Strategies for retaining healthcare workers in clinical settings

¶ … healthcare industry in the U.S., in particular the crisis in retaining healthcare workers. The paper will also discuss what can be done to retain these healthcare workers.

It is a well-known fact that the average age of healthcare workers in the U.S. is 40-45 years old, meaning that there are few new recruits coming to the profession (www.americanworkvisa.org).This, coupled with that fact that there is great job dissatisfaction amongst healthcare workers, means that retaining staff is also difficult: the lack of new recruits, and the difficulty of retaining staff means that there is, therefore, a shortage of healthcare professionals in the U.S. healthcare industry.

The shortage of healthcare workers is huge: there are 115,000 immediate job vacancies in this field, and it is expected that the industry will grow by 25.5% between 2000-2010, thus adding 1.3 million new jobs (www.doleta.gov).This is particularly frightening in terms of the future health prospects of the population as a whole, with the population ageing (thus storing up more problems in the future), and with the population that is not aged being largely obese, which also causes its own distinct health problems, such as heart problems, diabetes etc., which will need to be treated at some point, by someone.

This shortage of healthcare workers costs the healthcare industry in the U.S. A huge amount in 'lost' expenditure: a recent survey showed that in Colorado, in 1991, the costs of healthcare worker shortages amounted to: $36 000 in physical therapy services, which needed to be contracted out due to shortages; $149-000 in lost revenue, because procedures could not be carried out, due to staff shortages; $200-000 in wages to contracted out healthcare workers; and, $120-000 lost in revenue, because the hospital had to send patients elsewhere for treatment (www.chausa.org).

This half a million dollars plus in losses was in one hospital, in one city in the U.S.: the cost of healthcare worker shortages, due to lack of retention, and a general shortage of new, young, recruits to the profession: this, extrapolated to the U.S. As a whole is a huge amount in lost revenues, not to mention the human costs behind these dollar signs: the people who have had to wait, or to travel large distances for treatment etc. (www.chausa.org).This difficulty in retaining healthcare workers is, therefore, a huge problem for the U.S. As a whole: but, why are healthcare workers so dissatisfied (that they want to leave, and, in the case of the young, do not want to consider the profession) and what can be done about this?

According to a recent survey, the 2002 Healthcare @ Work survey, healthcare workers throughout the U.S. are very dissatisfied with their workplace, with consequent low levels of job satisfaction, and commitment to their workplace, and to their career (Hilton, 2002; (www.healthhub.com).In the survey, 49% of respondents (from a total of 1646 people, who were a representative cross-section of the healthcare community, from nurses and physicians, to management people), said that they were thinking about leaving their current place of work; further, 35% of respondents said that they were thinking of leaving the healthcare field all together (Hilton, 2002; (www.healthhub.com).

The survey also found that, compared to other sectors, healthcare workers levels of satisfaction fall well below the average (Hilton, 2002; (www.healthhub.com).The survey found that 59% of respondents had come into the healthcare field because they "wanted to help people," but then found that the endless paperwork, and the forced overtime, the tiredness that ensues, and the lack of support following colleagues leaving and not being replaced, had meant that they were no longer satisfied with the work, and that they wanted to leave.

Another point raised by the survey, through the answers from the respondents, was that many employees feel that their employers are so focused on finding new recruits to fill the gaps in their workforce that they neglect their loyal, old, employees (Hilton, 2002; (www.healthhub.com).Specific points that were raised are as follows: 40% of respondents said that their supervisors were unable to builds team spirit; 37% said that their supervisors were unable to challenge traditional processes, which leads to a failure in the development of new, positive, changes; 36% said their supervisors did not meet their needs, in terms of personal integrity, including respect for them, and in terms of trust (Hilton, 2002; (www.healthhub.com).

According to the survey, it is nursing staff who are most dissatisfied with their employers and their work situation, with high percentages of nurses believing that: being part of a team does not improve their skills base; coworkers would not sacrifice anything for the good of the group; their current place of work is not recommendable to potential employees, nor to patients; their current place of work is not the best place to work; they will not stay at their current place of work for the next year; and, they would leave their current place of work for even only a slight pay increase (Hilton, 2002; (www.healthhub.com).

