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Vidant nurse shortage a lasting challenge

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Vidant Senior Vice-President Nursing Executive, Linda Hofler, discusses the work of nurses at Vidant Medical Center on Jan. 25 2017.

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Michael Abramowitz

Sunday, February 19, 2017

Vidant Medical Center in Greenville continues to struggle with a persistent shortage of registered nurses a year after reporting that the shortage forced it to close some beds. As the aging population continues to increase, the problem will continue to challenge Vidant and most other hospitals in the region and nationwide, according to health care experts.

Vidant’s flagship hospital in Greenville employs about 3,000 registered nurses. In a report issued in February 2016, medical center officials said they were short about 240 registered nurses. A year later, Vidant still is short more than 200 nurses. While expanding recruitment approaches, the hospital is offsetting vacancies with a combination of supplemental pool staff, traveling nurses and central staffing, administrators said. About 30 percent of their vacancies are filled by travelers.

“We will keep them until we have all our vacancies filled,” Linda Hofler, senior vice president for nursing, said.

Patient care at Vidant has not been affected by the nurse shortage because the shortage is spread out among a large area, Hofler said. A quality report presented in November to the Vidant Health Board of Directors said employees reduced harmful patient events systemwide by 9 percent compared to 2015, from 573 to 522. Of those, 49 were rated as “serious safety events.”

In 2016, however, there were about 729 patients who, based on the level of care they required, asked to be admitted at Vidant Medical Center but could not be due to staffing shortages, Chief Financial Officer David Hughes said. The hospital treats about 44,500 inpatients annually.

“That’s the main impact,” Hughes said. “If we don’t have the necessary staffing, we’re not able to say ‘Yes’ every time a patient calls. We’re not one of those hospitals that when full, says, ‘Send them on and we’ll find a place for them.’ We make sure we have a bed available so when they arrive they go right to their bed.”

Vidant has about 900 beds and calculates its occupancy rate at two levels; according to the number of beds it has staffed and total capacity, the latter to meet external bond market requirements, Hughes said. 

Finding good help

Administrators face several challenges to maintain an adequate nursing workforce. The first is to recruit nurses to their flagship medical center and their other hospitals in eastern North Carolina. Data from the U.S. Bureau of Labor Statistics, and reports from the U.S. Department of Health and Human Services and the N.C. Association of Nurses, confirm a statewide and nationwide shortage of nurses, particularly in experienced nurses, essentially because those leaving the workforce outnumber those entering it.

“Most medical centers hover between 10-12 percent turnover rate,” Hofler said in a recent meeting with The Daily Reflector. “We ended last year with just a little over 12-percent turnover (about 360 nurses).” 

Less than 1 percent of hospitals in the U.S. Vidant’s size also have a teaching mission. As a result, Vidant sees a steady supply of young nurses entering the workforce each year and tries to hire as many as it can from eastern North Carolina, but the workforce is smaller here, Hofler said.

“We hire more than 300 nurses a year and hired more than 400 nurses in 2016,” she said.

Most are recruited from East Carolina University and Pitt Community College, but not all choose Vidant coming out of college. With two classes of 130 graduating from East Carolina University College of Nursing and another class of 90 from Pitt Community College, Vidant would have to hire all of them to meet its normal turnover needs, Hofler said. Recruiting horizons are expanding out of necessity, she said. 

“Up until about two years ago, the unwritten rule was that you don’t go to somebody else’s territory, but the gloves have since come off,” Hofler said. “Duke has been down east here a couple of times recruiting from schools and we’ve also sent our recruiting team to places we haven’t gone before.”

Vidant Health also invested years ago in a partnership with Pitt County Schools to develop a Health Sciences Academy, designed to prepare students for careers in health care while in high school or the early college program.

Vidant utilizes data provided by external compensation consultants to establish market-based pay ranges. In addition to hourly compensation, the hospital also provides annual merit increases based on performance, Hofler said.

The entry level pay for a nurse at Vidant is $22.40 an hour, which for a 40-hour work week comes out to about $46,600 a year, Hofler said. After three years of experience, the rate is $25.28 an hour, or a yearly salary of $52,580. Nurses also are eligible to participate in its rewards program, based on the accomplishment of financial, care quality and patient experience goals.

The U.S. Bureau of Labor Statistics lists North Carolina’s 2015 median hourly wage (the halfway point) for registered nurses at $28.34 per hour and the national median registered nurse hourly wage at $31.71 per hour.

Hughes said Vidant does not try to lead the North Carolina market in registered nurse wages because the leader never knows where the top threshold is.

“You have to look at the entirety of the benefit package and the culture within your organization,” he said. “If we can pay what the market rate is, the overall feel and touch is just as important. We have to make sure we’re creating a culture and building relationships that make us more attractive than others.” 

Keeping them around

Hughes and other local health care professionals and educators agreed that where a facility is located is a significant factor in attracting and retaining nurses.

“Not having a big city attached to Vidant presents additional challenges that hospitals in more urban areas don’t have to deal with,” Hughes said.

Compounding that fact, Vidant Medical Center is a tertiary hospital and level-1 trauma center, meaning it receives the most seriously ill and injured patients from a very large and very unhealthy eastern North Carolina region. 

