WHAT DOES HCA INTEND TO DO TO ADDRESS THE SEVERE STAFFING SHORTAGES WE HAVE IN MULTIPLE FRONT-LINE AREAS OF THE HOSPITAL? THE RN TO PATIENT RATIOS ARE ALREADY VERY HIGH AND MANY UNITS HAVE FUNCTIONAL VACANCIES OF GREATER THAN 30%. THERE ARE VERY LIMITED RESOURCES IN THE WAY OF TRAVELERS OR STAFFING POOL. SEVERAL OTHER AREAS INCLUDING IT, EVS, FOOD AND NUTRITION, AND FACILITIES ARE CHALLENGED DAILY WITH LESS THAN IDEAL STAFFING.

WHAT DOES HCA INTEND TO DO TO ADDRESS THE SEVERE STAFFING SHORTAGES WE HAVE IN MULTIPLE FRONT-LINE AREAS OF THE HOSPITAL? THE RN TO PATIENT RATIOS ARE ALREADY VERY HIGH AND MANY UNITS HAVE FUNCTIONAL VACANCIES OF GREATER THAN 30%. THERE ARE VERY LIMITED RESOURCES IN THE WAY OF TRAVELERS OR STAFFING POOL. SEVERAL OTHER AREAS INCLUDING IT, EVS, FOOD AND NUTRITION, AND FACILITIES ARE CHALLENGED DAILY WITH LESS THAN IDEAL STAFFING.

With respect to HCA’s intentions regarding supporting nurse staffing it is too soon to say.  But your question is important and there is a lot of information that we can share about current efforts.

Nurse staffing is a national challenge and Mission Health is not immune to the background trends identified in the Institute of Medicine report on nursing and the Advisory Board.  The aged and aging population in our area coupled with a high number of nurses in the United States and at Mission nearing retirement age, adds to the complexity of an already tight labor market.  Further, Buncombe County has the lowest unemployment rate in the state and one of the lowest in the nation.  The hospitality and service industry in our region also results in an extremely competitive market for CNAs, EVS, and food and nutrition compared to other areas of the nation.

Because of the crucial role that nurses have in caring for our patients, recruitment and retention are top priorities for Mission Health.  We regularly compare our nursing hours against the National Database of Nursing Quality Indicators(NDNQI).  While it is true that issues likely family medical leave (FMLA), vacation and other factors can contribute to staffing challenges on a given nursing unit, for the first quarter of 2018, Mission was at the mean for total nursing hours provided (employee + agency) against hospitals of like size.  Even with our challenges, at the end of May Mission Health RN turnover was 12.4%; Mission Hospital RN turnover was 11.9%, both below the Advisory Board 50thpercentile of 15.1%.  EVS turnover at Mission Hospital as of May was 29%, with nationwide trends ranging from 30-50% depending on the source and location.

From our candidate and employee feedback we know that the most important reason for joining Mission (and remaining with us) is our reputation for outstanding and compassionate care for patients and each other.  Below are a few of our best practice strategies in place:

  • We routinely evaluate and adjust our compensation strategy, which includes merit, market, and off-cycle adjustments.  Mission is very competitive with our competition nation-wide and the night shift differential was adjusted upward within the last year.
  • We have an on-site CNA classroom and lab which prepares candidates for our positions routinely.  CNA scholarships are provided to our employees, children and family members of our employees, and to the community.
  • 87 new RN graduates have been hired and began this month.  We continue to hire over 80 to 90 new graduates every year.
  • In addition to hiring 38 CNAs this month alone, we host regular CNA, EVS and Food and Nutrition “hiring blitzes” with same day offers. We also have partnerships with Green Opportunities and other community agencies to fill these positons.
  • CNAs and nursing students are being hired into our staffing pool to more effectively cover vacations, vacancies, high census needs and FMLA absences.
  • In addition to recruiting at nursing conferences nationally, we have held highly successful virtual job fairs, Facebook Live events and other campaigns. Special recruitment videos have been created and shared to emphasize the quality of our team members and there is a high utilization of social media engagement.
  • We have strong relationships with nursing programs throughout the Southeast, and continue to build our pipeline. Mission also hosts clinical rotations for nursing and other clinical specialties.  Additionally, we have a strong internship program, which also includes nursing and clinical experiences.
  • We have utilized sign-on bonuses, employee referral bonuses, and relocation assistance to increase our recruitment of top talent.
  • Traveling nurses have, and are, being utilized for support of units while searching for permanent candidates.
  • Mission provides roughly one million dollars per year in tuition reimbursement, and has invested in a Career Exploration Center.  HCA has just instituted more enhanced tuition reimbursement for RN growth and development, and is highly interested in Mission’s Career Exploration Center.
  • All nurses are encouraged to participate in our professional governance model, NDNQI RN satisfaction survey, clinical ladder, our mentor program, preceptor program, leadership development, and other growth opportunities.
  • To more effectively retain our nurses and other team members, we have invested heavily in our Great Place to Work and Practice strategy providing resources to support and build resilience in our team members.
  • Stay interviews are being conducted routinely.
  • To retain our employees we have several recognition opportunities, such as WooHoo, Daisy Awards, NC Great 100 Nurse awards, CNA Compassion in Action awards, Leadership Awards, Annual Quality awards and more.
  • Ongoing data reviews are conducted to identify areas where specific and additional strategies for recruitment and retention are needed.

As always we welcome partnership, ideas and suggestions from our team members as we work together to ensure an environment that welcomes and retains top talent.