If you consider nursing recruitment as a marketing exercise, the first things you notice are:

1. The demand for nurses is huge.
2. The recruiting methods are comparatively passive.

If  you look at the stats, the Bureau of Labor Statistics states that the number of nursing positions in the market is expected to increase by 23% in the next decade. That’s about double the average national figure.

The need for more basic support for nurse recruiting has been recognized. The new Healthcare Reform Bill passed through the House last week included several support measures for nursing, notably an extra $638 million over five years for Title VIII programs.

Let’s not count that particular chicken until it starts laying a few eggs of its own, but the fundamental issue remains: Where does the next generation of nurses come from?

The current situation is a pretty good indicator of what not to do. Importing foreign nurses has been a “fix”, not a cure. At best this will cover local needs, but not industry needs. The increased workloads created by the shortages have effectively devalued nursing positions, reduced job satisfaction, and undermined employee retention.

Nursing recruitment has been sandwiched into “healthcare,” not as a distinct image within its natural employment market. That’s done very little to encourage recruitment. Try searching for nursing career fairs on the Internet, and you’ll probably have a frustrating time. The most common result will likely just be a nursing booth.

In all other professions headhunting, actively looking for talented professionals, is long established. Nursing, which can involve multiple degrees and NASA-like levels of certifications, isn’t exactly famous for this form of recruitment which is desperately needed.

Apparently aspiring nurses are supposed to motivate themselves, put themselves through college, get their licenses, and then wade through an apathetic, outdated recruitment process. They’re also supposed to do this with a stereotypical market image of a nurse that consists of someone wearing a uniform, and use their powers of mental associations to fill in the blanks.

If you tried to sell that as a recruitment marketing policy in IT, finance, or other professions, you’d get scorned for vague babbling, and rightly so. The nursing profession needs motivated people, but how motivated can you get with an image like that to work with.

Nurses have a lot of respect in the community, a very positive image. It’s the primary selling point for a nursing career. That’s no thanks to any employment market initiatives, though, but rather through generations of nurses serving society.

Only motivated people can become nurses. Either the employment market wakes up to that fact, or the current lottery approach will continue to infest the profession.

Major mobile “medware” provider Epocrates Inc. has announced that it will be providing New York University College of Nursing (NYUCN) graduates with its mobile software. Both students and faculty were already using the Epocrates software, which operates both as a clinical database and “decision support” software.

The intention is to incorporate software training into the curriculum for future nursing students. From an industry perspective, this is a particularly significant development, because there are no formal industry standards in this area.

Plenty of health care professionals use mobile software, but software of any kind has its flaws, and it’s good to be able to make a comparison. This is a case of technology not being an expensive headache for nurses.

Nurses might agree that setting the quality bar for info systems as high as possible, as soon as possible, is a good way to go with this issue. There’s the added benefit that people trained on good software won’t use inferior products if they can help it, and will be more demanding of software suppliers for high quality.

Industry benchmark products are likely to dictate these standards, and Epocrates is an interesting system to study in this regard. You can see why NYUCN was pretty happy with this arrangement. Epocrates systems provide plenty of tools for decision support. You can do a lot of checking with one of these packages. There’s an obvious emphasis on “belt and suspenders” information, with multiple information sources.

This is an Epocrates blurb for its Epocrates Essential Deluxe Win Mobile application:

You’ll note that the information provided is quite comprehensive, and if you check out the links on the side, you can see a screen for “Diagnostic/Lab Tests.” The “Disease Information” link is worth a look too; plenty of information, including risk factors, etc (pity they didn’t have more actual info for their iPhone application, but you can see how the software works on this example). There’s also a range of support services available for users on the Epocrates website.

Another factor is cost, and from the business perspective the issue of quality also affects business viability. The required industry standard will have to be “best value and best quality.” This software could represent extremely significant cost savings to nurses across all areas of health care, particularly mobile nursing services, home care and elderly care. Whatever standard is created, it has to be excellent.

Americans seeking nursing care in the Northwest may be about to get some relief. The highly successful Canadian Nurse Next Door home health care business is expanding into the US, coming to Washington state sometime in the next 12 months.

