NURSING RECRUITMENT AND RETENTION

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2 CAREERS THAT COUNT NURSING RECRUITMENT AND RETENTION It s rare in this day and age to find a person who has worked at his or her job for nearly four decades. But that is exactly what Margaret Crowley, RN, charge nurse in outpatient oncology at NewYork-Presbyterian Hospital in Manhattan has done. I applied to NewYork-Presbyterian right out of nursing school, says the Washington Heights native. She never looked back: except for a brief stint as a private duty nurse when her sons were young, she has been at the hospital ever since. Initially, Crowley handled IVs for the department of medicine, and pretty soon, it snowballed into oncology, she says. Once I found oncology, I loved it. Staff oncologists took her under their wings and trained her. She eventually got certified in oncology, working as a patient oncology nurse for about 25 years. Ten years ago, she landed her current position. I always felt this institution was so big I would find the niche I wanted, she explains. The opportunities are limitless here. If you feel you need a change, there usually is an opportunity to break into something different. While the opportunities and rewards that the nursing profession provides are indeed limitless, the number of experienced nurses are not. National Nurses Week, which runs May 6 through 12, calls attention to the enormous importance of nursing in health care, this year emphasizing recruitment and retention. With the average age of the American nurse at 46.8, and with baby boomers starting to retire, the ranks of qualified nurses are dwindling. That s why area hospitals and Seasoned nurses have experienced all the hardships and challenges. Their insights are so valuable in guiding that new nurse. Rebecca Flood, RN health care facilities are reaching out to new nursing graduates and working diligently to retain more seasoned nurses. We need the new nurses, says Wilhelmina Manzano, RN, senior vice president and chief nursing officer at NewYork-Presbyterian Hospital. That s our pipeline. It s the future. We want to nurture our new grads and newer nurses, because this is the generation that is going to take care of us when we get sick, adds Jeanmarie Moorehead, MA, RN, nurse manager of open-heart surgery at Lenox Hill Hospital in Manhattan. At the same time, seasoned nurses mentor and pave the way for new grads, helping them develop their careers, says Rebecca Flood, RN, senior vice president for nursing at New York Methodist Hospital in Brooklyn. Scholarships, loan repayment programs, competitive salaries, generous benefits, nurse appreciation days, no mandatory overtime, flexible shifts and self-scheduling are just a few of the carrots being dangled by some health care systems to attract and retain nurses. Health care facilities have also cultivated innovative educational and nurse-friendly programs. We have to take care of our employees like we take care of our patients, says Mary Ann Radioli, RN, MA, director of nursing, nursing recruitment and retention at Maimonides Medical Center in Brooklyn.

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4 THE ART OF RECRUITING Many health care systems maintain relationships with nursing schools in the New York metropolitan area and along the East Coast: recruiters attend job fairs, staff members who teach look for promising students and students do their clinical rotations at area hospitals. For example, The Mount Sinai Hospital in Manhattan has relationships with about 15 nursing schools in all five boroughs, explains Maria Vezina, RN, EdD, senior director of nursing education, research and professional practice. As a result, these students do their clinical practicum at Mount Sinai. If they have a good experience, they will usually walk into our nursing recruitment office when they graduate, she says. Students can also gain clinical experience with the Visiting Nurse Service of New York (VNSNY), which has relationships with more than 22 nursing programs in the New York area. Every organization wants the smartest and brightest graduates, We need the new nurses. That s our pipeline. It s the future. Wilhelmina Manzano, RN says Mari Moriarty, RN, MA, manager of college relations. We develop a relationship with students while they are still in school. We give them the opportunity to go out in the field and shadow our staff nurses and participate in patient care as part of the education process. Danbury Hospital in Connecticut has instituted a career growth program dubbed Hot Jobs. People who work at least 16 hours per week at the facility while attending nursing school receive 100 percent tuition reimbursement. Often, student nurses will work weekends and attend school during the week, explained Moreen Donahue, DNP, RN, chief nurse executive. The program is also open to anyone who works in the hospital. During the past two years, we have hired 40 new graduates through this program, she says. Danbury also rewards employees who refer

5 nurses from new grads to experienced cardiothoracic nurses to the hospital. Recruiters are also hiring nursing students about to enter their senior year to work during the summer as externs helping with patient care. For example, each summer, Hackensack University Medical Center in New Jersey enrolls about 60 senior nursing students in an externship program, many of whom may be hired upon graduating. We end up feeding ourselves from these externs, says Dianne Aroh, RN, executive vice president and chief nursing officer at Hackensack. Memorial Sloan-Kettering Cancer Center (MSKCC) offers a summer clinical assistant program (CAP) open to seniors and some juniors. While students work as nursing assistants, the center offers classes that integrate what they are seeing in the hospital setting with their coursework, explains Liz Mc- Cormick, RN, executive director and chairman of the department of nursing. When the summer ends, some students stay with us and work per diem during other breaks or on weekends, she adds. All are invited back during the school year to attend continuing-education seminars. We keep in touch with the very best CAP students, says McCormick. At Maimonides Medical Center, student externs spend eight weeks in the summer paired with a nurse mentor. At the end of the externship, the hospital hosts a ceremony, during which the student nurses present their mentors with a rose. It is heartwarming because they get very close, says Radioli. TRAINING THE NEW NURSE It s a giant leap from nursing school to clinical care. So hospitals are committed to helping the new nurse acquire skills and confidence during a unit or specialty-specific orientation, or both. Its length depends on the nurse s learning curve, the specialty and the unit where she or he is placed. Hospitals also team the new hire with a nursing preceptor, or mentor, who guides the fledgling nurse. For example, at New York Methodist Hospital, orientations in such areas as the intensive care unit (ICU) or the neonatal ICU last six months or longer. We nurture and mentor new nurses to set them on the right foot, says Flood. Katherine Gaviria, RN, who has worked at NewYork- Presbyterian Hospital for about two years, found having a mentor invaluable. My mentor taught me my skills, she recalls. She gave me confidence and told me I could do it. We also developed a personal relationship, and I could come to her with any patient issues.

