I am a faculty member in Nursing Education at UVI in the Associate Degree Program on St. Croix. I would like to comment on the article Nurse Shortage At Luis Hospital Persists, which appeared in today's online St. Croix source.
The utilization of traveling nurses (specifically registered nurses [RNs]) by JFL Hospital is currently a required necessary "evil" for several reasons, one being the hospital's current hiring practices.
Might the "struggle to hire enough permanent full time nurses" be caused by the lack of NOPAs? As you most likely know, a NOPA is required to hire a VI govt. employee, and I have been informed (by several of the RNs at JFL) that there are no RN NOPAs being "awarded" at the present. There may be NOPAs available for some individuals, but the newest hires, employed by JFL over the past year, have been required to sign and are working under a JFL "contract". Working under a JFL "contract" means that no overtime or retirement benefits are allowed/earned. And, when working under this contract, union representation is not allowed/possible. As a result, these JFL "contract" RNs, many of whom are the primary breadwinners in their families, are not provided employment or retirement security.
When providing care to inpatients, nurses occasionally must stay past their scheduled time. Reasons for overtime vary, but often occur at JFL because the oncoming shift does not arrive on time. Other reasons for overtime may include emergencies (patients become more severe, requiring transport), loss of electricity (necessitating paper charting), etc. For whatever the reason overtime is needed, to ensure quality patient care, the "contract" RNs must decide whether to leave or to work for free. How many of you would volunteer to work for free? Why should a nurse be expected to work for free?
Last May 2008, UVI St. Croix Campus graduated 12 students, the majority of whom were born/educated in the VI. To date, 10 of these graduates have taken and passed the licensure examination (State Boards, NCLEX-RN), which is administered by the National Council of State Boards. Only 2 of these 10 RNs chose to leave STX for better pay, positions on the mainland. The remaining have stayed on the island and are working as RNs at the JFL Hospital (albeit under JFL "contract")!
There is one bright, new initiative underway at JFL. Beginning in June, 2009, the Benny Benjamin Foundation will fund a new summer program at JFL for 6 UVI nursing students. In this program, the student nurses will work as externs and receive extensive exposure to the multiple RN roles. It is my hope that these students will have a positive experience and will want to continue their JFL employment after graduating in May 2010.
Hiring new graduates from Puerto Rico, the Philippines, or elsewhere is not an answer to the shortage of nurses at JFL Hospital, or anywhere in the U.S. for that matter. Nurses from Puerto Rico, etc. may find the additional $0.20/hour they may earn at JFL initially enticing. However, how long will they stay on STX? The idea that graduate nurses from elsewhere are choosing not to move to STX because they need additional time to pass the NCLEX, as per Caliste in your article, is false. Additionally, let me share that research data shows that students who delay taking the NCLEX following graduation have a much lower success rate of passing. Requesting the VI Board of Nursing to extend a graduate's application to take NCLEX to two years is uninformed and will not prove effective in solving the shortage of nurses at JFL.
Instead of luring graduates from elsewhere, decisive action must be taken to improve RN recruitment and retention at JFL. Support must be awarded to the RNs. RNs are the bedside care providers that ensure quality patient care is delivered, as numerous research studies have established.
In my opinion, it is "all about the money". Monies must be made available to retain the nurses we have, instead of spending the scarce funds on travel nurses. Offering a competitive salary would go far in keeping our competent RN graduates employed here. It would probably also be a great incentive to those RNs that do live on the island, but have chosen not to work peanuts (or for free). Establishing a professional RN staff must be the hospital's priority and must begin today. Changing the hiring practices, offering flexible work schedules (weekend-option, part time), ensuring administrative support, and providing RN professional career ladders/opportunities would be a good start to solving the shortage of qualified, RNs employed by JFL Hospital.
Karen Cooper, MN, RN
UVI, St. Croix Campus
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