The country’s nursing shortage continues even as the nation’s baby boomers and nursing workforce grow older, and the need for health care expands. Although nursing colleges and universities around the nation are working to increase enrollment levels to meet the rising need for nursing care, demand is outstripping supply.
The United States is 10 percent short of the nurses it needs, according to Hospitals and Health Network magazine. In California, the problem is even more serious, with vacancy rates at health care organizations in the state approaching 13 percent.
Despite such statistics, recruitment at City of Hope was marked by a nearly 20 percent increase in nursing staff for the one-year period ending February 2006, according to Larry Kidd, R.N., vice president of Patient Care Services and chief nurse executive. During the past year, 100 new nurses have been hired, bringing City of Hope’s total number to approximately 500, including staff nurses, nurse practitioners, research coordinators, case managers, clinical nurse specialists and nurse researchers. Kidd credits the employee referral program, an effective advertising campaign and City of Hope’s long-standing reputation as a great place to work for the success in recent hiring.
"In addition to our status as a leading research hospital, attracting nurses to City of Hope is made easier by the institution’s favorable working conditions," Kidd said. "These include low patient-to-nurse ratios, flexible work schedules, better educational opportunities than many places, including up to three months of on-the-job training, and an extensive array of support staff for nursing teams, such as attendants, clerks, therapists, transporters and pharmacies in every unit.”
These factors also may account for City of Hope’s retention rate. The figure is better than that of many institutions, with a turnover rate of 7 percent annually, significantly lower than the statewide average of 16.4 percent.
Low nurse-to-patient ratios help attract and retain staff. City of Hope employs about one registered nurse for every four patients in its medical oncology/hematology nursing units.
In other areas, the pediatric ratio is approximately 1-to-3, and the intensive care unit ratio is about 1-to-2. Using an acuity tool, nursing staff provides additional support when needed by evaluating patient needs for ongoing patient care. If required, ratios may be adjusted in any area and nurses may carry even fewer patients.
Despite the number of new hires and relatively low turnover, the need for more nurses remains strong. The vacancy rate at City of Hope now stands at 12 percent annually, created by the addition of many new positions. Staffing needs for Helford Clinical Research Hospital at City of Hope, for example, are extensive. "We are near capacity during the weekdays, even after opening up additional beds in East Unit A (formerly Wing V)," Kidd said. "We now have a staffed available bed capacity of 154, and will incrementally open more as we are able to recruit and train additional nurses."
Contributing to the future demand is the maturity of City of Hope’s own nursing staff, reflecting a national trend. About 62 percent of the institution’s nurses are between 40 and 60 years old; the typical City of Hope nurse is 46. "While we have been able to attract a significant number of nurses, most have just graduated from nursing school or have entered into nursing as a second career, so the need to retain our experienced staff members for both staffing and training is great," he added. "Therefore, one of the goals of the nursing leadership team in coming months is to make further strides in nurses' working conditions at City of Hope, including addressing the needs of the more experienced nurses that have been here for many years.
"It’s not only about recruitment, but also retention."
Kidd said a number of opportunities for improvement exist that, when in place, will make working at City of Hope even better for all nursing staff. Including such professionals on more committees and involving them in decision-making, assessing nurses’ satisfaction with their work environment and addressing their concerns quickly, and engaging them in the development and design of educational programs will help.
Regarding day-to-day operations, improving on-the-job communications with advanced technology will keep City of Hope among the best places to work. "Currently, some nurses are visiting other hospitals to learn about wireless communications devices to identify the best ones to pilot at City of Hope," Kidd said. "Our nurses will also have input into the selection of a computerized information system, or CIS.”