1. D'Aurizio, Pat RN, CHCR, Cna, MPA
  2. Johnson, Kathie RN, MS, MBA, PhD

Article Content

Many believe today's nursing shortage is unlike previous shortages, and will be prolonged due to the diverse options available to future nurses and the anticipated increase in hospital service demand as baby boomers age.1 The focus on causes of medication and other errors, in addition to the potential impact of nurse understaffing, has added to the urgency to increase the supply of qualified nurses and to retain current nurses.2


Nonetheless, solutions to nursing shortage challenges are abundant. For years, researchers have recommended innovative ways to integrate concepts designed to improve recruitment, retention, and the workplace environment for nurses. To accomplish results, employment and nursing divisions at Forsyth Medical Center (FMC) collaborated to initiate these suggestions to achieve positive outcomes.


Retention strategies

The culture of the practice environment is crucial to the success of any retention strategy. With this in mind, the nursing division at FMC implemented five practice initiatives aimed at enhancing autonomy, professionalism, and teamwork among the nursing staff. These include:


[white diamond suit] Integrated council structure. Staff nurses chair five major councils that have hospital-wide authority and responsibility for practice decisions, staff education, continuous improvement planning and monitoring, nursing research, and the coordination of goals and strategies for the division of nursing. Nursing directors, who are nonvoting members, serve as facilitators.


[white diamond suit] Sabbatical program for staff nurses. This program is an innovative approach to recognize the contribution of experienced RNs to the division of nursing. Nurse leaders encourage staff to apply for a paid leave of absence for up to 6 weeks to complete training, research, or program development in an area of interest.


[white diamond suit] Clinical ladder. The division of nursing developed a five-step ladder that's part of the annual performance appraisal process. Points are assigned based on clinical skills, education, and professional involvement. This offers a variety of paths that staff nurses can take to achieve recognition.


[white diamond suit] No-lift program. The maturing of the workforce, coupled with the epidemic of obesity in the patient population, has created additional stress for nursing staff in the areas of lifting, positioning, and transporting patients. To address this issue, the nursing division implemented a no-lift initiative in 2003.


[white diamond suit] Clinical teaching role. The Clinical Teaching Associates Program provides training designed to enhance nurses skills in guiding the student learning experience. Nurses maintain their employment status with the hospital and assume the instructor role either as an assignment in their unit or as a supplemental role on off-duty days.



Recruitment initiatives

In 2001, a new director of employment and recruitment restructured and redistributed the workload between recruiters, resulting in two additional FTE recruiters allocated to nursing. Recruiters started to attend the biweekly nursing management council meetings, and recruitment was added as a standing agenda item. Also, the employment director was invited to participate in the nursing director's meetings.


Overall, these changes helped employment and nursing build their partnership model. Standing meetings and frequent communication between the vice president of nursing and director of employment established a climate of trust and respect, which translated into a strong and supportive environment for both staffs.


Increasing interest

Employment and nurse leaders worked on a local scale to increase interest in healthcare, and in particular, nursing careers. A program was implemented that awards approximately 50 scholarships a year. Leaders also partnered with the local community college on initiatives that included an LPN-to-RN program, an online RN program, and an onsite ADN program dedicated to FMC employees.


More than 20 employees enrolled in the weekend onsite ADN program. FMC pays for tuition, uniforms, books, fees, and instructors, and maintains the original benefit package for each participant regardless of the number of hours he or she works. Work schedules are flexible. The school provides instructors, flexible class times, and clinical rotations. For RNs, a BSN program is offered onsite. Additionally, outreach to middle and high school students is ongoing.


A positive change

The results of these multiple initiatives helped to build a positive climate that's enhanced nurse recruitment and retention. We reduced turnover by 28% over the past 3 years, and the current RN-LPN vacancy rate is 6.7%. Future plans include the introduction of additional programs to support professional activities, certifications, and nursing research. Other nursing departments seeking to improve their work environment may want to assess programs and opportunities currently in place and explore the implementation of initiatives such as those described here.




1. Reid Ponte P. The American health care system at a crossroads: an overview of the American Organization of Nurse Executives monograph. Online J Issues Nurs. 2004;9(2):manuscript 2. Available at: Accessed April 2006. [Context Link]


2. Advisory Board Company. Nursing Executive Center essay: regaining the initiative in the quality debate. 2004;2-41. Accessed at: Retrieved March 30, 2005. [Context Link]