Ambulatory surgery centers should get ready to face a harsher climate in nurse recruitment over the next few years.
Severe shortages of nurses peaked several years ago. Severe nursing shortages of the mid-00s were neutralized by the recession, which reduced demand and brought retired nurses back to the workplace to supplement their family incomes, says Bill Heller, president of RN Network, a nurse recruitment company in Boca Raton, Fla.
Now, however, as the recession subsides a little, nursing shortages are reappearing. "We have already started to return to a much more constrained supply," he says. "Demand remains at about half of what it was five years ago, but we anticipate it to rise over the next 12 months."
Nurse shortages are only expected to worsen as baby-boomer patients get older and sicker and baby-boomer nurses retire. Mr. Heller says the shortage cannot be easily fixed by supplying more nurses because there are not enough nurse-educators to teach them. Without sufficient faculty, he says nursing schools have had to turn away qualified applicants.
OR nurses in short supply
Operating room nurses are particularly in short supply, says Amy Goetz, division vice president at Nursefinders, a nurse recruitment company in Arlington, Texas. "The shortage of OR nurses is a national phenomenon, in both rural and urban areas," she says. "It can be hard to find an OR nurse even if you're offering top dollar."
She predicts that hospitals and ASCs will have to rely more on OR technicians to do some peri-operative work. In some California hospitals, she says, RNs just circulate in the OR, and the scrubbing is mainly left to the surgery techs.
Aging nurse workforce and its implications
Mr. Heller says another undeniable trend is the aging of the nurse workforce. "The nurse population is significantly older today than it was just a decade ago," he says. The median age of nurses rose from 45 in 2000 to 47 in 2004 and in 2010, 40 percent of nurses were age 50 or older. "Many of these nurses plan to retire in 10 years or so, which will continue to present staffing challenges," he says.
How will older nurses have to be treated? "All things being equal, an older nurse may be less inclined to work extra shifts than a younger nurse," Mr. Heller says. He advocates a mix of older and younger nurses. "More experienced nurses bring a ton of expertise and younger nurses can offer a fresh perspective, so it's good to have a mix," he says.
The aging nurse workforce could be a boon for ASCs that traditionally rely on a lot of part-time workers. "As nurses age, the ones who can afford it are going move to part-time work," Ms. Goetz says. "However, with the economy still weak, there will still be a lot of older nurses who will need to work full-time."
Competing with the hospital
ASCs looking to hire more nurses will be competing against hospitals, which tend to offer higher salaries and valuable extra benefits. Mr. Heller reports that sign-on bonuses, which were popular in the shortage five years ago, are coming back. "The sign-on bonuses require the nurse to make a certain level of commitment for x-period of time," he says.
In addition, Mr. Heller thinks nurse salaries, which have been relatively flat, are poised to increase. "We are just at the beginning of the demand curve," he says. "In the next 18 months that demand should increase to a level that might justify a salary increase."
Many nurses, such as young women without a family, prefer working in a hospital over an ASC because they can get longer shifts with time-and-a-half pay, Ms. Goetz says. She says states like California require nurses to receive time-and-a-half for work that lasts more than eight hours a day. Hospitals typically offer 12-hour shifts, which is practically unheard of in ASCs.
Showcase ASCs' advantages over the hospital
Rather than compete head-to-head for nurses with the hospital, Ms. Goetz advises ASCs to showcase how they are different from the hospital. One example is offering a steady workweek with no weekend work, which would appeal to nurses with young children. Another is offering a calmer, more intimate setting where a single nurse can make a difference, while hospitals tend to be more hectic and rather impersonal.
Mr. Heller thinks work culture could be the ASC's biggest asset. "When recruiting nurses, keep in mind that workplace culture is as important as salary and benefits," he says. "Some nurses might prefer the predictable hours and intimate culture that an ASC can provide, so marketing these benefits to prospective employees can aid in finding the right fit for your facility."
While hospitals offer financial incentives like signing bonuses, he suggests ASCs should point to "softer" benefits. "Employees of any type are more and more appreciative of the softer things, such as a nice break room with a TV in it," he says. "The facility might bring in pizza for the employees every Friday. He also suggests increasing paid time off.
Meanwhile, as hospitals open their own ASCs, they have an opportunity to offer the best of both worlds: more robust benefits and a more intimate setting. Mr. Heller adds that the affiliated hospital could also serve as a pipeline for hospital-based nurses who are interested in working in surgery centers.
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