While some healthcare organizations in the U.S. have enough nurses to fill their vacancies, others are struggling with a nursing shortage.
One area experiencing a nursing shortage is Erie, Pa. Understanding what is causing the shortage, and finding ways to lessen its impact with nursing shortage solutions, are key to maintaining high-quality care and safe staffing levels.
Possible causes of Erie’s nursing shortage
When Claire Zangerle, DNP, MBA, RN, FAONL, NEA-BC, chief nurse executive of the Allegheny Health Network in Pittsburgh, joined AHN in fall 2016, the vacancy rate was 16%. It’s now 8%.
“We’ve done a lot to alleviate the shortage and our turnover rate is better,” she said.
One of the causes for the nursing shortage in Erie was the passing of the Affordable Care Act, Zangerle said.
“No one asked us if we could satisfy the needs of increased numbers of patients with our workforce,” she said. “When the influx of patients came, many had waited for care due to a lack of insurance and were among the sickest — with many comorbidities. We soon realized we needed more staff to maintain quality.”
Another factor playing into the nursing shortage is a lack of nursing instructors.
“With a shortage of instructors, the wait times to get into nursing school are longer,” Zangerle said. “The long wait discourages some potential nursing students who then move on to other professions. Nursing schools need to up their game and compensate their instructors more.”
Weather also plays a contributing role in the nursing shortage.
Erie is in a snowbelt, and the harsh winter conditions can make it more challenging to recruit and retain nurses, said Jim Donnelly, MBA, BSN, RN, chief nursing officer and vice president of patient care services at the University of Pittsburgh Medical Center (UPMC) Hamot. “We don’t have a California climate here in Erie,” he said.
Even though there is a cyclical shortage of nurses in Erie, Donnelly said UPMC Hamot has a more blunted experience of the shortage.
“We’re an institution that grows our own,” he said. “We offer robust professional development options and partner with schools for educational opportunities.”
Zangerle said nurses are needed not only in acute care hospitals, but also in cancer and ambulatory care centers, home health, hospice and in the community.
“We also see more of a shortage in certain specialties such as behavioral health, the ICU and telemetry,” she said.
There is not usually a focus in nursing schools to train nurses to work in behavioral health.
“Many students come out of nursing school focused on working med/surg,” Zangerle said. “We need to increase awareness of the needs of behavioral health patients and the opportunities for work in behavioral health. There is not as severe a shortage in Erie for ICU and telemetry when compared to behavioral health. However, we continue to work hard to recruit for these specialties too.”
The OR is a specialty many nurses stay in for a long time, which is having an impact on the shortage.
“With the good economy right now, we’re seeing many OR nurses choosing to retire, so we’re losing a lot of experienced OR nurses and need to fill these positions too,” Zangerle said.
Nursing shortage solutions to increase recruitment and retention
Part of the strategy of growing their own at UPMC Hamot involves offering professional development through educational and leadership opportunities.
“We’re in a small market and wanted to create an attractive environment so people want to work here,” Donnelly said. “Some examples of educational programs range from a CRNA program in partnership with Gannon University to a BSN-to-DNP program in partnership with the University of Pittsburgh.”
UPMC Hamot also offers an in-house leadership development program as a nursing shortage solution.
“Nurses are required to have two years of practice first,” Donnelly said. “We train two nurses at a time over 90 days. They become part of the executive team, learn the nuts and bolts of leadership and management, and have opportunities to network with others.”
The Hamot Health Foundation is another path for nurses (and allied health professionals) to pursue more education through scholarships.
“Over the last five years, the Hamot Health Foundation has awarded approximately $1 million in scholarships,” Donnelly said.
UPMC Hamot achieved Magnet designation in 2016.
“Having a Magnet designation and a highly engaged nursing workforce and culture is attractive to other nurses and helps with recruitment and retention too,” he said. “Helping nurses achieve an advanced degree status means they’ll earn more money in the long term as money compounds and it provides more professional opportunities. This impacts my retention rates in a positive way and reduces my nursing turnover.”
Zangerle said the nursing shortage solutions used at AHN to recruit and retain nurses are not a one-size-fits-all strategy.
“If we try one program and see it’s not working, we’ll change our approach,” she said. “AHN is currently utilizing several strategies for recruitment and retention.”
AHN has a return-to-practice program for experienced RNs who have been away from nursing and want to get back into the profession.
“The program is called, ‘RetuRN,’” Zangerle said. “We offer these nurses a refresher course in conjunction with the University of Delaware and clinical rotation and flexible scheduling to help them ease back into the workforce. They’ll have a lower pay rate with the flexible scheduling. However, many find this a helpful way to get their foot back in the door while still fulfilling their other life commitments.”
One useful method to attract experienced RNs to AHN is offering a sign-on bonus and preferred shifts to experienced nurses.
“This attracts experienced RNs who want to join us but don’t want to be at the bottom of the ladder with a shift they don’t like,” Zangerle said.
Using foreign nurses when necessary to fill staffing needs has also helped AHN, said Zangerle, as their contracts are for three years, as opposed to 13 weeks for registry nurses.
“Having more staff lightens the workload for all,” she said. “This in turn helps to decrease our turnover and increase our retention rates.”
Why one organization isn’t experiencing a shortage
There is one Erie-based healthcare provider that’s not experiencing a nursing shortage, said Mary Jane Antoon, MSN, RN, NEA-BC, FACHE, administrator at Shriners Hospitals for Children.
“There is a need for nurses in Erie, however, we’re isolated from the shortage here at Shriners, and for a few reasons,” she said. “We don’t hire new grads and only hire BSNs with experience. We transitioned to an ambulatory care model in 2012 and operate Monday through Friday, so we don’t require nights, weekends or holidays. We offer great educational benefits and reimburse nurses for certifications once they successfully pass.
“We all live by our mission, which is caring for children,” Antoon said. “This helps us retain staff. We have a low turnover rate. We’re proud of the work we do.”