RSSRecent Articles

Filling the pockets of retention

By Lydia Ostermeier, RN, MSN, CHCR and Shelley Cohen, RN, BSN, CEN

When it comes to retaining staff, sometimes the hardest part is finding the dollars to drive your efforts. Too often, managers are unsure about the resources and support available to them when they budget for retention.

One of the first questions to ask yourself is, “What is my greatest resource to obtaining funds?” Whether you are determining the resource most likely to provide you with funding or the people most able to play a supportive role in validating the need for retention budgeting, the identification of these valuable sources is a key step toward monetary resources.

Here are some tips to keep in mind when working toward acquiring retention funds:

  • Always combine your budget request with ideas and plans that do not require funding, such as employee retention committees
  • Determine alternative methods of communicating retention tips, such as a monthly email sent out to managers
  • Listen to your staff to find out what things are really important to them; you don’t want to spend money on things that they do not value
  • Make a strong business case to your executive team, including the increased cost of turnover that would occur without retention efforts

If you are lucky enough to receive some specific funding for retention programs, build them in to a special general ledger in your budget so that you can keep track of your spending. And if you don’t succeed the first time, try again with a different angle. For example, it is not only important for retention of staff, but it may also help with recruitment as well; talk about the potential recruitment benefits.

If you are still not able to secure the funds that you need, take a look at your current programs, benefits, and perks. Are they all still important to your staff? Is there something that you can give up to reinvest the funds in something more worthwhile?

Many other strategies are taking place at hospitals nationwide, and communicating successful efforts is a retention strategy in itself. What have you found to be your most successful methods of gaining funding for retention efforts? How were you able to get the budgeted resources you needed to keep your nurses happy and by the bedside? To respond with questions or comments, just click on the comments link and let your voice be heard.

Who is accountable to the cost and use of patient supplies?

Are you finding yourself spending more time with a budget sheet, calculator and bottle of Tylenol these days? If you answer yes, that makes you normal as a Nurse Manager. With all your fiscal responsibilities do you ever wonder how much accountability staff should have?

Of course, their first response will be, “you make the big bucks you should take care of the money stuff. I’m here to take care of sick people and be a nurse, not an accountant”. Sound familiar to anyone? You might be wondering, where is Shelley going with this? Think about your role as a manager as it relates to sound fiscal practices in your department. With that in mind, how do you see your role as it relates to holding staff accountable from a fiscal perspective?

Have you wondered what goes on in the mind of the staff nurse when he/she reaches for supplies? You may be hoping they are calculating the cost to purchase the item vs the amount you are actually reimbursed. But, let’s be real here, after all a good professional blog prides itself on reality. When I work my prn shifts as a staff nurse and I am in need of a supply for a patient, my thoughts are (in order of priority);

Do I remember where this item is stored?

  • Will the item actually be there on the shelf?
  • What is going on with my other patients while I am in the supply closet?
  • When can I finally get to the bathroom (ok, maybe this is a number 2 priority)?
  • What time is lunch?

Can you put yourself in the position of your staff as they make selection decisions related to supply use? How can the manager educate and coach staff to lead to a more fiscally realized use of supplies? If the nurse needs one sterile 4×4 for a procedure and they have the following to choose between, how do they make their decision?

Option 1 package with 2 4×4’s
Option 2 package with 4 4×4’s

Some staff will select the item based on which one they see first. Another staff person may consider/rationalize the following;

If a liter of irrigating solution costs the same as a 250cc bottle, maybe the same applies to other supplies.

What do you think your staff consider as they make decisions about selecting supplies for their patients? How have you educated staff to details regarding costs vs reimbursement? If you had the opportunity, what would you implement that would hold staff more accountable to areas related to the costs of providing health care?

Retention tips!

Here is a quick idea that costs only about 2 minutes of time: Even though you may have thanked an employee at work for something they did “above and beyond”, take the time to call them at home after their shift to thank them again. It’s preferable for you to make the call from your home instead of your office. You may be surprised how far this small gesture can go!

When I originally sent this idea out to managers and administrators in our organization, our COO called me at home! I was not there to receive the call, but he left me a wonderful message saying how much he appreciated the retention ideas I sent out and how much he valued my position within the organization. WOW. I was floored!

If you’ve tried this idea, or are thinking about it, drop a comment on the blog and let us know how it goes!

Groundbreaking study seeks to uncover truth about new grad nurses

As new generations of nurses enter the workforce, questions abound. What influences a new graduate’s job choice? How long do they expect to stay? Why do some of them want to leave? Professors Christine T. Kovner, PhD, RN, FAAN, and Carol S. Brewer, PhD, RN, are spearheading an in-depth study to find answers to some of these critical questions. And thanks to a recent $4.1 million grant, in addition to $1.9 million in earlier funding, from the Robert Wood Johnson Foundation, the research is now funded into 2015.

