Patient Flow Enewsletter
Volume 2, Issue 3
Thursday, June 16, 2005
Emergency Department Nurse Recruitment and Retention Initiatives
Resources in this article:
When Melinda Stibal, R.N., B.S., C.E.N., joined Memorial Healthcare System (MHS) about 18 months ago as the administration director of the emergency department (ED) and trauma services, she was faced with 17 nursing openings. For a 684- bed public hospital with an ED that sees 70,000 adults and 30,000 children each year, 17 nursing vacancies had far-reaching effects on patient flow and staff morale. At a time when EDs across the country are overcrowded and under increasing pressure from nationwide nursing shortages, she knew that finding a system to stabilize staffing would not be easy.
Although there were general employee retention practices in place at MHS, the challenge would be adapting these for ED nurses. "It's almost impossible to find ER-experienced nurses. There are other things we do as a facility for education and retention, but we needed something specifically for nurses in the ED," Ms. Stibal said.
The Recruitment and Retention Program
When they began looking into ways to stabilize staffing, Ms. Stibal and her team realized they didn't need to start from scratch to build an effective recruitment and retention program. Instead, they decided to focus on the existing programs at the hospital that were already in place for nurses. For example, MHS offers about 100 educational scholarships per year, but ED nurses were rarely taking advantage of them.
"We have 100 percent tuition reimbursement, and we also offer scholarships for R.N.'s and B.S.N.'s, she said. "And benefits aren't really seniority-based, they are the same across the board."
To get the word out about MHS’s programs for ED nurses, Ms. Stibal began recruiting nurses both internally and externally. She worked with leaders of other departments to mention ED openings in their staff meetings and began sending fliers and blast emails to employees when they were actively recruiting for an open position. Ms. Stibal sent out mailers to students that highlighted MHS’s exceptional programs, attended local career days, and held internal and external job fairs. She also met with scholarship nurses at local universities and explained the program to them.
Besides highlighting these hospital-wide benefits, Ms. Stibal also initiated a comprehensive mentoring program for ED nurses. Experienced nurses now volunteer to be mentors to new nurses, assisting them with all aspects of new nurse orientation in the ED. Anyone who wants to be an ED nurse mentor takes an eight-hour course that covers topics like adult learning principles, dealing with conflict, documentation of performance, and follow up, after which the nurse is allowed to precept. All mentors get a monetary bonus based on the duration of the mentoring (one amount for mentoring an experienced nurse and another for mentoring a nurse new to the ED/nursing) and experience level.
See Preceptor Incentive Request Form
Orientation consists of a six-month program that four to five new nurses go through at the same time. “This creates a support system and helps new nurses get to know people. Going through a six-month program together gives these nurses a peer group and support system that they all start out with,” Ms. Stibal said. “And nurses are coming out of the classes are ready to tackle the ER.”
See Orientation Timeline
Results
After highlighting existing nursing benefits for about a year, MHS’s ED is down to zero nursing vacancies, leaving no question that recruitment and retention efforts are working. Patient care has also improved -- throughput times in the ED have decreased by two hours. “One of the best things now is that when an opening does come up, I don’t feel like finding someone will be hopeless,” said Ms. Stibal.
Staff feel better supported – since there aren’t as many vacancies, there are more nurses to do the work. There is also a renewed sense of enthusiasm among nursing staff in the department. “There have been a few ‘super stars’ that have gone through the program, and this has made the mentors enthusiastic,” Ms. Stibal said. “There is a new level of brightness among the young people – this motivates everyone.”
Ms. Stibal also closely tracks the mentoring program by having each new nurse evaluate the orientation program before he or she completes it. Ms Stibal also sits down with each new nurse about 30 days after completing orientation to get each nurse’s feedback on the program.
Lessons Learned
For other hospital EDs thinking about implementing a similar program, Ms. Stibal suggests that orientation classes not be broken up throughout the six-month period. “Every time the new people have to leave, and then come back to the ED, it’s an adjustment,” she said. “It’s better to just tackle orientation at once, and let then let the nurses settle in with their jobs and their colleagues.”
In addition, she suggests that during the first two weeks the new nurses hit the floor, it may be beneficial for them to manage one area in the ED as a group with the nurse educators. “Although they learn a lot during orientation, when they get out with their preceptors, they learn short cuts,” she said. If they spend some time with the nurse educators managing an entire area, they will learn the correct ED procedures, and how to find the answers they need.”
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Melinda Stibal, R.N., B.S., C.E.N.
Administrative Director of Emergency and Trauma Services
Memorial Regional Hospital
Hollywood, FL
