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If you’re like most ED managers, you’re struggling with high vacancy rates and a lack of qualified nurse candidates to staff your ED. The nationwide nursing shortage has become so severe that the U.S. Senate has formed a subcommittee to find solutions. The shortage is exacerbated by the fact that fewer people are choosing nursing as a career. According to government projections, the United States will need 1.7 million nurses by 2020; however, only 600,000 will be available.
The shortage is especially severe in the ED because of overcrowding that occurs when there are either no beds available to admit ED patients, or a lack of staff to open those beds, says George D. Velianoff, RN, DNS, CHE, executive vice president of nursing for the Emergency Nurses Association in Des Plaines, IL. "This causes a backup in the ED, and we are left caring for patients that belong in the critical care units, while still keeping our doors open to everyone else," he says. "With these conditions, staffing does become strained."
Velianoff notes that although overall vacancy rates nationally are around 14%, this number is quickly rising to 30% in some areas. "We are especially concerned about the next 10 years, when those ranks continue to diminish with no new faces coming into the ED," he adds.
Sen. Tim Hutchinson (R-AR), chair of the subcommittee, said senators would introduce a plan in the next few weeks that would include grants for nursing scholarships and training programs. Legislation has also been introduced by Sens. Jim Jeffords, (R-VT), and John Kerry, (D-MA) to provide training, incentives, and higher wages to current and prospective nurses.
The Senate subcommittee will help put the nursing shortage in the public spotlight where it belongs, according to Diana Contino, RN, MBA, CEN, CCRN, president of Emergency Management Systems, a Monarch Beach, CA-based consulting firm that specializes in staffing issues. "Raising awareness is always a step in the right direction," Contino says. "Look at how awareness has impacted domestic violence. People have a better understanding, and it is less tolerated."
Here are ways to combat the nursing shortage in your ED:
• Pay for conferences. Conferences can be a huge morale-booster and also improve the care nurses give in the ED, says Michelle Myers-Glower, RN, MS, former director of emergency and trauma services for Elmhurst (IL) Hospital. Myers-Glower is currently a consultant in Glencoe, IL, who specializes in nursing staffing and recruitment. "I don’t send my staff to Hawaii, but I will pay if anyone wants to go to the local ENA [Emergency Nurses Association] convention or conferences pertaining to their job," she says.
• Promote the profession. Emergency nursing leaders need to find new ways to promote the profession, urges Contino. "Right now, the ED is viewed as an exciting place for nurses to work because of the television show ER,’" she says. "As with all television shows, someday ER’ will no longer be popular. What will be our plan for future promotion?"
• Give nurses an opportunity for growth. New career paths are needed to bring nurses into the profession, Contino argues. "We need to provide incentives for them to increase their education and skills, and move from the lower-level support positions to nursing levels," she says.
Nurses are looking toward their goals and future employment, and security is crucial for many, says Myers-Glower. "I offer nurses to be on committees such as restraint, conscious sedation, and new products, and they enjoy being a part of a team," she says.
• Carefully assess your staffing. Do an intensive benchmarking review to see if your staffing is adequate for your ED, advises Contino. "Having adequate staffing often decreases turnover," she says.
• Decrease nursing workloads. Delegate tasks to the laboratory, transporters, and radiology wherever you can, says Contino. "Look at the respiratory therapy staff and LVN/LPN staff to see if they can assist in an expanded role," she recommends.
• Provide adequate orientation. Another recruitment strategy is defining the orientation program, says Myers. "Nurses want to know there is a structure in place with a designated preceptor," she says. "They will go to the institution that offers this before one that doesn’t."
• Offer free education. Nurses cannot afford to keep up with all the renewals and new certifications, says Myers-Glower. "I pay for them after they have worked in our ED six months," she says.
Offer on-site classes, Myers-Glower recommends. "Nurses love this, especially if you can provide an opportunity for instructor status," she says. "There may be an opportunity for your hospital to make money on holding these classes on-site. This advertises to nurses that the hospital is involved in continuing education and that you care about them as a nurse."
For more information about the nursing shortage, contact:
• Diana Contino, RN, MBA, CEN, CCRN, Emergency Management Systems, 24040 Camino Del Avion, Suite 123, Monarch Beach, CA 92629. Telephone: (949) 493-0039. Fax: (949) 493-7568. E-mail: firstname.lastname@example.org. Web: ConsultingEMS.com.
• Michelle Myers-Glower, RN, MS, 640 Grove St., Glencoe, IL 60022. Telephone: (847) 242-0825. Fax: (847) 242-0826. E-mail: email@example.com.
• George D. Velianoff, RN, DNS, CHE, Emergency Nurses Association, 915 Lee St., Des Plaines, IL 60016. Telephone: (800) 900-9659 ext. 4105 or (847) 460-4000. Fax: (847) 460-4004. E-mail: GVelianoff@ena.org.