This survey has shown that healthcare workers, in general, and nursing staff specifically, are less happy with their current positions and place of work than staff of a similar level of training from other fields: for instance, 23% of employees in the construction industry say their needs are unmet by their current workplace, but for healthcare workers, this figure is 43% (Hilton, 2002; (www.healthhub.com).

All leaders in the healthcare field that were interviewed for the survey agreed that retention is the key to a healthy healthcare environment, for employees and patients alike (Hilton, 2002; (www.healthhub.com).According to the American College of Healthcare Executives (ACHE), it is, further, an ethical necessity that healthcare executives develop plans to enable levels of patient care to be maintained in the face of staff shortages (www.ache.org).These include several measures that will also benefit the healthcare workers that are left behind, and thus may indirectly encourage staff retention, for example: preventing burn-out among staff whose workloads have increased; attracting sufficiently qualified staff, and strengthening the patient/clinician/executive partnership; offering professional development; and, closing units if staff shortages become too severe (www.ache.org).

The ACHE have called for a joint nation-wide strategy to be developed, which would encourage the retention of healthcare workers, and so to promote the continuance of high-quality healthcare throughout all American communities; and also, have called for the development of a program to encourage more high-school pupils to think about, and to pursue, a career in healthcare (www.ache.org).

It is clear, therefore, that it is an obligation, on the shoulders of leaders in the healthcare professions, for the issue of retention of healthcare workers to be addressed and solved, in order for their to be a better level of job satisfaction amongst healthcare workers in the U.S., and for this to reflect upon the successes of healthcare institutions. This is clear, but how is this to be done? Healthcare organizations need to catch up in the human resources area, with the training of middle managers, in particular in how to manage people effectively, and how to attract, develop and retain a workforce.

Healthcare workers themselves are seeing this time as an ideal opportunity to organize the labor force, with unions, such as the AFT, suggesting that nurses, in particular, should use this opportunity to seek improved staffing levels, to seek improved levels of pay and benefits, and also to arrange for better working conditions and better working hours (www.aft.org/publications.html).

But what can be done, practically, on the part of the leaders of healthcare organizations, to overcome the problem of staff retention? It should be recognized that retaining employees is as important, if not more important, than employing new employees, as the old staff have had valuable investments made in them, for example training, and as such are valuable 'resources' with a great deal more relevant experience than a new recruit: it therefore makes practical day-to-day sense, as well as economic sense, to retain employees as far as is humanly possible.

It is known, from many studies, and surveys of healthcare workplaces, that the key factor in retaining healthcare professionals is a work environment that promotes good relationships with supervisors and co-workers (www.chausa.org).In fact, it is known that workers place more value on good relationships than on salary, probably because the people entering the healthcare field are more likely to place more value on 'helping others' than on 'helping themselves' (www.chausa.org).It is therefore vital for healthcare institutions to recognize the importance of an organization's culture and its impact on retaining employees, and to focus on continuous improvements to the work environment (www.chausa.org).This necessitates a continued assessment of the cultural environment in the workplace by leaders: checking how the middle managers (supervisors, line managers etc.) are coping with their role as managers, which encompasses the sub-roles of encouragers, team builders, morale boosters, advice-givers etc. (www.chausa.org).As soon as warning signs are highlighted, indicating a failure of these middle managers in any of these areas i.e., support, team-building, encouragement, then top-level managers need to take the initiative and step in, to stop the source of the discontentment at its root, by removing the middle manager, and re-training them, in order that they generate the kind of environment where people want to work, instead of the kind of environment that people want to leave.

It is therefore vital for healthcare organizations to develop guidelines on how to retain employees, which for example, would give some measurement to how effectively the core values and mission statement of the organization (in terms of staff retention) are being implemented, in terms of human resource policies, programs, managers behaviors, policies, procedures, etc. (www.chausa.org).Such guidelines, which could be called 'values-based human resource guidelines', would also address such issues as orientation of human resource personnel, benefit levels and eligibility, and also the ways in which the organization could help employees to balance work and family life (www.chausa.org).With values-based human resource practices, as evidenced in the workplace, it is known that employees tend to be more fulfilled professionally and less likely to leave for a position elsewhere (www.chausa.org).

