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Retention & Recruitment


                                                    1




 Retention & Recruitment
            A growing trend

      Christopher La Rue Owens
Keller Graduate School of Management
           February 7, 2012
Retention & Recruitment

                                            Abstract                                                     2

Imagine the future of healthcare. Imagine a now twenty one year old person aging and is now
considered to being a “geriatric patient”; Imaging this patient being in need of care and having
little to no person interaction. Instead of a well mannered, professional nurse, and or other allied
staff members there’s a newly generated technological device in which robots can monitor your
every breath, pulse and current condition and send continuous, accurate reports to one personnel
members to whom will make visits on an as needed bases. Now think for a minute of two. Is this
the kind of service you want? Do you feel that this is the answer to addressing your population?
If you’d say that this is quite in personnel and inappropriate then you’d be correct. But please not
that while this is only a thing of imagination it’s also very possible to happen in the near future if
the retention and recruitment of key healthcare personnel are not addressed in a efficient and
effective manner.


                                   Problem Statement

For the past few years we have all been aware of the posed nursing shortage. We’ve all heard the
rants and raves of legislative change via the Presidential administration and most of us look
forward to embarking on a country to where both convenient and moderate access of healthcare
is available. But what does this mean exactly? How if we are facing a personnel shortage, can we
remedy an issue thru adding more consumers to a system with limited and shrinking crucial staff
members?

The fact of the matter is this; according to a recent study the average age of nurses are roughly
forty six; which is only sixteen years from the national retirement age of sixty two. In addition
more than fifty percent of the nursing workforce is close to retirement. As a nation we are seeing
rather large increase in patents over sixty five. This demographic has many needs, and will surly
put a strain on the health system. Not to mention the recent reforms in healthcare will give
millions of people access to the healthcare system. With all this in-mind it’s no wonder that more
nurses as well as health professionals are needed in response, (BLS, 2010).



                                     Problem Analysts
We are all concerned with the Healthcare reform and some of the key changes in which its
geared to bring to the nations healthcare system. One most important feature will be its high
increased consumer count that shall grow with every waking day. Looking at the reform on a
more business side I’d like to high light some business features that few of you may be aware of.
Changes such as Small business tax credits, which was implemented back in January of 2010.
This feature provides a tax credit towards employers with no more than twenty five employees
and annual wages of less than 50,000 that provide health insurance for its employees. This credit
Retention & Recruitment

covers of up to thirty five percent for for-profit organizations and twenty five percent for the
                                                                                                        3
non-profit organizations. Also, could qualify for up to fifty/thirty five percent of employers cost
only if purchased through a two year insurance exchange. Another feature is the pre-existing
condition insurance plan. This is a state and federal program that temporarily provides low
premium coverage for eligible candidates. Theirs also a tax for indoor training services, as well
as Medicare premiums for higher income beneficiaries. This feature freezes the income threshold
for income related Medicare part B premiums for the years 2011 thru 2019. This supportively is
suppose to have more people paying income related premiums all while reducing Medicare part
D; this is for those with income of over eighty five thousand individual annual income and one
hundred seventy couple. There are more regulations in effect and on the way in the future.

http://healthreform.kff.org/Timeline.aspx



All in all any business want to make profit, all while sustaining and or providing high quality
care and establish a good business reputation. Given the current trends in the industry, this it self
is becoming rather challenging. With age come a number of both good and bad things. From a
business perspective a geriatric nurse can be a double edge sword. While on one hand they are
wise and highly seasoned in their profession, their quality of work can very well dwindle and or
slowly diminish through poor eye sight, memory lapse, lack of physical strength, at risk sickness
and fragility. All these things and more give way to quality care and service.

The following is an illustration of what slowly but surly led us into this inevitable situation. If
you’d view figure 3B, notice the significant age difference in employees. Notice how back in
years 2002-2003 the majority of nursing staff where between the ages of thirty five and forty
nine at a whopping forty eight point three percentage. These once middle aged workers have now
transitioned into the retiring ages currently; mind you this is an illustration of results of nearly
Retention & Recruitment

ten years ago.
                                                                                                      4




("Graphic on nurses," 2009)




     Also note, through H.R. 876/S.58 also known as the registered nurse safe staffing act
     hospitals and or facilities are held to a higher standard in regards to accountability and
     procedural overlay. This would include whistle blower protection and providing public
     reporting of staffing information. All in all, this act insures compliance. “ANA and its
     Constituent & State Nurses Associations (C/SNAs) in the states are promoting legislation
     to hold hospitals accountable for the development and implementation of valid, reliable,
     unit-by-unit nurse staffing plans. These staffing plans, based upon ANA's Principles for

