Retention of nurses at healthcare organizations has been a problem for several years. With the aging population in the United States the nursing shortage will become more critical. The case at Grayson County Regional Health Center indicates a problem with employee retention. The group that is most affected are the nurses where retention rates have ranged from 15%-50 %( Fried and Fottler, 2010) over the last several years. The best ways to retain employees is to first screen and select the best qualified employees. This can be done through automated screening tools, peer interviews, and retention focused management. Three organizations will be compared in this article. The 30 nursing homes in New York and Connecticut, the Jupiter Medical Center in Jupiter Florida will be referred to as examples of how retention problems can be solved. The Eastern Idaho Regional Medical Center in Idaho Falls, Idaho is another organization that has successful solved recruitment issues and has created a culture where people stay due to good working conditions and benefits. Solutions to retain employees once they are hired will be discussed by creating a culture where people feel appreciated. Recommendations will be given to solve Grayson County Health Center’s employee retention problems.
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Shortage of Employees and Grayson County Regional Health Center
Grayson County Regional Health Center is a private non-for-profit 225 bed acute care hospital located in a rural community in a southeastern state. The hospital provides a range of inpatient and outpatient services. There is 24 hour emergency care offered. The hospital serves Grayson County and three other neighboring counties. The population of the county is 60,879 with 53% African Americans, 42% Caucasians and 5% Hispanics. (Fried, et al. 2010) The area suffers from economic hardships where many of the manufacturing jobs have relocated.
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The Employee turnover at the hospital is a 40%, and for nurses the turnover rate has ranged from 15-50% the last few years. (Fried, et al .2010) Medicare and Medicaid are heavily relied on for the income at the hospital. The hospital is not able to pay competitive market wages for the nurses and other professionals. The result is the hospital is under staffed and the quality of care is a concern. There are many things to consider to how this situation can improve. Can better communication between the staff and the management be implemented, to create an environment where employees feel valued? A retention specialist position or committee should be considered for retaining employees. Not retaining employees can cost an organization a lot of money. Do you have an estimate of how much it can cost? If more employees stayed with the organization money could be reallocated to pay staff a competitive wage. Another question to be answered is if anyone in the community can be retrained for the jobs at the hospital, where unemployment is so high in this county. Retrained for jobs such as…?
The costs of employee turnover can be radically changed by retaining more employees. One example given by Quint Studer (2006) if an organization with 3000 employees which have an average salary of $45,000 a year , a 1% reduction in turnover equals more than 1.3 million in a years’ time. One of the problems at Grayson County was the inability to pay employees competitive wages. Wages being one of the crucial ways to help retain employees it would be beneficial if the costs saved from employee turnover could create a way to pay the employees better.
In the text by Fried et al. (2010 p.198) states that recruitment and selection are the key to retention, one important part in the selection process is to screen the job applicants to see if they fit with the organizational values and have the skills necessary for the work. Another consideration is it can be easier to teach skills than to change attitudes of employees. Determining which applicant fits the organization can be done by asking behavioral questions in the interview to gain insight to the skill sets the applicant possesses and their values. How do behavioral questions differ from personality tests? Having peers involved in the interview process can help with the selection process to find an applicant that fits best with the organization. The first 30-60 days are the most crucial to retaining an employee. The employee turnover can be 25% in the first 30-60 days ( Studer, 2006). Making sure to follow up with new hires to clarify expectations, recognize efforts and encouraging the employee to give helpful examples of past work experience that would be beneficial for the organization can help with retention in the crucial first 30-60 days. These tactics have been proven to work at a 340 bed hospital in Downers Grove, Ill where a reduction of employee turnover improved by 36.5 % in a years time. ( Studer, 2006)
The Healthcare Advisory Board (HCAB) conducted an extensive review of recruitment and retention strategy and identified each strategy’ relative effectiveness. The HCAB review yields five effective retention strategies: Firstly, selecting the right employees. Secondly, management improving the orientation and on-boarding processes by creating a buddy program and other opportunities that help new employees establish professional and personal relationships with colleges. Thirdly, monitoring turn over to identify specific root causes, including identifying managers whose departments have high turnover. Fourthly, efforts in developing and implementing ways to retain valued employees in the organization will reduce turnover percentages. Fifthly, although marginal in its effectiveness the HCBA recommended systemically attempting to reverse turnover decisions. (Fried et al. 2010).
Other retention strategies given by Fried et al (2010) Where to create a culture where people want to stay because they enjoy their work. The manager does this thru empathy and truly caring for the welfare of the employees creating authentic connections with each staff member. This can allow for better focus on problem solving in the organization. A generic strategy for retention is through competitive compensation, differential and premium pay through signing bonuses, forgivable loans, and extensive benefits.
