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Meeting the demand for nurses in Florida - News - Nursesarena Forum

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Meeting the demand for nurses in Florida by Idowu Olabode : February 22, 2016, 12:41:18 PM
After a few slow years during the Great Recession, demand is growing for nurses. In 2016, Florida will need nearly 10,000 more registered nurses just to fill newly created hospital positions, according to a statewide employer survey.

It's a shortage that threatens the ability of the health system to meet the needs of both newly insured and aging patients. The shortage could be viewed as a crisis, but it's a challenge that Southwest Florida health leaders say they can meet.

By redesigning nursing education to promote bachelor of nursing degrees, providing clear career planning for nurses coming out of school and focusing on ways to change the workplace to retain experienced nurses, Southwest Florida's health-system officials are working to make sure that there are enough nurses to care for the growing patient population.

“It's not just about getting nurses, it's about making sure the ones we have are as educated as they can be,” said Bonnie Hesselberg, nursing education navigator for the Suncoast Nursing Action Coalition.

The growing need

In Southwest Florida and nationwide, the number of patients needing advanced health care is growing. At Sarasota Memorial, the overall volume of patients is up 20 percent from last year, and the increase has been consistent throughout the year. On Feb. 11, 2016, the hospital had 629 patients — one less than their highest-ever patient census.

The increase in patients is the result of two converging trends: More patients have insurance under the Affordable Care Act and more patients are getting procedures they'd put off during the recession, said Mary Lou Brunell, executive director of the Florida Center of Nursing, which conducted the statewide survey of nursing demand.

These increases in patients and in open nursing positions are occurring at the same time, Brunell said. The latter also is tied to the end of the economic downturn.

“During the recession, many nurses did not retire or nurses whose spouses lost their job picked up more shifts,” Brunell said. For example, in 2009, hospitals only needed about 5,000 registered nurses, compared to demanding nearly 10,000 new registered nurses in 2015.

Brunell said that as the economy has improved, more nurses are taking new and different jobs, which produced an increase in the number of vacant positions. But given that the demand for new nurses was relatively flat during recession, the new surge in demand is really just a correction to where demand would have been if growth had been steady from 2011 to 2015.

Paths to higher education

Managing a nursing shortage starts with ensuring a pipeline of qualified new nurses coming into the field each year. And in the past few years, that's meant encouraging nurses to get nursing bachelor's degrees before joining the workforce.

Traditionally, nurses learned many of their skills on the job and their education requirements were minimal, but a 2010 report from the Institute of Medicine found that patients had better health outcomes when cared for by nurses with bachelor's degrees in the field. Researchers attributed this to the increasing complexity of patient illnesses and of care environments, which require advanced medical understanding and problem-solving skills.

In response to the Institute of Medicine's recommendation that 80 percent of bedside nurses have a bachelor's degree by 2020, a local group of nurse leaders, colleges and nonprofits created the Suncoast Nursing Action Coalition and began meeting three years ago to develop a plan.

In the last year, Hesselberg, the nursing educator who has a doctorate in nursing, has counseled 98 nurses and students interested in pursuing a bachelor's in nursing degree, and about half of them have enrolled in a bachelor's degree program. She regularly visits associate's degree programs to tell students about the need for higher education.

“I go into those associate's classrooms, and I tell the students, 'This is a great start for you, but this isn't where you end up. This degree is just the beginning of your journey,' ” Hesselberg said.

At Manatee Memorial Hospital, chief nursing officer Candace Smith has made increasing the number of nurses with a bachelor's degree a priority at the hospital since she joined it last year.

“Our goal is to have about 60 percent of our nurses with a bachelor's degree in nursing,” Smith said. “We're at about 25 percent now. You want to partner with nurses with associate's degrees, but you want to make sure you give them a clear pathway to the bachelor's degree.”

What is being done

To increase the number of bachelor's degrees, Manatee Memorial, like many other hospitals and health centers in the region, offers tuition assistance and support for nurses with associate's degrees who are working toward a bachelor's degree. Some hospitals even require newly hired nurses with associate's degrees to commit to earning their bachelor's degree within five years.

The State College of Florida system, including SCF Sarasota Manatee, offers a bachelor of science in nursing program for working nurses.

Having the degree program available locally at state colleges allows nurses to stay in the community, said Debra Marr, chairwoman of the associate's of science in nursing degree program at SCF Sarasota Manatee.

“Most graduates of our nursing programs are from our community, and once they become a registered nurse, they tend to stay in the area,” Marr said. Of the 50 students who graduated in December 2015, Marr said, only one has left the state for a nursing job.

“We're growing our nurses to take positions within our community,” she said.

The problem of turnover

Once those nurses are hired, however, they're not likely to stay put for long. According to the statewide demand report, turnover among Florida nurses in some settings is well above the national average of about 27 percent.

For registered nurses in skilled-nursing facilities, a full 44.5 percent of nurses changed jobs between July 1, 2014, and June 30, 2015. For registered nurses working in home health care, the turnover rate was 34.8 percent in the same period. Hospital turnover rates were much lower, at 16.2 percent for the year, the study found.

High turnover rates have prompted hospital systems to make sure that nurses have a clear career advancement path as soon as they're hired. At Sarasota Memorial, that means newly hired nurses in specialty areas go through a residency program to learn the skills for advanced specialties such as cardiac catheterization, surgery and the emergency department.

Doctors Hospital, Blake Medical Center and Englewood Community Hospital all offer the StaRN program, sponsored by their parent company, Hospital Corp. of America. The program includes 13 weeks of classroom and in-hospital training to ensure that newly hired nurses are ready for their first day on the job.

Manatee Memorial has a partnership with SCF Sarasota Manatee that offers an operating room course, with credits, in which student nurses are introduced to the operating room setting, which is an area of great need. The average age of an operating-room nurse is well above the 50-year-old average age of nurses generally, Smith said.

Since it can take up to a year for an operating room nurse to become fully comfortable working without supervision, Smith said, it was a priority for the hospital to start building a talent pipeline.

“With operating-room nurses, you have to be several nurses ahead,” she said.

Adapting the working environment

Health systems are also working to adapt the work environment to encourage nurses to stay and grow in their careers.

For instance, in hospitals, nurses work 12-hour shifts, but the long hours are often not something older nurses are comfortable with physically, Brunell said. If hospitals and other health facilities were to offer eight-hour shifts or some other working arrangement, older nurses might stay in the profession longer.

Other tweaks, such as increasing the size of the text on medical documents, offering stress-break massages for staff and free on-site car washes could also help adapt the work environment to an older population.

There's also a health care culture shift underway that encourages nurses to take a more active role in health system management, Hesselberg said. This runs counter to the traditional nurse role, which has largely been to follow orders.

“Nurses have to be really good analytical thinkers, and their increased education helps them understand the cascading effects of one decision or another,” Hesselberg said. “Because the patients are generally sicker and more complicated, nurses need to be able to get their point across to other health workers and advocate for the patient, because they're the only ones there 24 hours each day.”

By keeping a close eye on the pipeline of new nurses and making the workplace better for current nurse employees, Southwest Florida health care leaders say they are confident they can meet the increasing demand for nurses.

They're also encouraging anyone and everyone interested in nursing to pursue the profession.

“The contributions people can make by going into nursing can really make a difference,” said Jean Lucas, associate chief nursing officer at Sarasota Memorial Hospital.

“We need talent at the bedside and at all levels across the health system, so the more we can encourage people to think about nursing as a career option where they can make a difference, that is really where we need to focus,” Lucas said.

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