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Q&A Healthcare – Nurse Shortage

The shortage of registered nurses was one of the hottest topics in the Orange County and California healthcare sector in the late 1990s and early to mid-2000s.

Hospital leaders began fretting about hiring and retaining nurses as they fought against demographic trends that included an aging population of nurses, and younger women pursuing a wider range of careers.

Much of the concern came from state studies that forecast California would need nearly 110,000 new registered nurses by 2010.

Hospital executives began to offer bonuses and flexible hours to recruit more nurses.

Salaries rose rapidly to an average of $88,000 a year in OC, according to the latest figures from the State Employment Development Department.

Another game changer has been the recession. The Business Journal decided to ask chief nursing officers at several Orange County hospitals to share their thoughts on the industry’s landscape today, including questions on how it’s changed; whether the hospitals have been able to hire adequate numbers of RNs; if they’re still using hiring incentives; and the status of their work with local colleges and universities to attract nurses.

Here are edited versions of their answers:

Kathy Dawson

Vice President, Patient Services; Chief Nursing Officer, Saddleback Memorial Medical Center, Laguna Hills and San Clemente

We as a nursing community have made tremendous progress in addressing the shortage and promoting nursing as an excellent career choice.

Partnerships among Saddleback Memorial, the entire MemorialCare Health System, and local colleges and universities continue to achieve outstanding results. Longtime nursing programs are increasing the number of slots available for perspective students, and more colleges are offering educational programs in nursing. Additionally, nurses from our hospital and other MemorialCare settings are pursuing graduate degrees to become clinical nurse instructors.

Today, there are more than enough registered nurses to fill our open positions, thanks to continued collaboration with academic institutions. With many new graduate nurses having challenges finding jobs, we actually have nurses coming to us from outside the area and other states applying for positions.

Twenty MemorialCare registered nurses recently graduated from our inaugural Nurse Leadership Academy. The academy’s curriculum of advanced knowledge and skills advances the participants’ leadership in current areas of expertise and/or allows them to move into nurse leadership roles in management, education or informatics.

Because of our efforts to ensure an adequate supply of outstanding nurses, we no longer offer signing bonuses.

We offer training programs for specialty areas, such as intensive care, neonatal intensive care, and labor and delivery, which are becoming more important as experienced nurses retire and more new graduates join the workforce.

Since our close partnerships with local college and university nursing programs allow us to more easily fill open nursing positions, there is no need to recruit from outside the area. MemorialCare Health System continues to offer learning opportunities and clinical experience at our hospitals for nursing students from University of California, Irvine; California State University, Fullerton and Long Beach; Saddleback College; Concordia University; Long Beach City College; and others.

Rick Martin

Senior Vice President, Chief Nursing Officer, Hoag Memorial Hospital Presbyterian, Newport Beach, Irvine

We are fortunate to have a “waiting list” at Hoag for RNs wanting positions and have always been able to recruit great nurses. This will change when the economy improves and RNs leave to retire [and] full-time staff go back to part-time and per diem. In addition, the demand for RNs in the homecare and outpatient settings will go up dramatically with the rollout of the Affordable Care Act over the next few years.

Hoag has been able to hire adequate nurses, and we have a significant number of RNs on [our] waiting list. We do not offer signing bonuses.

We hire graduates from the local colleges and universities, as well as out of the area. Hoag works with various universities and colleges in Southern California to help our over 1,500 RNs further their education to advance in their nursing roles.

In addition, we work with the local nursing schools to have their students do clinical rotations at the hospital.

Katie Skelton

Chief Nursing Officer, St. Joseph Hospital, Orange

Clearly, the healthcare landscape is changing. But one thing remains constant at St. Joseph Hospital, and that’s hiring and training the most talented RNs and clinical staff.

Nurses want to work in our practice environment, so for many positions, we have hundreds of applicants, and we select the cream of the crop.

Their incentive to work here is the extraordinary culture, the personal and professional development afforded them, and the mentoring that our staff provide.

Many of our nursing leaders teach classes for local colleges and universities, so there is a wonderful integration and connection with our local nursing schools and programs. We love nothing better than hiring new graduates from our exceptional community colleges and universities.

Dale Vital

Vice President, Chief Nursing Officer, Orange Coast Memorial Medical Center, Fountain Valley

Because [Orange Coast is] known for providing high-quality care and having a highly engaged workforce, we consistently attract high-caliber nursing candidates who desire to work in this environment. Therefore, the nursing shortage impacting so many hospitals in the past has not been as severe for Orange Coast Memorial. The shortage of critical care and other highly specialized nurses in specific clinical departments remains an issue for most hospitals.

We are currently experiencing an excess of new graduate nurses applying at Orange Coast Memorial. For example, we can expect more than 150 applications for every position posted.

The challenge is to ensure we continue to have experienced nurses for highly skilled areas, such as surgery, critical care, infusion therapy and case management.

To address this, we implemented an innovative program to hire and train new graduates and place them in areas where new graduates traditionally did not work, such as the emergency department, the gastroenterology laboratory and surgery.

We also expanded our orientation programs for new graduates to help support their transition into these specialized roles.

We will continue to balance our clinical team in preparation for the next five years, when a large segment of our workforce begins to retire.

[In regard to using college-trained nurses], a report from the Institute of Medicine encouraged healthcare managers to increase the number of nurses with bachelor’s degrees to 80% by 2020. The institute demonstrated that more education leads to higher quality of care.

Our goal is to hire BSN-prepared nurses or nurses in school for the BSN degree. We continue to support associate degree programs but are focusing our relationships with colleges and universities on bachelor’s degree programs.

Louise White

Vice President, Patient Care Services; Chief Nursing Officer, Children’s Hospital of Orange County, Orange

The “nursing shortage era” that the nation and CHOC Children’s experienced in the early 2000s seems foreign in today’s current nursing climate.

Throughout California and in Orange County, we have an abundance of new graduate nurses and a shortage of jobs. This has left many licensed RNs without opportunities for employment in a hospital setting. The crash of the economy created a situation where many nurses at retirement age continued to work. Nurses who were part time or per diem took full-time positions, causing a decrease in RN turnover.

However, the American Association of Colleges of Nursing anticipates a new nursing shortage will occur in 2020-2025. So at CHOC Children’s we are mindful of that potential, and we continue to maintain our collaborative relationships with many of the local colleges and universities, welcoming them at our facility for pediatric training.

Annually, we have opened approximately 30 positions for new graduates to begin the CHOC RN resident training program, and during each application period we have received over 1,000 applicants for these highly competitive positions. It is, however, a challenge to recruit and hire experienced pediatric nurses in the many specialty areas we have within CHOC, such as the critical-care areas and the newly opened perioperative services. Thus, we are always actively recruiting for experienced pediatric nurses to join our nursing team.

Our dedication to creating an attractive workplace for highly qualified pediatric nurses did enable us to hire 600 registered nurses to staff our new Bill Holmes Tower.

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