Once hired, another challenge is to retain the nursing staff in competition with other hospitals in other parts of the state and out of state. Vidant has some attractive qualities for nurses — and some potent challenges, Hofler said. 

“Nursing is hard physical work and it’s really hard mental work,” she said. “So, many of our retention efforts go toward making people feel like they’re cared for and that they have the tools they need to care for each other in the moment.”

Hofler said her 15 years studying data on nursing employment shows that nursing shortages are cyclical. Officials with the N.C. Nurses Association and data from the U.S. Bureau of Labor Statistics supported that view and Hofler’s belief that the current period of shortage is a bit different.

“The aging Baby Boomer generation is contributing to a greater need for medical care, but we also have a high number of Boomers in our work force and they’re also nearing retirement age,” she said. “The national average age of nurses is about 50, while ours has been hovering for some time between 39-42 years old.”

Vidant also is trying to lure some retired nurses back to work by offering fewer hours in less-intensive settings.

In terms of working conditions, adequate staffing in relation to patient volume is among nurses’ top concerns, Hughes said.

“If a nurse is scheduled to work six shifts in a two-week period and we have to ask the nurse to work another shift, that does create some potential dissatisfaction with our nurses if they have to do that,” he said. “It does occur here, but it’s not the norm.” 

Most frontline nurses work seven 12-hour shifts during a two-week period, Hofler said. That varies on units that aren’t open 24 hours. The emergency department also has different scheduling. 

Vidant has several approaches to offset or minimize the need to require extra shifts, Hughes said. 

“We allow nurses to bid on open shifts, so those who want to work extra shifts can request them,” he and Hofler said.   

The hospital also offers nurses the opportunity to work weekend shifts, which sometimes benefits parents with children. Other benefits the hospital offers are onsite child care, tuition assistance for nurses working toward master’s or doctoral degrees, or who have an associate’s degree and want to get a four-year nursing degree, Hofler said.

“Most nurses are hired as a .9 full-time employee, which is three 12-hour shifts equaling 36 hours per week,” she said. “Many organizations automatically schedule seven 12-hour shifts. If our nurses work 48 hours one week, they are back to 36 hours the next week. But there also are emergency situations. They can be resolved with a manager using our other types of scheduling. Some nurses prefer working all nights, which makes it easier for those who do not.”

Hofler said the issue of whether Vidant nurses feel overworked depends on who answers.

“Every two weeks I track the data that shows how many hours people are working. I don’t want anyone working when they’re too fatigued and might make the wrong decision,” she said. “Based on the data I review, I’d say, no, they’re not overworked.”

Changing landscape

Sylvia Brown, dean of the ECU College of Nursing, said she knows of no serious management issues facing Vidant nurses. The same general challenges in workforce retention seen there exist across the state and nation, she said. Brown did say she believes the vacancies Vidant has are an added stresser on nurses, due mainly to added workload.

“Most nurses are pleased a year after graduation. After that ‘honeymoon phase,’ the shortage does cause stress in the workforce and some amount of burnout,” Brown said. “The long hours become more difficult as you age. Stress and fatigue are the two primary factors we hear about. They get paid pretty well when starting, but pay increases are difficult as they advance. Some facilities offer ways to advance, but it’s frequently difficult.”

Acknowledging the work nurses do through recognition programs and clinical advancement ladders provides a way to recognize those who go above and beyond the call of duty, Brown said. Practices including tuition assistance to those who want to return for advanced degrees, scheduling flexibility, pay differentials and less overtime requirements are effective compensations, she said.

Brown said she believes Vidant has done a lot to enhance its organizational culture.

“Our graduates who work there find it to be a good place to work,” she said. “They are a magnet hospital (among the 6 percent of U.S. hospitals recognized by the American Nurses Credentialing Center for providing the best in nursing care). They have provided incentives for nurses to return to school. They have a clinical ladder approach that financially incentivizes nurses as they move up the ladder.”

Donna Moses, director of nursing and health education at Eastern Area Health Education Center in Greenville, which provides educational resources to several North Carolina health care providers, said changing approaches to health care delivery present new challenges for hospitals and providers to attract people to come to eastern North Carolina and other rural areas with their families.

“Historically, graduating nurses went to work in a hospital, but because of the way health care has evolved, there are many more ways to impact health outside of that setting,” Moses said. “We’re starting to see community health care worker roles develop because there just are not enough nurses available to meet all the health care system needs.” 

Unlike traditional nurses who care for patients individually, community health nurses provide care, education and monitoring for groups of people or entire communities at a time.

The result is growing competition for the same resources, the nurse educator said. Even Charlotte and Raleigh, which have much more to offer away from work, are facing shortages and recruitment problems.

“What does this area have compared to others that would attract them to making a life here?” Moses said. “Many nurses choose to get educated here and work here for the experience, then go back to their home communities. 

“The fact remains that Vidant and the Brody School are vital for the health of eastern North Carolina. Without them, we’d still have people going all the way to Chapel Hill to get care.”

Contact Michael Abramowitz at mabramowitz@reflector.com.

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