“There is a lot of information floating around about new graduates,” says Kovner, who has been at New York University since 1985. “But, in my opinion, there is no solid, systematic research.”

Already, that is changing.

The study, which tracks more than 3,000 nurses from 35 states, touches on a variety of topics including workplace experience, relationships with managers, and violence against nurses. Some early highlights from the first few years of the study include:

  • About 66% of newly licensed registered nurses (NLRNs) worked a 12-hour shift
  • Poor management was cited as the top professional reason for leaving a first job
  • About 62% of NLRNs reported at least one incidence of verbal abuse
  • 27.2% of NLRNs who had worked at least 13 months in nursing had already left their first job
  • Nearly 60% of NLRNs reported they were satisfied or very satisfied with their jobs
  • 41% of NLRNs planned to stay in their first jobs for less than three years
  • The median income for NLRNs was $45,000
  • The most important work characteristics to new RNs are “the ability to do the job well” and “being rewarded fairly for the work”

What are your impressions of these early study findings?

For more information on the study, visit or for more of this article, click here.

Frequently asked questions about blogs

What is a blog? A blog (short for Weblog) is a Web site where you post thoughts, articles, and ideas on an ongoing basis. New posts show up at the top, so visitors can read what’s new. Then they comment on it. The posts can be broken down into categories and topics for easier navigation.

For more information, watch this video.

What is a blogger? A blogger is someone who posts an article on a blog. (Email the blog editor at for more information on how to become a blogger on this site.)

What is the benefit of a blog? You can network with peers, gather new insight, and share stories and successes. More specifically, on our blog, you can learn about new ideas, programs, and best practices at facilities across the country, get some tips to help you in your daily life, or share some advice or an opinion with others in the nursing industry.

How can a blog help you, specifically, in your job? Our blog is filled with valuable articles, insight from others in the nursing industry, and links to other items of interest. Because your time is tight, we try keep posts short and to the point. Feel free to share any of the information you find with peers or employees or post your comments on a particular topic with others who visit the blog.

What is the difference between a blog and a discussion board? The idea is basically the same: People can read what has been written and add their own comments. However, a discussion board usually begins with a single idea or question. A blog begins with a longer post, something that typically portrays a certain idea or opinion. Then, people can comment on that particular topic.

How do I comment on the blog? It’s easy. Click on the headline of a post to go to that particular post. Scroll down and click on “Add comment.” Then, simply fill out the fields and click “post.”

How do I comment on a comment? The same way that you’d comment on the blog.

Can anyone comment on a blog? Yes. The blog is open for anyone to comment on any topic they wish.

Getting another chance . . . thanks to robots

By Charlene Gordon, RN, Emergency Preparedness Manager at Huntsville (TX) Memorial Hospital

Ever have a patient go bad and just wish at the end of the day you could get a chance to replay it and fix what went wrong?

I just got done with a three-day WMD (weapons of mass destruction) course that had a robot for a victim. And this guy was so real, it was scary.

“The guy” was a manikin that blinked, had pupils that were reactive to light, and emitted pulses from every place a real person would. He made different heart sounds and different lung sounds (from rales to wheezing to rhonchi) while his chest rose and fell. He had an IV site that takes into account which drug you are pushing, how much you are giving, and how fast you are giving it! He responds by computer to all your interventions, including reading an exact Oxygen saturation to see if you are bagging correctly. (Don’t push the versed too fast!)

Crashing him is okay . . . just re-boot and start all over again. With this one, you can play it again. And, what a learning experience it was!

It would have been awesome for just basic assessments or regular ACLS (advanced cardiac life support), but this guy put ER nurses, ICU nurses, floor nurses, respiratory techs, and paramedics through their paces for a WMD treatment roundtable. We treated chemical emergencies, including viral and biological illnesses that were bad and getting worse.

The real beauty of the course was that several of the nurses have been around the emergency/ICU block a few times and were pretty sure this class was going to be a dud. They were one wound up bunch of nurses after three days. They loved it! This guy is spooky real and it really feels like he is dying, but unlike ACLS, where you alone have to answer, the group cooperates just like a real crashing patient.

The class really helped to prepare us to understand these complicated patients during a critical time where hesitation or a wrong choice could mean life or death for them. I just wish every nurse and all healthcare professionals could take this course every year. This was a great experience!

Don’t you wish you could get another chance sometimes?

