Recently, many hospitals worldwide have experienced some setbacks in reference to health care delivery system. This setback was primarily caused by the growing shortage in the number of experienced and competent healthcare workers, particularly nurses in the health profession. One of these hospitals is Renfrey Memorial Hospital, who is facing not major problems related to an aging nursing staff, overworked personnel and migration of able and experienced nurses to other health institutions because of the more promising professional life.
This report would identify the best practices and benchmark techniques used by differently medical facilities that have experienced similar problems. The goal of this paper is to decide which of these benchmarks could be used by Renfrey Memorial Hospital to address its own problem. After extensive review, it has been found that the best way to deal with the problem is to develop a system that would improve rotation or scheduling of the staff to ensure that every employee is overworked. In addition, the hospital could also invest in an electronic-based technology or information system technology that would make work more efficient. Finally, aside from this temporary solution the government should create a mandate that would motivate individuals to pursue a career in health care as RN, LPN and CNA.
A 200-bed capacity regional hospital, Remfrey Memorial Hospital, better known for its abbreviation RMH, is located in the Midwest. Named after a famous philanthropist around the region, Gilbert H. Renfrey, the hospital has been serving the community for more than 32 years. Renfrey is the only hospital in the area that has an open emergency services department for 24 hours aside from the extended hours serviced by the urgent care clinic.
Unfortunately, the hospital is encountering some problems relating to maintaining the current nursing staff. The hospital is composed of an aging nursing staff with approximately 68% of nurses being over and above the age of 45. Some of them are already facing their retirement. The hospital also noticed a very slow-paced work among its medical staff. In lieu with this, the hospital commissioned a third party representative to conduct a survey. The goal of the survey was to identify the sentiments and the opinions of the employees regarding their work at Renfrey.
According to the survey, several findings had been significant. First, the nursing staff admitted that their job at Renfrey is too physically demanding. Thus, they admit to being physically exhausted and emotional burned-out. And second, their jobs are almost conflicting with their personal responsibilities as many of the nurses are still caring for an aging family member after their jobs at the hospital. In the past, the hospital has witnessed what has been termed as the nursing exodus. This nursing exodus pertains to the movement of nurses from one hospital to another, either within the same locale or to another country.
The nursing exodus or nursing diaspora has brought in numerous implications in the medical profession. Not only has it crippled the health institutions, but it also compromises the delivery of health care services to the people and the community. To temporarily and immediately address the problem, Renfrey has been forced to hire nurses from agencies to cover the shortage in nursing staff. Sadly, the temporary pool of nurses that are hired temporarily to fill in the deficiency in nursing staff has a dramatic effect on the hospital’s finances. It is comparatively more expensive to hire nurses on a temporary status than have them regularized as permanent employees of the hospital.
Needless to say, this practice has also lost the commitment and dedication in the service because customer satisfaction rating has also dropped following the scarcity of experienced nurses and the coming in of reliever nurses to fill in the position left by the retiring nurses and those who simply left to transfer to another hospital. The Human Resource Department of Renfrey Memorial Hospital has already expressed their concern regarding the complexity of hiring new nurses to replace the retiring staff because of the shortage of available nurses.
The Hospital recognizes that this is a major setback which might cripple operations if the right solution is not found. The solution does not rest on finding temporary relievers for nurses who do not report to work or temporarily hiring nurses from the agency to augment the scarcity of nurses in the unit.
A medical facility like a hospital, health center or another medical institution relies heavily on their medical staff, specifically the nurses. Therefore, there is an urgent need to address any issue that might compromise the quantity and the quality of health care services provided by these institutions as caused by the scarcity of experienced and competent workforce.
Benchmarking and standardization are essentially being pursued by the United States to establish a rule to specify the specific provision as stipulated in the policy pertaining to healthcare. This is in accordance with the Joint Commission on the Accreditation of Health Care Organizations.
Benchmark and standardizing hospitals in terms of policy is directed on issues that confronts hospital management particularly relating to finances, human resources and effective delivery of health care to the people and the community.
Hospitals and medical facilities experiencing similar problems with Renfrey Memorial Hospital initiated their own research into finding out the effective ways on how to provide a solution on the growing problem on the scarcity of nurses in the US. In this paper, five medical institutions shall be taken into consideration to review their respective solutions in terms of economic feasibility, professional credibility and efficiency in execution. These institutions would include Central Mississippi Medical Center, Sta-home Health, San Antonio Community Hospital, Columbia-Presbyterian Center and Spartanburg Regional Healthcare System.
