A national shortage of qualified nurses has plagued hospitals for years, and Missouri isn't immune, according to the Missouri Hospital Association's 2016 Workforce Report.
But while an abundance of nurses is rarely available anywhere, the hospitals serving the Jefferson City area are having more success retaining nurses than some other areas of the state.
The MHA report, released in July, shows turnover rates statewide for hospital-based health care professions have increased from the year before.
"The data this year illustrate a health care workforce shortage that is progressively getting worse, with employee turnover at an all-time high. These high turnover and vacancy rates can influence access to health care," according to the report.
With the continued shortage of qualified candidates — the U.S. Bureau of Labor Statistics projects employment of registered nurses will grow 16 percent from 2014-24, much faster than the average for all occupations — vacancy rates for staff nurses remain high, and turnover for staff nurses in Missouri has reached its highest level — 17.9 percent — since MHA began collecting hospital workforce data in 2004.
"We always watch our nursing turnover because of the shortage that's out there," said Avis Eden, talent acquisition leader at St. Mary's Hospital in Jefferson City.
St. Mary's saw a 23.03 percent turnover rate among registered nurses in fiscal year 2015 — nearly 3 percentage points higher than the Central Missouri region's 20.4 percent and more than 7 points over the statewide 15.7 percent in last year's MHA workforce report.
But while the 2016 report found the region's staff nurse turnover to be 17.2 percent, St. Mary's has more than cut its staff nurse turnover in half, with a 7.9 percent annualized turnover rate through the end of June.
"It's an ongoing thing — hiring the right people, following our mission, and of course, we've moved into our new facility, so it's a great place to work," Eden said.
At Jefferson City's Capital Region Medical Center, too, turnover among registered nurses dropped from around 14 percent in fiscal year 2015 to 6.21 percent this year, said CRMC Marketing Director Lindsay Huhman.
"We've got such longevity with our staff, and we've got a workforce in the community that works a long time. That helps our turnover," Huhman said, attributing some of the hospital's stability to the culture of Mid-Missouri's more rural community, which offers a more limited number of job opportunities compared to the state's more urban areas.
St. Mary's Hospital has nearly halved its overall turnover rate, from 20.13 percent in 2015 to an annualized 11.26 percent this year through the end of June.
Those improvements come with a laser focus on employee retention. Both hospitals have upped their employee engagement efforts over the past couple of years, and St. Mary's initiated a new onboarding program this past January.
"It lays the foundation for a consistent, standardized, system-wide approach to onboarding new employees to the mission, values and culture at SSM Health," Eden said. "The best practice is having touchpoints with the employees — day one, day two, first day in the department, first week in the department — and then our HR department and leaders follow up with the employees.
"It's allowing us to keep the employee engaged, and that really has an impact on employee satisfaction and retention."
The MHA report echoes that sentiment: "Employee engagement has a direct impact on turnover. Investing in programs that promote increased employee engagement through promoting growth, recognition and trust are cost-effective compared to the cost of losing a valued employee."
The MHA estimates the average cost of replacing a single bedside registered nurse is between $36,900-$57,300.
CRMC spent a good part of the past year focusing on nurse recruitment, offering incentives and hosting a nurse recruitment fair, among other efforts.
"One of the things that we monitor is specifically first-year turnover because that's really the most vulnerable time," Huhman said. The hospital's first-year turnover dropped from 16 to 15 percent in 2016.
Aside from staff nurses, the MHA report noted particularly high statewide turnover rates in several positions, such as behavioral health nurses at 29.2 percent, occupational therapy assistants at 20.8 percent and medical laboratory technicians at 18.2 percent.
"I was very surprised with the behavioral health number being so high for Central Missouri because we currently have no open positions in our behavioral health unit," Eden said.
CRMC, too, reported low turnover for behavioral health staff, contrary to the statewide statistics. Both Jefferson City hospitals are trying to fill openings for medical laboratory technicians, as are many hospitals statewide.
Huhman said CRMC also had lower turnover than the statewide rate for occupational therapy assistants. (St. Mary's currently does not employ that position.)
Eden noted St. Mary's has the most trouble filling specialized nursing positions not listed in the MHA report: intensive care nurses, emergency department nurses and especially surgical first assistant nurses.
"They weren't listed in the report, but I will tell you that there are several open across the state of Missouri for that position," she said of the latter, noting it requires a special certification. "Those are three areas that are in very high demand across the country. What we've been doing is offering sign-on bonuses to attract nurses to these positions."