Nurse Retention

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I. Introduction

II. Situation Analysis

A. Industry Review

B. Company HistoryCheap custom writing service can write essays on Nurse Retention

III. Marketing

A. Marketing History

B. Current Marketing Plan

1. Product, Price & Place

. Promotion

C. Target Market

D. Statement of the Problem

E. Marketing Objective

IV. IMC Objective

V. Copy Platform

A. Basic Problem

B. Target Market

C. Major Selling Idea

D. Creative Strategy Statement

1. Campaign Theme

. Campaign Slogan

. Appeal

4. Execution Technique

E. Support Information and Requirements

VI. Creative Work Magazine Ads, TV Storyboard, Radio Ads, etc.

VII. Media Plan (See figure 10- in Belch)

A. Select Broad Media Classes

B. Select Media Within Classes

C. Develop a Media Schedule

VIII. Media Use Decisions

Everyone must have one broadcast, one print and one other major category, as a minimum.

A. Broadcast

1. Television

a. Vehicle Selection (VS)

b. Creative Work (CW)

. Radio

a. VS

b. CW

B. Print

1. Magazines

a. VS

b. CW

. Newspapers

a. VS

b. CW

C. Direct

1. Programs

. CW

D. Internet

1. Program

. CW

E. Sales Promotions

1. Programs

. CW

F. Personal Selling

1. Program

. Presentation Outline

G. Publicity & Public Relations

1. Program

. CW

H. Others, Promotional Products, Transit Advertising, Product Placement, Outdoor, Trade Shows, etc.

1. Programs

. CW

IX. Conclusions

X. Ethical and Environment impact statement

XI. Bibliography

XII. Appendix

According to a July 00 report by the Health Resources an Services Administration, 0 states were estimated to have shortages of registered nurses in the year 000. The shortage is projected to intensify with 44 states plus the District of Columbia expected to have RN shortages by the year 00. (Cox)

The solution lies in redefining recruitment and retention. Hospitals should develop techniques that can be sustained- building interest and image, developing scholarship programs, and cultivating a positive workplace culture and sense of community. These efforts are only successful with bridge building among all stakeholders, including CEOs, CFOs, nurse executive, nursing schools, and physicians. To encourage this collaboration HFMA brought together five experts to offer their perspectives on both problem and possible solutions. (Cox)

Hospitals should tap into this trend with retention and recruiting efforts.

Going to take time to tell the story about health care as a profession and the security of employment found in the healthcare profession.

(People moving into the technology sector�people were moving to those career paths without realizing that technology might not continue its rapid growth. Heath care, on the other hand, has been around for many decades.

Nursing shortage was brought about by an aging workforce,-- average age of a nurse falling between 40 and 4 years of age nationally, and by unresolved or unaddressed workplace issues.

Nurses are leaving the bedside and hospital setting to work in other areas, such as pharmaceutical sales, outpatient health care altogether. Until something is done to make nursing more attractive to both men and women, we will continue to see a problem.

Hospitals facing battle to reclaim the heart of nursing and maintain levels of care for their patients. Nurses say that hospitals must improve the environment of care. Doing so will no doubt require that models of care are redesigned to focus nurses on direct patient care and use other support staff to fulfill the duties that take nurses from the bedside.

Staffing shortage affect the financial outlook of a healthcare organization. Can case the organ to look to traveling nurse as a solution to the shortage issue, and that can cost the organization up to three times more for that staffing resource.

Staffing shortages can reduce the number of beds that are available, resulting in emergency- department overcrowding due to the unavailability of beds. Also, hospitals may choose to close beds to avoid the substantial financial impact of using contract staff.

staffing shortages can also be associated with low staff satisfaction, turnover, and low patient satisfaction, thus whether patients return to your organization.

Hospitals are learning that retention is as important== perhaps more important=-- than recruitment. The cost of turnover is tremendous in financial terms, and then there is the issue of the morale of remaining staff.

it's imperative that they hire the right person for the right job and ensure that the individual is a fit for the organization. Hospitals need to take time to review their mission and core values with the applicant during the interview process. The applicant needs to know what is important to the organization's success.

hospitals also should make every attempt to avoid implementing compensation programs that are too costly over time to continue. Wages and benefits should be market competitive.

Advocacy is also important. Hospital leaders should make sure that state legislators in their area are educated about how the community is being affected by workforce shortages and how the legislators can help.

Providing on-site education is very important for recruitment, as well as retention.

Hospitals should involve staff in decisions that affect their work environment, helping ensure the organization is meeting their needs.

Today, nurses need the greater challenges of a career that provides personal satisfaction for the long term. Therefore, recruitment and retention go hand in hand.

Hospitals and health systems are focusing their efforts on retention and employee satisfaction because they are recognizing that internal scorecards reflecting employee satisfaction are as important as measure of financial viability. Involving nurses in professional development and patient care issues is extremely important. Hospitals have developed shared governance models to bring nursing staff to the table in making decisions that will affect their daily lives, such as developing staffing models, redesigning patient care models, recruiting and interviewing nurse candidates, ad defining equipment needs.

Nurse managers have been challenged to provide alternatives to traditional 8, 10, and 1-hour scheduling. Providing for associates to work full time at higher pay in lieu of benefits and integrating flexible scheduling are important ways to meet changing needs and expectations of associates. There has recently been, and will continue to be, a more proactive focus on nursing. Prioritization will be based on each region's need.

President Bush has signed the nurse Reinvestment Act, which will provide for scholarships, a loan repayment program, public-service announcements to promote nursing as a career, and many other programs to support nursing.

The right mentality is, "I want to be able to make some decisions." One hospital chief nursing officer went directly to the nursing staff to solve the problem. Together, they came up with a protocol, assigning mandatory overtime only as a last resort. Nurses made extra efforts to avoid the mandatory overtime by first looking for volunteers and ten working through the protocol. As a result, mandatory overtime was reduced, and nurses gained some control over their scheduling.

Today's nursing workforce wants to have some choices and be able to make decisions.