SOLUTIONS OF THE STAKEHOLDERS
Central Mississippi Medical Center
In 2002, the Central Mississippi Medical Center launched a campaign and recruitment effort in the Philippines that lasted for several years . A representative was sent to the country to convince the local nurses to consider the possibility of working overseas. The effort was done to recruit local nurses from the country to work and relocate in the US. The campaign has been able to sign-up 100 nurses. One-third of which, were located to Jackson, Mississippi.
The effort was very inviting to local nurses from the Philippines. The offer of working in the US was not simply a promise of a bigger salary, but more rewarding professional experience. It is very clever of the organizers to launch their campaign in the Philippines because many of the locals in the country were lured by the idea of fulfilling their American dream. Working as a nurse in a US-based hospital is their fastest ticket to the US. Not to mention the fact that the offer is not only limited to the nurse, but is extended to his/her immediate family. The recruited Filipino nurses were assisted with their immigration requirements, housing needs and even in acquiring their license through the NCLEX. In exchange for this, the nurse should stay at Central Mississippi Medical Center for 30 months.
The Sta-home Health, inspired by a program launched by Medicare adapted a similar program. They followed after the pattern that was set by Medicare when it used the money saved from the Medicare Reimbursement fostered by the adaption of the Balanced Budget Act of 1997 to start the Interim Payment System (IPS) . However, instead of offering financial assistance to health institutions grappled by the shortage of health practitioners, Sta-home Health founded the Frances Young Scholarship, named after a nurse who met an accident while in the call of duty. The scholarship awards $2,500 to any worthy LPN (licensed practical nurse) who want to take his/her education to the next level by taking BS Nursing to qualify him/her an RN licence.
San Antonio Community Hospital
The San Antonio Community Hospital offered a different approach in assisting their nurses and showing them that the hospital management understands and recognizes that they too have their own personal needs. The hospital is already satisfied with their staff so their only concern was how to retain them so they will not be motivated to leave. Aside from offering financial assistance and other monetary compensations, the San Antonio Community Hospital launched a “concierge service” that would assist their nurses who would normally have to work a straight 12-hour shift . The concierge service would help nurses with their daily chores at home like doing the laundry, picking the mails, doing the groceries and other errands that can be done by another person. The goal here of San Antonio Community Hospital is to help nurses out by lifting a few of their usual chores off their shoulders.
Columbia-Presbyterian Center has a creative way of addressing the issues. The intervention that was proposed by Dr. Michael Treat was employing the use of robot's programs to do the tasks that are usually completed by a human . This approach is, in fact, used in the operating room, where a single-handed robot passes out the tools and instruments to the surgeon during an operating procedure. This practice relieves and dispenses the role of a human nurse.
According to Dr. Treat, there are other duties that can be assigned to robots other than handing out instruments in the operating room. Another popular practice relates to dispensing medication and meal distribution, which are now being performed by rotating robots.
Spartanburg Regional Healthcare System
Many nurses typically hate the graveyard shift, while others hated morning and midmorning shift. In Spartanburg Regional Healthcare System, they have a clever approach in ensuring that these shifts are filled and that the nurses working on that time are satisfied nurses in order for this happiness and satisfaction to reflect in their work and service . Instead of appointing the extra hour on their schedules, the management of Spartanburg Regional Healthcare System allows their nurses to bid on an extra shift schedule. The lowest bidder gets the shift. This is an online auction that starts the bidding as high as $40/hour. Everyone who would like to bid down is entitled to waged down by ¢50 bid. Usually, an extra shift gets paid at $36/hour or more than 50% of the regular rate.
SOLUTIONS AND IMPLEMENTATIONS
Evaluating the proposed solutions of the five hospitals would give Remfrey a good idea of how to innovate in empowering nurses to work for the hospital. Central Mississippi Medical Center, Sta-home Health, San Antonio Community Hospital, Columbia-Presbyterian Center and Spartanburg Regional Healthcare System all provided useful insights on how to address the issue of retention, selection and the growing scarcity of experienced and credible nurses in the active workforce.
Among the five hospitals, the most economical and efficient approach would be San Antonio Community Hospital and Columbia-Presbyterian Center. This analysis has been made because of the long-term effect of their proposed solution to the problem of nursing exodus. One should always remember that the issue here is not only with the scarcity of the nurses but the fact that nurses do grow old and reach a point of retirement. In addition, this is also related to the problem of retention, or ensuring that the current nurses under their payroll would not leave their post and transfer to another hospital.
