By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
It has always been challenging to recruit and retain nurses on medical-surgical units but never harder than it is today. The following story is one I have heard repeated by so many medical-surgical managers across the country:
I have 25 RN vacancies on my unit and absolutely no candidates. I am ashamed to admit that I have not interviewed even one nurse in the past three months. My unit used to be the place where new graduates started. I had a core team of experienced nurses who were great preceptors. Today, my core staff have either retired or are out traveling. Half of the RNs on the unit are travelers. New graduates now have a wide range of specialty choices and can move right into critical care, ED, NICU, or even the OR. Our recruiter tells me that the idea is not well received when she mentions starting on a medical-surgical unit. Our medical center is working to recruit international nurses and I have been promised that I will get some of those candidates, but that won’t happen overnight.
The media message is evident in both TV shows and in the movies. The excitement in healthcare is in critical care units, emergency departments, operating rooms and labor, and delivery. It is not surprising that most new graduates come into health systems seeking a position in one of these areas. Over time, we have devalued working on medical-surgical units, which has been to the detriment of patient care. As I work with young medical-surgical nurse managers, I am concerned because many feel their situation is dire, and no one seems to care unless there are issues with the unit’s performance measures or traveler costs. Most inpatient care occurs in medical-surgical units. Patient acuity has increased, as has the number of daily admissions, discharges, and transfers. This new employment trend of no-nurse candidates has been devastating in many settings. It impacts quality, safety, ED throughput, and patient length of stay.
There are no easy answers to what has become a pretty wicked problem. Here are some strategies that nurse leaders are trying:
Rebrand the name Medical-Surgical Units
What’s in a name – it may be more than you think. Some systems had moved away from calling these units medical-surgical and retitled the unit names to acute care. Just the name change alone generated more interest among young nurses who want to work in units perceived as more challenging. In some respects, retitling to Acute Care provides a far more accurate description of the acuity of patients seen on the unit.
Provide Electronic Remote Monitoring of Medical-Surgical Units
While historically, most remote nursing monitoring of real-time practice has been in critical care, more health systems are looking at this type of backup for medical-surgical units. Some labor-intensive nurse activities such as admissions and discharges are now done remotely.
Convert Medical-Surgical and Telemetry Units to DEUs or Teaching Units
Leaders in some organizations are now redesigning care by designating their medical-surgical units as Dedicated Education Units (DEUs). Every new graduate spends three months there before moving to their first choice specialty assignment. This plan has advantages, as new nurses today need more intensive upskilling. It also allows the recent graduate to do shadow days on specialty units to assess whether it is a good job fit for them. These units are staffed with highly experienced Clinical Specialists, CNLs, Educators, and ARNPs who are there 24/7 to support the clinical care given by staff. Bringing back retired nurses with recent acute care experience as clinical coaches is also a program under consideration.
Redesign Care Delivery on Medical-Surgical Units and Telemetry
Primary care may not be the best delivery system for units with a high staff turnover. These units may need more of a team nursing approach where the teams are led by very seasoned Clinical Nurse Leaders or Clinical Managers who work with new graduates and patient care technicians. Innovative ideas such as incorporating pharmacy technicians to pass medications may be a needed strategy. These units could be the pilot units for the “most flexible scheduling” in the hospital – 4, 6, 8, 10-hour shifts or the Baylor Plan units.
Albert Einstein has been quoted as saying that “we can’t solve problems with the same kind of thinking we used when we created them.” I believe this to be true. We will need to be much more creative and it may involve discarding sacred cows. This problem cannot be placed on the plate of these nurse managers with the expectation that they will solve it. We owe it to them and their patients to rethink what we are doing.
© emergingrnleader.com 2022
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