The survey undertaken by the ACHE (entitled Healthcare @ Work) outlined three key areas which leaders of the healthcare organizations needed to take on board, in order to help with retaining staff: attracting, developing and retaining (www.healthcarepersonnel.org).

Under 'attracting', the survey noted that over half of the Healthcare @ Work respondents had considered pursuing a job in the healthcare field prior to high school graduation, and that most of these cite "a desire to help people" as their primary motivator (www.healthcarepersonnel.org).The passion to provide service to others, however, is soon overshadowed, in practice, by the reality of the burdens of policy, paperwork, lack of resources and overall poor workplace environment, as shown in the survey, as we have seen, which showed that employees are looking elsewhere, as 49% are considering leaving their current organization (www.healthcarepersonnel.org).To attract new employees, therefore, healthcare organizations must reinvent the healthcare workplace to enable caregivers to answer their calling: caring for patients (www.healthcarepersonnel.org).

Under 'developing', the 'Healthcare @ Work' survey, and the AHA Commission on Workforce for Hospitals and Health Systems in their report, 'In Our Hands' both identified eleven key middle management competencies (www.healthcarepersonnel.org).In Healthcare @Work, it was discovered that the majority of employees feel their leaders do not exhibit those eleven competencies, and in fact, employees lack confidence in leadership, as 51% of respondents said that their organization is not doing a good job in developing effective supervisors and 36% said they do not have faith in leadership to do what is right (www.healthcarepersonnel.org).Healthcare organizations must therefore develop leadership with the skills necessary to motivate a workforce and manage the organization (www.healthcarepersonnel.org).

Under 'retention', the survey concluded that retention is the key to success in an environment riddled with shortages in just about all allied healthcare professions (www.healthcarepersonnel.org).Yet, increased turnover is looming, as most employees do not feel affiliated with their organization, as we have seen (www.healthcarepersonnel.org).In fact, 49% of respondents say their managers fail to involve them in planning changes, and 49% feel their organizations fail to demonstrate the importance of retaining employees (www.healthcarepersonnel.org).

Over time, organizations must learn how to retain workers of all ages and skill levels, but to address the short-term crisis, older workers must also be a key focus for retention: as, as we have seen, the majority of the workforce in the healthcare field is of an average age of 40-45 years old (www.healthcarepersonnel.org).Older workers therefore comprise the largest segment of the healthcare employee population, and also have the greatest level of experience to draw upon, and therefore should be encouraged to stay with an organization as long as possible (www.healthcarepersonnel.org).For this approach to be successful, alongside managerial changes from the top-down via middle management, it is imperative that healthcare organizations redesign the physically demanding healthcare process currently in place, for example, extraordinarily long shifts, compulsory overtime etc. (www.healthcarepersonnel.org).

One factor that also needs to be considered with regards to the retention of healthcare workers is the salary levels that are currently in place for such workers, as all employers rely on wage and benefit offers to draw and retain willing and qualified employees (www.mnwfc.org/lmi/trends/jun01/heal3.html).Comparisons can be made between the wages of two healthcare occupations with two other occupations that have similar job vacancy rates and educational requirements, in order to examine the appropriateness of the pay level for healthcare workers (www.mnwfc.org/lmi/trends/jun01/heal3.html).Comparing occupations with similar job vacancy rates ensures that the demand for workers is the same, and likewise, identical educational requirements guarantee that similar training was needed to become qualified for this job (www.mnwfc.org/lmi/trends/jun01/heal3.html).

Nursing aides, orderlies and attendants are therefore compared to hairdressers, hairstylists and cosmetologists, as many of the job vacancies in these occupations require a vocational degree or certificate (www.mnwfc.org/lmi/trends/jun01/heal3.html).The wages offered in these occupations are also very similar: with nursing aides receiving a median (50th percentile) wage of $9.25 per hour, and hairdressers, hairstylists and cosmetologists receiving $9.00 (www.mnwfc.org/lmi/trends/jun01/heal3.html).

