By V. Dion Haynes, Washington Post Staff Writer
Nurse Jennifer Dimmick helped her 71-year-old patient, George Mulligan, struggle from a chair to his feet for his daily walk around the corridor outside his room at Inova Fairfax Hospital.
During the previous three days following Mulligan’s aortic valve replacement surgery, Dimmick was preparing him to care for himself after his discharge — demonstrating how he should gingerly lift himself when he rises for his walks so that he won’t damage his incision and playing videotapes that show him how to dress the wound to prevent infection and how to use a breathing device so that he won’t get pneumonia. The hospital introduced the education program after Dimmick and other nurses discovered an unusually high readmission rate for heart patients.
Like hospitals around the country, Inova is grappling with a nursing shortage that is projected to worsen over the next two decades. Hospitals increasingly are responding with a new recruitment and retention strategy — giving nurses like Dimmick much more say in their patients’ care.
Five years ago, hospitals waged intense bidding wars to fill nursing vacancies, luring nurses with huge signing bonuses and even sport-utility vehicles and vacations to the Bahamas. Those efforts often only served to exacerbate turnover, spurring nurses to remain in jobs just long enough to claim the prizes before moving to other hospitals with better incentives.
As it turns out, many nurses want better working conditions more than they do extra money. Hospitals now are responding by introducing technology to dramatically reduce paperwork, offering more flexible hours, reducing caseloads, paying for advanced training and giving them more authority.
“Autonomy is a big thing,” said Dimmick, who has been at the hospital for 7 1/2 years. “It’s important for me to know that what I do matters.”
Inova Fairfax recently introduced a state-of-the-art data system — consisting of video monitors and other equipment that track the vital signs of intensive care patients — to reduce the amount of time nurses spend filling out paperwork. It also has established a concierge that offers such services as dry cleaning, movie tickets and car detailing for busy nurses trying to juggle their professional and personal lives.
Inova is part of a nationwide movement. These days, nurses at Children’s Mercy Hospitals and Clinics in Kansas City, Mo., for instance, set their own schedule and have a say in what type of equipment should be purchased and whether patient-staff ratios need to be adjusted.
“Having the option to voice an opinion is amazing,” said Jana Schlosser, a nursing education coordinator at the hospital.
Closer to Washington, nurses at Georgetown University Hospital have been encouraged to conduct research projects, which often become institutionalized as new care plans. Some are looking at whether giving chewing gum to patients who went through gastrointestinal surgery can more quickly restore their digestive functions and whether an electronic device that automatically dispenses medication can reduce pain for patients who had their knees and hip joints replaced.
“Morale was low,” before Georgetown introduced the new programs in 2004, said nurse Laurie Dohnalek, adding that her colleagues’ attitude was “just get through the day.” Now, she added, “everyone is looking to grow — how can I make this place better?”
Hundreds of hospitals are spending millions of dollars to retool their practices, experts say, because of the high expense in losing nurses. “It costs $50,000 to $100,000 to replace one nurse — and that’s not counting salary,” said Pat Rutherford, vice president of the Institute for Healthcare Improvement, a nonprofit organization based in Cambridge, Mass. The money, she said, is spent on overtime payments and temps to cover the position, as well as recruiting and training for a permanent replacement.
The number of open nursing jobs nationwide reached 116,000 in 2007. The vacancy rate has dipped slightly; for now, the dismal economy is providing some respite as nurses take on more work to make up for income lost by others in their households who were laid off.
But hospitals are bracing for 2025 when retirements and other factors are projected to push the number of open jobs to as many as 1 million, just when Baby Boomers will require more nursing care.
“We’re in a big, big world of hurt coming up,” said Peter I. Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University. Buerhaus said having fewer nurses would seriously compromise hospital care, putting patients at greater risk for pneumonia, falls, bed sores and infections. “This would be lights out for many [hospital] organizations.”
More than 150 hospitals have launched pilot projects under the Institute of Healthcare Improvement, which works with such facilities to enhance patient care and nurse retention. And about 300, including Inova and Georgetown, have become certified under the American Nurses Credentialing Center’s Magnet Recognition Program. The credentialing center’s program is awarded to hospitals deemed to be “magnets for nurses” for introducing more training programs and mechanisms for nurses to have a greater say in patient care.
Experts say the hospitals’ investments are paying off.
“We’re able to show that nurse satisfaction is significantly higher in magnet hospitals than in matching hospitals” that don’t have the status, said Linda H. Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania. With a higher proportion of nurses with bachelor’s and master’s degrees, Aiken added, “magnets have significantly lower mortality rates than other hospitals.” Moreover, she said, patients at magnet hospitals have fewer complications, keeping pharmaceutical and diagnostic costs low.