High retention rates are the cornerstone of a stable workforce. Retention also happens to be one of the most complex and difficult areas for hospitals to address. The fundamental issue is the need for a redesign of the work environment, which includes increasing the safety and satisfaction of workers and patients, while increasing the efficiency of the health care delivery system.

Redesign the Work Place

Long-term solutions to the nursing shortage will require a fundamental change in the job of nursing, both with respect to the level of stress involved in the job and the physical demands placed on nurses. Job dissatisfaction stems from “a lack of communication between management and the nursing staff, increased administrative duties and decreased clinical duties, and a general lack of professional treatment by physicians and management.” As noted earlier, the majority of nurses are significantly more concerned about the stress and physical demands of the job than with the amount they are paid. Fitch Ratings concludes that successful hospitals will fundamentally change the nature of the nurses’ jobs, retain staff, and keep expenses in check.

In AON Consulting’s recent “healthcare @ work survey,” they found health personnel were loyal to patients and to their co-workers, but not to their employers. The increased movement to temporary agencies refutes the notion that nurses and others do not want to work in hospitals, since that is where agencies send the majority of their clients. The message it sends is that workers are looking for control over when, where, and how often they work.

There is ample evidence of patients and staff voting with their actions for the changes they would like to see in the hospital environment. The experience of hospital staff working in settings that focus heavily on patient satisfaction is positive and that experience can boost retention. At many hospitals the labor and delivery rooms, for example, have evolved from a standard institutional floor plan to become homey birthing suites that downplay monitors and machines.

Some hospitals have embraced the Planetree model of care, which is designed around “human beings caring for other human beings.” The concept promotes a positive patient experience by focusing on several areas, including human interaction; empowering patients through information and education; recognizing the importance of family, friends and social support networks; spirituality; the importance of human touch; arts and entertainment; complementary therapies to expand patient choice; healing architectural and interior design; and the importance of nutrition and nurturing aspects of food. The Planetree approach involves not only compassionate care for patients and families, but works to create a culture where the organization supports and nurtures the staff as well.

Increase the Versatility of Personnel

Many hospitals have already maximized the productivity and efficiency of their workers by cross-training them and allowing them to work to the greatest extent allowed by their licenses. Sixty-three percent of the laboratories in Washington state that responded to a state Department of Health survey indicated they are crosstraining existing personnel to staff adequately during times when vacant positions exist.104 To further this effort, hospitals may be able to review the statutory scope of practice for various types of workers and determine how the efficiency of those workers could be improved.

Cross-raining and allowing employees to work to the full extent of their skill level have dual benefits. Employees continue to be challenged by the skills required by their work, and they are capable of shifting from one type of work to another depending on where they are most needed.

Create a Career Ladder

To promote retention of valuable workers, hospitals should design a career ladder that targets development of entry level employees. The ladder should progress through the various levels of clinical disciplines. Also, hospitals should have a clearly articulated plan for moving personnel to the next step in clinical training. A good example would be transitioning licensed practical nurses to registered nurses through coordination of education programs with local educational institutions.

Design Flexible, Comprehensive Compensation Packages

The composition of compensation packages must go beyond salary. Hospitals need to include comprehensive benefits responsive to employee needs. Onsite child care is very helpful to some workers, particularly if it is open during evening and night shifts. Benefits for part-time employees may also help retain workers. Benefits should be tied to the hospital’s strategic plan, which should, in turn, treat the workforce as a critical hospital asset.

Recruitment and retention of some non-nursing health professionals would likely be improved with better salaries. These shortages are primarily due to the strong economy and increased options rather than a fundamental dissatisfaction with the job, as is the case with nurses.105 Again, financial challenges for hospitals and free standing laboratories make this difficult.

Although increasing compensation of hospital staff initially seems like an expensive endeavor, it may not be over the long term. Staffing agencies and incentive bonuses are short-term measures for dealing with the acute shortage of personnel — and they are very expensive. In 1999, on average, individual hospitals spent $400,000 on contract-nursing expenses alone — a total of over $40 million for Washington state hospitals. However, increasing salaries on any large scale in the current payment environment is extremely difficult. Without improvements in the payment area, hospitals may be unable to pursue this strategy.

Harness the Power of Technology

Successful efforts at relieving the personnel shortage will focus on increasing the number of workers available to do the job. There is also a role for technology in relieving some of the burden on health care providers. Hospitals must carefully acquire helpful new technology while keeping a watchful eye on cost. Some hospitals are better positioned, both in terms of size and available finances, to make use of new technology.

New technology must be evaluated to ensure that it helps rather than hinders the job of the clinician. Specifically, with respect to the shortage of pharmacists, the Health Resources Services Administration suggests initial use of technicians, automation, and technology to relieve the pressure.106 It also suggests development of a uniform prescription benefit card to relieve the administrative burden associated with third party payment. Computerized charting and physician order entry may ease some of the paperwork burden.