Nurse Next Door has been spreading across Canada like wildfire. It started in 2001, and has built itself up. Just a little more than two years ago, NND had three locations; it now has 27. One of the founders is quoted as saying they could have had 150, but they wanted the right partners. That statement refers to the fact that aspiring NND partners have to prove the capacity to cope with upfront costs of $125,000 in the first year, put up $35,000 in advance, and make a five-year commitment to royalties of five percent on gross income.

Nurse Next Door is an interesting concept. It’s a targeted home care service, working, if you can stand the cultural shock, on client budgets, not operator budgets. The clients pay what they can afford, not the usual lucky dip on fees.

That’s more than slightly interesting, because it also seems to fit NND’s business model, which is apparently based on “what works” and not an off the rack business model like all the others that can fall to bits in the real market. One of the really intriguing things about NND is that it has the business structure of many highly successful businesses: A small administration based on much larger operational organization. That means NND has comparatively low non-operational costs.

That business model would mean a lot to people in the US home health care industry. It could also mean a lot to US nurses who are more than slightly tired of the on again-off again cycle of accountancy in the industry, which means they have to play “spot the viable home care provider” as a career option.

Most impressive is the fact that Nurse Next Door is a 24/7 operation. In Toronto, NND got a lot of attention when it started up, and it seems that one of the reasons it’s so popular is the low rates: $21 to $28 an hour for anything from companion care to complex care. As you can see, this improves the affordability equation considerably for families looking for a minder of their loved ones.

America’s long suffering aging population could benefit a lot from a nursing service that recognizes the realities of costs to clients, and a good business model for those providing the services. It could be a real shot in the arm for the US industry, where the costs for businesses and clients seem to have been worked out in the early Jurassic times.

Looks like Nurse Next Door is open for business for anyone who meets their criteria. US nurses might want to give NND a thorough examination.

An exciting idea that could work out as a pilot program for big improvements in the nursing profession is now under way: $10,000 scholarships for the Accelerated Bachelor of Science in Nursing. These scholarships are granted as part of the New Careers in Nursing Scholarship Program through a collaboration of the Robert Wood Johnson Foundation (RWJF) and the American Association of  Colleges of Nursing (AACN). Nationally, 58 colleges out of 113 applicants were granted the new scholarships.

The Accelerated Nursing program allows applicants with an existing Bachelor’s degree to earn their nursing degree in 16 months. These scholarships add a much needed boost to funding for students at a time when nursing numbers are a big issue and meeting industry and public demand is a top priority.

The RWJF program aims to provide 1,500 scholarships to minority and disadvantaged students. This initiative is getting a very positive response from some of the nation’s top colleges, notably Duke. Duke University has been operating a scholarship program called Broadening the Community in the same field in its own Accelerated Nursing program, and received more applicants than it had funds to place.

The Accelerated Nursing Program and New Careers in Nursing Program have also uncovered a lot of information which is starting to define the real training needs of the profession:

1. Duke’s research indicates that entrants at Bachelor’s and Master’s levels are much more likely to remain in the profession. These are the core professional qualifications, and the good news is that these graduates, who will also be primary level trainers, will stay in the field. Sustainability of this professional core is vital to practical  nursing.
2. Nurses with good academic backgrounds are going to be required to deal with the steady deluge of scientific and technological inputs into medicine at all levels. This is a “learning hyperbola” where nurses return their upgraded skills to the workplace and can train and advise in their own work. It’s a very cost-effective result if the Accelerated Nursing program can deliver, and it looks like it can.

A criticism has been raised about the RWJF scholarships and other initiatives, however. There is concern that emphasis on demographics will miss promising students who need the money and don’t fit the criteria. The criticism is really a reflection of the need to support and motivate all nursing talent. The New Careers in Nursing Program has proven it’s the right mechanism to address this extremely important issue.

Many nurses want to be able to unionize. The Employee Free Choice Act, which would allow unionization, is moving through the Senate, but it’s looking like there are going to be some roadblocks as the idea of nurses being represented by unions seeps through to government and industry.