Keep the lines of communication open. Share financial data with staff; let them understand the financial challenges.

Focus as much on retention as on recruitment. It is important to keep your current staff engaged and satisfied by creating a positive work environment for your nurses. Use surveys to determine their needs, and be willing to respond with the changes they desire, such as self-governance models, sufficient support staff, adequate equipment, ongoing staff development, and other resources.

Don't ignore the needs of your nursing leadership team. these are the people who will help maintain your nursing workforce. Be sure to offer them opportunities for education, professional development, and mentoring so they are well equipped to help you with the challenges of the future.

Create an attractive environment to retain the nurses within the organization. Hospitals might look at furthering efforts toward work flexibility, and they might look at eliminating mandatory overtime in healthcare, the needs of patients cause wide fluctuations in census and acuity causing sharp spikes in demand for nurses. Can you picture a nurse leaving to go home in the middle of a surgery?

The pieces of the puzzle between nursing and finance must link because staff retention reduces turnover, which reduces labor costs associated with recruitment, orientation, and education. As all the dots connect, you should have happier associates and enhanced satisfaction among physicians and patients.

Misallocation of RN staffing on one sift can mean short staffing on another, resulting in lower morale, diminished patient care, and erosion of nursing supply. Finance and nursing should collaborate to measure the use of nursing staff (RNs, LPNs, nursing assistants) on a daily, shift-by-shift basis. A simple spreadsheet of days, evenings, and nights collect minimal data and disclose how well the staffing model is being used, where utilization is not appropriate, and where nurse managers can focus.

Calculating highly variable components such as overtime will ensure that there are no surprises at month's end. Staffing grids, average wage rates, and budget targets should be combined to create a monitoring tool that provides useful, actionable information. Shift-to-shift knowledge about variances from the staffing model supports decision-making about vital nursing resources. The simple spreadsheet becomes a management tool that reflects variance in staffing hours, rates, overtime utilization, and skill mix.

There needs to be good working relationship with nursing, and that starts with good communication.

One solution to complicated CFO-nurse manager relations is to allow the nurses to have more authority and influence on interdepartmental relations, as seen with the relatively new role of nursing financial officer. This person interacts heavily with the financial staff and is responsible for monitoring the budget, nursing position control, the float pool, and nursing interns. Giving the nursing division the final work on the top three candidates of the nursing financial officer position ensures a positive working relationship between the departments, and it adds some accountability. (Cox)

Industry experts say that by 00, this country could have 800,000 fewer nurses than it needs.

We've even begun to understand, as studies from the University of Pennsylvania and other places suggest that there is a direct connection between the ratios of nurses to patients and mortality rates. The fewer nurses, the higher the rate.

Good new is that more students are interested in nursing. A 00 Harris poll found that 6 percent of 18- to 4- year- olds have discussed a nursing career for themselves or a friend. Nursing school applications in man places have soared. Baccalaureate nursing school enrollments, according to the American Association of Colleges of Nursing, rose 8 percent last year. In February, Congress approved $0 million for nurse education programs that include scholarships and continuing- education grants for practicing nurses.

Geriatric training for nurses also needs to be expanded. More than half of all hospital patients are over 65, and their umbers are expected to rise during the next 0 years.

The American Nurses Credentialing Center, raises nursing care standards, as well as improves the recruitment and retention of nurses.

Nurses are an essential element of our health care system. Research consistently shows that nurses increase the cost effectiveness and quality of care and improve the efficacy of a wide range of interventions, from heart surgeries to depression treatments.

Qualified people are answering our nation's call for more nurses. Let's do what we can not to lose them. (Fagin and Rieder)

Welcome Susan MacMillan, Senior Vice President, Chief Nursing Officer, comes form Cap Gemini Ernst and Young, where, for nine years, she served as a consultant understanding and developing best practice models of Nursing throughout the country.

Our recruitment and retention initiatives are well underway and coincide with the launching of our nursing marketing campign "exceptional Care Extraordinary Nurses."

Care Delivery Model

Launching nurse "quality council" that will include nurses from al units focusing on patient care issues such as skin care, falls, teaching, etc.

Clinical subcommittee for physician-nurse issues (generated at the unit liaison meetings) will continue quarterly.

Medical-Surgical areas are conducting team building sessions and role classification for nurses and technicians. Expectations to meet patient care needs and workloads are being redefined.

Recruitment and Retention

Implemented "new" approach to compensation with focus on our experienced nurses.

New "marketing" campaign to attract nurses includes a logo, brochures, slide show and commercial. Focus on highlighting what Mercy has to offer and attracting experienced nurses.

MHA (Maryland Hospital Association) nurse retention survey completed. Results and action plans will be shared with staff during April and May. Major areas for focus included compensation, use of agency staff and meeting role expectations.

(The Morning Report)

HR 4654 IH

107th CONGRESS

d Session

H. R. 4654

To amend the Public Health Service Act to provide programs to improve nurse retention, the nursing workplace, and the quality of care.

IN THE HOUSE OF REPRESENTATIVES

MAY , 00

Mrs. MCCARTHY of New York (for herself and Mrs. BONO) introduced the following bill; which was referred to the Committee on Energy and Commerce

A BILL

To amend the Public Health Service Act to provide programs to improve nurse retention, the nursing workplace, and the quality of care.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the 'Nurse Retention and Quality of Care Act of 00.

SEC. . FINDINGS.

Congress finds the following

(1) The current nurse workforce is aging, and the average age of practicing registered nurses is 4. years, representing an increase of 5. years since 18. This means that the nursing workforce is aging at twice the rate of other occupations in the United States, and the enrollment in nursing programs has decreased in the past 5 years. Many hospitals around the country are reporting vacancy rates for nursing positions.

() Studies have shown a correlation between higher nurse staffing levels and reduction in adverse patient outcomes, including risk of infection, shock, upper gastrointestinal bleeding, and increased length of stay.

() Retention problems are contributing to the nursing shortage problem. According to a 001 survey, 50 percent of nurses say they have recently considered leaving the nursing profession for reasons other than retirement.