6 VNSNY trains new grads for a year to develop their skills as home health nurses, says Moriarty. The training is a combination of orientation, shadowing an experienced nurse, working with a clinical adviser and classes. By six months, the new nurse is really getting a sense of what the job is all about and developing confidence, she says. The Hospital for Special Surgery in Manhattan has instituted a six-month nurse residency program in areas that are difficult to recruit for, like the operating room (OR), explains Stephanie Goldberg, RN, MSN, chief nursing officer and vice president of nursing. The training program consists of classroom instruction, simulated OR training and working alongside an experienced OR nurse. It s costly, but it s well worth the outcomes we are receiving in terms of recruitment, says Goldberg. Because oncology nursing is highly specialized, MSKCC funnels new grads into orientation programs that last from three to six months. Orientation is a combination of instruction, structured self-learning activities and work with preceptors in the clinical setting. In some specialties, you are considered a novice almost throughout the first year of employment, says McCormick. The center has also developed an educational program called Bridges to Oncology, geared to grads and other nursing hires new to cancer treatment. North Shore-Long Island Jewish Health System, headquartered in Great Neck, NY, has instituted nurse fellowship programs in both critical care and the emergency department. These are highrisk areas, says Susan Shevlin, RN, MA, MED, assistant vice president of talent acquisition. Patients are very sick, and nurses need good skills. Both yearlong fellowship programs combine classroom training with work in hospital units, where the new nurse is mentored by a specially trained nurse. Also, the system s Patient Safety Institute has computerized mannequins, which let the nurse practice high-risk scenarios like using a defibrillator or administering cardiac medication. It gives new grads confidence, says Shevlin. They are not doing something for the first time on a real patient. New grads hired by Lenox Hill Hospital who are interested in critical care must first work in the medical surgical unit for a year. When they are accepted into critical care, they attend classes and are paired with a preceptor nurse. There is a lot of information to absorb, says Moorehead. I start them off in the intermediate area and build on their skills until I can bring them into the ICU and train them with critical patients. When they feel comfortable with those patients, I train them to recover patients just out of open-heart surgery, which is a skill set in and of itself. RETENTION STRATEGIES Keeping a talented nurse on staff isn t simply a matter of guaranteeing a steady paycheck. Happiness in your job is directly related to the people you work with, says Susan Dietz, RN, vice president of patient care services and chief nurse at St. Luke s-roosevelt Hospital Center in Manhattan, part of Continuum

7 Health Partners Inc. Managers play the key role in nurse retention and satisfaction, so we believe very much in supporting the manager in that role. At St. Luke s-roosevelt Hospital Center, nurse managers have lots of opportunities for continuing education, she says. We re also sensitive to their issues, holding regular management sessions and discussion meetings. Irv Naar, director of recruitment for Continuum Health Partners Inc., agrees. The primary reason people leave a job is because of management, he says. When there is strong camaraderie on a unit, there is a sense of staying with your friends. We build on that by looking for good managers when we bring them in from the outside and by keeping our managers well trained. Continuum Health Partners Inc. also includes Beth Israel Medical Center, Long Island College Hospital and New York Eye and Ear Infirmary. Because it takes retention so seriously, The Mount Sinai Hospital has earmarked 2007 as the Year of Retention. We re working with clinical nurse managers in every unit to create a welcoming environment for newly hired staff, especially the new graduate who has a little bit more of a leap to make, says Vezina. Each year, the hospital presents awards to a top performing clinical nurse and a preceptor and recently introduced the Rookie of the Year award. NewYork-Presbyterian Hospital also presents a Rookie of the Year award. Clearly a new nurse can t compete with somebody who has been practicing for two years, says Manzano. We make them feel good about their work and let them know we value it. The award has created such appreciation. Flexibility and autonomy are key reasons many nurses choose to work at VNSNY, says Linda Reid, director of work force planning. But there is also tremendous opportunity within the organization, from newborn care to hospice care. And VNSNY makes sure nurses get the skills they need, thanks to onsite education programs and tuition reimbursement. You could reinvent yourself here every year if you were interested in changing jobs, says Moriarty. At Lenox Hill Hospital, Laura Giles, RN, nurse manager for emergency services, notes that when a nurse leaves her unit, it s usually to move on to a The challenge for all of us is how to motivate the aging nurse to stay in the work force longer. Liz McCormick, RN higher level of nursing experience, like interventional radiology or the catheter lab. Lots of nurses use emergency services as a stepping stone to the next stage of their career, she explains. MSKCC nurses can apply to a nurse research fellowship program. If accepted, the nurse is trained in every aspect of conducting research, from posing a clinical question to analyzing data and writing up results for publication, explains McCormick. Still, as a nurse grows older, it s natural to want to try something different or scale back hours. And hospitals and health systems are more than willing to meet nurses halfway. The challenge for all of us is how to motivate the aging nurse to stay in the work force longer, says McCormick. At Maimonides Medical Center, for example, an experienced nurse can choose a seasonal shift, working six months per year while maintaining fulltime benefits. Being able to transition from full- to part-time status and move within the health system helps North Shore-Long Island Jewish Health System keep the annual turnover rate for its nearly 10,000 nurses at nine to 10 percent. Says Shevlin, We would much rather have our staff stay in our health system than go somewhere else.