The Changing Nurse Workforce: What Hospitals Need to Know

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Changes in healthcare are starting to have a dramatic impact on the nursing workforce, which should concern any hospital that wants to retain top nursing talent.

According to Karlene Kerfoot, PhD, RN, NEA-BC, FAAN, vice president of nursing at API Healthcare, nurses have more out-of-hospital employment options now than they did even a decade ago. In short: competition for nurses is growing fierce. Two main factors have contributed to the growth of job opportunities for the nation's nurses.

•    Accountable care efforts. As accountable care organizations and other triple aim-minded programs grow in popularity, nurses are being called upon to take on new roles in healthcare delivery. For example, there is a large demand for nurses to become care managers for ACOs or insurance companies, according to Dr. Kerfoot. These efforts have also led to the increased need for nurses in informatics.

•    Retail health. The retail and walk-in clinic market has been booming: the first retail care clinic opened in 2000, and as of March there are more than 1,500 throughout the country. These clinics are typically staffed by a nurse practitioner, and their services are in high demand as retail clinics continue to grow. This represents a relatively new competitor for hospitals that want to recruit and retain their NPs.

Further complicating the effects of increased competition is the challenging work environment often found in hospitals. Nurses in hospitals are on a shift schedule, and those shifts are sometimes cancelled. On the other hand, care managers and retail clinic nurses can typically work a more set schedule with consistent hours, which can be more attractive to many nurses, Dr. Kerfoot says.

Also, in many hospitals, the acuity of patients has risen in recent years, according to Dr. Kerfoot. This trend is in part due to the increased emphasis on preventive and wellness care that keeps patients out of the hospital setting unless they are seriously ill. "Patient volume in hospitals is decreasing, but the patients are very ill," she says, so hospitals need more skilled or experienced nurses to properly treat their patient populations. In other words, hospitals have more reason than ever to retain their most experienced nurses at a time when those nurses have other new job options.

What hospitals can do

All of the above factors "should push hospitals to develop healthy work environments so nurses want to stay and feel fulfilled," Dr. Kerfoot says. "It's a good time for hospitals to rethink what they're doing."

Dr. Kerfoot says nurses are likely to job hunt or plan to leave their hospital-based job if they feel they are in a dangerous situation with staffing levels, feel undervalued or feel they cannot properly do the work they are passionate about — treating patients.

An important first step for hospitals is to look at nurse staffing levels. Not only can improper staffing levels lead to a nurse exodus, it can also result in unhappy nurses, unhappy patients and lower patient outcomes. Instead of staffing by numbers, Dr. Kerfoot recommends hospitals staff by acuity. Scheduling technology can help ensure more experienced nurses are matched with patients who have a greater care need, for example, which means newer nurses wouldn't be overwhelmed by high acuity patients.

Along with rethinking staffing, hospitals that do not already offer professional development options for nurses should consider doing so, Dr. Kerfoot says. "It's very important to have offerings for people to be able to transform themselves." Some options popular with nurses include certificate programs in areas such as informatics or case management and credentialing to work in the growing areas of ambulatory services.

On a more positive note for hospitals, Dr. Kerfoot says hospitals will likely continue as the training grounds for nurses in years to come. Nurses will continue to have many opportunities, but if hospitals are attractive workplaces with opportunities for professional growth, nurses will want to stay there.

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