Beth Israel Deaconess Medical Center Older Perioperative Nurse Project

1. Beth Israel Deaconess Medical Center Older Perioperative Nurse Project Joanne Pokaski, Director of Workforce Development Network of Healthcare Workforce Planning Professionals April 29, 2010

2. Background We specifically chose to focus on Nurses in Perioperative Services because: • The department volunteered to participate; • BIDMC staff are national leaders – Association of Perioperative Registered Nurses (AORN); • 38% of the nurses in Periop are over the age of 50; • there is a long orientation period to prepare new nurses for this area; and • the work is physically demanding.

3. Nursing Director of Perioperative Services Nurse Manager, OR Perioperative Nurse Specialist (and AORN President) Chief Nurse Officer and SVP Patient Care Services Human Resources Director of Workforce Development Director of Employee Relations Program Manager, Workforce Development Steering Committee

4. MA Older Worker Retention Strategies Grant Helped Us: • Turn “Someday we ought to…” to “This year we will…” • Hire an external consultant to staff and help structure the project. • Stay accountable to producing results within grant timeframe. • Compare notes during and after the grant period with other workforce leaders. • Take time to explore an issue that has not yet become an urgent problem.

5. Original Goals (grant application): Understand retirement plans of older nurses Find ways to encourage nurses to consider staying longer Avoid a surprise sudden retirement of many nurses Avoid a sudden knowledge drain Revised Goals: Given that many nurses now plan to retire much later, how do we keep our nurses: Engaged Safe Listen to their concerns about continuing to do this work as they get older Understand retirement plans The Economic Downturn Impacted Our Goals Retention  Optimal Retention

6. Methodology • Collected information through focus groups and one-on-one interviews • Nurse Focus Groups • Clinical Advisor Focus Groups • Nurse Manager Interviews • Conducted an on-line survey • All nurses who were at least 50 years old were invited to participate. There were 47 respondents (68% response rate). • Conducted a best practice review of the literature. • Collected and reviewed dozens of articles having to do with the engagement, retention and succession of older nurses.

7. Survey Responders: Demographics • Most of the respondents were in their 50’s; with almost half in their early fifties. • Most (76%) have long service at BIDMC, more than 15 years. 57% have similarly long service in Periop. • There was a good distribution of respondents across work units: • East vs. West Campus • OR • Post-Anesthesia Care Unit • Pre-Anesthesia Testing Unit • Almost all work at least 20 hours and 62% work full-time. • Most (68%) work on the day shift.

8. Survey: Nursing Role - Fulfilling Q: Please rate the degree to which you consider your nursing role to be fulfilling:

9. Survey: Plans for Retirement Q: How many more years do you think you will work in your current role? The most common response was 9 – 10 years.

10. Survey: Plans for Retirement • Q: Prior to the economic downturn, how many more years were you originally thinking you would stay in your current role if different from your answer to the previous question? • 42% indicated having different retirement intentions prior to the economic downturn. The most common response was that RNs are now planning to work 2 – 3 more years than originally thought. • Q: How likely is it that you will reduce your hours between now and retirement?Almost half are likely (very or somewhat) to reduce their hours prior to retirement, with the most common intention being 5 – 10 hours. • Q: After you leave this job, what are you most likely to do? • 55% plan to retire after leaving this job. • 18% plan to work for a different employer. • 13% plan to work in a different job at BIDMC.

11. Survey: Retention Ideas • Q: Please rate the value of the following ideas in supporting you to stay as long as you’d like in your current job:The top 6 retention ideas (rated as “very valuable”) were: • Retirement benefits at the highest rate of pay even if reduction in hours (87%) • Ability to influence my work schedule (85%) • Limited off shift/weekend requirement (66%) • Limited on-call requirement (64%) • Continuing education to keep abreast of trends (57%) • Limited physical challenges in my work (47%)

12. Survey: Work Challenges Associated with Aging Q: Please rate the degree of actual or anticipated challenges related to your work as you age: • Q: What ideas do you have to limit the physical difficulties / risks of your job: • Ideas mentioned by several respondents in this open-ended question were: • ancillary support, including trained attendants and OR assistants • more and better positioning equipment, transfer and lifting devices

13. Survey: Wellness Q: Please rate the importance of the following self-care activities for Periop nurses to maintain their health in this nursing role: percent rating activity as “very important” is charted belowQ: Please rate how consistently you engage in these self-care activities: percent rating “very consistently” for engagement is chartedbelow

14. Survey: Wellness Q: How much stress does the care of dependents (children, aging parents, grandparents) cause for you right now? Q: How much stress do you anticipate the care of dependents will cause for you in the future,prior to your retirement? 81% 73%

15. Survey: Nurse ManagerRole Q: Have you held a nursing leadership role in the past? Q: What do you think are the possible reasons that few RN’s pursue the Nurse Manager role?

16. Planning and Implementation • 5 initiatives coming out of this effort • 2 themes being responded to by larger hospital efforts • Steering Committee will continue to meet quarterly • 5 work groups being formed to implement initiatives

17. Strength Training Pilot What we heard: • 62 % of survey respondents said that strength training was very important to maintaining their health in the nursing role • 19% of nurses reported very consistently engaging in this activity What we plan to do: • Pilot a strength training program aimed at older peri-operative nurses, convenient to their work shift. • BIDMC has an in-house fitness center that is part of Human Resources. • Introduce nurses to or reinforce regular strength training sessions. • Assess nurse strength, health, well-being before and after pilot.

18. Benefits Education What we heard: • Nurses are concerned/confused around how retirement choices they might make (e.g. cutting back hours) would impact their benefits. • 73% of RNs found care of dependents (young and old) stressful currently, and 81% anticipated some to a great deal of stress in caring for dependents in the near future. What we plan to do: • HR Benefits staff will provide for peri-operative RNs an “in service” education on benefits related to retirement and dependent care.

19. On-Call Practices Research What we heard: • Older nurses expressed as one of their primary concerns the physical demands of performing on-call work. What we plan to do: • There are not easy answers to address both the nurses’ concerns and the hospital’s coverage needs. • A working group will research and review alternative on-call scheduling practices within BIDMC and at other hospitals. • If we find a model we want to pilot, we will seek feedback from perioperative nurses to see if the new plan is perceived to add value.

20. Workforce Planning BIDMC Concerns: • From the retirement dates projected in the nurse survey, it seems likely that there may be clusters of nurses leaving at roughly the same time. What we plan to do: • Bring a group together to take a “deeper dive” into using data to plan for workforce needs. Develop a model to determine appropriate yearly recruitment of perioperative nurses, based on expectations of retirement, turnover, and orientation time.

21. Emerging Nurse Leadership Program BIDMC Concerns: • Staff nurses view the nurse manager role as assuming a great deal of extra responsibility for little extra reward. What we plan to do: • Develop a program to encourage nurses across the organization and at various stages in their career to be interested in and excited about a career in nursing leadership.

22. Concluding thoughts Other themes we heard – being addressed through other venues • Physical challenges were the #1 anticipated challenge related to aging. • Concerns about availability and training of OR support staff. Looking back: • Nurses appreciated being asked questions, hearing the survey results and being asked for feedback about potential strategies. • Management was open minded to taking a new look at some timeless issues. • None of these themes were surprising. Many issues were being raised through other venues. But this effort reinforced the importance of those themes. • It was great to have resources for planning, but implementation will require a good deal of time and effort as well.