In Jupiter Medical Center (JMC) in Jupiter, Florida Paul Dell Uomo (2009) reported that they suffered from recruiting and retention problems which were a problem in opening up more beds to serve the community. After weighting the options it was decided to outsource the recruitment function which helped in organizing hiring practices. This cut costs including a 1 million dollar decrease in contract labor (Uomo, 2009).<–Who did use for outsourcing? One problem solved was the seasonal increase in nursing and bed use during the month that the snowbirds wintered in the community. One issue that the JMC had trouble resolving on their own was that the staff vacancies took too long to fill can added additional labor expenses due to temporary labor costs, contract labor costs and staff overtime. Outsourcing helped JMC improve on its hiring practices by conducting extensive workforce planning. JMC found it difficult to devote the necessary resources to recruitment. Training for new staff takes time, costs money, and consumes capacity of current staff to conduct the training. It is also challenging to prioritize recruiting efforts which lengths the time to fill the vacancies. JMC was training on average 30 new employees a month. The University of North Carolina found that cost per hire to an RN was $5300(Uomo, 2009).
If there is significant turnover rate then it signals that the organization is not proficient in its screening and selection process. JCM suffered from a significant first-year turnover. The solutions to their problems started with a discovery process. First they started utilizing an applicant tracking system which helped screen for the qualified applicants to reduce the time the Human resource management department spent on interviewing. Secondly a multifaceted recruitment marketing plan was designed. Leadership training to focus on recruitment, retention and employment engagement to optimize the hospital retention rates was implemented. Then metrics system for the HR department was developed to track costs and effectiveness of recruitment efforts. Another process that allowed for filling open vacancies quicker was to establish a passive pool of candidates.
The implementation of the retention program took eight weeks and by the end of three months JMC was seeing positive results. The processes that were put in place helped to improve their overall financial performance. Then continual evidence for the first year showed excess revenue over expense was up 188% from 2007 and revenues were up 13% from 2006(Uomo, 2009). Other outcomes were reduction in costs from employee turnover, improvement to employee retention, and patient, employees and physician satisfaction.
In a randomized controlled intervention study conducted for nursing homes facilities designed to reduce the turnover of employees in thirty nursing homes in the states of New York and Connecticut found that the use of a retention specialist helped to retain employees. The group that was evaluated consisted of 762 certified nursing assistants (CNAs). The outcomes were measured by staff interviews and employee turnover rates. A staff member was selected to be the retention specialist for each facility and they received three days training and support services for the year. The retention specialist advocated and implemented the retention program to improve staff retention and commitment. The study provides evidence for the effectiveness of the retention specialist. The facilities experienced significant declines in turnover rates of the CNAs.
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The need for intervention was determined because of the long term problem with CNA retention for nursing homes. The CNA turnover annually was nearly 100%, other nurses where 50% and other employees 70 %(Pillemer,K. Meador,R. Henderson,C. and Robison,J. 2008) .The high turnover especially of the CNA staff impacted the quality of care and morale due to chronic stress of being short staffed. This is an enormous problem due to the aging population of America in increasing. Experts agree the cost to the facility for replacing a direct services worker typically amounts to 25% of annual compensation of the worker or more.(O’Malley,M.N.2000 as cited in Pillemar,K. et al.).
Three reasons were given to why this approach of having a retention specialist increased employee retention. First the range of possible solutions required specialized expertise. The specialist has the ability to determine specific staff and facility needs which can make retention successful. Secondly, the retention specialist monitoring ongoing activities is more effective than the programs structure that only focuses on a program. The retention specialist is can play the roles of strategist, interventionalist and innovator on staffing issues. (Armstrong,M (2001) as cited by Pillemar,K. et al.).Thirdly, The role of an empowered individual can create change in an organization. An appointed individual that is vigorously promoting and overcoming opposition to change can make it retention successful.
The strategies that the retention specialist used were; training on how to build a stable work force, intervention strategies such as peer mentoring, career ladders, communication training, and recognition of employees work effort, work-life balance, and improved supervision. Three programs were found to be effective from the study which was programs about respect and recognition, improved management practices, and work and family support. Change occurred through implementation of formal programs, an atmosphere of respect for employees and communication. The most commonly used program was peer mentoring, followed by employee respect and recognition programs, and communication programs. The least utilized program was career ladders due to most facilities had this program already. The studied concluded that a committee for retaining employees would be a better option than a single person due to turnover of that person at the retention specialist position.
At the Eastern Idaho Regional Center (EIRMC) in Idaho Falls, Idaho the need to for more nurses currently is not problematic. With the recent economy issues more women are seeking work where their husbands have been laid-off. About ten years ago in this area there was a nursing shortage. According to Shonda Brown (personal communication, November 14 ,2010) a nurse in the emergency room at EIRMC there were many programs that were implemented to bring new nurses to the facility as well as retention programs to keep the nurses currently employed. Brown (2010) feels like the nursing shortage is currently being masked by the poor economy due to less elective procedures occurring and more women seeking out employment. She also feels the aging baby-boomer population will bring about the need for more nurses in the healthcare market in the future.