However, the situation for the profession is too complex for purely polarized, pro and con simplifications about the principle of unionization. There’s a lot more at stake here. The entire nursing profession has daily representation issues across the health care spectrum. The degree of difficulty ranges from national issues to infuriating local nuisances.

Any union has to be able to operate in real time with issues, represent its members effectively and must above all be able to deliver credible results. The nursing profession needs ultra-functional performance levels.

Nursing is a unique profession. It needs a unique methodology to make its unions work. The Employee Free Choice Act offers  some very positive possibilities here, if the union can do the job:

1. Giving nurses a working legal ability to deal collectively with issues, on site and elsewhere.
2. The chance to be represented effectively regarding health care policies and issues.
3. A problem solving mechanism where nurses don’t have to fight every battle that comes along individually on an ad hoc basis when they’ve got five minutes.

Representation is the major problem underpinning all nursing issues in the health care industry mainstream. The American Nurses Association, which is a national body with an affiliate structure, represents registered nurses, a total of 2.9 million members. The ANA is usually off the public radar, and not on the political screen at all. The ANA apparently has nothing to say about Employee Free Choice Act, or unionization, for example.

The question is, can unions fill the representation gap for nurses? Every other major profession has effective national representation at policy level in the government, and a strong public profile. Unionization does provide at least a partial fix to local issues. How these unions are organized, and the nature of their membership representation, is going to decide whether they can get nursing issues on the national radar.

Whatever happens with the Employee Free Choice Act, please let’s not assume that enough local band aids will equate to a national body cast. Representation is the issue that won’t go away.

A Medicare rate adjustment, combined with cuts in Federal and state spending, has started to have a deep impact on nursing homes. Medicare cuts alone are expected to average a $1.6 billion reduction in funding per year. 24 states have already cut funding. Further cuts are currently before Congress. There are currently 16,000 nursing homes operating in the US, with an estimated 1.85 million people in care.

The cuts are expected to force closures as well as layoffs, as the juggling act of compensating for reduced funding begins in earnest. Industry sources state that inadequate funding through Medicaid has already forced some closures.

For specialist nurses in this area, the question is now how to dodge the cuts and stay in viable work. The common wisdom at this stage is that the upmarket nursing homes are in better condition to deal with the cuts. These homes, however, are a relatively small part of the sector. It’s unlikely the resized industry can absorb the staff losses directly.

An alternative job strategy would be to move into other forms of care like retirement homes and related areas. Nursing home skill sets apply to other areas of care, and the basic nursing roles are eminently portable, particularly in a nurse-starved employment market.

However, the reductions in the nursing home industry are a symptom of a major issue for nurses in the sector. The cuts show a structural weakness in the financial management system. This could result in many “nomadic” nursing jobs; traveling nurse work in a tight budgetary regime where spasmodic employment and arbitrary, time-based terms of employment replace regular full-time jobs.

That may mean a general move away from the sector into more stable employment, which inevitably would hit nurses remaining in the nursing home industry with heavier workloads and less qualified help. And we can assume salary rises aren’t on the agenda. This could cause a stampede of qualified nurses to better jobs.

“Nursing by spreadsheet” isn’t likely to be a viable option. The industry’s bottom line approach is understandable, but hardly a sustainable working proposition. The industry is about to receive the full blast of demand from the retiring baby boomers. This could be the wrong knee jerk at the wrong time. “Rent A Nurse” won’t appeal to the profession as a meaningful job option, either. Nor is it likely to be an effective solution to the obvious holes in the bucket.

There’s one common factor in all nursing careers: hard work, and lots of it. There are tough sides and good sides, explaining the reasons for 12-hour shifts to your feet, and laughing your head off at some little kid with a grin on her face.

The other side is making some space for yourself. All work and no play doesn’t make you dull (you don’t have the time and you’re in the wrong place for “dull” anyway), but there’s a mold effect, a conditioned state of mind.

You may not be able to go on holiday any time you feel like it, but you can create some personal time and space with a bit of planning. This is more time management than anything, just leaving some time free on the schedule. Time where you’re not committed to the work cycles, and out of the Instant Crisis Response mode.

The hard work, the constant filling in and attention to everything is so normal for nurses that it’s too easy to overlook the personal element. Few nurses give it a second thought, but there’s an underlying stress component if you forget you have an “off” switch and don’t use it occasionally.

