News and Events

March 15, 2008

Aging population. Nursing shortage. Hudson Hospital is ready for the challenge.

Recently, Wisconsin Hospital Association (WHA) released the Wisconsin Health Care Workforce Report 2007 stating that it comes as no surprise that Wisconsin hospitals and health care facilities report it increasingly difficult to recruit the number and type of employees needed to fill specific vacant positions, including nursing. While the vacancy rate is not as high for registered nurses as it is for pharmacists or physical therapists, the number of vacant RN positions in the state (2,759) is large and concerning, especially as the current workforce ages. Wisconsin hospitals employ 30,000 nurses. (Report: www.wha.org/Workforce/2007WorkforceReport.aspx).

According to WHA Vice President of Workforce Judy Warmuth, author of the report, “serious workforce shortages are on the horizon despite targeted efforts to accommodate older workers, provide more flexible employee benefit programs to keep and attract employees, and redesign of the role of workers within the health care delivery system to meet the demands for care they are experiencing.”

The health care delivery system is dependent upon people – a lot of them and as the population ages and the demand for health care increases, more workers are required. The ability to meet the health care needs of the communities served is directly linked to a hospital’s ability to attract, recruit and retain highly skilled professionals (WHA workforce report).

Registered nurses – recruitment, training and retention

Hudson Hospital ’s registered nurse turnover rates for the past three years – 25% (2005), 20% (2006) and 5.8% (2007) reflect the success we’ve had with our Registered Nurse – Recruitment, Training and Retention initiatives.

Three years ago, long shifts, staff fatigue, staff retention, and a nurse shortage were primary concerns for nursing leadership. Realizing staff satisfaction and retention directly impact patient care delivery, and ultimately patient satisfaction; efforts began both on organization-wide and department levels to more intently engage all staff in the hospital’s mission and vision. Having the best and most satisfied employees became one of the organization’s major long-term goals.

Organizationally, the Elements of Care (People, Quality, Experience, Stewardship and Growth), which give focus to the work we do, and our Shared Values (Respect, Integrity, Hospitality, Teamwork and Life Long Learning) – guides for everyday actions, were introduced in response to employee feedback from the hospital’s first Press Ganey Employee Perspectives Survey in October 2005. “Results indicated there was the opportunity to increase employee satisfaction and staff engagement across the organization”, says Carolyn Milbrath, director of Human Resources for the hospital. Nursing Care leadership committed to taking care of patients and the business of our organization.

Within Nursing Care, efforts were underway to recruit, train, and retain registered nurses. Initiativesinstrumental in bringing about change include:

Recruitment

Better known as “perks” to Human Resources staff, recruitment efforts include the selling of amenities such as Hudson Hospital’s healing environment philosophy – it doesn’t look, feel or smell like a hospital. Unique facility features throughout the hospital such as the Wintergarden indoor and outdoor gathering areas, the Healing Arts program, the meditation labyrinth, and the family kitchen (family space for patient guests) all enhance the work environment. Once a candidate visits, they’re usually sold, says Cindy Johnson, Human Resources.

Attractive benefit and work schedule options are appealing to younger workers, who today, are more focused on work-life balance (flexible work and part-time employment opportunities). The WHA workforce report states that workers entering the workforce today are less interested in working the number of hours that retiring workers may have worked. For nurses here, the 8-week block schedule (days/nights/ every 4 th weekend) provides employees advance coverage notice and the ability to plan ahead – outside of work. “Most hospitals do not offer block scheduling”, notes Cindy. “It’s proven to be a great “perk” for prospective nursing candidates.”

Additionally, the hospital hires enough nurses to provide optimal care and ensure staff stabilization with built-in replacement time (to cover vacations, shift rotations, etc.) to alleviate staff shortages.

No one has ever turned down the Health Reimbursement Account (HRA) – $1400 (FT) and $700 (PT) offered to employees annually to help offset medical expenses. And once recruited, new nurses know that they will not be left to fend for themselves; a comprehensive orientation/training program awaits them.

For Melissa Wittstock, RN, it was the 8-week block scheduling that initially hooked her. Having been an employee since 2006, she adds, “ Hudson Hospital is competitive with Twin Cities hospitals and gives me the opportunity to provide my family, friends and neighbors with quality care close to home. I have the ability to impact care locally.”

Training

Nursing students and preceptorships

Training is offered at various levels to nursing students, new graduates, and new hospital nursing staff. Hudson Hospital offers a greater number of preceptorships (80-96 hours of clinical on-site training) to nursing students through their school nursing program – a requirement to complete their degree than other hospitals our size, acknowledged Philip Hughes, manager of Professional Development.

In 2007, the hospital provided preceptorship opportunities to 30 nursing students, one of which was Caroline Yoerg, a WITC nursing student at the time and now a registered nurse and hospital staff member. “Training in a small hospital gave me the opportunity to cross-train in multiple areas including specialties such as surgery. My preceptors were committed to the program. Not only did they lighten their loads and dedicate time to me, they encouraged me to experience all areas of interest.”

Sixteen students, from four nursing programs, are already scheduled to participate in preceptorships between March and June of this year.

New graduates and nurse residency program

Beginning in 2007, registered nurses (new grads) beginning their career at Hudson Hospital had opportunity to join nurses from across Wisconsin and Minnesota and participate in a nurse residency program – a multi-faceted, year-long program designed to meet individual nursing needs and help with the transition from school to practice. Monthly learning sessions are offered. Five new grads are attending this first year and have been partnered with a clinical coach, an experienced nurse working at the hospital, who takes special interest in their professional development.