San Antonio Community Hospital is the most economic approach out of all the proposed solutions. The “concierge service” is economical in the sense that the service expenses used to cover for laundry, grocery and shopping would still come from the nurse. However, the hospital will only be paying for the service of the person hired to do this task. This is comparatively less cheap than the system currently practiced at Renfrey of hiring a pool of the temporary nurse from the agency. In addition, if one have heard of a study on employee satisfaction and motivation it was found that employees are not always after the monetary reward for doing their jobs right. A pat on the back, recognition or a praise usually goes a long way. If one would also go back to the result of the survey commission by Renfrey Memorial Hospital, majority of their nurses complained of being physically and emotionally stressed out from work. It would help a lot if, during the nurse’s off from work, he/she can full enjoy the day by sleeping, resting or any form of recreation. Unfortunately, a large number of these nurses have to face the problem of having to work on their chores during their day-off from the hospital. According to some nurses, this is their only available time to do their laundry, pick up their mails, do their grocery, clean the house on top of other obligations like paying the bills. This is would be highly appreciated by nurses especially those who have been working long enough to know the value of taking one or two chores off your shoulder.
Columbia-Presbyterian Center Solution addresses the problem on the aging workforce. Regardless of whether hospitals find an able replacement, time will come that there is still a need to look for a replacement to this replacement because as years go by, the recruit nurses will also age and reach retirement age. In addition, by using robots to perform the jobs of human nurses, the level of consistency will always be the same. Robots doesn’t get tired. They don’t complain of physical discomfort or fatigue. The level of consistency in the work of a robot will be the same as with the first time the task was performed because they are programed to perform at an uniform pattern. While the hospital necessarily has to invest money on acquiring these technological breakthroughs, the hospital should think of long-term rewards. Remfrey can save on regular hiring and selection, training and team-building. The hospital can also save money on paying for monthly compensation and benefits. However, on the downside the use of robots are less personal. Some patients may find it intrusive or impersonal because robots cannot interact with patients. In effect, customer satisfaction rating might be compensated.
There are a number of reasons for the nursing exodus that is experienced by several health and medical institutions worldwide. In fact, nursing diaspora is experienced not only in the US but even in the other parts of the world. Contrary to the belief that the Philippines might have an overabundance of nurses because they are the widely recruited nurses that fill in the gap in the scarcity of nurses overseas, a number of Philippines hospitals are also complaining of the scarcity of experienced and credible nurses.
If one would closely examine the reason for the nursing diaspora, its can be pointed towards the direction of education. Very few are encouraged to enroll in nursing schools because of the tuition fees that colleges and universities ask from the students and their parents. On top of the tuition fees, there are numerous trainings and apprenticeship that a nursing student necessarily has to complete, and that would also require payment. On the other hand, while some third world countries offer nursing degree and students are motivated to take them up, there is the problem of standardization and meeting the standards of the US or UK or Canadian system. Hence, despite the number of unemployed nurses in some Asian countries, not everyone can exactly be called in to fill in the gap.
Another problem that is related to nursing exodus is the uncontrolled migration of nurses because their country could not find ways to prevent them from leaving and seeking for greener pasture. In the Philippines, a number of health centers, hospitals and other medical facilities were forced to close down because they do not have a number of workforce to keep these institutions running. Majority of the nurses had been lured into moving elsewhere to practice their profession. As mentioned earlier, the offer is much better abroad than in their local country. The movement of nurses has largely been due to a more competitive salary and benefit offered by hospitals elsewhere.
If Renfrey Memorial Hospital is to adapt a system among the five solutions used and implemented by the five health institutions used in this study, the best will be the solution used by Columbia-Presbyterian Center. Adapting robot to replace some of the jobs of nurses. This is the most cost-efficient and most practical thing to apply. While the hospital will initially have to invest a lot of money to acquire these breakthroughs, in the long run the hospital can benefit from the said venture.
However, it should be made clear that this recommendation is not aimed at dispensing all the human nurses and replacing them with android. However, this recommendation is initiated because it is economical. It also addresses the problem of aging workforce, the migration of nurses, retention issues and low quality of work. These had all been explained accordingly in the earlier part of this paper.
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Tarkan, L. (2004, January 6). Nursing Shortage Forces Hospitals to Cope Creatively . Retrieved June 22, 2014, from New York Times: http://www.nytimes.com/2004/01/06/health/nursing-shortage-forces-hospitals-to-cope-creatively.html