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Cultural Problem Between Senior Nurses and Newly Graduate NursesCapstone Project

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Cultural problem between senior nurses and newly graduate nurses

The nursing shortage at the Community Medical Center of Scranton, Pennsylvania: Cultural problems between senior nurses and newly graduated nurses

The nursing shortage at the Community Medical Center of Scranton, Pennsylvania: Cultural problems between senior nurses and newly graduated nurses

The Community Medical Center of Scranton, Pennsylvania is currently suffering a critical nursing shortage. While nursing shortages, despite the recession, remain epidemic around the nation, the Center's shortage is particularly acute. Furthermore, its retention rate is also catastrophically low: the rate has dropped below 60%. As a point of comparison, in March 2005, a national poll of 138 health care recruiters found that the average national nursing turnover rate was 13.9% (AACN Fact sheet, 2009, AACN). The CMC's high 'drop-out' rate of new nurses means that the Center must continually retrain new staff as well as deal with the constant, consistent shortage of current nursing staff.

This has created a burdensome demand on the Center's human and financial resources, even while the needs of the community have expanded and the CMC's financial resources have contracted. This paper will examine the degree to which institutional and cultural tensions between younger, new nurses and older nurses compound the problems of retaining qualified nurses within the Community Medical Center. The friction is part of a larger, national issue: namely the shortage of nurses nationwide.

History

The Community Medical Center of Scranton, Pennsylvania (CMC) is an institution with a long, proud history of serving the community. It began as a female-centered effort. Long before women were accepted leaders in medicine, in 1897, "a partnership of 15 women in Scranton, Pennsylvania, planted the seed for a new hospital dedicated to the people of their community" (History, 2010, CMC). Currently, the center is staffed by 1,500 medical professionals and administrative employees. The hospital offers a wide range of services, including obstetrics, community education, emergency and traumatic care, and cardiac care. Diabetes management, hospice, pain management, physical therapy, and a Ronald McDonald House, along with MRIs and other routine services span the range of offerings provided by the CMC for the Scranton community.

Problem

Pennsylvania hospitals have exhibited historically low rates of nurse retention. Dissatisfaction with nursing pay runs deep. The Altoona Regional Health System, for example, posted $19 million in total profits from 2004-2007 and increased CEO pay by 16% in 2006, but spending on nursing care remained unchanged (Towey 2007, p.1). This is despite a widespread national mandate to increase nursing recruitment and retention. Financial resources are now shorter than ever before, however, and even if willing to address the low payment scale for nurses in the area, many local area hospitals are now unable to do so.

The aging of the population, the retirement of many current nurses, and a shortage of nursing faculty have all conspired to create small nursing class sizes and thus smaller ranks of new nurses nationwide. Many institutions are forced to turn away qualified applicants because of a lack of teachers and resources. "In the July/August 2009 Health Affairs, Dr. Peter Buerhaus and coauthors found that despite the current easing of the nursing shortage due to the recession, the U.S. nursing shortage is projected to grow to 260,000 registered nurses by 2025" (AACN Fact sheet, 2009, AACN).

Insufficient numbers of nursing graduates combined with high levels of nursing dissatisfaction and low levels of retention compounds the shortage. Nurses are often overworked and overburdened. In an effort to address the problem, Congress authorized the Nurse Reinvestment Act of 2002 which included both recruitment and retention strategies, such as loan repayment programs and nursing scholarships, career advancement programs for young nurses, best practice grants, and perhaps most importantly "a fast-track faculty loan repayment program for nursing students who agree to teach at a school of nursing" (Addressing the nursing shortage: Background brief, 2010, Kaiser Permanente). In February 2009 the Nurse Education, Expansion and Development Act (NEED Act), still pending, was passed to authorize Capitation Grants (formula grants) for nursing schools to increase the number of faculty and students (AACN Fact sheet, 2009, AACN).

