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Flexibility cited as nurses choose private hospitals over state positions

State House Bureau

March 13. 2017 9:49PM
Grace Donison now works as a nurse at Concord Hospital. She left her job at New Hampshire Hospital after only four months, saying it did not offer the flexible hours nurses are looking for. (Allegra Boverman/Union Leader)

CONCORD — Grace Donison is exactly the kind of nurse the state psychiatric hospital is desperate to hire as it competes with private hospitals for talent amid a widely acknowledged nursing shortage.

The 24-year-old Weare native and Bishop Brady graduate has a B.S. in nursing from the Manchester, N.H., campus of Massachusetts College of Health Sciences. With an ambition to work in psychiatric nursing after graduation, she applied for and was offered positions at both New Hampshire Hospital in Concord and Dartmouth-Hitchcock in Lebanon.

After only four months at the state hospital, she took a position at Concord Hospital, not because the pay is better (it isn’t), and not because the benefits are better (the state actually offered better benefits), but because of scheduling issues.

“New Hampshire Hospital is so rigid for nurses to work five eight-hour shifts, which is highly uncommon for nurses to work,” said Donison. “One of my good friends from nursing school still works there and tells me she is looking at other jobs too because she’s frustrated by the same issue.”

It’s become common in the health-care industry for nurses to work three 12-hour shifts, for a total of 36 hours, and remain eligible for the full employee benefit package.

With the demand for nurses far exceeding the supply, flexible scheduling has become a popular incentive, according to hospital administrators. But the state can’t compete on those terms, at least not under the current contract with the State Employees Association.

“The framework for our employees is that we have to work with the collective bargaining agreement,” said Robert MacLeod, chief medical officer at NHH. “We could certainly have people work 12 hours a day, three times a week, but full-time is defined as 37.5 and above, so people working 36 hours wouldn’t get the same benefits. We can’t directly compete with private hospitals when it comes to that.”

The issue could come up in the next round of contract negotiations affecting nurses at NHH and other state facilities, according to a spokesman for the State Employees Association.

“I hear from SEA members at all of our direct-care facilities about the impact of these recruitment and retention issues,” said SEA President Rich Gulla. “I understand the challenge the state is facing; it’s a very competitive market, and the demand outpaces supply. The bottom line, though, is that the state needs to be more nimble in keeping pace with the market.”

Heavy investment

The state has invested heavily in becoming competitive, including boosting the salaries of nurses at NHH to compete directly with raises granted at Concord Hospital last year, increasing wages of NHH nurses by 15 percent.

The Department of Health and Human Services is asking for nearly $1 million in the next two-year budget to extend the 15-percent pay hike to all other nurses employed by the state, but there has been no talk of addressing the scheduling issue.

The SEA contract states: “Nothing in the agreement shall prevent the employer and an employee, or group of employees ... from mutually agreeing to flexible or alternative work schedules.”

But MacLeod says even if NHH had nurses willing for forego benefits to work three-day shifts, he couldn’t do it because of the nursing shortage that has the hospital trying to fill 16 full-time positions.

“We could do something for 36 hours a week as long as the employee was willing to waive some of the benefits, but we just don’t have the staff yet to be able to accommodate that,” he said.

Much in demand

At Concord Hospital, Chief Nursing Officer Amy Guilfoil-Dumont is short 35 nurses, but is still able to offer the flexible scheduling, which she said is much in demand.

“As millennials enter the workforce, they’re looking for that work-life balance, and have very different expectations of an employer,” she said. “Most of our shifts are 12-hour shifts.”

There are often weekends involved, and there’s no guarantee a shift won’t go longer than 12 hours, but the nurses can be confident that they will have the other four days open.

“Some choose Friday, Saturday and Sunday night,” said Guilfoil-Dumont, “then they are home all week with their children or significant other. It can allow them to take care of elderly family members or special needs children.”

The fact that nurses are often required to stay beyond their scheduled hours further complicates the state’s five-day scheduling, according to Donison.

“I wholeheartedly believe that retaining nursing staff (at NHH) would be much less of an issue if they would just allow 12-hour shifts instead of burning out nurses with too much overtime many days a week,” she said. “If they want to retain nurses, that’s what’s necessary.”

Risking burnout

Recent research by the Robert Wood Johnson Foundation and the Institute for Health Care Improvement suggests that 12-hour shifts present challenges when it comes to safety, burnout and critical thinking.

“There is literature out there that says 12-hour shifts probably aren’t the optimal shifts in the industry,” said Guilfoil-Dumont, “but as we have more households with both parents working, needing to be able to manage both home and family, without high child-care costs, and more child-bearing women in the health care industry, it becomes more and more important to figure out how we mesh the needs of the organization with the needs of the workforce.”

Guilfoil-Dumont came to Concord Hospital from Frisbie Memorial in Rochester, where she served as chief clinical officer and vice president of patient care.

“I do know that at Frisbie, all of their nursing shifts, other than operating room and some specialty areas, are predominantly three days,” she said.

Catholic Medical Center in Manchester offers a variety of scheduling options, including 12-hour shifts, with anyone who works more than 30 hours qualifying for benefits.

“I would say, based on the feedback from our directors in a meeting we were at this morning, that requests for 12-hour shifts are increasing,” said Jennifer Torosian, associate chief nursing officer at CMC. “Staff is really looking for that work-life balance, so you have to find the right fit, the right combination.”

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