     Nurse Staffing, are not mandated ratios. They are created in coordination with direct care
     registered nurses (RNs) themselves, and based on each unit’s unique circumstances and changing
     needs.” ("Safe staffing," )



     The nursing industry has had the chronic illness of high retention need for quite some time
     now. Visual illustration below shows a significant trend in nursing education from years
     past:
Retention & Recruitment


                                                                                                        5




As a potential nursing student myself, I’ve gained some much needed insight on higher education
and the various paths and or barriers in potential students’ educational endeavors. I’ve researched
various accredited Universities and trade schools. What I‘ve discovered is a strong demand for
highly grade point averages and firm background in science. For me, myself, I found it quite
challenging to enter an attractive BSN program. Even though I recently obtained a BS in business
management, my overall grade point average hinders me from being a desired candidate. I believe
that my situation as well as many others are the same in that there are many people to whom
want to enter the licensed profession, but are faced with scholastic, financial and some what’s
bias barriers in doing so.

There are a number of various ways in which people can enter the nursing field. The most typical
levels RN, (registered nursing) are bachelors level, Associates, and Diploma. Even though these are
options many facilities are cutting back on the retention of candidates to whom has less than a
BSN degree. This can be interrupted as higher education equals higher quality personnel. Because
of the cost and difficulty of admittance into some RN programs a lot of people are taking even
lower roles in the allied force as Certified Nursing Assistance, and Licensed Practical Nursing. This
will only cause a future incentive for these people to return school and further their education.

Not only is the difficulty of entering a good program challenging, but dealing with and having
access to passionate and helpful instructors are also becoming of a great concern. Prime example;
in my quest to admittance into a universities nursing program I just so happen to meet a former
nursing school student from that very same school. She informed me of her experiences with the
department and stated that she decided to switch her major because of the nursing facility and
Retention & Recruitment

staff. She was reassuring that It would be in my best interest to consider another school. She also
stated how it was rumored that the school may even be loosing their nursing accreditation. This is         6
all because of the nursing instructors disconnect with the new generation. There’s a barrier among
the two and not only that many instructors feel under compensated for their roles as instructors
and there for only perform to the level of which they receive… little to nothing. It was stated that
instructors did not fulfill office hours, and hand a very condescending attitude towards students.
This is the sad truth of our state and nation and should be addressed A.S.A.P.




                                    Proposed Solution

It is within the best interest for an employer to focus on appropriate ways to satisfying their current
staff and discover creative ways of both evaluating motivate and satisfy their staff. Regardless of
their staff demographics, (gender, age) there’s always room for being unique in engaging staff to
perform to high standards while proving excellent care if appropriate actions are in place.



In referencing the issue of recoupment, its’ also important for organizations to be well informed on
the current trends when dealing with jobs seekers; knowing what they may find attractive in an
employer is key for gathering some of the best talents within the industry. This would be best if it
were not the typical short term tactics, such as sign on bonus, relocation coverage and premium
packages, for these have shown to work best in retaining and redistributing staff, not necessarily
recouping them.



These simple actions can be quite effective regardless of the industry. It’s universal and would even
be effective in the R&R for nursing instructors. This is where it’s key. For if there’s little to no one
to teach the potential students then, eventually they’ll be no newly educated RN’s. We must meet
the wants and desires of key staff, keep them motivated and engaged toward there roles, and see
longevity and growth within there jobs.




                          Implementation& Justification


Implementing these keys things are all in simply creating a good working environments
matched with continuous development and personal accommodations. Employees want to
Retention & Recruitment

       feel that they are apart of family, an organization that cares and understand there needs.
                                                                                                       7
       From single working mothers/fathers to newlyweds, they all have unique demands in which
       there lifestyle must meet in order to be productive both within there career as well as there
       personal lives.

Key players in any implementation process should involve top level executives. One in particular
         would be the chief nurse officer. There role as the top nurse would be to open, engaged
         and establishing relationships with fellow nurses. Let staff know that they are the go to
         person for any and all matters and allow the CNO to be the representative for all nurses.
         Leadership must be involved and set the example, let others know that they are cared for
         and are apart of a team. Things such as eating lunch with new, and seasoned staff every
         quarter would be a great way for establishing trust, communication and resolving any and
         all issues. ("Nurse retention," 2006)




       Here’s a key reference in ways of establishing R&R:

