CorrectCare

Rx for RN Shortages
Correctional Facilities Aim to Recruit and Retain
by Jaime Shimkus

The crunch is on, and correctional facilities, like hospitals and other health care organizations across the country, are feeling it. Far too many nursing positions are going unfilled for far too long. 
We’ve seen this before, but this time it’s not just cyclical. Demographic trends practically guarantee a tough time ahead. An aging workforce in the nursing profession. Greater demand for nurses as the Baby Boomers grow old. More lucrative career opportunities for women, who still make up the majority of nurses. Decreases in nursing school enrollment. Shrinking numbers of nursing faculty. Add to all that the fact that nursing, as an occupation, gets a bad rap these days (even by some nurses!) and it’s no wonder there’s a shortage.

A report prepared for Congress does not concede there’s an “across-the-board shortage” of RNs at present, based on labor market indicators, but says evidence points to a national shortage by 2010 unless preemptive actions are taken. Titled “A Shortage of Registered Nurses: Is It on the Horizon or Already Here?” the report was issued in May by the Congressional Research Service of the Library of Congress.

Congress isn’t alone in its concern. Chiming in with studies, testimony, task forces, recommendations and legislation are other federal agencies, dozens of state legislatures, nursing associations and other professional groups, labor unions, academics and consumer groups. Everybody’s talking about the looming shortage, and if all this talk leads to action, the long-term outlook should improve.

But to those correctional health services recruiters struggling to fill vacancies today, the crisis is not “looming”—it has arrived.

A DUAL FOCUS
The situation is dismal, to be sure, but there’s much correctional facilities can do to keep their staffing slots filled.

First, it’s important to realize that retention of staff is every bit as important as recruitment, says Kleanthe Caruso, RN, MSN, CCHP, director of nursing, Texas Department of Criminal Justice. That means knowing not only what it takes to attract good employees, but also how to keep them happy.

“Organizations that pay attention to the employee market and understand what people are seeking from the work environment have a better chance to recruit and retain top talent,” Caruso says. The immediate past chair of NCCHC, Caruso presented a session on this topic at the Clinical Updates conference in May.

Before you can retain you have to recruit, and that can be a real challenge if potential employees have a poor opinion of correctional nursing, says Stacey Ryan, RN, MSN, CIC. Ryan is regional infection control nurse and special projects coordinator for Correctional Medical Services—Massachusetts, which provides health services to the 22 prisons operated by the state department of corrections.

A task force created by Ryan and her colleagues conducted a study of the nursing workforce in Massachusetts and used the results to hone their recruitment and retention efforts. A key finding: Negative community perception was identified as the greatest barrier to recruiting nurses.

CORRECTING MISCONCEPTIONS
What are some of the perceptions that discourage nurses from considering correctional settings? “Many people label the correctional nurse as someone who couldn’t get a job elsewhere,” says Joanne Dorman, RN, CCHP-A, nurse manager at Hampden County Correctional Center, Ludlow, MA. Dorman conducted her own staffing survey at the county facility, which has about 30 nursing positions.

Others dwell on the risk factors. “The security risk is higher in prisons, and there’s higher incidence of infectious diseases. Nurses ask why they should work in prisons for the same or less money when there may be more desirable options,” says Caruso.

In reality, correctional nursing is a dynamic, rewarding specialty that offers advantages over hospital or other community settings, according to many in the field. Compared to a typical hospital, correctional facilities tend to offer greater stability, more manageable shifts, lighter caseloads, a clinic-type setting (vs. acute care), and a strong public health mission. A survey by the Academy of Correctional Health Professionals found that its members relish the unique clinical challenges. Those are messages that will appeal to many nurses, and they needs to be broadcast loud and clear.

A logical place to start is with yourself and your staff, says Caruso. “Each nurse is the most important recruiter. We all shape the impression others have about our profession, so we must be aware of how we discuss our work in public. If needed, nurse executives could educate staff on how to communicate in social settings.”

Beyond that, a well-crafted marketing campaign could go a long way toward reversing negative biases. That’s one of the first things the CMS—Massachusetts task force tackled, with considerable success.

“We had to ‘sell’ correctional nursing as a specialty,” Ryan explains. It’s a multipronged effort. A chief activity has been outreach to nursing students. The task force has contacted about 30 nursing schools, sending speakers and taking part in career fairs.

Dorman, who began to work with local nursing schools four years ago, says such relationships have been very fruitful. Some schools even send students to the jail for curriculum-related training, which gives them a hands-on taste of the environment.

“We usually end up getting one person from each class, but those people didn’t even know about corrections before,” Dorman says.

