Grayson County Regional Health Center is a private, not-for-profit, 225-bed acute care hospital located in a rural community in a southeastern state

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Grayson County Regional Health Center is a private, not-for-profit,

225-bed acute care hospital located in a rural community in a

southeastern state. The hospital provides a broad range of inpatient and

outpatient services, including cardiology, obstetrics, gynecology,

general surgery, internal medicine, urology, family medicine,

dermatology, pediatrics, psychiatry, radiology, nephrology,

ophthalmology, occupational medicine, and rehabilitation services. The

center offers 24-hour emergency care. The center is built on a 96-acre

site, and its service area includes Grayson County and parts of three

neighboring rural counties.

In the last 20 years, the region has suffered severe economic setbacks. Most of the textile industry has moved out of the region because of outsourcing, and the town itself has fallen into disrepair. An increasing proportion of the population—33 percent of children and 22 percent of the elderly—lives below the poverty line. The county has a civilian labor force of 27,568 and currently has an unemployment rate of 13 percent. The county's infant mortality rate is 2 percent.

The center has 85 physicians, representing 29 subspecialties, on staff. It has affiliation relationships with two academic health centers—one about 90 miles away, and the other 100 miles away. The center employs more than 800 people, is fully accredited by The Joint Commission, and is certified to participate in Centers for Medicare & Medicaid Services (CMS) programs. The center is governed by an 18-member board of trustees, which includes the chief of the medical staff, the immediate past chief of the medical staff, the chief executive officer, and 13 members selected by the board from the community at large.

The center has strong community ties. Its staff members participate in community health screenings, health education programs, and health fairs. It serves as the meeting place for many support groups. Although it has been under financial stress for the last five years, it continues to have strong support in the community.

The employee turnover rate at the center is 40 percent. Over the last few years, the turnover rate for nurses has ranged from 15 to 50 percent. Physician recruitment and retention are also major concerns. Currently, only one radiologist is practicing in Grayson County, and there is a shortage of physicians in all specialties.

The center relies heavily on Medicaid and Medicare revenue, leaving the hospital in a difficult financial condition. It is unable to pay market rates for nurses and other professionals, so nursing units are understaffed, and nurses feel overworked and underpaid. The quality of patient care may also be decreasing. A local newspaper article reported that patients at the center were often left on stretchers in the hallway for long periods, staff members were unresponsive to patient and family concerns, and crying in the hallways is not unusual.

Nurses and other professional groups report poor communication between senior management and employees. Bad relationships between middle managers and frontline staff are also a problem in some departments. This situation became particularly difficult two years ago when the center embarked on a large building project. Employees could not understand how the center could afford to build new facilities but was unable to pay market rates to its staff.

The nursing turnover problem at the center has reached crisis proportions. Recent exit interview surveys indicate that financial concerns are the major reason for leaving. The center has tried numerous strategies, including improving the work environment by adding amenities (such as lower prices in the cafeteria) and training middle managers. For a short time 18 months ago, nurse salaries matched market rates, but the center fell behind again shortly thereafter. The RN vacancy rate currently is 18 percent.

As a consultant to the center, you are expected to make recommendations to address the nursing shortage. Specifically, you have been asked to develop short-term strategies to cope with the current crisis and long-term strategies to improve the overall recruitment and retention picture. Consider the following questions:

• How will you identify the most important reasons for the current shortage?
• How will you develop specific short-term and long-term strategies?