Recruiter Barbara Striker, left, and nurse manager Stephanie Haynes on the MICU at Bayview.

Before she joined Bayview as nurse manager on the medical intensive care unit, Stephanie Haynes was a nurse in the military. When she said, Do it, it got done. But when she started issuing orders on Bayview’s MICU, her charges didn’t exactly click their heels and salute.

Bright clinical experts, Haynes’ staff had been without a nurse manager for a couple of years. In the MICU’s fast-paced environment, they had developed entrenched ways of doing things and an assertive style of communication. They had grown apart from one another personally. New recruits never seemed to fit in and didn’t stay. The staff vacancy rate soared at around 50 percent, with travelers and agency nurses filling the gaps.

Not surprisingly, the MICU had sailed to the top of the radar screen in the office of Vice President of Patient Care Services Maria Koszalka. Before long, nurse recruiters were taking a long, careful look at hard-to-fill units. Recruiter Barbara Striker zeroed in on the MICU and took action. Within six months, vacancies there were slashed from 11 to just two. Vacancies on other units, meanwhile, were plunging as well. Surgery and neuroscience now have no positions to fill. One medicine unit has only one vacant spot left; the other is fully staffed.

All around the country, hospitals like Bayview are starting to see the various strategies they have employed to attract and retain nurses begin to pay off. At Howard County General Hospital, vacancies have dipped to 6 percent. At Hopkins Hospital, as of the end of December, the vacancy rate was 4.4 percent, compared to 10 percent a year ago. Vacancies there have dropped—particularly in areas such as medicine, surgery, peds, and labor and delivery. While some vacancies remain in areas such as the ED, ICUs and ORs, the situation, says Peggy Hamilton, coordinator for nurse recruitment, “is very manageable.”

At Bayview, the reduction in vacancies is the result of widespread improvements—the stepped-up recruitment effort among them—all aimed at making the units a more appealing place to work. Nurses have been offered more opportunities for training and education, additional scheduling models, unique benefits (including dependent tuition and 403b match); and a work environment enhanced by technology.

Four-channel portable phones, for example, which have made it easier for nurses to stay in touch with physicians and other departments, now are part of a nurse’s work life. “They say they can’t live without them anymore,” says Koszalka, who is chair of the technology subcommittee of the statewide Commission on the Nursing Shortage.

Physician order entry (POE), a computerized system that enables clinicians to electronically manage all patient orders, now is in place on several units (medicine, medicine critical care, psychiatry and chemical dependency). So far, order entry has meant nurses spend less time searching for a chart, clarifying an order and deciphering handwriting. It’s too early to tell if POE will depress vacancy rates further, Koszalka says, “but I’m anticipating it will, because nurses will have more time available to do what they most want to do, which is to take care of patients.”

Further improvements have resulted from fresh approaches to old dilemmas. Some staff nurses work extra shifts through agencies, for example. There was no getting around it, Koszalka knew, but she wondered, Why not let them do it at Bayview? Thus in some units, slots have been kept open for staff who want to sign up for extra shifts beyond their regular hours and be compensated at premium pay. “They’re familiar with our policies and procedures. They’re much more committed,” says Koszalka. “We monitor them carefully to make sure they’re not fatigued, and we maintain patient safety at all times.”

As for the recruiters, they took it upon themselves to understand the culture of hard-to-fill units, right down to the types of personalities who would thrive there. In the case of the MICU, Striker made it a point to be visible, attending staff meetings, getting answers to questions, and offering support to Haynes as she built esprit de corps on her unit. The enhanced relationship between recruiter, management and staff has made it easier to bring new nurses on board, says Terry Bennett, recruiting director. “Staff give us leads of possible recruits. When interviewees or new hires come to the floor, they are welcoming and more involved.”

Overall, Bayview’s vacancy rate is 5 percent. And yet, the nursing shortage still looms large and is expected to peak over the next decade as the bulk of the nation’s nurses begin to retire. Striker knows that her work is not over yet. “We have some young staff,” she says. “Now we will have to work hard to make sure we don’t lose them.”

—ABS

High Profiles JHM nurses have a lock on leadership in a statewide nursing organization Maria Koszalka, incoming president of the Maryland Organization of Nurse Executives, left, and Judy Brown, outgoing president. Two Hopkins Medicine nurses are at the helm of efforts to influence the delivery of health care in Maryland through their leadership of the Maryland Organization of Nurse Executives (M.O.N.E.), a non-profit group consisting of 160 nurse leaders who represent most of Maryland’s acute care hospitals. Judy Brown, senior vice president of nursing at Howard County General Hospital, is the organization’s outgoing president; Maria Koszalka, vice president of patient care services at Johns Hopkins Bayview Medical Center, is its incoming.