Angie Adams , RN remarked that “transitioning from student to staff is often overwhelming for a new grad. Not only is there the realization that you are responsible for your patients, but the warning heard in school still lingers – ‘beware the older nurses, they eat their young!’ As a new nurse at Hudson Hospital, I couldn’t disagree more. The experienced nurses eagerly teach, support and encourage new grad participation. I look forward to the day when nursing students or new grads look to me for advice.”

Staff nurse employee orientation

Orientation for new nursing staff at Hudson Hospital, unlike most hospitals, is customized to fit each individual and is based on demonstrating core competencies, not length of orientation. It may take a week to orient an experienced nurse, but 10 weeks to orient a new grad, depending on their critical thinking skills and comfort level. Orientation is specific to the nurse’s job at the hospital.

“My orientation process was substantial and very thorough. I was asked repeatedly how I felt things were going – where did I feel comfortable and where did I need more experience,” says Melissa Wittstock, RN. “Positive patient outcomes were always of primary importance throughout orientation.”

Continuing education

Nurse skills fairs (to educate nursing staff on new skills, equipment, and changes to ensure competency requirements are met), on-line learning, specialty courses in ER – Trauma Nursing and Basic Critical Care are just some of those offered in support of the hospital’s Shared Value – Life Long Learning to encourage specialization and advance critical care capabilities.

“Although the hospital requires more life-saving training (CPR, ACLS, Pediatric LSC, etc.) than most hospitals, we are willing to pay for staff time to attend – it’s that important,” says Philip.

Retention

Retention initiatives are important to help prevent loss of nursing expertise, knowledge and skill and avoid replacement costs to the organization. In addition to engaged nurse leadership, creation of a positive work environment, collegial relationships between nurses and physicians who depend more on nursing support in a smaller hospital, and increased professional growth opportunities due to hospital and community growth, Hudson Hospital’s unique retention initiatives include regular rounding opportunities for nurses with Board members, Medical Chief of Staff, Chief Nursing Officer, Senior leaders and department manager – nurses are heard.

Hudson Hospital selected to participate in national quality program

Nursing staff rally around the newly introduced Transforming Care at the Bedside (TCAB) national quality initiative. This past summer, Hudson Hospital was selected to participate in TCAB sponsored by the Institute for Health Care Improvement (IHI) and the Robert Wood Johnson Foundation. The hospital was selected as 1:68 hospitals and 1:2 Wisconsin hospitals (from over 500+ applicants) and was the only Critical Access Hospital chosen to participate nationwide.

The focus of TCAB is to improve the quality of inpatient care by making it safer, more reliable, and more patient-focused. The goal is to get nurses back at the bedside spending more time, 70% of their time, providing direct patient care. Studies show increased time spent with patients translates into better patient outcomes.

“We want to be able to provide the exact care the patient wants/needs exactly when they want/need it,” states Deb Brisch-Cramer, RN, Vice President and Chief Nurse Officer. TCAB is about giving bedside nurses the ability to recognize the need for improvement and make the necessary changes. TCAB creates opportunities for front-line staff to innovate, test and measure new ideas, it encourages staff to deliver better care, helps to develop leadership skills, and fosters teamwork among nurses to lead quality improvement efforts. This adopted philosophy of care has the potential to change and improve the relationship between nurses, other caregivers, and their patients. It not only empowers nurses to redesign work processes to better achieve clinical outcomes in an effort to improve patient care quality, it helps to reduce staff turnover.

“Nurses have seen what this quality initiative is about and want to be more involved; they want to be part of the solution,” says Jennifer Osterbauer, RN. “TCAB has brought great changes to Hudson Hospital and reminded nursing staff that we are respected and valued for the hard work we do and that we can impact patient care and that’s important.”

Based upon a paper written by Jennifer on the hospital’s participation in TCAB, she and Mary Brooks, CRN will present at the national American Organization of Nurse Executives (AONE) conference in April. Both look forward to presenting to nurse leaders from across the country and sharing the successes Hudson Hospital has achieved in transforming care at the bedside.

TCAB committee members include: Helen Lanis, RN; Kelly Ilavsky, RN; Sherri Berg, RN; Robin Melin, RN, Nurse Manager; Elizabeth Triebold, CNA; Dorothy King, Unit Coordinator; Mary Brooks, CRN and Jennifer Osterbauer, CRN.

Wages alone aren’t the only “draw”

Hudson Hospital has built an infrastructure to meet our community’s growing and changing health care needs and knows through experience that competitive wages or close proximity to home alone can’t guarantee employee commitment to the organization. It is a combination of many things including culture, shared values, work environment, work/life balance, engaging opportunities and knowing that as an employee you are heard, and more importantly that your employer responds, acknowledging you as a valuable participant in helping to shape the organization.

Note: Overall organization turnover rates for the same survey time period fell dramatically – (37%) 2005, (23%) 2006, (12%) 2007 – a significant improvement in staff satisfaction, engagement and retention.

For more information on Hudson Hospital nursing initiatives contact:

Deb Brisch-Cramer, VP & CNO at 715/531-6012
dbrischcramer@hudsonhospital.org
Karen Hansen, Community Relations at 715/531-6056
khansen@hudsonhospital.org.

Hudson Hospital is an independent, non-profit community hospital since 1953, and is located just off Interstate I-94 in Hudson, WI. The hospital campus is designed with the latest technology and amenities to support whole health and healing for patients and their families. Twenty-five private hospital rooms feature private bath, garden views, guest accommodations, room service for patients and guests, and spacious room to relax or visit with family, friends and even the family pet. Hudson Hospital recognizes the important role that family and friends can play in health and recovery, and personalizes a plan of care that works best for the patient and their family. Specialty services include inpatient and outpatient care in rehabilitation, emergency care, orthopaedic care, maternity and birth, surgery, cardiology, and treatment, rehabilitation and medical imaging.

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