming increasingly complex with residents battling multiple comorbidities. Nursing graduates are time-consuming because they require on-the-job training and mentoring, whether it's teaching how to hang an IV bag or draw blood well.

Even if you want to take the time and energy, many providers tell me they fear hiring a recent graduate because they don't have institutional loyalty. They hesitate to hire new nurses because they believe they'll dedicate hours to helping them get on their feet only to find the nurse leaving after a year or so for a better-paying job. Plus, 17.5% of new nurses leave the profession entirely within a year.

How did we get here? For starters, there's increasing pressure for hospitals and other institutions to hire nurses with more education. Decades ago, nurses with an associate's degree (RNs) were reasonably certain of being able to land a job. Today, in Houston, where associate degree nurses make up 40% of newly licensed nurses, it's tough to even get an interview.

Long-term care also has a disadvantage related to what it can pay experienced nurses. While a nurse in a hospital may make an average of $35 per hour, it's $30 an hour in a nursing home, according to the Bureau of the Labor Statistics. Rural providers also increasingly have a tough time luring and keeping staff. The allure of small town America may be strong for families, or those looking for a better cost of living. But millennial nurses may want to see what challenges and opportunities await in a city.

Still, there are signs of programs that work. One is tuition reimbursement tied to a commitment to the job. If your facility has trouble both recruiting and retaining, crunch the numbers related to RN-to-BSN programs. Start with a pilot program to see if paying a stipend or full tuition for a handful of RNs would pay off in that it would tie them to your facility for a longer amount of time.

In New York City, a group of employers and the Department of Small Business Services is testing a six-month course for BSN-level nurses who are unemployed or underemployed in a transition-to-practice program. Participants are paid a stipend to work two days a week at a hospital and Saturdays in training, but don't make a commitment to a specific employer.

Also consider changing the way you use human resources. If you contract with a vendor that understands hiring for senior living, it lets your internal human resources people focus on orientation, training and creating a culture where people want to work.

Finally, with regard to that culture, ask your nurses what would make their lives easier. One of the advantages of large hospitals is there may be dry cleaning, banking, child care, or other services on site. A small nursing home may not be able to offer that, but can find no-cost ways to brighten up people's days, whether it's asking a food truck to make a stop nearby, or seeing if a pet therapy group wants to pay a visit.

Or, if you ask your nurses, you may find out that their biggest challenge is feeling unheard or given a lack of autonomy. There's no reason young nurses can't lead committees or form quality-related improvement groups. When you find ambitious nurses doing a good job, realize they need to be ambassadors for your organization — pay for them to attend a networking event or conference. Rather than think of the possibility of them being lured away, ask them to speak up about the benefits of where they work.

While there's no one way to solve an organization's nursing shortage, you do have the power to take small steps to help nurses feel your facility is a good place to work.

Follow Elizabeth Newman @TigerELN.

 

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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