(4) A majority of those individuals who are considering leaving nursing express a low level of overall job satisfaction, and their lack of participation in decisionmaking is a major factor contributing to dissatisfaction.

(5) Magnet hospitals are hospitals that have reorganized care to be more participatory, collaborative, and patient-centered and as a result are able to attract more nurses.

(6) Even in times of nursing shortages, magnet hospitals enjoy low turnover. The average length of employment for registered nurses in magnet hospitals is 8.5 years, which is twice the length of employment in hospitals generally, and magnet hospital nurses consistently report greater job satisfaction than other nurses.

(7) Magnet hospitals report lower mortality rates, higher patient satisfaction, and greater cost-efficiency, with patients experiencing shorter stays in hospitals and intensive care units.

SEC. . AMENDMENT.

Title VIII of the Public Health Service Act (4 U.S.C. 6 et seq.) is amended by adding at the end the following

'PART H--INITIATIVES TO IMPROVE NURSE RETENTION, THE NURSING WORKPLACE, AND THE QUALITY OF CARE

'SEC. 851. DEVELOPING MODELS AND BEST PRACTICES IN NURSING CARE.

'(a) PROGRAM AUTHORIZED- From amounts appropriated under section 85, the Secretary shall award grants to eligible entities to enable the eligible entities to carry out demonstrations of models and best practices in nursing care for the purpose of developing innovative strategies or approaches for retention of professional nurses.

'(b) DEFINITIONS- In this section

'(1) ELIGIBLE ENTITY- The term 'eligible entity means a health care facility, or any partnership or coalition containing a health care facility and a collegiate, associate degree, or diploma school of nursing.

'() HEALTH CARE FACILITY- The term 'health care facility means a hospital, clinic, skilled nursing facility, long-term care facility, home health care agency, federally qualified health center, rural health clinic, public health clinic, nurse managed health center, or any other entity as designated by the Secretary.

'(c) PRIORITY- In awarding grants under this section (other than awarding grant extensions under subsection (e)()), the Secretary shall give priority to applicants that have not yet been designated as a magnet hospital by the American Nurses Credentialing Center.

'(d) DISTRIBUTION OF GRANTS- Grants awarded under this section shall be distributed among a variety of geographic regions, and among a range of different types and sizes of facilities, including facilities located in rural, urban, and suburban areas.

'(e) DURATION OF GRANTS-

'(1) THREE-YEAR GRANTS- A grant awarded under this section shall be awarded for a period of not greater than years.

'() GRANT EXTENSIONS- A grant awarded under this section may be extended if the grantee demonstrates that--

'(A) as determined by the Secretary based on the factors described in paragraph (), the grantee has significantly improved the quality of its workplace for nurses and has enhanced patient care; or

'(B) after the original award of the grant, the grantee was designated as a magnet hospital by the American Nurses Credentialing Center.

'() PREFERENCE- In awarding grant extensions under this subsection, the Secretary shall give preference to entities that have--

'(A) significantly increased retention rates for professional nurses;

'(B) significantly reduced rates of workplace injuries for professional nurses; and

'(C) significantly reduced rates of nursing-sensitive adverse patient outcomes.

'(4) MAXIMUM DURATION OF GRANTS- The total maximum duration of a grant under this section shall not be greater than 6 years.

'(f) USE OF FUNDS- An eligible entity that receives a grant under subsection (a) shall use funds received under the grant to carry out demonstrations of models and best practices in nursing care for the purpose of--

'(1) promoting retention and satisfaction of professional nurses;

'() promoting collaboration and communication among health care professionals;

'() promoting nurse involvement in organizational and clinical decisionmaking processes;

'(4) organizing care to enhance the satisfaction of professional nurses, improve the nursing workplace environment, and promote the quality of nursing care;

'(5) promoting opportunities for professional nurses to pursue education, career advancement, and organizational recognition;

'(6) promoting high quality of patient care--

'(A) by enhancing institutional measurement of quality outcomes, including identification and measurement of nursing-sensitive patient outcomes;

'(B) by basing the development of policies, procedures, guidelines, and organizational systems on research findings and patient outcomes measurement, including nursing-sensitive patient outcomes measurement; and

'(C) by involving professional nurses in developing and implementing ways to measure and improve the quality of care;

'(7) promoting a balanced work-life environment; and

'(8) offering such other activities as may be determined by the Secretary to enhance the workplace environment for professional nurses.

'(g) APPLICATION-

'(1) IN GENERAL- An eligible entity desiring a grant under subsection (a) shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require.

'() CONTENTS- An application submitted under paragraph (1) shall--

'(A) include a description of the project proposed to be carried out with grant funds;

'(B) demonstrate the eligible entitys commitment to the project through a statement describing--

'(i) the involvement of high-level executive management, trustees, nurse leadership, and medical staff in designing, implementing, and overseeing the project;

'(ii) the designation of key personnel and management structures to design, implement, and oversee the project;

'(iii) any actions that the eligible entity has already taken that contribute to developing innovative models and approaches for retention of professional nurses; and

'(iv) the eligible entitys funding or any evidence of other contributions and commitment for the project, along with information on overall project budget and funding resources; and

'(C) include information regarding the retention rate and occurrence of workplace injuries to nurses at the entity applying for such grant and any other information as the Secretary may reasonably require.

'SEC. 85. SURVEY AND EVALUATION.

'The Secretary, in consultation with the Agency for Healthcare Research and Quality and the Health Resources and Services Administration shall--

'(1) conduct an annual survey of the projects carried out under section 851 and provide to Congress the results of such survey beginning not later than years after the date of enactment of the Nurse Retention and Quality of Care Act of 00; and

'() develop and provide to Congress, not later than December 0, 007, a final report that--

'(A) evaluates the projects funded by grants under section 851; and

'(B) includes findings about best practices and the impact on patients and staff of employing participatory, collaborative, and patient-centered models of nursing care.

'SEC. 85. AUTHORIZATION OF APPROPRIATIONS.

