ALTIUS is back with the third installment of our ALTIUS Answer/Asks interview series. In this segment, our team gained insight on trending topics and industry challenges through our ALTIUS Asks interview with Dr. Sheri Matter, Assistant Teaching Professor for the Graduate Nursing Program and the Director of the MSN online programs and the DNP Leadership program at The Pennsylvania State University.
- The Great Resignation is a current hot topic in healthcare. As a former CNO and current nurse educator, can you please provide your thoughts on the impacts of this shift from the perspective of those preparing for a career within the industry?
- Those who are entering the industry have a different situation than previous new graduates. They have the ability to negotiate salary to some extent and to negotiate more flexible shifts. They are also given many more work opportunities. In the past, specialty areas were reserved for only experienced nurses. Now, due to the Great Resignation, there are positions everywhere in hospitals, and these positions must be filled. As a previous CNO, I would caution specializing too early in one’s career. It locks a nurse in, not that they can’t change, to one area of healthcare. It is difficult if a new nurse does not acquire the basic skills after graduating to change course in their career. That is the beauty of nursing. There is a role for everyone, and it is finding that passion. It is important that new nurses demand an appropriate orientation and work on a unit that is safely staffed. As new nurses are being interviewed, they should remember that they are interviewing their upcoming employer. Shadowing a couple of hours during a shift often exposes any concerns and is a beneficial experience for the employer and the employee.
- How about from the perspective of healthcare leadership?
- As for leaders, they need to rethink several areas to recover from the Great Resignation. One area is the salary structure of the bedside nurse. The nurses who are working weekends, off-shifts, and holidays will need to be rewarded with higher pay. For way too long, experienced nurses have left the bedside for Monday through Friday dayshift roles that are less physically, emotionally, and mentally demanding for higher pay than when they were at the bedside. Many nurses left the bedside during the Great Resignation, yet they continue to work. However, their work site has changed. Healthcare systems need to place the money on their current bedside nurses and not reward those who are leaving the bedside or Travel Nurses. This still allows for a good salary for those who choose Monday to Friday, better work-life balance, and for longevity to be rewarded as well. Many nurses age out at the bedside while others thrive at the bedside throughout their career. It is about knowing your staff and helping them meet their needs.
- As stated above, leaders need to know their staff’s work-life balance needs. Leaders work on relationships with their staff, know them as a person, what makes them continue to come to work, and what will keep them there. Flexibility in start times, shift length, what constitutes full-time for benefits, and flexible benefits are ways to tailor roles to staff based on what is important to them. Whether it is related to pay, healthcare, or education, leaders need to find a way to meet the individual needs of the nurses at the bedside.
- Organizations need to reallocate funds, taking the money being spent on travelers and paying loyal employees at the bedside. The large sums of money that are being spent on nurses who are not loyal to the healthcare system does not help with the Great Resignation. Those nurses without roots are following the money, and organizations are losing their own nurses to these programs. Hospitals have been creative in using bonus pay and short-term contracts for staff to pick up extra shifts as a means of being competitive. There needs to be a plan to boost all baseline pay, build reserves for surge times, and ultimately stabilize the staff.
- Great leaders also make a difference through recognition. It may be something as easy as a shout-out at the daily safety huddle, a personalized note, or a nomination to the system’s recognition program. Scheduled one-to-ones are also important to find out what is and is not working for them. Recognition and having a voice are important to all nurses and especially to today’s nurses. It is important to routinely re-recruit one’s staff.
- Organizations need to move on from the healthcare hero’s campaign. It was a nice thought initially but has outlived its purpose. Signs hanging at the entrances without any backup of recognition are not found to be a meaningful tactic anymore, with some staff actually finding it to now be insulting.
- In your experience, what programs/steps have hospitals and health systems implemented to promote the emotional well-being and safety of their staff?
- It was hard for organizations to initially respond to the emotional well-being of staff. There were so many unknowns, and everyone was in a state of survival. As the pandemic lingered, there was an eventual attempt to look at the staff’s well-being. It was late in the game, and many were already demoralized, frustrated, and burned out. This was the fault of no one. The healthcare system, at all levels, was stressed beyond imagination. Soft items were introduced, such as free meals, coffee cards, puppies being brought into pet, etc.