SEARCH STRATEGIES
Back at the state level, the Massachusetts task force redesigned all promotional and recruitment materials, emphasizing the benefits of correctional nursing. Ads make it clear that new graduates are encouraged to apply, something that isn’t always true in other specialties, says Ryan.
They also expanded their advertising program beyond the major metropolitan newspaper to encompass small community papers (including those serving Hispanic audiences), nursing journals and even direct mail. These alternative outlets have paid off with numerous leads, Ryan says.

Aware of the intense competition from other employers, the task force has minimized the time between an ap-plicant’s first inquiry and all the candidate management duties that follow. “Usually one person, often the director of nursing, carried the entire load,” Ryan says. “We’ve broken up those jobs so that others can make callbacks, schedule interviews, do background checks or conduct facility tours.”

A shadowing program, developed at the national CMS office, is offered for those who are interested in the job but still harbor some doubts. Potential hires are paid to come in for a day and observe staff nurses. If they’re still unsure, they can ask to be placed on the facility’s list of per diem workers.

To prevent any misgivings among those who do accept the job, the task force developed a mentoring program. Now, new employees are partnered with an experienced nurse so they have someone to whom they can turn for support long after traditional orientation has ended.

OF MOTIVATION AND MONEY
What about retention? Joanne Dorman has made great strides in this area, and much of it boils down to fairly touchy-feely—but effective—tactics such as coaching, motivating and empowering.

Professional development is ongoing, with employees receiving cross-training to help them learn about other aspects of correctional nursing. Dorman also encourages staff to take part in special projects, and says one good way for them to feel involved is to work with the nursing students who frequently visit the facility, showing them around and explaining the important work they do.

Communication is essential, says Dorman, but rather than relying only on formal feedback methods, Hampden County managers have made it customary to talk often with employees, to discover their concerns and needs—and to act on that information. Slightly more formally, the nursing staff also holds weekly meetings, just 15 or 20 minutes, to talk about workplace issues and to float ideas.

Perhaps most importantly, says Dorman, “We let our staff know we value them and their knowledge. After all, they’re the ones who bring change to the workplace.” A simple pat on the back can work wonders in boosting motivation and satisfaction.

And then there’s money. While surveys show that monetary compensation is seldom the key driver influencing nurses’ career choices, it sure can help. To sweeten the pot, management at the University of Texas Medical Branch, which provides medical services to the state’s prisons, recently increased nursing salaries by $1,000 per year, Caruso reports. (There is no pay differential for those who work in the prisons, however). UTMB also provides meals, which translates to more money in employees’ pockets.

To prevent frivolous use of sick days, each quarter, UTMB rewards each employee who has perfect attendance with a gift certificate to a local restaurant. The certificates are issued every three months rather than annually to discourage people who are truly ill from dragging into work. Those with perfect attendance are also entered into a drawing to win $1,000.

“It’s a good motivator for those who might stay home just because they don’t feel like working that day. In the long run, it costs less; otherwise we’d have to pay overtime or bring in agency workers,” Caruso says. “Our management philosophy is, instead of trying to catch people doing things wrong, reward them for doing things right. This improves attendance, performance and productivity.”

Other places offer financial incentives such as referral bonuses for bringing in a new recruit and retention bonuses after several months. But be wary of sign-on bonuses, Caruso says, because it encourages job hopping.

Not to be overlooked: familiar human resources tools such as strong benefits packages, flexible scheduling, float pools and continuing education.

A ‘MALDISTRIBUTION’ PROBLEM?
The Congressional Research Service report suggests that current “shortages” may actually reflect a maldis-tribution of labor, with problems cropping up in certain geographic areas or specialties (e.g., emergency medicine). Janice Hill, RN, MPH, CCHP-A, thinks that’s a good point. 
As health services administrator for the Pinellas County Sheriff’s Office in Florida, Hill was struggling to fill jobs designed for LPNs. She participated in a “nursing shortage consortium” in the region and found that, due to the area’s large geriatric population, many LPNs were in high demand in nursing homes and hospitals.

Thinking creatively, Hill restructured some positions so they could be filled by RNs, then advertised for RNs in the newspaper. Voila! “We had no shortage of applicants. The RNs earn a few dollars per hour more than LPNs, but it’s worth it to fill those spots.”

Still, Hill knows this is a short-term fix. Like many others, her facility offers perks and intangible incentives to entice nurses to sign on—and to stay. Long-term, she says, “We have to make it personal. We have to show people that nursing is dynamic, it’s vital and it’s rewarding.”

— About the author: Jaime Shimkus is the editor of CORRECTCARE.

[This article first appeared in the Summer 2001 issue of CORRECTCARE.]