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Happier days: RN leaders, mature nurses collaborate on retention strategies

Monday March 11, 2013
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Several years ago, Carondelet Health Network in Tucson, Ariz., was grappling with a serious problem. The organization had a shortage of nurses and was spending $20 million per year on traveling nurses to fill the gap. The average age of the staff nurses in the hospital was 45 — more than 25% were 55 and older. Leaders at the hospital decided a critical strategy for tackling the shortage was to focus on retaining their experienced or “mature” nurses who were 45 and older. To find out how, they went straight to source and asked.

Feed the mind

“We started meeting with the experienced nurses and asked what they needed in order to stay,” said Lynda Gallagher, RN, MSN, BC, director of education operations and career development at Carondelet. “We were dumbfounded with their answer because we thought they would want more money or better shifts. What they really wanted was to further their education. They were eager to enroll in BSN and MSN programs so they could advance their careers.”

Carondelet went on to launch a highly successful on-site education program that has saved the hospital millions of dollars by transforming the facility into a retention magnet for seasoned nurses. Although a shortage of nurses may seem like a distant reality in today’s slow economy, in many ways Carondelet was forced to face a situation that is looming for the rest of the country. “I believe that retaining seasoned nurses needs to be a higher priority in hospitals because we have a perfect storm for a nursing shortage of crisis proportions,” said LeAnn Thieman, LPN, CSP, CPAE, a national speaker and expert on nurse recruitment and retention. “We are not educating enough nurses fast enough, so we are short on the number of nurses entering the field when the baby boomer nurses start to retire. This will hit when one third of the population will enter an age when they have the highest healthcare needs.”

Although the economic slowdown may be delaying retirement for many mature nurses, researchers say it is imperative to take advantage of this extra time to strategize how to retain these nurses as long as possible. According to data from the Current Population Survey by the U.S. Census Bureau and the U.S. Bureau of Labor Statistics roughly 900,000 nurses today are older than 50, which is almost 40% of the nation’s nursing workforce, said Peter Buerhaus, RN, PhD, FAAN. Less than one third of nurses are younger than 40, according to 2008 data from the National Sample Survey of Registered Nurses.

“Over this decade we expect that many, if not the majority, of nurses [who reach retirement age] will retire, and we need to delay their retirement to provide enough time for new nurses to come in and replace them,” said Buerhaus, Valere Potter Distinguished Professor, Institute for Medicine and Public Health at Vanderbilt University in Nashville, Tenn. “Also, the mature nurses are excellent caregivers
because they have a ton of knowledge and skills, and they can be teachers and mentors for new nurses.”

Although an education program was a successful retention strategy at Carondelet, Gallagher believes there is not a standard formula for success that works for every facility. “The best thing to do is really talk to your experienced nurses,” she said. “Show that you are sincere about wanting to hear what they need, and then follow through with it. In other hospitals, it may be something else that they want.”

At Carondelet, the hospital partnered with Grand Canyon University, Phoenix, to start offering a BSN program on-site at the hospital starting in 2005. Carondelet paid the $12,000 fee for tuition and books, and the courses were offered once a week from 4:30 to 8:30 p.m. Gallagher expected 20 nurses to attend the initial introductory meeting, but more than 200 nurses came. Since the program began seven years ago, 312 nurses — the vast majority of whom are 45 and older — have completed the BSN program. The program was so successful the hospital added an MSN program, and there are always waiting lists for the programs.

For Carondelet, the return on investment has been phenomenal, Gallagher said. Ninety-four percent of the graduates of the program still are working for the hospital, and many moved into roles such as clinical leads, preceptors, managers or directors. Not only are the mature nurses more eager to continue working, but they also are stepping up to prepare those who eventually will replace them when they retire. “It has been moving to see how this program helped the nurses feel more self-confident and eager to mentor the new graduates,” Gallagher said. “That was not happening in the past nearly as much.”

Keep stress off the body

At Mon Health System in West Virginia, one of the retention strategies was to involve experienced RNs in the design of Mon General Hospital’s new patient tower. The seasoned nurses on the design team not only felt valued, but they also knew which structural nuances would enhance mature nurse satisfaction. “The designers asked details like where we would want the outlets in the rooms,” said Audrey Veschio, RN, BSN, unit director of orthopedics and pediatrics. “The outlets are kneehigh or higher so we don’t have to bend over to look for them. The bathrooms are larger so we can get in and out more easily with a wheelchair.”

“It is very clear that the experienced nurses were involved in laying out the new units,” said Melissa Montgomery, RN, BSN, MHA, senior director of nursing operations. “There is less walking distance for nurses, and for the older nurse that is very important. You won’t see the long hallways. The nursing units are laid out in pods in a square fashion, and the computers and basic nursing supplies are conveniently located outside patient rooms.”

Offer opportunities

At Bon Secours Health System in Richmond, Va., a recent retention experiment involved the creation of a new role outside of the hospital setting. About two years ago, the facility started hiring nurse case managers to work in physician offices to coordinate care for patients. “Rather than lose an experienced RN from the health system because he or she is burned out from shift work and working evenings and holidays, we created a role for them that is much more palatable,” said Robert Fortini, PNP, CNE at Bon Secours Health System. “As case managers outside the hospital, they can experience the satisfaction of patient contact and work 9 to 5. Mature nurses are ideal for these roles because they’ve been in healthcare so long that they know the lay of the land. They are very effective at developing care management plans and navigating the health system.”

The program started with three nurses, and now there are 37 nurse case managers spread throughout two dozen locations. The majority of the nurses in the program are former ICU or ED nurses. To prepare for the new roles, the nurses undergo a two-day orientation followed by six weeks of general orientation. They gather once every other week to participate in a two-hour education session to confer about case studies and other topics. Although the hospital does not have data to track whether this new program has had an impact on retention rates, the energy Fortini witnesses among the seasoned nurses in these roles is hard to ignore.

“I interact with the group, and I attend the biweekly meetings, and the camaraderie is just so refreshing to see,” he said. “I took the first cohort of newly certified nursing case managers out to dinner, and one of the mature nurses commented that she would have been retired if not for the new role and the opportunity it presented. They are seeing themselves in a new light and their importance in nursing and healthcare delivery, and I think that is so critical going forward as we tackle our country’s healthcare woes.”


Heather Stringer is a freelance writer. Post a comment below or email specialty@nurse.com.