Nine Principles to Help Foster Staff Retention

        Respectful collegial                   • Team orientation
1    communication and behavior                • Presence of trust
                                            • Respect for diversity
      Communication-rich culture            • Clear and respectful
2
                                              • Open and trusting
       A culture of accountability    • Role expectations are clearly
3                                                    defined
                                         • Everyone is accountable
       The presence of adequate     • Ability to provide quality care to
4     numbers of qualified nurses         meet client/patient needs
                                       • Work and home life balance
        The presence of expert,    • Serve as an advocate for nursing
      competent, credible, visible                   practice
5              leadership          • Support shared decision-making
                                      • Allocate resources to support
                                                     nursing
     Shared decision-making at all    • Nurses participate in system,
                 levels                  organizational and process
                                                    decisions
6                                        • Formal structure exists to
                                     support shared decision-making
                                     • Nurses have control over their
                                                     practice
7       The encouragement of                      • Continuing
       professional practice and           education/certification is
    continued growth/ development           supported/encouraged
Retention & Recruitment

                                     • Participation in professional
                                        association encouraged                              8
                                  • An information-rich environment
                                               is supported
    Recognition of the value of  • Reward and pay for performance
8
       nursing’s contribution      • Career mobility and expansion
   Recognition of nurses for their
9 meaningful contribution to the
             practice
Source: The Nursing Organizations Alliance, 2005




Five characteristics of successful recruitment and retention programs

       Sustained leadership commitment to workforce as a strategic
 ONE
                                  imperative
 TWO         A culture centered around employees and patients
THREE Work with other organizations to address workforce needs
            Systematic and structured approach to four strategies
            outlined in the 2002 AHA report, “In Our Hands.” They
           include: foster meaningful work, improve the workplace
 FOUR      partnership, broaden the base to attract a more diverse
        workforce and collaborate with other organizations, including
         other hospitals in the community and schools, to ensure an
                       adequate workforce in the future.
  FIVE              Excellence in human resource practice
Source: The AHA Commission on Workforce for Hospitals and Health Systems, 2005
Retention & Recruitment


                                                                                              9




                                        Works Cited


(2009). Graphic on nurses . (2009). [Web Graphic]. Retrieved from
       http://nursesaida.files.wordpress.com/2009/12/graphic-on-nurses-by-race-in-pa2.png
Nurse retention. (2006, January 10). Retrieved from
       http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?
       dcrpath=HHNMAG/PubsNewsArticle/data/0601HHN_FEA_Gatefold&domain=HHNM
       AG
Safe staffing. (n.d.). Retrieved from
       http://nursingworld.org/DocumentVault/GOVA/Federal/Federal-Issues/Safe-Staffing-
       Fact-Sheet.aspx
oetjen, D. (2010). The fininacial managmanet of hospitals and healthcare organizations, 4th
       edition. (4 ed.).

