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Positions for older staff keep expertise levels high
Unique and creative hiring practices at Bon Secours Richmond (VA) Health System not only have boosted morale and helped offset job shortages, but they also have ensured a larger pool of qualified health care professionals for quality assurance and quality improvement positions.
Bon Secours Richmond Health System includes three hospitals, numerous outpatient and diagnostic facilities, physician groups, and a school of nursing. A fourth hospital, the 130-bed St. Francis Medical Center, is under construction in Chester-field County and scheduled to open in June 2005.
In the Bon Secours system, nurses older than 55 are able to fill part-time or 9-to-5 positions without the loss of certain benefits, the most notable being pensions. This policy is particularly appreciated by Francine Barr, RN, MS, vice president and chief nursing officer of Bon Secours St. Mary’s Hospital. "Definitely, for [quality] positions, you need a very experienced nurse; we cannot hire a new graduate or someone with one or two years’ experience," she notes.
In the Bon Secours system, this is not necessary. "Most RNs retire from direct patient care at 55; they do that because of the physical demands of the job," observes Jim Godwin, SPHR, administrative director of human resources at Bon Secours. "It’s not so much that people that age are not strong, but they start to have back problems, foot problems, and other issues that come with the job over time. But we have a need for nurses who do not do bedside care — things like management, quality assurance efforts, patient financial services, and so on."
The size of the potential employee pool is significantly expanded because, while all sorts of schedules are available, part-timers do not necessarily suffer when it comes to benefits. "We offer all sorts of people part-time work — whatever schedule you can imagine," Godwin adds. "Any person at this stage of life who wants to cut back can."
If they choose to do so, however, their pensions will not be affected adversely. "Most pension plans are based on your salary for the last five to 10 years of employment," Godwin explains. "We have a set-up based on the highest earning years — whenever they occur. So, instead of someone deciding they have to quit working altogether in order to retain their pension, they can continue to work part-time. They benefit, and we benefit as well."
The positions Bon Secours offers older RNs are not simply favors being done out of recognition for years of service; they require specific skills that these individuals have.
These older workers fill a variety of positions, Godwin explains. On the quality assurance front, for example, nurses who no longer handle bedside care are hired to conduct patient chart audits.
"We keep all types of quality statistical analysis that only a medical person can understand — patient outcomes, utilization of resources, and so on," he says. "You can’t just take a clerk and train her. It’s very important to provide quality improvement feedback to physicians, and it’s better received when it’s coming from a nurse."
Billing is another area where accuracy and compliance are key. "Hospital billing is very complex, and the bills have to be accurate for the insurance companies," Godwin notes. "And with Medicare, you really have to know what’s going on. So, we have nurses who are no longer able to handle bedside care — either because they are older, or due to a workers’ comp claim. They become our auditors; before bills are processed, they ensure that the charges make sense. They notice things that would not be apparent to you or me, and that’s a very useful thing to have on staff."
"Most hospitals have a QI or QA department, and the scope of job responsibilities can range from nurses facilitating the entire [departmental] activities to more limited ones, where they are actually the liaison to medical staff performance improvement, staff the committees, or they do some of the preliminary work and take it to the physician so they can conduct peer review," Barr adds.
"In fact, many hospitals that had cut nursing-specific performance improvement coordinator positions due to budget pressures now are reinstituting them due to the renewed focus on patient safety," she adds.
The people she’s looking to hire for these positions are very different from the staff she was looking for just a couple of years ago, Barr continues. "We are really looking for those analytical, interpersonal skills; that’s what will drive the performance improvement — not just numbers, but guidance."
Accordingly, she needs the expertise, knowledge, and clinical experience that these nurses have brought to QI activity, Barr explains. "A lot of that activity is the analysis of current processes going on, bringing other disciplines to the table, and determining what needs to be done to improve processes and outcomes."
"For that, you need a mature individual who can lead a meeting and bring people together. Also, you need to have the physicians at the table, which can be difficult at times. The more experienced individual can pull everyone together and get people thinking in a different way," she notes.
At present, more than a quarter of Bon Secours’ work force is age 50 or older, and in 2002, more than 10% of new hires were older than 50. It is important, says Barr, that this trend continue. "Quite frankly, it is really hard to find the people you need, so having this resource is a real benefit," she says. "And as the [nursing] shortage gets worse, which it is going to do, it will affect every area of nursing."
Bon Secours is seeking to continue attracting these workers with a variety of benefits. In addition to its creative approach to pension calculation, Bon Secours:
It will be years before younger nurses are ready to fill some of these important positions, Barr emphasizes. "It will take years for the new grads to be at the level we need them to be," she says. "We can try to give them all the orientation, help, and mentoring we can ASAP, but we don’t want to lose those experienced nurses. We will gladly find them positions within the hospital to keep that expertise; it will really help to drive the positive outcomes we are looking for."
Need More Information?
For more information, contact:
• Francine Barr, RN, MS, Vice President and Chief Nursing Officer, Bon Secours St. Mary’s Hospital, Richmond, VA. E-mail: Francine_barr@bshsi.com.