At the time when there were nursing shortages a sign on bonus for working for EIRMC was offered. If nurses would commit to work for a certain amount of time, EIRMC would help pay off student Loans. They created mentoring and training programs for new graduate nurses for critical care areas that needed experienced nursing care. To retain the currently employed nurses a pay differential was offered to nurses to take on extra shifts. EIRMC would pay $12 dollars more per hour on the extra shift plus overtime pay. They created a pool of nurses that would float to floors where they were needed and they would have a pay differential of $8-$10 more per hour for those shifts.(Brown 2010) Longer shifts scheduling was implemented to cover more time with the same nurse. The down side for the current employees working during the nursing shortages was burnout. The nurse’s morale was low do to the inability to care for patients properly because of high patient to nurse ratios. The nursing staff had frustrations due to quality of care being lower from having too many patients to cover and any problems that were not taken care of was ultimately the nurse’s responsibility.
According to Wendy Anderson (personal communication, November 15 ,2010) the Human Resource Manager at EIRMC indicated that there current turnover rate is %5 for RNS and over the last year the rate has been between10-12%. They did not have a five year data base to refer back. In their website they had costs of recruitment listed at in 2006 at $545,000 per year for employees and for physicians 1 million per year (Anderson, 2010). However, due to using their website and specific data base search engines for niche advertising, they have lowered their cost of advertising to $2000 in 2010 from $200,000 in 2007(Anderson, 2010). The recruitment costs have also decreased due to the ability to do virtual interviews which cost about $100 compared to having to bring someone in from out of area and paying for cost of hotel and driving which averaged $ 1500.The organization spends about 1.5% of the new employees annual income to recruit(Anderson, 2010).
The EIRMC has recruitment strategies in place to retain the employees that are successful for the organization. The hospital has behavior standards that an employee must agree to when hired. They have created a culture that is friendly and family orientated. They have values that are implemented into their behavioral standards like respect, recognition and high quality of patient care. Another strategy they have incorporated is management development programs. There are bonuses for people to continue and train to be the next managers. There are programs to make sure people are not overworked thru scheduling appropriateness. EIRMC has added a benefit for employees this year was an e- health screening and $500 to help the employees obtain better health. The challenge that they have had lately with recruitment is people are having a harder time relocating because of the economy and cannot sell their homes in order to move.
The Jupiter Medical Center, the nursing home study, and Eastern Idaho Regional Medical Center all had strategies to increase the success rate of their recruitment and retention efforts. ALL organizations placed a stronger emphasis on the recruitment and retention to solve their problems with the high turnover rates of employees. The nursing home implement a retention specialist program to have continual focus on retaining employees, through building a stable work force, peer mentoring, communication training, and improved supervision. JMC choose to outsource their retention problem in order to have continual focus on retention of employees. Their effort was in using better screening applications, providing metrics of the costs, marketing to a more qualified applicant group, and creating a passive pool of employees for future needs. EIRMC at the time of shortages implemented pay differentials and loan pay back programs. EIRMC now emphasizes a culture of respect and recognition for the employees.
To solve the retention problems a Grayson County, these changes will be implemented. First a discovery assessment will be completed to see what their current programs are and what technology they have available. Through the screening technology the best applicants will be selected to interview saving time and money for the management. A retention committee will be formed to focus on implementing the changes needed to create a better retention program. Using behavior based questions in the interview process to assess the skill set of the applicant will be utilized. Creating a peer review committee to determine if the applicant is a good fit for the organization will be established for the interview process. Next utilizing a metric system in order to track the progress of our efforts in decreasing cost and retaining employees by using the technology in the organization will occur. Create a passive retention pool that can be accessed for quicker hiring at times of increased organizational activity. Then the retention committee will periodically assess how the new and current employees are doing. Development of a mentoring and training program that will assess retention efforts and report to the retention committee that shows the support that the new employees are receiving. The mentoring program can access if the job is meeting the new employee’s expectations or if more training would help them with completely job duties more efficiently. Creating a culture for the organization where respect, recognition, and empathy for the employees work life balance is important to retain new and current employees.
In Conclusion the problem of recruitment and retention of employees can be detrimental to an organization in cost and quality of care. The solutions to the problem are by first selecting the right employees for the job through proper screening. Have the organization create a buddy system or a mentoring system to help new hired employees have support during the first 30-90 days for better retention of the new employees. Form metrics to track employee satisfaction to find the root of the retention problems. Develop ways to create a culture where the employees feel recognized and appreciated .Out sourcing the retention problems can allow for a more focused approach to retaining employees. Having a retention specialist can increases job satisfaction by having continual focus on retaining and networking with employees.
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