'(a) GRANTS- There is authorized to be appropriated to carry out section 851, $0,000,000 for the period of fiscal years 00 through 007.

'(b) SURVEY AND EVALUATION- There is authorized to be appropriated to carry out section 85, $,500,000 for the period of fiscal years 00 through

The HeartMath Report

A journal devoted to developments in how thoughts and emotions affect our health, performance and relationships. Major categories include

• education

• emotional intelligence

• healthcare

• heart health

• heart rate variability • mind/body medicine

• positive psychology

• organizational performance

• stress research

If youd like to post comments to the articles, youll need to register - see the Register link in the upper left corner of the screen. If you have any comments, questions, or items to suggest, email the editor at tom@heartmath.com.

Delnor Hospital increases patient satisfaction, employee retention with HeartMath

Diane Ball, R.N., had just about reached her breaking point. I was at a point where I was starting to second-guess my nursing career and position, she says. Familiar reasons like burnout, information overload, changes in technology, time pressures and family issues were starting to take their toll.

Posted on Nov 1, 0 | 100 pm

[0] comments | link

Study Looks at Nurse Workloads

Nurses are getting older and there are fewer of them, leaving patients and hospitals in serious trouble as a work shortage reaches a crisis level in American hospitals.

Nursing advocates warn the staffing situation in hospitals is getting worse and a study published Tuesday in the Journal of the American Medical Association finds the higher the patient-to-nurse ratio in a hospital, the greater the likelihood of patients dying or suffering life-threatening complications from surgery.

Article More...

Posted on Oct , 0 | 111 pm

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US nursing shortage a national security concern

The nursing shortage that is sweeping through the USA is already at a level that has been upgraded from a health crisis to a national security concern, according to report issued by the Institute for Public Policy and Social Research and Institute for Health Care Studies at Michigan State University.

Article More...

Posted on Sep 14, 0 | 4 pm

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Hospitals are being revitalized with HeartMath

While some hospitals are playing bidding wars for registered nurses, other hospitals are evaluating how they can increase employee retention and reinvent their reputation for being a high-quality health care organization. Delnor-Community Hospital, outside Chicago, is such a hospital. They've re-invented their hospital by making their employees and patients their top priority and as a result they've realized $800,000 in annualized savings due to their first-year turnover reduction. Measurables from staff retention to staff satisfaction and patient satisfaction have dramatically improved for Delnor over the past two years.

Article

Posted on Sep 10, 0 | 17 pm

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The Patient Has Turned the Corner

The patient is nursing. There are signs of nascent recovery. This is a good time to review those signs and to focus on the problems that remain and could still doom the patient. But there is reason for hope.

Article

Posted on Sep 06, 0 | 557 pm

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Predicting Nursing Turnover

The nursing shortage problem has continued to devastate labor budgets all around the world. While there are many theories as to why hospitals and other medical providers cannot maintain an appropriate level of staff nurses, the overall demand for nurses will continue to grow. Yet the supply of competent nurses will not ascend to the predicted levels needed to replace the accelerated attrition within the field.

Posted on Jun 05, 0 | 600 pm

[0] comments | link

Retain, recycle, replenish, and recruit

It must be about the same where you live. The newspapers, news magazines, radio, and television news report almost daily on some aspect of the current nursing crisis, or on its sequelae in the world of healthcare delivery. Thats the good news. We need to keep this situation in the public focus.

Posted on Mar 1, 0 | 1001 pm

[0] comments | link

Where Have All the Nurses Gone?

When it comes to recruiting nurses to staff long-term care facilities in Genesis ElderCares Chesapeake region, Deborah Rowe, M.S., R.N., Ph.R., is using tactics shes never considered before

Contentment

Magnet hospitals tend to attract and retain nurses

UC Davis Medical Center nurse with patient.

Youve read the article. Now tell us what you think.

For more information

Magnet Nursing Services Recognition Program

Cedars-Sinai Medical Center

Hackensack University Medical Center

UC Davis Medical Center

By Todd Stein

May 11, 000

When actor Judd Hirsch sang the praises of nurses on a New York radio station late last year, it had an astounding effect on the profession.

We got calls from nurses all over New York saying, 'My God, it was so inspiring,' said Toni Fiore, MSN, RN, chief nursing officer at Hackensack (N.J.) University Medical Center. It showed that people really do care about nursing.

Hirsch, who was paid for his services, announced Hackensack's receipt of magnet hospital status from the American Nurses Credentialing Center (ANCC), an honor that so far only 17 hospitals and one long-term care facility can claim. The award certifies that a hospital meets 14 standards of nursing care, which the credentialing center credits with fostering a pro-nurse workplace. The standards seem to make it easier for a hospital to attract and retain nurses.

The Washington-based, nonprofit arm of the American Nurses Association evaluates nurses' status, freedom to make emergency care interventions without fear of punishment, collaborative efforts to improve patient care with physicians and administrators, and the ratio of nurses to patients.

Magnet recognition is the one award that exists in the nursing profession that recognizes that an institution provides outstanding quality care and service, and is the best place to work for nurses, said Linda Burnes Bolton, DrPH, RN, FAAN, chief nursing officer at Cedars-Sinai Medical Center in Los Angeles, which in January became only the second California hospital to earn magnet status. It's a great feeling.

Cedars-Sinai Medical Center staff with the magnet hospital award, Linda Burnes Bolton, DrPH, is second from left. Photo courtesy of Cedars-Sinai Medical Center

It also is a great promotional tool. Magnet hospitals tend to flaunt their status to draw patients, win grants, beat their competition, and recruit nurses. Hackensack Medical Center splashed its certification on roadside billboards, and Cedars-Sinai handed out free phone cards to its 1,00 nurses at the magnet award ceremony, telling them to call their friends and tell them you work at a magnet hospital, Burnes Bolton said.

In an era of chronic nurse shortages and rampant job burnout, it is understandable why hospitals would go to such lengths to advertise their virtues to nurses. But is the magnet award more than a gimmick?

