Outlook 2012: Newer approach to nursing
Hospitals constantly working to get enough RNs to satisy expanding demand
CAPITAL REGION After decades of growth in skilled nursing for every subtype of care, from preemies in nurseries to cancer patients in hospice care, the field is expanding further.
Or perhaps it’s returning to its roots.
New jobs being created in the nursing field include nurse navigators and others who are entrusted with creating an entire health system for the patient. These nurses aren’t focused on blood pressure and medicine checks. They sit down with the patient to talk about home life, health insurance and support groups for their diagnoses.
“That’s where nursing is heading,” said Ellis Chief Nursing Officer CeCe Lynch. “Nursing is starting to come full circle, to the caring profession it was intended when it started.”
During her career, she’s seen nursing become more and more technical, with nurses specializing in particular fields.
But that’s changing, partly because patients demanded more than being woken up in the middle of the night for a blood draw.
“If you look at the basics, they want to know that you care about them,” she said. “We’re trying to get back to the basics of caring.”
SCRAMBLING FOR STAFF
And that means more jobs — as well as the nursing jobs that are already available. The spectrum runs from home health aides to laboratory techs to licensed practical nurses and registered nurses.
They’re all in demand. For workers, that means there are plenty of jobs to choose from. For employers, that means the effort to recruit, hire, train and mentor is never-ending.
Ellis Medicine in Schenectady hires about 100 nurses a year, a pace that requires constant recruitment. They turn to the Ellis School of Nursing for half of their new employees and hire experienced nurses to fi ll the rest of the vacancies each year.
Albany Medical Center pays employees to become RNs, paying for their time as well as for teachers and books. In return, the new nurses agree to stay at Albany Med for up to four years, said Vice President of Patient Care MaryEllen Plass.
The program began in 2002, during a nursing shortage in which the hospital had about 200 vacancies.
So far, 67 nurses have graduated. That’s not enough to fill the hospital, which employs 1,400 nurses, but it is a start.
The hospital also trains nurses to handle more than one specialty, so they can fill in when there’s a sudden vacancy on another unit.
“If we do ask people to float to other units, we don’t expect them to take a full assignment. We would expect them to partner with their colleagues,” Plass said.
Nursing schools also filled classes to the maximum to pump out more nurses, and a national campaign brought attention to the industry, she said. That brought many more nurses into the pipeline to resolve the immediate crises, she said.
But it still wasn’t enough to keep Albany Med running. So the hospital contracts with an agency to hire nurses from the Phillipines. There, too many nurses graduate each year, and all of them have bachelor’s degrees in a curriculum similar to the one in the United States. Two Albany Med officials fly to the Phillipines every year to interview and hire about 10 nurses, who must then apply for a visa on their own. “It is expensive,” Plass said. It’s also time-consuming, and sometimes the nurses can’t get visas because of tightened quotas. But she says the hospital will likely need to keep recruiting from overseas.
She expects to see a nursing shortage again in the next few years as baby boomer nurses retire. When the recession ends, she expects to see another wave of retirements from nurses who couldn’t afford to retire at their expected retirement date.
At Saratoga Hospital, the need is already so great that they have a full-time nurse recruiter.
“I think that makes a big difference. We’re in constant recruiting mode,” said Human Resources Director Marcy Dreimiller.
Top officials meet weekly to go over vacancies. Part of the problem is that they can’t simply put any nurse into an open slot.
“Nursing is very specialized now. A nurse on a telemetry unit is not the same as a surgical nurse,” she said.
Nurses have told her that they can’t fi ll some vacancies for even one shift.
“They’ll say, ‘There’s 150 drugs on the cardiac floor, I don’t even know what they’re for,’ ” Dreimiller said. “It can be very technical, very focused.”
The small hospital also spends $300,000 a year on tuition assistance to encourage RNs to get a bachelor’s degree in nursing, rather than a two-year degree. Twenty-four RNs are in that program now.
The hospital pays for everything: tuition, books, even study time. Teachers from Maria College come to Saratoga Hospital once a week to run classes.
Nurses are also offered money for tuition if they want to sign up for classes somewhere else.
“Our focus right now is that higher-educated nurse,” Dreimiller said. “Research shows there are less errors, there’s higher patient care. The bachelor’s degree focuses more on aspects around critical thinking, information technologies.”
Saratoga Hospital also offers tuition funds to employees who want to become nurses. Ten workers are enrolled in that program now.
“That is purely to increase the number of RNs,” Dreimiller said. “Demand exceeds supply. You don’t have enough coming out of the schools.”
But there’s a dark side to the constant need for new nurses: Hospitals must keep hiring because many nurses leave.
Lately, Albany Medical Center’s director of the center for learning and development has seen nurses leave for smaller offices and clinics, rather than abandoning nursing altogether. But the turnover rate emphasizes that while the jobs are available, they aren’t easy work, Director Alicia Williams said.
Most hospitals now have plans in place to ease nurses into the job, mentoring them and attempting to smooth over the “reality shock,” as officials from Ellis and Albany Med called it.
Ellis assigns a mentor to nurses for the first year as they adjust to the pace of hospital work.
“When you look at nurses in schools, they’re used to taking care of one, maybe two patients,” Lynch said. “They’re now responsible for that whole system of care for a number of patients. They are the drivers of care. That role is not engrained in them in school.”
The nurse must not only take care of the patient’s diagnosed medical needs but also find out “what else is going on,” Lynch said.
Their job? To plan and coordinate all services, from support groups to visiting nurses to assistance getting to a grocery store.
“They make sure they send the patient on discharge ready to manage their care,” Lynch said.
At Albany Med, the focus is also on nurse’s self-care.
“You have to take care of yourself first if you’re going to take care of others,” Plass said. “Rest and relaxation. Physical activities.”
Albany Med now has a gym, which is open to all employees. It also offers free massages and meditation rooms.
Dreimiller also thinks nursing is shifting as state and federal funding rewards patient outcomes.
“How do we prevent them from being re-admitted? That’s a huge focus,” she said. “There’s going to be a lot more work on patient compliance, discharge instructions.”
Nurses must be given the time to create a discharge plan that the patient will actually follow, she said. Nurses are already feeling the time crunch.
“It does take time,” she said. “In the nurse role, you can only do so much. It’s going to continue to evolve.”