BY: GORDON BURNSIDE
A New Book from the American Hospital Association Addresses the Growing
Crisis
No health care leader needs to be told that the contemporary United
States is facing a workforce crisis. In 2001, 84 percent of U.S. hospitals reported
a shortage of registered nurses (RNs); 71 percent reported a shortage of radiology/nuclear
imaging technicians; and 46 percent reported a shortage of pharmacists.* Although
the deficits were less dramatic for other categories of health care workers,
they continued across the board.
* All statistics cited in this article are from AHA Commission on Workforce
for Hospitals and Health Systems, In Our Hands: How Hospital Leaders Can
Build a Thriving Workforce, American Hospital Association, Chicago, 2002.
Nor is the situation likely to soon get better. Hospitals are increasingly
having a difficult time hiring new workers—and at the very moment when those
workers are needed most. Not only is the U.S. population as a whole aging; the
vast "baby boom" generation will soon begin entering its 60s. To provide high-quality
care for its citizens, the United States must first find a way to staff its
health care organizations. The nation, which had 10.9 million health care workers
in 2000, will need more than 14 million of them by 2010!
Unfortunately, this workforce crisis comes at a time when people are finding
careers in health care less attractive than formerly. Women, for example, used
to take hospital jobs because they had few other options. Today women are free
to work in any field they choose. The same is true for ethnic and other minorities.
To help hospitals meet the workforce crisis, the American Hospital Association
(AHA) formed the AHA Commission on Workforce for Hospitals and Health Systems.
Last year, that group published In Our Hands: How Hospital Leaders Can Build
a Thriving Workforce. The book is organized in five chapters, each of which
offers a key to the recruitment and retention of workers. Each of the five keys
is illustrated by a description of recruitment/retention efforts at AHA member
hospitals.
Readers will note that CHA-member organizations are mentioned in a number
of the book's recruitment/retention efforts. Many AHA-member hospitals also
belong to CHA.
Foster Meaningful Work
"Today," the authors write, "many workers see hospitals as traditional, bureaucratic,
and driven by rules and regulations rather than caring." To change this perception,
health care leaders must work with employees to redesign jobs and make them
more meaningful.
Via Christi Regional Medical Center, Wichita, KS, has created what
it calls an "Attending RN" care model for its nurses. Attending RNs staff nursing
clinical practice groups that, like similar physician groups, accept responsibility
for evening and weekend coverage. Each group has a rotating chairperson who
facilitates group decisions regarding practice issues. Attending RNs take rounds
with attending physicians and manage patients' clinical needs through coordination
of an outcomes-driven team effort.
Teams are also at the heart of a new care model adopted by the Veterans
Health Administration (VA). At VA hospitals, multidisciplinary teams—including
physicians, advanced practice nurses, physician assistants, pharmacists, and
other health professionals—provide a coordinated continuum of care to a defined
population. In essence, the teams are group practices.
Improve the Workplace Partnership
"The overall situation will not improve if employees leave organizations as
fast as new workers are hired," the authors say. "Retention is just as important
as recruitment."
In efforts to make their workplaces more employee-friendly, both St. Marys
Hospital Medical Center, Madison, WI, and Baptist Hospital, Pensacola,
FL, are promoting a "no secrets" culture.
St. Marys leaders share as much information—from data on financial trends
to strategic and legislative initiatives—as possible with staff members. Nurses
have a voice in the hospital's strategic planning. At Baptist Hospital, quarterly
meetings provide employees with information concerning finances, patient satisfaction,
quality measurement, and other matters.
Mission St. Joseph's Health, Asheville, NC, teamed up with the federal
government's Fannie Mae and a local housing coalition to make home ownership
part of the hospital's benefits package. The program offers home-buyer education
and assistance in securing loans.
Broaden the Base
"The health care workforce does not mirror the diversity of the general U.S.
population," the authors write. "Ethnic and racial minorities are severely underrepresented."