RNs are compared to substance abuse and behavioral disorder counselors, which have a job vacancy rate of 7.0%, and all of which require post-secondary education (www.mnwfc.org/lmi/trends/jun01/heal3.html).RNs are offered a median wage of $18.25 an hour, while substance abuse and behavioral disorder counselors are offered $15.00: a difference in median wage rates of over $3 an hour (www.mnwfc.org/lmi/trends/jun01/heal3.html).

This comparison reveals, therefore, that healthcare occupations may already be offering a higher starting wage rate compared to other occupations with similar educational requirements; likewise, these healthcare positions are offering a higher wage compared to other occupations with the same or similar job vacancy rates (www.mnwfc.org/lmi/trends/jun01/heal3.html).So, even with a similar demand for workers, some healthcare positions are offering a relatively higher starting wage, perhaps due to stressful job duties, as no-one would argue that a nursing aide has duties that require more physical stamina than those of a hairdresser (www.mnwfc.org/lmi/trends/jun01/heal3.html).

It should be noted, then by healthcare executives, that although wages may be used as a tool to attract new interest, unless they are bumped up enough to allow supply to meet demand, increasing wages alone may not be enough on its own to encourage new entries into healthcare (www.mnwfc.org/lmi/trends/jun01/heal3.html).In addition to higher wages, 90% of full-time healthcare vacancies offered health insurance and paid vacation according to the survey, and eight out of 10 employers with full-time healthcare vacancies offered retirement benefits and paid sick leave: thus, these 'added extras' come as standard with such posts, and as such cannot be used as 'carrot and the stick' type enticements: healthcare workers, who go into the profession from a caring point-of-view, need more than wages and benefits to entice them to work in a really stressful profession: they want tangible, emotional, benefits: a good working environment, supportive middle managers and colleagues etc. (www.mnwfc.org/lmi/trends/jun01/heal3.html).

As we have seen, there is no denying that healthcare workers are and will continue to be needed in the U.S.: in 2000, about 35 million people -- " 13% of the U.S. population -- " were aged 65 or older, and by 2030, this number is expected to increase to 70 million, or 20% of the U.S. population (www.mnwfc.org/lmi/trends/jun01/heal3.html).

Disease management and general health issues have become constant front-page news, with people joining health clubs and trying to watch their diets (www.mnwfc.org/lmi/trends/jun01/heal3.html).Advances in technology have improved patient care and increased consumer confidence in medical facilities, and all of this has contributed to a growing demand for health services and workers (www.mnwfc.org/lmi/trends/jun01/heal3.html).

Yet, with the current worker shortage in healthcare showing few signs of coming to an end, what can be done (www.mnwfc.org/lmi/trends/jun01/heal3.html)?It has been said that, "The problem is so big that nobody is spearheading the whole effort to address it. And simple solutions are not what they seem.... It is not as easy as training more workers. The number of openings in educational programs has to be increased, which relates to funding. And the number of students wanting to enter healthcare has to be increased. It is complex and will take a multifaceted approach (www.mnwfc.org/lmi/trends/jun01/heal3.html)."

Many have called for an increase in the number of openings in educational programs, such as curriculum changes in K-12 schools and an emphasis on outreach to potential students, which could help generate interest in the field: in addition, more comprehensive scholarships and shorter, more flexible training programs may help encourage new entries into healthcare (www.mnwfc.org/lmi/trends/jun01/heal3.html).

Regardless of the method, it is clear that a way to generate fresh interest in the healthcare field must be found -- " and soon, and on top of this, as we have seen, and discussed in detail, ways must be found, incorporating better top-down management practices, to retain valuable healthcare workers once they have been recruited (www.mnwfc.org/lmi/trends/jun01/heal3.html).

Another suggestion put forward to solve the problem of retention of healthcare workers is to relax visa regulations for healthcare workers from abroad, and to offer these people (from all around the world) the chance of living in "the land of the free" in exchange for dedication in the workplace. It is believed that these foreign healthcare workers work harder than 'home' workers, and are also more dedicated than 'home' workers, and as such, that it should be easier to retain these workers: perhaps this is not due to racial/ethnic stereotypes, however, nor any sense of gratitude on behalf of these people, rather because the place they have left is awful, and they do not want to be deported back there, so they work under any conditions to ensure they do not lose their visa, and are therefore not asked to leave the country.