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Retention

  • 1. Retention & Recruitment 1 Retention & Recruitment A growing trend Christopher La Rue Owens Keller Graduate School of Management February 7, 2012
  • 2. Retention & Recruitment Abstract 2 Imagine the future of healthcare. Imagine a now twenty one year old person aging and is now considered to being a “geriatric patient”; Imaging this patient being in need of care and having little to no person interaction. Instead of a well mannered, professional nurse, and or other allied staff members there’s a newly generated technological device in which robots can monitor your every breath, pulse and current condition and send continuous, accurate reports to one personnel members to whom will make visits on an as needed bases. Now think for a minute of two. Is this the kind of service you want? Do you feel that this is the answer to addressing your population? If you’d say that this is quite in personnel and inappropriate then you’d be correct. But please not that while this is only a thing of imagination it’s also very possible to happen in the near future if the retention and recruitment of key healthcare personnel are not addressed in a efficient and effective manner. Problem Statement For the past few years we have all been aware of the posed nursing shortage. We’ve all heard the rants and raves of legislative change via the Presidential administration and most of us look forward to embarking on a country to where both convenient and moderate access of healthcare is available. But what does this mean exactly? How if we are facing a personnel shortage, can we remedy an issue thru adding more consumers to a system with limited and shrinking crucial staff members? The fact of the matter is this; according to a recent study the average age of nurses are roughly forty six; which is only sixteen years from the national retirement age of sixty two. In addition more than fifty percent of the nursing workforce is close to retirement. As a nation we are seeing rather large increase in patents over sixty five. This demographic has many needs, and will surly put a strain on the health system. Not to mention the recent reforms in healthcare will give millions of people access to the healthcare system. With all this in-mind it’s no wonder that more nurses as well as health professionals are needed in response, (BLS, 2010). Problem Analysts We are all concerned with the Healthcare reform and some of the key changes in which its geared to bring to the nations healthcare system. One most important feature will be its high increased consumer count that shall grow with every waking day. Looking at the reform on a more business side I’d like to high light some business features that few of you may be aware of. Changes such as Small business tax credits, which was implemented back in January of 2010. This feature provides a tax credit towards employers with no more than twenty five employees and annual wages of less than 50,000 that provide health insurance for its employees. This credit
  • 3. Retention & Recruitment covers of up to thirty five percent for for-profit organizations and twenty five percent for the 3 non-profit organizations. Also, could qualify for up to fifty/thirty five percent of employers cost only if purchased through a two year insurance exchange. Another feature is the pre-existing condition insurance plan. This is a state and federal program that temporarily provides low premium coverage for eligible candidates. Theirs also a tax for indoor training services, as well as Medicare premiums for higher income beneficiaries. This feature freezes the income threshold for income related Medicare part B premiums for the years 2011 thru 2019. This supportively is suppose to have more people paying income related premiums all while reducing Medicare part D; this is for those with income of over eighty five thousand individual annual income and one hundred seventy couple. There are more regulations in effect and on the way in the future. http://healthreform.kff.org/Timeline.aspx All in all any business want to make profit, all while sustaining and or providing high quality care and establish a good business reputation. Given the current trends in the industry, this it self is becoming rather challenging. With age come a number of both good and bad things. From a business perspective a geriatric nurse can be a double edge sword. While on one hand they are wise and highly seasoned in their profession, their quality of work can very well dwindle and or slowly diminish through poor eye sight, memory lapse, lack of physical strength, at risk sickness and fragility. All these things and more give way to quality care and service. The following is an illustration of what slowly but surly led us into this inevitable situation. If you’d view figure 3B, notice the significant age difference in employees. Notice how back in years 2002-2003 the majority of nursing staff where between the ages of thirty five and forty nine at a whopping forty eight point three percentage. These once middle aged workers have now transitioned into the retiring ages currently; mind you this is an illustration of results of nearly
  • 4. Retention & Recruitment ten years ago. 4 ("Graphic on nurses," 2009) Also note, through H.R. 876/S.58 also known as the registered nurse safe staffing act hospitals and or facilities are held to a higher standard in regards to accountability and procedural overlay. This would include whistle blower protection and providing public reporting of staffing information. All in all, this act insures compliance. “ANA and its Constituent & State Nurses Associations (C/SNAs) in the states are promoting legislation to hold hospitals accountable for the development and implementation of valid, reliable, unit-by-unit nurse staffing plans. These staffing plans, based upon ANA's Principles for Nurse Staffing, are not mandated ratios. They are created in coordination with direct care registered nurses (RNs) themselves, and based on each unit’s unique circumstances and changing needs.” ("Safe staffing," ) The nursing industry has had the chronic illness of high retention need for quite some time now. Visual illustration below shows a significant trend in nursing education from years past:
