Emergency Department Nurse Recruitment and Retention

Intervention Title: Emergency Department Nurse Recruitment and Retention – Memorial Regional Hospital (MRH); Hollywood, Fla.

Goal: Improve nurse recruitment and retention in the emergency department (ED).

Innovation: A team was assembled to develop an initiative to improve nurse recruitment and retention, including internal and external recruitment strategies, comprehensive training, and a mentoring program for new ED nurses.

Result: The recruitment and retention initiatives have resulted in a significant decrease in the turnover rate in the ED, decreased patient throughput times and increased patient satisfaction. The hospital now has a 3.1 percent turnover rate among nurses in the ED, while the national average is approximately 10 to 12 percent.

Institution: Memorial Regional Hospital 3501 Johnson Street Hollywood, FL 33021 P: (954) 987-2000

From the Experts: "When we began this program, we had a nurse vacancy rate of 20 percent and a temporary staffing rate of 20 percent. When you are operating with 60 percent of the staff you need, it not only affects staff morale, but it also affects patient care. Once we put our plans into place, we were up to full staffing in 18 months, which helped to dramatically improve staff satisfaction. Since we began this program, we have significantly decreased our treat-and-release time as well as our quick-care time. From where I sit, that directly translates to more efficient, patient-centered care."

Melinda Stibal, M.B.A., R.N. Administrative Director of Emergency and Trauma Services

Profile: Memorial Regional Hospital is a 690-bed facility in Hollywood, Fla., with 65 acute ED beds. It is part of the not-for-profit Memorial Healthcare System.

Clinical areas affected:

  • Emergency department

Staff involved:

  • Emergency department

Timeline: There was a four-month planning period followed by six-month training classes. The ED was fully staffed in 18 months.

Contact: Melinda Stibal, M.B.A., R.N. Administrative Director of Emergency and Trauma Services mstibal@mhs.net P: (954) 985-5904

Innovation implementation: Large emergency departments operating at full capacity must be staffed fully and appropriately to run effectively. But for many hospitals, it is a struggle to recruit and retain specialized ED nurses.

In 2003, Memorial Regional Hospital had a 20 percent vacancy rate for its ED, despite hospital-wide recruitment and retention efforts. A team led by a nurse administrator was assembled to address the problem.

The team began by obtaining administrative support for two things:

  • making eligible for an existing scholarship program the current staff from the telemetry, medical/surgical and outpatient departments.
  • beginning intensive training in emergency nursing for new hires.

To advertise the open ED positions, e-mails and fliers were sent to hospital employees and internal job fairs were held. Mailers highlighting the hospital's scholarship program were distributed to advanced nursing students at local universities.

Initiating a comprehensive mentoring program for ED nurses was critical to the recruitment and retention strategy. Experienced nurses volunteered to mentor the new nurses who were accepted into the program. Nurse mentors took an eight-hour course and received a monetary bonus based on the duration of mentoring and their experience levels.

Orientation for new nurses now consists of a six-month program, with four to five nurses entering the class at the same time. The training includes 380 hours of classroom instruction followed by clinical experience in the ED working with a specific nurse mentor.

Advice and lessons learned:

  1. Safety in numbers.
  2. Identify barriers.
  3. Complete classroom training, then move to the ED.

Cost/benefit estimate: While the program costs approximately $32,000 per new hire, the team discovered that the cost of nursing turnover was approximately $64,000 per nurse. In addition, the efforts have improved patient satisfaction. The Memorial Regional Hospital ED now ranks in the 99th percentile in patient satisfaction, compared to scores in the 20s and 30s prior to the initiative.

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