Merging competency validation and performance evaluation

A new way to look at competencies, from the pages of our Briefings on Long-Term Care newsletter:

Making sure nurses are competent in their skill sets is one of the most important responsibilities of a director of nursing. But as the need for validation goes beyond technical skills and focuses on professional development as a whole, the traditional methods of assessing competencies need to be examined in a new light.

“It has always been important to validate competencies, but how some institutions are choosing to look at it is taking a different spin,” says Sheila St. Cyr, MS, RN-BC, OCN, performance-based development system coordinator at the University of Oklahoma (OU) Medical Center in Oklahoma City. “Now we’re not just looking at technical skills, we’re validating interpersonal skills as well. It used to be more about the technical skills checklist. And that’s just not how it should be.”

With the recent shift in focus, directors of nursing must arm themselves with the necessary tools and information to think beyond simply validating skill sets.
St. Cyr says there are two main areas of assessment on which to focus: competency validation and performance evaluation. Recently, the shift has been to combine the two efforts rather than have an instructor simply check off that a nurse is able to complete a particular skill.

Developing a definition of competency validation for your facility must take place prior to any assessments, says Diana Swihart, PhD, DMin, MSN, CS, APRNBC, clinical nurse specialist in nursing education at the Bay Pines (FL) VA Healthcare System.

When you begin working with staff members to validate competencies, St. Cyr says one of the best strategies toward education is to play the what-if game. “Use a questioning technique with staff members,” she says. Give your nurses a scenario, then ask the following questions:

  • What complications can happen?
  • What are the signs or symptoms?
  • Would you need to call the doctor?
  • What assessments would you need to make?

Other methods for validation, adds Swihart, can include:

  • Case studies, which can help measure critical thinking
  • Quality improvement monitors, which are a strong determinant of competency because they reflect an individual’s overall performance
  • Mock events, which are useful in measuring cognitive knowledge

What methods are used at your organization?

Learning Management Systems: Their place in healthcare

By Diane M. Billings, EdD, RN, FAAN

Following our discussion during today’s audioconference, we realized that one big component of implementing new classroom technology includes bringing in a Learning Management System (LMS). Basically, an LMS includes software tools designed to manage learning. Many LMSs are Web-based and are able to facilitate “anytime, any place, any pace” access to administration and learning content. LMSs are especially relevant in healthcare as compliance training remains essential. Characteristics of LMSs often include:

  • The ability to manage users, courses, and instructors
  • The inclusion of a course calendar
  • Access to messaging learners
  • The chance to display scores and transcripts

There are many different types of LMSs that are available, including Blackboard Inc., Saba Software, and ATutor. What have your experiences been with using LMSs, and which ones have you found to be most effective (or ineffective) in your educational endeavors?

A great idea for teambuilding!

Purchase a puzzle large enough for each staff member to have a piece. Give each one a piece of the puzzle (during a staff meeting, in their mailbox, etc.). Explain that you need everyone’s participation to make the team fit together. Have a designated place for staff to begin working the puzzle until it’s completed.

Kick It Up A Notch: Leave a few pieces out, but give them to ancillary staff (RT, PT, CM, etc.). After a time of having “holes” in the finished picture, ask the other disciplines to fit their pieces into the picture. You could even have someone glue the puzzle and ask engineering to hang it–as a reminder that we cannot work together without everyone’s input.

“Whoever does not love his work cannot hope that it will please others.” (unknown)

“Leaders must be close enough to relate to others, but far enough ahead to motivate them.” (John Maxwell)

Lessons learned from my first class

When the Leader’s Lounge was born, I started the blog with my decision to return to school in my mid-50s. What was I thinking? It is hard to believe that my first course has already ended, and that I am preparing for the next one. Wondering how it went?

Better than I expected.

I took the one course that was only for two credits, as I knew the load would be less and I could plan from that for the other three- and four-credit course loads. I found out today I received an “A” (I never read so much in such a short time period; eat lots of carrots!) and found the overall experience was good. Getting a good grade certainly helped with that perception. I would prefer to be in a live classroom as I thrive on that interaction, but “life” gets in the way of that. Online courses can be interactive in their own way, but I miss the voices, tones, and facial expressions. Call me a product of my generation compared to the younger ones who don’t use the phone much (they text message).

I learned a great deal from my first course on Issues in Health Care Informatics. Along with the acquired knowledge of real substantial material that I can use, I learned how to study at an airport with people around you talking (shouting) into their blackberry’s, I learned how to scan articles for what I have to read, and mostly, I learned that my nursing experience, every bit of it, is relevant.

Additionally, because this was a two-credit course, it did not take nearly the time away from my home life as I thought it would. Being able to do a great deal of the work while on the road, left little time taken away once I was home.

Are you still on the edge about going back to school? What’s holding you back?