Satisfaction guaranteed? A sampling of strategies to keep experienced nurses on the job

Nevada RNformation, Feb 2003 by Trossman, Susan

They're often described as veterans or die-hards. They're hospital nurses who've been through it all: team nursing, SOAP charting, downsizing and DRGs. But their numbers are dwindling, and many are poised to retire within the next 10 to 15 years. That's if they don't quit sooner.

Florida Nurses Association member Nancy Hartley knows senior RNs who left the profession largely because of the ever-increasing workload.

"I fear we're losing more and more nurses, because they're willing to work for less money as a cashier or in a card store - anywhere where there's less stress," said Hartley, RN, an ER staff nurse. "And of course when they leave, that increases the stress of the experienced nurses who remain."

As the nursing shortage has taken hold, many veteran nurses have watched their employers offer sign-on bonuses, increase starting salary levels and promise new employees premium shifts, while long-time RNs' loyalty and experience has gone unrewarded.

"Sign-on bonuses do not recognize the long-term staff who put their shoulder to the wheel day after day. And they don't create loyalty, because they allow nurses to bounce from facility to facility," said Arizona State Nurses Association (AzNA) member Rhonda Anderson, MPA, RN, chief operating officer at Desert Samaritan in Mesa, Ariz., and a nurse for 30 years.

New and veteran nurses know that having a solid core of experienced nurses is the key to patient safety. Sp they are working harder than ever with their administrations to create or maintain workplaces designed to retain experienced staff.

So what do long-time nurses want?

"There's not a global, magic answer," Anderson said. "But they want a reasonable wage and flexibility in scheduling and time off. They want respect from both physicians and hospital administrators for the work they do and the real protection that their seasoned assessment ability brings to patient care."

And, experienced nurses say they want what all nurses want - control over their practice and a safe working environment.

Financial gains

Nurses nationwide have been working on various efforts to decompress wage structures for experienced nurses, who saw their salaries stagnate while starting pay for new nurses escalated.

"Many hospitals in the state were experiencing retention problems, and ours at Yuma Regional (Medical Center) was growing," said AzNA member and telemetry staff nurse Ray Kronenbitter, RN. "Nurses were burned out and were leaving to take on less rigorous nursing roles."

To keep experienced staff, Yuma Regional altered its salary structure to bring it more in line with hospitals in the Phoenix, Tucson and San Diego regions. In July 2000, Yuma Regional nurses saw their wages increase an average of $2 an hour, six months ahead of the routine annual performance raises. Then in December 2001, they gained an average of another $2 an hour as part of their annual performance raises. These changes have resulted in reducing the turnover rate to 14.36 percent annually, as compared to the 26.68 annual statewide average.

Other strategies to make the salary structure more equitable include:

* Administrators at Shands Teaching Hospital at the University of Florida agreed to reward long-timers by raising all nurses wages by $1.79 an hour (on top of their annual performance raises) and providing one-time bonuses, said Hartley, the bargaining unit president. Bonuses ranged from $500 to nurses on staff for less than five years to $1,250 to those with 15-plus years at the facility.

* Minnesota Nurses Association member Jacquie Luoma, RN, said her bargaining unit at Fairview University Medical Center - Riverside Campus negotiated annual longevity bonuses that ranged from $1,500-3,500 (depending on length of service), in addition to any step increases for employees who have not yet topped out on the pay scale.

* At Sparrow Hospital in Lansing, Mich, nurses at the top of the scale recently won salary improvements that increased the previous maximum hourly pay from $25.58 to $28, according to Gail Jehl, RN, co-chair of the negotiating team and a nurse at Sparrow since 1988.

* And nurses at Appalachian Regional Healthcare, Inc.'s hospitals won the addition of another step in their salary structure that rewards nurses who've been on staff for 25 years or more. They now get $ 1,000 annually, according to Pat Tanner, Kentucky Nurses Association director of labor.

Nurses also gained other financial incentives that are attractive to long-time staffers. For example, Fairview nurses negotiated additional pay for nurses who serve as preceptors.

"It seems like putting a dollar amount to the preceptor role made administrators realize experienced nurses' value," said Luoma, a critical care float pool nurse and co-chair of her bargaining unit. (Preceptors also gained more autonomy over their role and are no longer expected to take full assignments while overseeing new nurses.)

Fairview nurses also won increases in shift differentials $2.50 an hour for working evenings and $4 an hour for nights.