There’s also an element of personal deprivation and neglect, as well as the physical pack mule effect. The personal element can be ignored to the point that a personal life is a memory, not an active thing. Remember that “rest and relaxation” is often prescribed as a cure for other people, to get them out of hyperactive behavior and allow them to recuperate physically from demanding situations. The same should be true for nurses.

If you can organize yourself into a work and play mode where you get enough time for some R&R on a reasonable, if not regular basis, you’re giving yourself a recharge. Quality of life outside picks up a lot, too. You can do some shopping, have some fun, enjoy your life and your home properly, and generally take yourself out of the Nursing Olympics training camp for a while.

Give it a shot, get back on speaking terms with your toaster oven,  and have a nice lazy day or two.

I’ve received a letter from one of my readers this week. I’m sure that every nurse can relate to her problem. This is what she said:

I’m a new graduate nurse working in a busy medical surgical unit in a large city in the Midwest. I really love my job except for one thing. I hate the gossip. I’m just plain sick and tired of the workplace gossip that I hear on an almost nightly basis. Not only is it just plain ignorant, but it can also be very hurtful. I have seen people who appear to be good friends, talk about each other behind their backs. It’s so cruel and unprofessional. What bugs me is if they are saying those things about their friends, I wonder what they are saying about me. It’s making me really upset. Do you have any advise?

Sincerely, Newbie Nurse.

I’ve worked in a community hospital as well as in a major trauma center in a large metropolitan city, and gossip is a common denominator in every health care setting. Since we can’t suture people’s mouths shut, nurses must forge ahead and do everything that we can do to curtail the demeaning effects that gossip creates in the workplace.

Gossip not only eats up time that should be devoted to patients, it’s a form of workplace violence. According to relationship coach Peter G. Vajda, Ph.D, gossip is any language that would cause another harm, pain, or confusion that is used outside of presence of another for whom it is intended. I’ve seen so many excellent nurses driven out of clinical settings because of gossip. Nurses generally feel powerless in their workplace environment, so they frequently engage in passive aggressive activities with each other. Hence, the rumor mill thrives at the nurses station.

Gossip is poison. It’s not harmless and in certain circumstances, it can lead to serious legal litigation for the employee and for the employer. If one employee is defaming another, in most states there is a potential claim if the employer does not try to change the false story that is circulating around the nurses station. Some companies are now creating gossip free work zones. That means you will be fired for gossiping about your coworkers.

Do you want to stop gossiping in its tracks? Here are a few tips that can help you break the cycle of gossiping in the workplace:

When someone comes up to you and says, “Did you hear about Dr. X and Nurse Y?” Respond with, “No, I didn’t. Let’s go ask him or her about that and find out if that is true.” You can also say, “I’m not comfortable talking about that,” or say, “I don’t like talking about other people because I don’t like them talking about me.”

When someone tries to gossip with you, walk away or change the subject.

Go to others when they are gossiping about you. Tell them what you heard, and ask them to come to you in the future about their questions or concerns. (Trust me on this one. I use this one a lot and it works.)

Don’t gossip yourself. What goes around comes around. Don’t set yourself up for trouble by backstabbing others.

Do you have any advise about how to break the gossip cycle at work? Come to Nursing Voices and tell us about it. We’re waiting to hear from you.

You interviewed for your new nursing job. It was a nerve-racking experience, but before you knew it, the nurse recruiter was calling you up and offering you a job that you couldn’t refuse. Now what do you do? There are some things that you can do that will help you make a smooth transition into your new nursing job.

Learn Everything You Can About Your New Employer

Going into a new work environment is always a challenge, so learn as much as you can about your new employer. Not all health care facilities are created equal. Learn about the health care services that they provide, their philosophies, and learn about their corporate culture. Call around to your friends before you go into work. Nursing is a small world. Maybe one of your friends knows someone that you’re going to be working with at your new nursing job. It’s always nice to see a familiar face when you walk into work.

Know The Lay of the Land

This is going to sound so simple, but a lot of people don’t think about this until it’s too late. Or should I say, until they are late. Here’s an example of what I mean.

