- Email: [email protected]
Shocking staffing statistics
EDITORIAL
Shocking Staffing Statistics taff turnover is costly. Few businesses can survive even a 50 percent employee turnover, particularly when the turnover is among its most highly skilled workers. Besides the expense of recruiting a replacement, think of the amount of staff time and patience consumed orienting a new employee. When an industry needs to replace three-quarters of its employees every year, the experience drain can be crippling. So how can we expect the nursing home industry to continue limping along with such shocking statistics as a 65 percent turnover rate for nurses and 103 percent for nurses aides? Even if we could dismiss the high nurses aides turnover as typical for less skilled workers, how are we to explain the fact that nursing homes cannot retain two out of three skilled nurses? Salary----or its inadequacy--is an undeniable factor. While nurses generally have not chosen the profession for the money, they can't survive without it. According to a 1988 survey conducted by the DHHS's Commission on Nursing, nursing home nurses average 35 percent lower salaries than their counterparts in hospitals and home care. Is it any wonder, then, that nursing home nurses jump from place to place, and sometimes from long-term to acute care, in search of better pay and employment conditions? Gerontological nurse Pat Scuffle, testifying on behalf of HR 1649, a bill that would require nursing home nurses to be paid on a par with hospital nurses, pointed out that RN retention is just 65 percent in a nursing home that pays RNs less than $300 per week. The retention rises to 83 percent in a facility that pays RNs more than $500 per week. (See "Pay Equity for Nursing Home RNs" page 295.) Plus, Veterans Administration nursing homes, which offer staff the same salary and benefits as hospital staff receive, reportedly have no more problem recruiting and retaining staff than VA hospitals do. Indeed, with acute-care salaries on the rise, the shortage of nurses in hospitalsTs beginning to ease. Not so in long-term care where the nurse vacancy rate continues to hover at nearly 20 percent. Add to the existing shortage the expected impact of the 1987 Omnibus Budget Reconciliation Act (OBRA '87)
S
mandate effective October 1. According to a study by the National Committee to Preserve Social Security and Medicare, nursing homes need 5,434 RNs and 1,103 LPNs immediately just to comply with those minimum federal regulations requiring 24-hour staffing with licensed nurses (RN or LPN) and an RN at least 8 hours a day, seven days a week. If nursing homes are to provide more than minimum staff so that nurses can offer the patient care planning and coordination that frail elders require, they will need 35,000 more RNs and 27,000 more LPNs. Hardly a cushy staffing situation, the added numbers would merely provide the ratio of one licensed nurse per 30 residents on days, one per 45 on evenings, and one per 60 on nights that the ANA Council on Nursing Administration recommended in 1987 as the bare minimum. (See "Nearly 90% of Nursing Homes Are Short Staffed" on page 266.) Nursing school enrollments have begun to turn upward, but how many of those new graduates will choose long-term care? From 1984 to 1988, the percentage of nurses who practice in nursing homes slid from 7.7 to 6.6 percent, and we haven't yet seen the number for 1990. How can we make long-term care attractive enough for nurses to enter and stay in the field? That is the focus of Geriatric Nurshlg's second annual survey. We could think of no one better to ask about how to recruit and retain nurses in long-term care than those now practicing there. We know some of the problems that discourage nurses from entering the field, but what about the positive side? If you're in long-term care, what was the attraction for you? What do you think would attract more nurses to work in the area? What factors are important to your remaining in long-term care, and how satisfied are you with those factors in your current facility? Please help. Fill out the survey on page 285, and make copies for your RN and LPN colleagues to fill out and retum, too. The paucity of information on what brings nurses into long-term care is appalling. The bright long-term care nurses who deliver quality care despite all the odds against them clearly belie the old stereotype of nursing home nurses as those who entered the field because they couldn't make it in hospital nursing. But it doesn't tell us who does enter or why. With your help, we can begin gathering the data we need to make the staffing statistics in long-term care less shocking.