Definitely, said Linda H. Aiken, PhD, RN, FAAN, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania in Philadelphia, and a recognized nurse-practice researcher. Magnet status is the most positive idea around in this era of re-engineering nursing, she said.

Aiken was the lead author of a recent study that found nurses at the credentialing center's 17 magnet hospitals had higher levels of job satisfaction and lower burnout rates, and gave the quality of care provided at their hospitals higher ratings than did nurses at other top hospitals in the country.

The study, published in the March issue of the American Journal of Nursing, compared nurses' written evaluations of their jobs at ANCC-designated hospitals to those from nurses in 41 hospitals studied in 180-8 by the American Academy of Nursing�what the academy then called magnet hospitals for their high quality of care and their ability to attract and retain nurses.

Aiken and her colleagues are nearing completion of a much broader study of 700 hospitals in the United States, Canada, England and Germany that will research whether hospitals with magnet-like qualities actually produce better care. Our preliminary research to date suggests that the answer to that question is 'yes,' Aiken said. Nursing is the single most important factor in a hospital's ability to save the life of a patient who develops a serious complication.

Aiken estimated that as many as 0 percent of American hospitals could qualify for magnet status under the credentialing center's guidelines. That only 17 have done so reflects more on the center's internal process than on the quality of U.S. hospitals. The center offered magnet certification only as a pilot program in 15, and opened the process to all hospitals just two years ago.

Many hospitals are still not aware of the award. But word is spreading fast. The ANCCreports that 6 hospitals have paid the $500 magnet application fee and are in the early stages of certification.

UC Davis Medical Center

Many hospitals haven't bothered with the magnet program because they're looking for quick solutions to the nursing shortage, such as sign-on bonuses and bringing in travel and registry nurses, said Carol Robinson, MPA, RN, associate director of patient care services at the only other magnet-designated hospital in California, the University of California, Davis, Medical Center in Sacramento. They don't really think about the core reasons that people don't want to come or don't stay.

While the UC Davis center had promoted magnet-like nursing values and programs for years, Robinson said the credentialing center's lengthy certification process encouraged the staff to listen more carefully to floor nurses when making care decisions.

It has really heightened our sense that nurses should be making those decisions from the bedside, she said. Now, every time we make a decision from the perspective of clinical care, we ask'What is it that the staff nurses would want us to do?'

And for our staff, it's a recognition that what they do is of the highest quality, which is a message I think they should hear as often as possible.

FACTS ABOUT AMERICAN NURSES CREDENTIALING CENTER MAGNET RECOGNITION PROGRAM

Program Overview

The Magnet Recognition Program was developed by the American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA), in 14 to recognize health care organizations that provide the very best in nursing care and support professional nursing practice. The program also provides a vehicle for the dissemination of successful practices and strategies among nursing systems.

The Magnet Recognition Program is based on quality indicators and standards of nursing practice as defined in the ANAs Scope and Standards for Nurse Administrators (16) and as identified as forces of magnetism in research undertaken by the American Academy of Nursing in the early 180s. Recognizing quality patient care and nursing excellence, the Magnet Recognition Program provides consumers with the ultimate benchmark to measure the quality of care they can expect to receive.

To obtain Magnet status, health care organizations must apply to the ANCC, submit documentation that demonstrates their compliance with standards in the ANAs Scope and Standards for Nurse Administrators, and undergo an onsite evaluation to verify the information in the documentation submitted and to assess the presence of the forces of magnetism within the organization. Magnet status is awarded for a four-year period, after which the organization must reapply.

Benefits of Becoming a Magnet Designated Facility

Magnet Designation

• Is an important recognition of nurses worth

• Is a major factor in nursing recruitment and retention

• Is a competitive advantage

• Enhances nursing care

• Increases staff morale

• Attracts high quality physicians

• Reinforces positive collaborative relationships

• Creates a magnet culture

• Improves patient quality outcomes

Independently sponsored research projects suggest that Magnet facilities have positive outcomes for patients, nurses and workplaces. Specifically, patients experience lower mortality rates, shorter lengths of stay and increased satisfaction; nurses experience increased job satisfaction, increased perceptions of quality of care given and productivity, and increased RN mix; and workplaces have a lower incidence of needlestick injuries, increased RN retention and recruitment rates, and lower rates of nurse burnout.

For more information on the Magnet Recognition Program and for a list of Magnet facilities, go to www.nursingworld.org/ancc/magnet.htm or call (0) 651-76. (Press may call ANAs Communications Department at (0) 651-708).

The identification of magnet hospitals in the USA.

( A brief summary)

Dr Jenny Carryer

In the 180s the American Academy of Nursing (AAN) conducted a study of US hospitals to identify the organisational attributes of hospitals that were successful in recruiting and retaining nurses during a national nursing shortage. Six AAN fellows in each of 8 regions of the country were asked to select 6 to 10 hospitals according to the following criteria

1) Nurses consider the hospital a good place to practice nursing.

) The hospital has the ability to recruit and retain professional nurses, as evidenced by a relatively low turnover rate.

) The hospital is located in an area where it will have competition for staff from other institutions and agencies.

A total of 165 hospitals were nominated, 155 of which agreed to take part. Each hospital provided information on a range of nursing-related issues including nurse vacancy, turnover and absentee rates; the ratio of inexperienced to experienced nurses; use of supplementary staffing agencies; nurse staffing policies; educational preparation of nurses in leadership positions; and the predominant mode of nurse organisation on the units (primary, team, functional or other). Hospitals were then ranked and staff nurses and directors of the top 41 were interviewed. These 41 hospitals were awarded "magnet hospital" designation.