It’s Nurse Jones’ first day of work. She’s really excited, and she’s looking forward to her first day of hospital orientation. She hops into her car after a quick breakfast and hits the freeway. Nurse Jones thinks she knows the route she is going to take to the hospital because she looked it up on Map Quest, but she really doesn’t have a clue. She is running into detours and roadblocks, and now she’s running late at the peak of rush hour traffic. Nurse Jones finally makes it to the hospital, but she can’t find a place to park. Parking is at a premium at most hospitals, and she drives around in circles for a long time before she finally finds the employee parking lot. Poor Nurse Jones arrives late for her first day of hospital orientation and doesn’t make a good first impression with her new boss.

Nurse Jones could have avoided a lot of her problems if she had taken a practice run to the hospital before her first day at work. A practice run is a simple thing that you can do that will help you make a good first impression on your first day on the job.

Know What You’re Going to Wear On Your First Day At Work

Again, this sounds simple, but knowing your unit’s dress code with save you from feeling like odd man out while saving you a lot of money at the same time.

Nurses use to have a universal dress code. We wore white dresses or pantsuits to work. Period! Now nurses wear all types of color combinations to work while other nurses no longer wear uniforms. They wear street clothes to work. Some employers have strict dress codes. They require nurses to wear specific colored uniforms that indicate which unit they work on within the hospital. Learn your institution’s dress code before you report to work. Uniforms are expensive, and you want to make sure you are buying the right outfits before you report for your first day at work.

There is a pervasive problem within the nursing profession. It’s been called nurse-to-nurse hostility, lateral violence, intergroup conflict, and eating our young. There are a lot of different names for it but whatever you chose to call the problem, it’s responsible for ruining a lot of nursing careers.

A Bully In Scrubs

There are many reasons why a nurse turns into a bully. Nurses have little autonomy in the workplace while being held accountable for everything that happens on our unit. We are also low man on the hospital hierarchy structure totem pole. Doctors and hospital administrators outrank us, and we work in a very intense environment. Throw in a few hostile patients and family members and you get the recipe for a bully in scrubs. Nurses who feel overwhelmed and oppressed at the bottom of the health care ladder engage in passive aggressive acts. Unfortunately, this type of behavior only perpetuates the cycle of lateral violence on the unit.

Lateral violence comes in all shapes and sizes. It can be verbal or non-verbal and either overt or covert. The most common forms of lateral violence include undermining, withholding information, sabotage, infighting, backstabbing, scapegoating, and undermining nursing colleagues. Bullying is a type of lateral violence that is generally associated with individuals at different levels of power and authority, but can also occur nurse to nurse. This type of behavior includes humiliation, intimidation, victimization, and verbal abuse.

It doesn’t take long before new nurses experience these types of destructive behaviors in the workplace. According to research conducted by Martha Griffin, RN, PhD, clinical specialist and program coordinator of nursing professional development at Brigham and Women’s Hospital in Boston, 60% of nurse new to practice leave their first positions within six months because of some form of lateral violence being perpetrated against them. Griffin’s research also shows that 20% of new RNs leave the nursing profession within three years due to lateral violence in the workplace. Even seasoned nurses can run into lateral violence when they chance jobs.

Bringing Down the Bully

It isn’t easy facing a bully, especially if you’ve been bullied in the past. However, you can transcend your fears and establish a healthier relationship with your coworkers by using a few simple techniques.

Improving the work environment starts with open, honest, and respectful communication. People must hold themselves and each other accountable for unacceptable behavior on the unit. Confront and address inappropriate behavior immediately as it occurs with the perpetrator. This is important because it shows that you will not tolerate the behavior. It is also helpful in some cases because the other person is not aware of their own behavior. Make “I” statements when you talk about your feelings. “I feel… when you.” Keep repeating yourself if the other person makes excuses, denies, or dismisses the incident. Keep records of incidents and communications if all else fails, and show them to your supervisor.

Patient care suffers when nurses can’t get along with each other. It’s time for the infighting to stop. Do you have stories about lateral violence in the workplace? Come to Nursing Voices and tell us about it. We’re waiting to hear from you.