In an effort to increase minority representation, SSM Health Care,
a St. Louis–based system, has launched an initiative that requires diversity
training for all employees; offers a diversity mentoring program; sponsors internships
and summer development programs for minority students; and presents a Diversity
Forum that brings together people of color, different ethnicities, and disabilities
to network and enhance their leadership skills.
The Arizona Hospital and Healthcare Association's Salsbury Scholarship
Program awards scholarships to Hispanic, African-American, and Native American
students seeking careers in health care. Clarian Health Partners, Indianapolis,
has joined the Indiana Minority Health Coalition in promoting activities and
events that encourage minority youth to pursue careers in health care.
Collaborate with Others
Health care has become a highly competitive field. "Unfortunately," the authors
note, "that sense of competition has extended to the workforce arena. . . .
The Commission firmly believes that collaboration, not competition, is the key
to solving the growing workforce shortage. The fact is, the work that must be
done is too overwhelming for most hospitals to accomplish on their own, and
partnerships are essential."
One example of such a partnership is that involving Lakes Region General
Hospital, Laconia, NH, and Franklin General Hospital, Franklin, NH.
The facilities have formed what they call the Nursing Resource Network, a group
of intensive care unit (ICU) nurses, who shuttle between the two ICUs as the
need for them arises. A similar partnership exists among Westbrook Health
Center, Tracy Area Medical Services, and Murray County Memorial Hospital,
three rural facilities in southwest Minnesota, which have teamed up to share
both medical and administrative personnel, as well as equipment.
Northwestern Memorial Hospital, Chicago, has collaborated with the
city's public school system to develop a Medical and Health Careers Academy.
Through the academy, two high schools immerse their students in health care
topics, skills, and career options; volunteers from the hospital visit the schools'
classrooms to discuss health care work.
Build Societal Support
"The American public, businesses, and governments all count upon a well-staffed
hospital system," the authors note. "Just as hospitals must make changes to
address the workforce shortage, the broader society must also understand and
support the actions that must be taken to eliminate the shortage of caregivers
and support personnel."
To ensure that hospitals are well-staffed, the commission urges the United
States to:
- Increase its investment in the health care system
- Provide the resources hospitals need to invest in new technologies that
improve work and patient care
- Reduce the excessive regulations and standards that result in the paperwork
and fragmentation that are a major source of worker dissatisfaction
- Reform the many employment policies that favor retirement and discourage
creativity in retaining older workers
- Reform the narrow training and licensure of health professions that hinder
interdisciplinary solutions to the workforce shortage
- Provide consistent resources for data collection, analysis, and publication
to avoid both future shortages and oversupply
— Gordon Burnside
It Truly Is "In Our Hands"
In Our Hands accurately describes the current health care environment
and provides comprehensive, integrated, and focused responses to the critical,
long-term challenges we face as health care providers—especially those of us
called and privileged to serve in leadership.
Given today's tumultuous health care climate, it's not uncommon for leaders
to wonder how we have come to where we are today. As leaders, we must acknowledge
that we have played a significant role in the development of the current health
care ministry. Therefore, it is appropriate that it is "in our hands" to provide
the ongoing leadership to initiate positive change in our work environments
and processes, initiate collaborative efforts, and re-earn the support and trust
of our coworkers and society at large.
This demands a commitment for the long haul—not a quick fix. If we sincerely
desire and are committed to this change, we must commit to changing ourselves.
We must demonstrate through the allocation of our time, presence, and resources
our commitment to, and deep appreciation for, the caregivers with whom we serve.
These women and men must know by our words and actions that they are truly God's
healing presence in a hurting world, and we are privileged to support them in
this important mission.
—Sr. Mary Roch Rocklage, RSM
Immediate Past Chairperson,
American Hospital Association, Chicago
Board Chair, Sisters of Mercy Health System, St. Louis
Copyright © 2003 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.