Key characteristics

The magnet hospitals shared certain organisational features that served to promote and sustain professional nursing practice. These features included

® a flat organisational structure (see following section);

® unit-based decision-making processes decision making was decentralised to the unit level, giving nurses on each unit as much discretion as possible for organising care and staffing in a manner most appropriate to the needs of their patients

® influential nursing executives the nurse executive was a formal member of the highest decision-making body in the hospital, which signified the high priority that hospital administrators placed on nursing

® investments in the education and expertise of nurses

® the administrative structures supported the nurses' decisions about patient care

® good communication existed between nurses and physicians

® very high patient satisfaction

® excellent RN to patient ratio

® a decrease in hospital acquired infections, falls/other injuries, and medication errors and related complications

® very low RN turnover rate

A sub-set of 16 of the originally identified magnet hospitals was followed throughout the 80s and early 0s. It was found that these hospitals not only maintained the "attributes of magnetism" but also continued to enhance their nursing practice environments to more closely approximate the "ideal" professional nursing practice model through the following strategies

® Moving towards all registered nurse (RN) staffing

® Increasing the RN-to-patient ratios

® Continuing to flatten organisational structures

® Implementing shared-governance initiatives

® Implementing RN salaried status as opposed to hourly wages

® Implementing flexible and varied nursing care delivery models designed to meet patient and staff needs throughout units within the organisations.

These hospitals continued to be distinguished for their quality patient care, nurse autonomy, education and striving for excellence.

Currently the American Nurses Credentialling Centre (ANCC) designates magnet status by way of the Magnet Recognition Program process that includes a rigorous self-assessment, documentation, site visit and review. Magnet status is awarded for a four-year term and The Magnet Award is the highest award a hospital can receive for outstanding achievement in nursing services that highlights a commitment to excellence. Measurement criteria is based on outstanding performance on the following fourteen standards as indicated in the Scope and Standards for Nurse Administrators document (16, Publication No. NS-5 available through American Nurses publishing at 1-800-67-0)

1. Assessment

. Diagnosis

. Identification of outcomes

4. Planning

5. Implementation

6. Evaluation

7. Quality of care and administrative practice

8. Performance appraisal

. Education

10. Collegiality

11. Ethics

1. Collaboration

1. Research

14. Resource utilisation

Nursing structure

A key characteristic of the original magnet hospitals was that nursing services were organised in a flat organisational structure with few supervisory personnel, rather that a pyramid structure composed of many layers.

The organisation of nursing in magnet hospitals has consistently demonstrated three distinct core features that are elements of a professional nursing practice model

® Professional autonomy over practice

® Nursing control over the practice environment, and

® Effective communication between nurses, physicians and administrators.

This enables nurses to use their knowledge to do for clients what they know should be done in a manner consistent with professional standards. This is key for providing high-quality and cost-effective patient care because

® RNs are the healthcare providers who perform round-the-clock patient surveillance

® They are physicians' primary source of information about changes in their patients

® Nurses often have to act in the absence of the physician when timely intervention is required

Thus nurses are positioned as the providers most likely to identify the early stages of complications and, in some cases, are the providers who are first in line to intervene. What is noteworthy about the professional practice models identified in magnet hospitals is that they may provide the organisational support that enables nurses to exercise their professional knowledge, judgement, and skill to initiate intervention to "rescue" patients from dire and costly consequences.

Patient outcomes demonstrated at magnet hospitals.

This was written prior to the recent release ( December 001) of outcome related information which has increased the recognition of links between RN staffing and patient outcomes.

The organisational characteristics that attract nurses to magnet hospitals have also been found to be consistently and significantly associated with better patient outcomes than those of matched non-magnet hospitals.

A study of mortality rates in Medicare patients compared magnet hospitals with 15 matched comparison hospitals controlling for hospital characteristics which had been previously suggested to influence patient mortality (such as ownership, teaching status, size, location, financial status, physician qualifications, technology index and emergency admissions). Results suggested that magnet hospitals had lower mortality rates than those in matched hospitals by approximately 5 per 1000 (4.6, 0.-.4 5% CI). As magnet hospitals differed from their matched controls on skill-mix, nursing staff differences were controlled in subsequent analyses but the mortality differences remained.

Another study investigated mortality rates in AIDS patients and found up to 60% lower mortality rates in scattered bed units in magnet hospitals when compared with similar units in non-magnet hospitals. Other outcomes measured demonstrated significantly higher levels of patient satisfaction, lower levels of staff burnout and fewer needle-stick injuries in nurses. In addition, research has shown that nurses working in magnet hospitals reported significantly higher levels of job satisfaction than their non-magnet colleagues reported and, specifically, report that their administrators were more supportive and placed a higher value on nursing.

While magnet hospitals have been shown to have higher nurse-to-patient ratios than other hospitals, the cost of more nurses was more than offset by significantly shorter lengths of stay and lower utilisation of ICU days.

According to a report by the Centre for Outcomes and Policy Research, Aiken, Sochalski and Silber have expanded the patient outcome measures beyond hospital mortality rates to include "failure-to-rescue", described as "a promising nurse-sensitive measure that captures the mortality rate among patients who experience serious inpatient complications". The measure has been shown to be inversely related to nurse staffing levels.

References

Aiken L. H., Havens, D. S., & Sloane, D. M. (000). The Magnet Nursing Services recognition Program, A comparison of two groups of magnet hospitals. American Journal of Nursing, 100(), 6-5.

Aiken, L. H., Smith, H. L., & Lake, E. T. (14). Lower medicare mortality among a set of hospitals known for good nursing care. Medical Care, (8), 771-787.

Havens, D. S., & Aiken, L. H. (1). Shaping systems to promote desired outcomes. The magnet hospital model. Journal of Nursing Administration, (), 14-0.

Center for Health Outcomes and Policy Research. University of Pennsylvania School of Nursing. www.nursing.upenn.edu/doctoral/research/center_for_health_outcomes_and_p.htm

www.hospitalhub.com/resources/career/magnete101/.

Sunday, March 5, 001

Respect for nurses drives success at St. Elizabeth

Good pay and chance for input result in low turnover

By Tim Bonfield

The Cincinnati Enquirer

Most Tristate hospitals have been struggling to hire nurses.

The problem is so severe that hospitals have diverted record numbers of life squads elsewhere five of the past six months.

Tracei Schack (right), a registered nurse, drops by to show her newborn to fellow nurses.

(Patrick Reddy photos)

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One exception is the St. Elizabeth Medical Center group in Northern Kentucky.