- Months into COVID-19, it was recognized that there were nurses within organizations who were not working, such as those in operating rooms, post-op areas, and procedural areas, as they were only providing treatment for emergency situations. This takes me back to one of the previous comments about nurses sometimes being too specialized. The well-being of all could have been addressed with nurses in the underutilized areas coming to work and supporting those caring for the COVID-19 patients. The mental well-being of those on the front line felt defeated by those who could have provided support and, in fact, did not. This is a catch-22 as nurses that work in the specialty areas often do not feel “safe” working in other areas of the hospital. This provides emotional stress to them. There should be a plan on how to utilize both groups to fully care for patients while the safety and emotional support of all involved are being addressed.
- What other areas still need to be addressed to improve recruitment/retention moving forward?
- Much of this question has been previously addressed. Leaders need to listen to their staff’s concerns. They need a plan for how to support the staff during a time of surge. This could be something such as COVID-19 or a quick surge from a local event. One other area to focus on in organizations is to train leaders on how to identify the early signs of burnout and work with staff to take time off when they are showing those symptoms. Organizations should set a limit on how many hours staff can work in 24 hours and how many hours they should have off to recover from a long shift. There should also be a limit on how many days staff can work in a row. Leaders are the voice of the staff to hospital administration and need to represent the staff by communicating their needs.
- One of the items that created the problem with COVID-19 was the rebound in the fall of 2021. Staff thought the worst was over, and then the next surge came, which was harder than the first for most organizations. This created a second wave of resignations as staff had reached their limits. The early tactics were no longer effective for staff retention, and staff began to base their decisions on work-life balance. Staff recruitment and retention is a 24/7 job and one of a leader’s most important roles. Staff have the answer to what will keep them in an organization and what will entice new staff. Listen to the staff. Sign-on bonuses, although very popular, do not help with retention and only maintain staff for the length of their contract as they look for the next sign-on bonus. They only work long-term when they are paired with a retention bonus. Another pay practice that could be effective is offering staff nurses similar outcomes-based bonuses as those that healthcare leaders receive.
- From a COVID-19 standpoint, do you feel that most healthcare organizations now have a good response plan in place for any future case spikes to avoid any further disruption of services?
- This is a tough question to answer. All organizations have surge plans. No one predicted the severity and the longevity of COVID-19. There are better national responses with supplies which was a large part of the battle with the first wave of COVID-19. Organizations were spending precious time and money on securing supplies. This also left staff nurses angry as they felt their welfare was left unprotected as infection control practices were not followed due to lack of supplies. Now, as far as supplies are concerned, there is a better plan.
- Staffing will continue to be an issue until we, as a nation, fully recover from the RN staffing shortage. Nursing shortages have a cyclical pattern and often follow a dip in the economy. There has been an increase in nursing programs which has exposed the other nursing shortage of qualified nursing faculty. During the latest downturn of the economy, one would expect that there would be an increase in hospital-based programs, second-degree programs, and the use of LPNs in acute care settings. Systems will once again see themselves examining their nursing models and perhaps going back to the days of loan forgiveness to recruit staff to be able to stabilize and prepare for the future.
- The pandemic brought about a lot of quick, but necessary changes to overall operations and care delivery. Can you provide an example of a new or updated practice started by the COVID-19 response that has continued longevity/viability?
- One area that happened quickly in many organizations was to bring the Monday-Friday nurses who left the bedside back to the bedside as a need to staff the filled beds. Although this was not a popular decision for this group of nurses, it did support the bedside nurses and help to ensure safe staffing patterns. As census returned to pre-COVID-19 levels, the staff were able to return to their “regular” jobs. This is a sustainable answer to future surges in organizations.
- Nurse Leaders supporting staff in the clinical areas also became a practice during COVID-19. Although this is great during emergencies and at a time of surge, this is not a sustainable answer. If they are working “in staff,” they cannot appropriately mentor, recruit, retain and represent their teams at the organizational level. While this tactic is good for morale in times of need, it is not a sustainable practice for the future.
Join us next month for the final ALTIUS Answers/Asks interview when our team chats with another healthcare expert and gets their take on pressing concerns from across the industry! In the meantime, to learn more about our services, reach out directly at [email protected] or visit our website here.