What Nurses Want
Saturday, September 13, 2008
Nurse Jennifer Dimmick helped her 71-year-old patient, George Mulligan, struggle from a chair to his feet for his daily walk around the corridor outside his room at Inova Fairfax Hospital.
During the previous three days following Mulligan's aortic valve replacement surgery, Dimmick was preparing him to care for himself after his discharge -- demonstrating how he should gingerly lift himself when he rises for his walks so that he won't damage his incision and playing videotapes that show him how to dress the wound to prevent infection and how to use a breathing device so that he won't get pneumonia. The hospital introduced the education program after Dimmick and other nurses discovered an unusually high readmission rate for heart patients.
Like hospitals around the country, Inova is grappling with a nursing shortage that is projected to worsen over the next two decades. Hospitals increasingly are responding with a new recruitment and retention strategy -- giving nurses like Dimmick much more say in their patients' care.
Five years ago, hospitals waged intense bidding wars to fill nursing vacancies, luring nurses with huge signing bonuses and even sport-utility vehicles and vacations to the Bahamas. Those efforts often only served to exacerbate turnover, spurring nurses to remain in jobs just long enough to claim the prizes before moving to other hospitals with better incentives.
As it turns out, many nurses want better working conditions more than they do extra money. Hospitals now are responding by introducing technology to dramatically reduce paperwork, offering more flexible hours, reducing caseloads, paying for advanced training and giving them more authority.
"Autonomy is a big thing," said Dimmick, who has been at the hospital for 7 1/2 years. "It's important for me to know that what I do matters."
Inova Fairfax recently introduced a state-of-the-art data system -- consisting of video monitors and other equipment that track the vital signs of intensive care patients -- to reduce the amount of time nurses spend filling out paperwork. It also has established a concierge that offers such services as dry cleaning, movie tickets and car detailing for busy nurses trying to juggle their professional and personal lives.
Inova is part of a nationwide movement. These days, nurses at Children's Mercy Hospitals and Clinics in Kansas City, Mo., for instance, set their own schedule and have a say in what type of equipment should be purchased and whether patient-staff ratios need to be adjusted.
"Having the option to voice an opinion is amazing," said Jana Schlosser, a nursing education coordinator at the hospital.
Closer to Washington, nurses at Georgetown University Hospital have been encouraged to conduct research projects, which often become institutionalized as new care plans. Some are looking at whether giving chewing gum to patients who went through gastrointestinal surgery can more quickly restore their digestive functions and whether an electronic device that automatically dispenses medication can reduce pain for patients who had their knees and hip joints replaced.
"Morale was low," before Georgetown introduced the new programs in 2004, said nurse Laurie Dohnalek, adding that her colleagues' attitude was "just get through the day." Now, she added, "everyone is looking to grow -- how can I make this place better?"
Hundreds of hospitals are spending millions of dollars to retool their practices, experts say, because of the high expense in losing nurses.