Unlike their big competitors north of the Ohio River, St. Elizabeths three hospitals in Covington, Edgewood and Williamstown are not desperate for nurses. They are not facing financial crises. And they are not sending life squads someplace else every other day.

St. Elizabeth has been adding beds and services while other hospital groups have endured closings and deep cutbacks. Along the way, St. Elizabeth is quietly developing a reputation for low cost and high quality, especially in cardiac services.

"The key to all this has been the nurses," said Joe Gross, St. Elizabeth president and chief executive. "Our product is patient care, and the biggest raw material in that product is our nursing employees."

SURVEY HIGHLIGHTS

A survey for the Greater Cincinnati Health Council conducted in December and January measured job satisfaction views of 6 randomly selected hospital nurses

• 77 percent were somewhat or very satisfied with their jobs

• 5 percent said excessive patient-to-staff ratios or intensity of workload would be most likely to make nurses quit

• 5 percent would not recommend nursing as a career to friends and relatives

Of those who would not recommend nursing as a career, reasons included

• 5 percent citing inadequate pay and benefits

• 1 percent citing intensity of workload

• 0 percent citing lack of professional respect

When asked What one change would most increase their likelihood to stay on the job?

• 47 percent said provide adequate staffing

• 4 percent said increase pay and benefits

• 10 percent said professional respect and recognition

• 8 percent said improved communication and better management

Source Greater Cincinnati Health Council

ST. ELIZABETH

Founded 1861 in Covington.

Locations Covington, Edgewood, Williamstown.

Affiliations Catholic Healthcare Partners, Archdiocese of Covington.

Employment About ,00, making it Northern Kentuckys third-largest employer.

Patient volume More than ,000 inpatient admissions per year, ,000 emergency visits and 50,000 outpatient visits per year.

Awards June 000 HCIA-Sachs rated its heart services among the top 100 in the country; April 000 Healthgrades.com rated its cardiac program among the top percent nationwide, including five-star ratings in specific surgeries and treatment of heart attack; Fall 000 Data Advantage Corp. ranked it among the nations 100 lowest-cost providers for 0 of the 50 highest volume services provided by hospitals; April 1 St. Elizabeth featured in a front-page Wall Street Journal article; August 1 St. Elizabeth Medical Center named the nations 0th "Baby-Friendly" hospital by an affiliate of UNICEF.

No hospital, not even at St. Elizabeth, is having a rosy time. But its confrontation with economic troubles offers insight into issues facing hospitals today.

Among the signs of success at St. Elizabeth

• With a $5.6 million profit on operations, St. Elizabeth was the only big hospital group in the Tristate that made money in 000. It earned enough to give nurses a 6.5 percent raise this year and all employees a bonus averaging $500. Cincinnatis biggest hospital groups the Health Alliance of Greater Cincinnati, TriHealth and Mercy Health Partners have reported losses and closings in recent years. Mercy Hospital in Hamilton is the latest, expected to close by June 1.

• St. Elizabeth has about half the nurse vacancies other Tristate hospitals face. The average nurse has worked there more than 10 years.

• The hospital group hasnt gone on diversion at all in 001. Hospitals go on diversion when they are swamped, directing life squads to take all but the most unstable patients someplace else. Through February, Jewish Hospital declared 41 diversions; Christ Hospital, 6; Good Samaritan and Bethesda North, 15 each; and University Hospital, 1.

• St. Elizabeth has collected several industry awards since 1, including a ranking among the nations 100 lowest-cost hospitals and among the nations top 100 hospitals for cardiac care.

• St. Elizabeth has been adding services, including a new cancer wing in 000 and a womens health unit this year in Edgewood. It also recently tripled the size of its emergency department in Williamstown.

St. Elizabeth has spent years building a culture of respect for nurses, Mr. Gross said.

"At its best, nursing is no cakewalk," he said. "Its a demanding profession, emotionally and physically. We try to let nurses do what they like to do care for the patient and work with their families."

Other nurses in the Tristate notice.

"Nurses are staying there," said Cheryl Townsend, a nurse at University Hospital. "They seem to have a family atmosphere. They seem to have a close connection between the administration and the nurses that do the work."

St. Elizabeths treatment of nurses is uncommon, said Dr. Linda Aiken, an expert at the Center for Health Outcomes and Policy Research at the University of Pennsylvania.

Hospitals nationwide are failing to retain nurses, she said, because they no longer offer the pay, the involvement and the institutional support nurses expect. Hospitals are less able to compete for nurses with home-care services and doctors offices.

"There are plenty of nurses in the United States at the moment," Dr. Aiken said. "But they dont feel good or safe about the work theyre doing in hospitals.

"There are some hospitals out there, like St. Elizabeth, that are developing those conditions. But most hospitals are way, way, way behind in terms of modern approaches to managing their workplaces."

St. Elizabeth can afford to offer the highest average hourly pay for nurses in the region $0.8 per hour. And the hospital group involves nurses in many decisions, such as what supplies to buy and how to staff the units.

Perhaps most important, St. Elizabeth avoided two morale-bursting policies common among Cincinnati hospitals It does not pay large signing bonuses to new employees. And it does not hire temporary-agency nurses.

At some hospitals, as many as half the nurses in hard-to-fill shifts are temporary staff, Mr. Gross said.

Nurse Melanie Ingram and social worker Jim Bishop.

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"Nurses dont like working with (agency) nurses that get higher pay than they do but dont know the hospital as well," Mr. Gross said. "They dont like seeing new co-workers getting bonuses they dont get."

St. Elizabeths willingness to close medical units rather than overburden nurses also breeds loyalty, said Jane Swaim, who left University Hospital five years ago to become vice president of nursing at St. Elizabeth.

"The administration truly supports nursing. Ive had (nursing staff) increases every year Ive been here," she said.

Melanie Ingram, 4, has been a nurse at St. Elizabeth since 1. She came to the hospital because it offered much higher pay than the hospital near her home in Milan, Ind. She stayed because she feels involved in how the hospital runs.

"I have a vested interest in seeing that things go well," Ms. Ingram said.

