¶ … 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...

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…