I know We Are Different, I’m Just Not Sure How

Healthcare has finally gotten around to producing some good, quality numbers regarding employee turnover, vacancy and retention rates as well as cost-per-hire, days-to-fill/start and increased universe, but as with anything else, once we “get it” it’s not enough.

Sharron Hadick, Nurse Recruitment Program Manager at Lucile Packard Children’s Hospital in Palo Alto wrote to ask about “specific numbers for pediatric hospitals”. As part of the renowned Stanford Hospital and Clinics, it is important to Sharron that she is on the cutting-edge. She just isn’t sure exactly where that edge is.

Well, neither does anyone else. It seems implausible that the numbers aren’t out there somewhere, but in reality they are only available on a hit and miss basis. Some facilities have an impressive array of metrics but most have something between a Big Chief Table and Number Two pencil compilation and a workable document that provides a good base of HR-driven metrics.

For over ten years I have begged clients, as well as non-clients, for their numbers and it is only now getting routine for them to hand them over with the trust of confidentiality the numbers will only be aggregated and not shared individually. With enough systems providing the intelligence, we’ve been able to build a fairly solid base.

RNs are less stable now than ever before with about 32% leaving prior to their first anniversary—a large number of those exit before six months. Office and clerical employees are turning over less and less, but entry-level is still averaging about a 47% turnover and they are leaving around four months–and just as they obtain the basic skills. Hospital Pharmacists stay longer on the job, but fewer are initially willing to take $25,000 less in salary than what is being offered in retail. Lab professionals just don’t exist so their vacancy numbers are growing each quarter along with respiratory, imaging and rehabilitation.

But, what about the specific pediatric numbers Sharron is looking for—are they really meaningful? My advice to Sharron is that while there are some differences worth considering, it would be more important for her to look specifically at geographical differences.

In general, and I don’t have enough current data to make this a statistical-based statement, nurse turnover tends to be a little less in stand-alone pediatric hospitals. Peds is different, and in part that they operate in a smaller recruitment world than most other types of healthcare delivery. Just like an OR nurse is an OR nurse is an OR nurse, it is the same for peds—once a peds healthcare practitioner, it’s unusual to change. It is conventional wisdom that there are less options to go from one stand alone to another stand alone in the same geographical area, so when a nurse has made a commitment to take a specialty (just like stand-alone heart hospitals) she/he tends to stay longer and be more engaged.

Other unique situations include teaching and research facilities which have a higher number of employees including nurses and allied professionals. The vacancy rate may seem higher, but in reality they are often simply better staffed. Long-term facilities don’t worry about RNs because they don’t operate with very many, but it is aides and CNAs which make a difference.

What Sharron might want to consider is not the turnover at other peds facilities, but rather what is happening in Southern California. California—especially Southern California—is the most challenged area in the country for nurse recruitment and retention. California alone has nurse-to-patient legislation and they have the lowest nurse to population ratio in all fifty states. Competition is fierce in California and all of these factors combine to form the perfect storm for RN recruitment and retention.

On the other hand, the Midwest and in particular Illinois has it much better. Lots of nursing schools, high nurse to population ratios and affordable housing. So Children’s Memorial in Chicago does not have the same turnover or vacancy as Lucile Packard Children’s Hospital. Texas Children’s Hospital has its own challenges, but Texas is the best state in the nation when considering opening the pipeline to educate more nurses. They have invested millions into better facilities, faculty and clinical rotations and it’s beginning to pay off.

Children’s Hospital of Philadelphia (CHOP) and Children’s in Boston are caught in the shortages of the Northeast, but they also have the benefit of being ranked number one and two in the nation. Their housing and travel times don’t compare with Southern California and the public transportation is reasonable and efficient.

Bottom line, I don’t think Sharron wants to look at just peds facilities because they aren’t playing in the same ball park. Her ball park is rife with reasons she is feeling the pinch in recruitment and retention that have nothing to do with being a specialty or a pediatric facility. It has everything to do with being in California.

If you have a question you’d like me to answer on this blog please email me at askgreta@tmp.com. I will continue to answer questions every few weeks and look forward to hearing your challenges.

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Thomas Delorme
Written by Thomas Delorme

VP, Digital Products & Strategy

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