At other hospitals, temporary nurses often dont get involved in planning or solving problems, Ms. Ingram said.

St. Elizabeths location also has contributed to its growth during difficult times for health care.

A Rays of Hope pin means an employee contributes to the "Vision" program.

St. Elizabeth is 140 years old, and is Northern Kentuckys third-largest employer. The areas continuing influx of residents and businesses provides its hospitals with employees, volunteers and financial support.

The sense of pride at St. Elizabeth can be measured in hard dollars More than 75 percent of employees give part of their pay to the hospital groups "Vision" program, contributing $1.5 million for various hospital projects.

St. Elizabeth moved its main hospital from a limited-growth location, Covington, to a fast-growing suburb, Edgewood.

The greater demand has given the hospital greater leverage with health insurers.

In contrast, many of Cincinnatis biggest hospitals remain concentrated in older neighborhoods with shrinking populations. Until the mid-10s, the state blocked them from moving into growing suburbs.

St. Elizabeth also avoided the waves of hospital consolidations, which led to downsizings, closings and management reorganizations at Health Alliance, TriHealth and Mercy Health.

St. Elizabeth is not immune to the industrys ills. It still copes with tight reimbursement from insurers and a shrinking pool of nurses. The hospital group has vacant nursing jobs.

"Lots of days, I think I cant walk one more mile," Ms. Ingram said. "But the reasons I went into nursing are still there. I always wanted to fix things for other people."

socialist newsweekly published in the interests of working people

Vol. 64/No. 8 October , 000

Striking Washington nurses Treat us with respect

BY JANICE LYNN

WASHINGTON--A sea of picket signs reading RNs on Strike, filled the streets here outside the Washington Hospital Center September 0, as more than 1,00 nurses walked out. Some held handmade signs saying, We have a life, no more mandatory overtime. A number of passing cars and trucks honked their horns in support.

The issue is not money, but working conditions and quality of care for patients, explained Sharon Clark, who works in emergency surgery and has years at the hospital. Clark is local president of the D.C. Nurses Association. Our members can be told at the end of the shift, without prior notice, that they will have to stay another two to four hours. They dont care how that affects your family or that you need to be home for your kids after school, Clark said.

They need to adjust the staffing, declared Greg Pelletier who works in the cardiovascular recovery room. Were tired of working 1-hour shifts every day. And we want to be treated with some dignity and respect, he added. There are times when you dont even get a lunch break. This was the first walkout since 178 when nurses struck for 1 days for union recognition.

Kiveyette Nelson, 1, just started working at Washington Hospitals Intensive Care Unit in August after graduating from Delaware State University. I came here in the midst of this, but I feel the nurse-patient ratio is very important for giving people safe care, Nelson said. If youre overloaded, stress and burnout sets in. On the picket line, many young nurses said this was their first job and their first strike.

Jeanette Walker works in neonatal care, and has 8 years at the hospital. Sometimes nurses have as many as eight patients to care for. This means youre making rounds from one patient to the next the entire shift, increasing the odds that something serious can happen to one of the patients while youre trying to complete the round, she said. Walker explained the turnover was very high because of the mandatory overtime and the lack of a decent benefits package, where not everyone has full medical coverage.

Linda Pope, a nurse at D.C. General Hospital, came to show her support for the strike at Washington Hospital. This fight and the fight to keep D.C. General Hospital open is part of the same thing, she said. If D.C. General closes, nurses here will face even more mandatory overtime and the quality of care will be badly affected. Iron workers, teachers, and others have joined the picket lines.

The hospital brought in replacements from an outfit called U.S. Nursing Corp., which specializes in strike-breaking. Along with the bosses they are trying to keep the hospital operating. Patients beware, management giving care, is one of the chants on the picket line. The employers have embarked on a media campaign to try to portray the nurses as overpaid and insensitive to patients needs. The nurses explain that they want a voice in setting hospital policies and that they are determined to hold out for their demands.

Sam Manuel, Socialist Workers candidate for D.C. Delegate to the House of Representatives, contributed to this article.

Respect Medical Services

Contact Patrice Foster, President

1718 Knights Road

Philadelphia, PA 1154

Phone 866-757-544

Email PFo10668@aol.com

http//www.respectmedicalservices.com

FOR IMMEDIATE RELEASE

NOW MORE THAN EVER, AMERICA NEEDS NURSES

In the wake of terrorist attacks, Americas nurse shortage is being strongly felt

Philadelphia, PA -- In a recent speech about the September 11th terrorist attacks, President George W. Bush stated that, the hour is coming when America will act, and you will make us proud. As our President and other government and military officials have clearly said, America will take military action to punish those involved in the tragedies of last month, which took thousands of American lives and injured hundreds of others.

Now more than ever, when America is staring war in the face, hospitals and other medical facilities need to be fully staffed with nurses and other qualified personnel. Our boys could be going to war any day now, says Patrice Foster, President of Respect Medical Services, and America is short on nurses as it is. Nursing schools, hospitals, and medical staffing firms need to join forces now, forming an alliance to care for those who will be injured.

Especially over the past few weeks, America has felt the immediate and potential need for nurses, as well as the shortage were currently suffering from. Especially back east, we have a lot of big cities from New York, to Philadelphia, to Atlanta, and as weve seen, these cities can be attractive targets for such attacks, says Foster.

One solution to the nursing shortage problem, in addition to heavy recruitment of nursing students, is for hospital administrations and medical staffing companies to work together to find, recruit, and handle the staffing issues of new nurses, says Foster.

If and when America goes to war, whether with Afghanistan or any other country, experts say were going to need more medical staff than we have right now to cope with the injuries. That includes recent graduates as well as those currently out in the field.

Our firm specializes in matching nurses with facilities and the associated staffing work, and I can tell you that firms like ours are a great resource that are extremely under-used. says Foster. Its a problem that can be solved, but we must be willing to start now and work together, for the good of our country.

For more information about finding or filling a nursing, physician, or mental health position, see http//www.RespectMedicalServices.com.

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