However, many Pennsylvania regional hospitals have fallen short in fulfilling this national mandate to improve the quality of life of nurses. For example "RNs in Altoona and the surrounding county had the 3rd highest rate of mandatory overtime of all of Pennsylvania's 67 counties" and nearly one third of RNs in Blair County reported being mandated to work overtime within the previous two weeks when surveyed (Towey 2007, p.4).

Historical performance of the organization

According to U.S. News & World Report, Community Medical Center of Scranton is one of nearly 5,000 institutions ranked in the magazine's listing of America's Best Hospitals. Hospital satisfaction was rated at 62%, hovering at the national average, as was patient willingness to recommend the hospital to other patients, family members, and friends. Nurses were rated high for courtesy and clarity.

External environment

To improve working conditions for nurses, some states have begun to pass legislation to reduce nursing stressors and factors leading to 'burnout.' As of December 2002, eight states had implemented laws banning or severely restricting the mandatory overtime a nurse could be required to work. Despite this fact, complaints in Pennsylvania have continued about this practice. Nursing shortages and burnout have severe consequences for patients. A 2005 survey for Nursing Economics found that 79% of RNs agreed that the nursing shortage affects quality of patient care and 93% reported having major time-management problems that compromised patient safety (AACN Fact sheet, 2009, AACN). In 1999, California mandated specific patient-to-nurse ratios for its hospitals beginning in 2003, with nineteen other states following suit.

One of the much-anticipated, potentially 'good' effects of the recession was supposed to be the improved recruitment of new nurses from the ranks of job-changing professionals. However, "because of the recession, state nursing schools are facing budget cuts, which renders them less able to hire enough faculty members to train enough new nurses to meet projected needs…at the same time, health care philanthropies are crunched for cash and, as a result, are less able to give nursing students and universities the same levels of financial support that they had provided in recent years. As a result, fewer students may now be preparing to become nurses -- the opposite of what needs to happen to fill the projected need for as many as half a million nurses by 2025" (Has the recession solved the nursing shortage, 2009, RWJF). A shortage of faculty members means that many schools must turn away qualified applicants. Conversely, many qualified applicants are unable to complete their degrees because of a lack of access to student loans and available credit. The nursing shortage is thus real, yet there are fewer ways to deal with the shortage, financially, at institutions nation-wide.

Market analysis

The shortage in the market of nurses is likely to grow, and may be temporarily hidden by the recession, given that some older nurses are putting off retirement for a few years, if either their or their partner's retirement savings 'took a hit' during the market collapse and credit crisis: "The average age of registered nurses was 47 in 2004, according to the U.S. Department of Health and Human Services. And while many may put off retirement for a few years for financial reasons, they will not be able to do so indefinitely. Meanwhile, fewer than 10% of registered nurses are under age 30, which means there will not be enough younger nurses to fill the shoes of their more senior colleagues when they do retire" (Has the recession solved the nursing shortage, 2009, RWJF).

Market share

Dire warnings still continue to be manifested at the Community Medical Center regarding the nursing shortage and burnout leading to low levels of retention. CMS is a regional hospital. Pennsylvania, unlike some of its neighboring states, such as New Jersey and Ohio, continues to face a nursing shortage.

Stakeholders

All stakeholders with an interest in the hospital have an interest in improving rates of nursing retention. Patient care is improved by increased access to high-quality nursing staff. Nurses themselves will benefit from lower patient loads and less mandatory overtime. Administrators will appreciate the higher ratings that will ensue, given the improved rankings of the institution's patient care.

Organization development strategy

Greater financial constraints make it all the more essential to improve conditions for nurses to improve retention. Financial incentives such as scholarships, raises, sign-in bonuses, and monetary incentives for moving into the community are not available. A positive workplace culture must be fostered. As well as a lack of financial compensation, quality of the work environment and a lack of respect by superiors and colleagues are often cited as influential in causing nurses to leave their jobs. Young nurses are especially apt to leave, as they suffer "heavy workloads, pressure from patients and colleagues, lack of support and recognition, and inadequate compensation for the hassles of night shift[s]" and holidays (Without support, 2008, the Lamp).

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