A Prescription for the Nursing Shortage

Recent news stories suggest that the nation may be in for a nursing shortage more severe than the one it witnessed in the late 1980s and early 1990s. But Memorial Hermann Healthcare System’s Human Resources department believes careful planning will enable it to beat this potential crisis.

With more than 4,500 nurses at 11 hospitals, Memorial Hermann has managed to maintain a lower nursing vacancy rate than the rest of the country. Memorial Hermann’s top human resources officials report that turnover has improved, and that for every 100 nurses hired, less than 20 leave.

Make no mistake about it, the system is spending big bucks to attract top nursing professionals from around Houston and all over the world. Margaret Loper, Memorial Hermann director of strategic recruitment, seeks nurse candidates from as far away as Canada, Ireland and Scotland. Her domestic recruitment strategy includes advertising in local publications and professional journals and through radio, direct mail and open-house events.

But Loper said the most effective recruitment tool by far has been referrals by Memorial Hermann employees.

"That accounts for close to 40 percent of our hires," she said. "We make all of our employees recruiters."

There’s a hefty reward for being one of Loper’s deputies. The system pays $1,000 for referrals of full-time, experienced nurses who are hired and up to $10,000 for nurses hired to fill what are considered more challenging positions like those involving overnight shifts and working in hospital intensive care units and emergency rooms.

"We spend a lot of money on the employee referral bonus and we consider it money well spent," says Loper.

Memorial Hermann devotes at least as much time and attention to keeping qualified nurses as it does to attracting them to the system. Director of Development & Retention Susan Shelander said money is a big part of that process, as well.

"In 1997 and 1998, our starting salary for nurses was anywhere from $14 to $15 an hour," she said. "Right now, it’s $20 an hour, so Memorial Hermann has really made some significant jumps and certainly kept up with the community standard in nursing salaries in general."

Shelander is president of the American Society of PeriAnesthesia Nurses and was recently elected as a member of the coordinating team of the newly formed Nursing Organizations Alliance that represents the recent merger of the National Federation for Specialty Nursing Organizations with the Nursing Organizations Liaison Forum. The mission of "the Alliance," as it’s known, is to increase the nursing profession’s visibility and impact on health through communication, collaboration and advocacy.

Loper says when Memorial Hermann loses nurses who relocate out of Houston, it’s generally because they’ve decided to become travelers. Travelers work for agencies that place them on temporary nursing assignments all around the country. While Loper admits that traveling nets better pay than a staff position (salaries start around $50 an hour), she’s quick to point out that it fosters a lifestyle in which a nurse never settles down in a given location or grows to become a permanent member of a hospital’s medical team.

By contrast, Shelander says Memorial Hermann’s goal is to build a core, stable, nontraveling medical staff at all its facilities. For a nurse, that means someone who "lives in your community, is part of your community, gives to your community and is committed to their employer."

Filling nursing positions is going to become even more challenging over the next 20 years as current staff members reach retirement age along with the nation’s baby boomers. Experts fear that by 2020, half a million nursing positions will go unfilled in this country. That’s about five times the current vacancy rate.

While it’s needed, Memorial Hermann’s $420 million hospital expansion program will further add to the system’s staffing challenges. At Memorial Hermann Memorial City Hospital alone, it will mean hiring 429 new nurses by early 2003. To put that in perspective, the system typically hires 120 nurses a month on average. That translates to almost four months worth of hiring just to address the nursing staff of one facility.

"That new workforce is not in nursing school yet. Some of them are still in elementary school and junior high. This puts extra pressure on recruiting because your pool is dwindling tremendously," Shelander noted of those who will answer the call to join the nursing profession.

"We need to make nursing attractive to a much younger generation if we expect to have prepared applicants by high school graduation," she added. "They’re just not turning them out of nursing schools like they once did."

In fact, the National League of Nursing reports a 13 percent drop in nursing school graduates between 1995 and 1999.

Shelander said hiring faculty to handle nursing school applicants is another critical issue. In the last six months, Memorial Hermann has spent $300,000 to add four Ph.D.-accredited nurses to the faculty of The University of Texas School of Nursing at Houston and Houston Baptist University, which are affiliated with the system. The move followed concerns by the nursing directors of both schools, citing that they lacked sufficient faculty to address the number of student enrollments.

Loper begins recruiting the moment a nursing student begins his or her rotation at a Memorial Hermann facility.

"We hope they like what they see in our system, because our system has a lot to offer," said Loper. "One of the most important recruitment cards we have to play is that you can live close to where you work if that is important to you."

Nurse Sandra Uribe doesn’t mind the 40-minute commute from Pearland to the labor and delivery unit at Memorial Hermann Hospital. After devoting nearly two decades to the system, her passion for her work at Memorial Hermann Hospital grows each day.

"There is a sense of pride knowing that I have been given the gift to be able to work here and influence the life of another person," said Uribe.

Uribe said her influence is not limited to the lives of patients.

"My true passion is the influence I have personally made on nursing students the past 18 years," she said. "Houston has excellent nursing programs, and we are blessed to have them join us in caring for our patients."

Uribe has high expectations of the nurses she helps train.

"I want passion in the work they do," she said. "I need commitment. I need someone with initiative to do better at all times, to assume responsibility for the success of the hospital. We want to be ‘Pioneers in Practice,’ constantly valuing and striving for learning opportunities."

Loper encourages nursing students who serve a rotation in the system for academic credit to work for the system in their spare time as a nurse technician or professional student nurse.

"It pays pretty well and gives them the experience that they need when they graduate," she said. "If they are already working for us as student nurses, they come in at a higher rate of pay than those who have not worked for us."

During the past five years, Memorial Hermann has developed nursing internship programs within its hospitals. Shelander said this gives new graduates hands-on clinical experience that they might not have gotten in school and exposes them to "the diversity of nursing while working side by side with the best nursing role models and mentors in our system."

Loper said the vacancy rate for nurses at hospitals throughout the system is 9.5 percent compared to a national average of 11 percent. While that puts Memorial Hermann in an enviable position, Loper cautioned that some units within the system need help.

"For instance, the night shift and intensive care unit vacancy rate may very well be 25 percent," she said.

Shelander said the system is trying to entice nurses not only with better pay but with flexible shifts to accommodate people’s lifestyles.

"The hospital as a whole has done a lot of creative things with their schedule so they can attract whoever is available to fill that schedule," she said.

Memorial Hermann Chief Human Resources Officer Doug Beckstett said many nurses who’ve left the system quickly returned when they discovered qualities missing in their new employer.

"We’ve had many people leave our organization for that extra $2 an hour, and they come back in two to three months saying, ‘There was a lot I took for granted in the culture we had, in the work environment, how I was treated, and it was completely different over there and that’s not worth it for a buck or two,’" said Beckstett.

Both Shelander and Loper see improvement in the way the nursing profession is regarded among key members of the medical staff.

"I think it’s really important for nurses to understand the value they bring to an institution, stand up for that value and be respected for it," Shelander said.

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©2006 Texas Medical Center

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