Geriatric Nursing November/December 1990 265
Shocking Staffing Statistics taff turnover is costly. Few businesses can survive even a 50 percent employee turnover, particularly when the turnover is among its most highly skilled workers. Besides the expense of recruiting a replacement, think of the amount of staff time and patience consumed orienting a new employee. When an industry needs to replace three-quarters of its employees every year, the experience drain can be crippling. So how can we expect the nursing home industry to continue limping along with such shocking statistics as a 65 percent turnover rate for nurses and 103 percent for nurses aides? Even if we could dismiss the high nurses aides turnover as typical for less skilled workers, how are we to explain the fact that nursing homes cannot retain two out of three skilled nurses? Salary----or its inadequacy--is an undeniable factor. While nurses generally have not chosen the profession for the money, they can't survive without it. According to a 1988 survey conducted by the DHHS's Commission on Nursing, nursing home nurses average 35 percent lower salaries than their counterparts in hospitals and home care. Is it any wonder, then, that nursing home nurses jump from place to place, and sometimes from long-term to acute care, in search of better pay and employment conditions? Gerontological nurse Pat Scuffle, testifying on behalf of HR 1649, a bill that would require nursing home nurses to be paid on a par with hospital nurses, pointed out that RN retention is just 65 percent in a nursing home that pays RNs less than $300 per week. The retention rises to 83 percent in a facility that pays RNs more than $500 per week. (See "Pay Equity for Nursing Home RNs" page 295.) Plus, Veterans Administration nursing homes, which offer staff the same salary and benefits as hospital staff receive, reportedly have no more problem recruiting and retaining staff than VA hospitals do. Indeed, with acute-care salaries on the rise, the shortage of nurses in hospitalsTs beginning to ease. Not so in long-term care where the nurse vacancy rate continues to hover at nearly 20 percent. Add to the existing shortage the expected impact of the 1987 Omnibus Budget Reconciliation Act (OBRA '87)
S
mandate effective October 1. According to a study by the National Committee to Preserve Social Security and Medicare, nursing homes need 5,434 RNs and 1,103 LPNs immediately just to comply with those minimum federal regulations requiring 24-hour staffing with licensed nurses (RN or LPN) and an RN at least 8 hours a day, seven days a week. If nursing homes are to provide more than minimum staff so that nurses can offer the patient care planning and coordination that frail elders require, they will need 35,000 more RNs and 27,000 more LPNs. Hardly a cushy staffing situation, the added numbers would merely provide the ratio of one licensed nurse per 30 residents on days, one per 45 on evenings, and one per 60 on nights that the ANA Council on Nursing Administration recommended in 1987 as the bare minimum. (See "Nearly 90% of Nursing Homes Are Short Staffed" on page 266.) Nursing school enrollments have begun to turn upward, but how many of those new graduates will choose long-term care? From 1984 to 1988, the percentage of nurses who practice in nursing homes slid from 7.7 to 6.6 percent, and we haven't yet seen the number for 1990. How can we make long-term care attractive enough for nurses to enter and stay in the field? That is the focus of Geriatric Nurshlg's second annual survey. We could think of no one better to ask about how to recruit and retain nurses in long-term care than those now practicing there. We know some of the problems that discourage nurses from entering the field, but what about the positive side? If you're in long-term care, what was the attraction for you? What do you think would attract more nurses to work in the area? What factors are important to your remaining in long-term care, and how satisfied are you with those factors in your current facility? Please help. Fill out the survey on page 285, and make copies for your RN and LPN colleagues to fill out and retum, too. The paucity of information on what brings nurses into long-term care is appalling. The bright long-term care nurses who deliver quality care despite all the odds against them clearly belie the old stereotype of nursing home nurses as those who entered the field because they couldn't make it in hospital nursing. But it doesn't tell us who does enter or why. With your help, we can begin gathering the data we need to make the staffing statistics in long-term care less shocking.
Geriatric Nursing November/December 1990 265