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Nursing Staff Remains Highly Effective Despite Challenges
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Speaking to members of the Deputy Chiefs' Committee and Medical Center Task Force on Feb. 17, Laurie Gunderson, director of patient care services at Stanford Hospital and Clinics, outlined a variety of efforts being undertaken to ensure that Stanford has a sufficient number of skilled nurses. "We've had periods of up to three months with few experienced nurses applying for positions here. Nationally, 85 percent of all RNs are employed, and that statistic is the benchmark, indicating how tight the current situation is for everyone," Gunderson said. During the month of February, Stanford had approximately 88 vacancies among 1,000 RN slots. (That number reduced to less than 40 in March, because of hires and transfers, but primarily as a result of positions being put on an interim hold while institution-wide staffing was examined, said Jennifer Dickman, manager of nursing and ancillary recruitment for UCSF Stanford). Nevertheless, careful assignment of qualified and skilled nursing staff has enabled the hospital and clinics to function effectively without having to close beds, Gunderson said. The greatest shortage is in the operating rooms, intensive care units and the emergency department - areas where new graduates wouldn't be appropriate job candidates because of the complexity of the assignments, Gunderson added. The key is not simply to attract skilled, RNs, but to attract bright, qualified RNs who have the skills to be integrated quickly into a high-acuity environment, she said. Fortunately, Stanford's RN turnover is about 7.5 percent annually, about half the national average for acute hospitals, she added. Gunderson said Stanford is taking the following steps to ensure it attracts and maintains enough experienced nurses: - It has launched a partnering program with UCSF's School of Nursing to employ master's degree nursing students during the one-year hospital training the program requires. These students already have an RN degree and are ready to work in high-acuity units under the supervision of Stanford mentors and their own UCSF faculty, Gunderson said. She noted that in past years Stanford rarely hired new graduates, preferring instead that new RNs gain a year of experience in a community hospital before applying here. However, more nurses are able to be comfortably integrated into units after graduation because of the mentoring program. - In-house training programs have been developed to help general RNs develop the skills they need to move into areas experiencing a shortage, such as the ORs and critical care units. - Training programs for nursing assistants and unit service assistants (USAs) have been expanded. These programs are intended to help RNs focus on patient care. Gunderson noted that the optimal ratio of RNs to nursing assistants and USAs is about 60 percent RNs to 40 percent nursing assistants in general care units. A higher ratio of RNs are assigned in higher-acuity areas. - Registry and traveling nurses are currently being used to fill slots during peak periods. These outside resources ensure there is sufficient coverage of qualified nurses, said Gunderson. Gunderson said a variety of programs, such as unit recognition activities and competency workshops, are offered regularly to help build the morale and retention of existing staff. Nursing shortages appear to occur in 10-year cycles, Gunderson said. Experts have hypothesized that the cycles occur because young people looking for careers enter nursing school in large numbers during times of shortage. Soon after these large classes graduate, the shortage ends, jobs become scarce and prospective students turn to other, more open fields and the cycle repeats itself. Gunderson, who is responsible for staffing at Stanford Hospital, said the RN shortage is occurring throughout UCSF Stanford Health Care. |
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