  • 5. Retention & Recruitment 5 As a potential nursing student myself, I’ve gained some much needed insight on higher education and the various paths and or barriers in potential students’ educational endeavors. I’ve researched various accredited Universities and trade schools. What I‘ve discovered is a strong demand for highly grade point averages and firm background in science. For me, myself, I found it quite challenging to enter an attractive BSN program. Even though I recently obtained a BS in business management, my overall grade point average hinders me from being a desired candidate. I believe that my situation as well as many others are the same in that there are many people to whom want to enter the licensed profession, but are faced with scholastic, financial and some what’s bias barriers in doing so. There are a number of various ways in which people can enter the nursing field. The most typical levels RN, (registered nursing) are bachelors level, Associates, and Diploma. Even though these are options many facilities are cutting back on the retention of candidates to whom has less than a BSN degree. This can be interrupted as higher education equals higher quality personnel. Because of the cost and difficulty of admittance into some RN programs a lot of people are taking even lower roles in the allied force as Certified Nursing Assistance, and Licensed Practical Nursing. This will only cause a future incentive for these people to return school and further their education. Not only is the difficulty of entering a good program challenging, but dealing with and having access to passionate and helpful instructors are also becoming of a great concern. Prime example; in my quest to admittance into a universities nursing program I just so happen to meet a former nursing school student from that very same school. She informed me of her experiences with the department and stated that she decided to switch her major because of the nursing facility and
  • 6. Retention & Recruitment staff. She was reassuring that It would be in my best interest to consider another school. She also stated how it was rumored that the school may even be loosing their nursing accreditation. This is 6 all because of the nursing instructors disconnect with the new generation. There’s a barrier among the two and not only that many instructors feel under compensated for their roles as instructors and there for only perform to the level of which they receive… little to nothing. It was stated that instructors did not fulfill office hours, and hand a very condescending attitude towards students. This is the sad truth of our state and nation and should be addressed A.S.A.P. Proposed Solution It is within the best interest for an employer to focus on appropriate ways to satisfying their current staff and discover creative ways of both evaluating motivate and satisfy their staff. Regardless of their staff demographics, (gender, age) there’s always room for being unique in engaging staff to perform to high standards while proving excellent care if appropriate actions are in place. In referencing the issue of recoupment, its’ also important for organizations to be well informed on the current trends when dealing with jobs seekers; knowing what they may find attractive in an employer is key for gathering some of the best talents within the industry. This would be best if it were not the typical short term tactics, such as sign on bonus, relocation coverage and premium packages, for these have shown to work best in retaining and redistributing staff, not necessarily recouping them. These simple actions can be quite effective regardless of the industry. It’s universal and would even be effective in the R&R for nursing instructors. This is where it’s key. For if there’s little to no one to teach the potential students then, eventually they’ll be no newly educated RN’s. We must meet the wants and desires of key staff, keep them motivated and engaged toward there roles, and see longevity and growth within there jobs. Implementation& Justification Implementing these keys things are all in simply creating a good working environments matched with continuous development and personal accommodations. Employees want to
  • 7. Retention & Recruitment feel that they are apart of family, an organization that cares and understand there needs. 7 From single working mothers/fathers to newlyweds, they all have unique demands in which there lifestyle must meet in order to be productive both within there career as well as there personal lives. Key players in any implementation process should involve top level executives. One in particular would be the chief nurse officer. There role as the top nurse would be to open, engaged and establishing relationships with fellow nurses. Let staff know that they are the go to person for any and all matters and allow the CNO to be the representative for all nurses. Leadership must be involved and set the example, let others know that they are cared for and are apart of a team. Things such as eating lunch with new, and seasoned staff every quarter would be a great way for establishing trust, communication and resolving any and all issues. ("Nurse retention," 2006) Here’s a key reference in ways of establishing R&R: Nine Principles to Help Foster Staff Retention Respectful collegial • Team orientation 1 communication and behavior • Presence of trust • Respect for diversity Communication-rich culture • Clear and respectful 2 • Open and trusting A culture of accountability • Role expectations are clearly 3 defined • Everyone is accountable The presence of adequate • Ability to provide quality care to 4 numbers of qualified nurses meet client/patient needs • Work and home life balance The presence of expert, • Serve as an advocate for nursing competent, credible, visible practice 5 leadership • Support shared decision-making • Allocate resources to support nursing Shared decision-making at all • Nurses participate in system, levels organizational and process decisions 6 • Formal structure exists to support shared decision-making • Nurses have control over their practice 7 The encouragement of • Continuing professional practice and education/certification is continued growth/ development supported/encouraged
  • 8. Retention & Recruitment • Participation in professional association encouraged 8 • An information-rich environment is supported Recognition of the value of • Reward and pay for performance 8 nursing’s contribution • Career mobility and expansion Recognition of nurses for their 9 meaningful contribution to the practice Source: The Nursing Organizations Alliance, 2005 Five characteristics of successful recruitment and retention programs Sustained leadership commitment to workforce as a strategic ONE imperative TWO A culture centered around employees and patients THREE Work with other organizations to address workforce needs Systematic and structured approach to four strategies outlined in the 2002 AHA report, “In Our Hands.” They include: foster meaningful work, improve the workplace FOUR partnership, broaden the base to attract a more diverse workforce and collaborate with other organizations, including other hospitals in the community and schools, to ensure an adequate workforce in the future. FIVE Excellence in human resource practice Source: The AHA Commission on Workforce for Hospitals and Health Systems, 2005
  • 9. Retention & Recruitment 9 Works Cited (2009). Graphic on nurses . (2009). [Web Graphic]. Retrieved from http://nursesaida.files.wordpress.com/2009/12/graphic-on-nurses-by-race-in-pa2.png Nurse retention. (2006, January 10). Retrieved from http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp? dcrpath=HHNMAG/PubsNewsArticle/data/0601HHN_FEA_Gatefold&domain=HHNM AG Safe staffing. (n.d.). Retrieved from http://nursingworld.org/DocumentVault/GOVA/Federal/Federal-Issues/Safe-Staffing- Fact-Sheet.aspx oetjen, D. (2010). The fininacial managmanet of hospitals and healthcare organizations, 4th edition. (4 ed.).