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5/7/2002

Hospital Group Offers Strategies for Easing Worker Shortage

Donna Young

The health care field must make bold, innovative changes to avert the "looming crisis" of long-term staffing shortages, the American Hospital Association (AHA) reported at its annual meeting in April held in Washington, D.C.

Staffing shortages in health care settings pose a "fundamental threat to communities" and directly affect the quality of services provided by hospitals, AHA President Gary A. Mecklenburg said at the annual meeting.

The current nationwide shortage, he said, is "not cyclical" and cannot be solved "by hiking salaries and trying to take workers from the hospital across town."

Staffing shortages reach many areas. Several studies released in the past year reported that recruitment and retention of health care workers have become more difficult, and vacancy rates have increased substantially since 1999.

A poll of U.S. hospitals conducted last fall (PDF) by First Consulting Group found double-digit vacancy rates, 12.7–15.3%, for pharmacy, nursing, and imaging technician positions. The AHA Special Workforce Survey in May 2001 (PDF) found that 21% of unfilled budgeted positions in hospitals were for pharmacists.

According to anecdotes reported during the fall 2001 survey, a Texas medical center took six months to recruit two pharmacists and a Los Angeles medical center took two years to fill a night-shift pharmacist position.

One hospital reported that its nursing budget increased by $500,000 in one year when the facility had to rely on temporary staff from a nursing agency to fill gaps in the work schedule. Overall, 41% of the hospitals surveyed had paid sign-on bonuses to recruit nurses.

The General Accounting Office, the agency that conducts investigations for Congress, released two reports in 2001 that warned about severe shortages of health care workers, specifically in the fields of nursing, pharmacy, and imaging technology.

AHA responds. After spending a year studying problems related to staffing shortages, AHA’s Commission on Workforce for Hospitals and Health Systems released its recommendations in April in the report titled "In Our Hands: How Hospital Leaders Can Build A Thriving Workforce."

Mecklenburg, who chaired the commission for the past six months, said the report contains strategic and tactical recommendations that hospital administrators and employers can use to recruit and retain employees.

The commission has provided in its report real-life examples, Mecklenburg said, from numerous hospitals that are successfully tackling staffing shortages.

Commission member Sara J. White, director of pharmacy services for Stanford Hospital and Clinics in Stanford, California, said that, while many of the report’s examples are not pharmacy specific, pharmacy directors should "be innovative enough to use some of the nonpharmacy [examples] and adapt them to pharmacy."

White was the only pharmacist to serve on the commission.

"It’s good to have the unique perspectives of pharmacy represented," she said.

In addition to several representatives of the health care profession, the commission included a school board superintendent, a business school chairman, a community college president, a labor union leader, and representatives of the technology and business communities.

AHA, White said, intended for the commission to be "very broad based" to benefit from the "research that folks are doing outside of health care."

Recruitment must start early. Health professionals, White said, need to establish partnerships with school systems and community colleges.

"We need to be working now to get the young people in the school systems interested" in health care careers, she said.

Younger students, White added, are generally not exposed to pharmacy or pharmacy technology as a career option.

"We as pharmacists need to be participating in career days and seeking out opportunities to be visible in our school systems," she said. "And not only with schools, but with parents and with [school] counselors. We need to be putting in the time and the effort now so those kids know what’s available."

Health care professionals need to take a proactive approach, White said, to help prepare students for health care careers. For instance, health care professionals could volunteer in the classroom to teach science and math.

"Maybe it’s a commitment that organizations need to make—that we’ll provide people to do some of that," she said. "We’ve got to do things very differently if we’re going to ensure this work force in the future."

Inner-city schools could especially benefit from volunteer efforts from health care professionals, White said.

"A lot of minorities are educated in inner-city schools that may not have good enough math and science education programs," she said. "So even if we interest [minorities] into going on to pharmacy school or tech training, they may not have the basics to be successful in those programs."

Mecklenburg said the commission’s study revealed that the health care field has not "done a good enough job of reaching out to other groups and making our work force diverse."

"If we don’t deal with diversity," he said, "we will not solve this problem. There is no question about that."

Help must also come from outside. The commission’s report, Mecklenburg said, is also an effort to place health care’s work-force shortage on the national agenda to get government, education, labor unions, businesses, and community leaders involved in dealing with the problem.

"This report is a call to action for leaders in the field, leaders in their institutions, and leaders in their communities," he said.

As one of its tactical recommendations in the report, the commission suggested that the hospital community should seek an appointment to the U.S. Department of Labor’s Council on the 21st Century Workforce.

The Bush administration appointed 10 of 13 members to the council in March. None of those appointees represent the health care field.

At press time, no decision had been made on the other three appointments, said Elissa Pruett, Labor Department spokeswoman.

"It’s the intention to round out the council with individuals that address specific needs," she said.

The Labor Department, Pruett said, could not comment on whether the president was expected to appoint someone from the health care profession to the council.

James D. Bentley, AHA senior vice president of strategic policy planning, said health care workers represent about 10% of the nation’s work force, but the Labor Department has ignored the field.

"When you look at what’s happening with the 21st Century Workforce commission and the Department of Labor, we are almost a forgotten [group] of society," Bentley said. AHA, he said, has provided recommendations for potential council appointees to the Bush administration.

"Long-term, if this report is successful, a president four years or eight years down the road would never question" whether the health care field should be represented on the council, Bentley said. "But if you’re invisible, you don’t get anywhere," he added. "And we need to make it so that never happens again."

But Mason Bishop, special assistant to Labor Department Employment and Training Administration Assistant Secretary Emily Stover DeRocco, argued that the federal government has already recognized the staffing shortage in the health care field.

Independent of the Council on the 21st Century Workforce, Bishop said, his office has been working to get people employed in health care.

"I think we’ve been very engaged and very aggressive," he said.

One effort made by the Labor Department to alleviate the health care staffing shortage is a business-led partnership with HCA Inc., owner of about 185 hospitals and 80 ambulatory care surgery centers in the United States.

Last fall, HCA offered $5 million for a program to train unemployed workers for health care positions if the federal government matched the offer, Bishop said.

"We are excited because it is a business-led program, and it is coming from within the industry," he said. "It’s not just companies coming to [the] government and asking for money. They are saying, ‘We are willing to put up our dollars—here are our needs, here are the geographical locations we need [to] help.’ It’s a true public–private partnership that involves state and local communities to provide a work force."

HCA offered the money, in part, Bishop said, to help workers who lost their jobs as a result of the September 11 attacks to find new jobs.

Scholarships and financial assistance for the training program are offered, in exchange for a work commitment equal to the length of the training, to any unemployed person who seeks to become a registered nurse, licensed practical nurse, radiology technologist, surgical technician, or certified nursing assistant, according to HCA.

Bishop said the program is the "start of a larger industry effort to meet the challenges" of health care’s work-force shortage. "We’ve been approached by other companies to see if they can do the same thing," he said.

The Labor Department is depending on Congress to appropriate an additional $50 million to expand the High Growth Initiative Training program so that the department can fund other projects like the HCA partnership.

Bishop said the Labor Department plans to expand its Web site to include an area where health care-related businesses can post job announcements.

 

Nurses Release Strategic Work-Force Plan

Nursing organizations around the nation have banded together to develop a strategic plan to tackle the shortage of practicing nurses.

A coalition of 60 nursing organizations led by the American Nurses Association (ANA) recently released its report "Nursing’s Agenda for the Future," which outlines specific objectives and goals, including improving patient safety and recruiting and retaining nurses.

The report has been distributed to nursing organizations nationwide, according to ANA.

A steering committee of 19 nursing organizations will lead and monitor the overall work of the initiative.