Jeff Perry, RN, and Mary Vela, RN, of Southwest General in San Antonio are examples of the hospital’s efforts to recruit and retain nurses. Jeff has been on staff for one year, while Mary’s tenure is 20 years.

Any Sunday. Any city, USA. Check out the want ads, and you’ll find more open nursing positions than people to fill them.

We know from experience. IASIS currently has an average of 20 nursing-related vacancies per facility.
Of course, the labor shortage is by no means unique to IASIS. It’s a nationwide epidemic. As people live longer and need more healthcare, as an aging nurse work force moves toward retirement, and as fewer people enter the profession, the nursing industry is defying the law of supply and demand. By the year 2020, it is predicted the nation will be short about 800,000 nurses.
“Nursing has always been a challenging profession and it isn’t getting easier,” says Cathy Story, chief nursing officer for IASIS. “We have to work hard to decrease our nursing vacancies, keep the good nurses we have, and ensure that patient care isn’t affected.”
IASIS can’t solve the nursing shortage on its own, but the company has developed some short-term and long-term strategies to attract and retain nurses.

Immediate Efforts
To fill current vacancies, IASIS hospitals have stepped up nurse recruitment efforts, using advertising and unique incentives. In the Utah market, for example, hospitals have offered new nurses free maid service for a year and weekly massage therapy. Other markets have arranged discounts at area restaurants and offer signing bonuses or finder’s fees to employees who help recruit new hires. The company is also looking at untraditional nursing candidates, bringing on more male nurses and people who have chosen nursing as a second career.
“We also recognize that to be successful as a nurse, they have to feel valued at work,” Story says.
“Reducing our nursing shortage depends on us making our hospitals great places to work,” she adds.
IASIS is also seeking magnet certification by the American Nurses Credentialing Center, which recognizes hospitals that demonstrate excellence in nursing care. Only 67 healthcare organizations currently carry the magnet designation. “This is a national seal of approval that nurses look for,” says Sandra McRee, IASIS chief operating officer. “We’re assessing our hospitals now to see how we can improve and qualify.”
IASIS is also examining nurse workloads, to be sure a nurse’s time isn’t spent on tasks that others could be performing.

Addressing Future Needs
Long-term efforts range from looking within each hospital’s walls to searching overseas. “One thing we’re trying to do is grow our own nurses,” Story says. “We’re partnering with colleges and universities to provide tuition assistance to nursing students interested in working at IASIS hospitals when they graduate.”
Since there’s also a shortage of nursing instructors, IASIS is subsidizing the salaries of nursing instructors so the partner schools can take more students.
IASIS is also looking beyond our borders to places like India and South America for qualified candidates. Five nurses have joined IASIS hospitals from India, and the company is coordinating the development of nursing courses so that Indian nursing graduates can pass U.S. licensure tests. “There are very few companies making this level of commitment to long-term solutions,” Story says. “But that’s what it is going to take to be successful.”

Bottom Line
Getting back to the Sunday classifieds, all those openings may give nurses some sense of security – that there will always be a job somewhere. But as long as there is a critical labor shortage, employed nurses will carry a heavier burden and hospitals will struggle to maintain a high level of quality care.
“It has to be a priority for everyone in healthcare, and it is a priority for IASIS, because how well we manage this crisis directly affects the health of our company, and really, the long-term health of every single one of us,” Story says.

Joe DiMaggio was a slugger – a player whose grace and consistency won him the respect of a nation of baseball fans, even those who cursed the New York Yankees. Known for playing every inning hard, Joltin’ Joe had a simple answer when he was once asked why he was so intense on the field. It was, he said, because there might be somebody out there who’s never seen me play before.
That was the kind of attitude Joe DiMaggio brought to work every day. He knew that each time he went after a fly ball to centerfield, every time he stepped into the batter’s box, and all the times he circled the bases on a home run, someone might be forming an opinion about what kind of player Joe DiMaggio really was.
Most of us aren’t superstars who transcend generations. But, like DiMaggio, each of us has the same opportunity to bring a “best effort attitude” to our jobs every day. And like DiMaggio, we, too, might assume that every time we interact with our patients, no matter how seemingly insignificant that encounter may be, someone may be forming an opinion about what kind of caretakers we are.
Joe DiMaggio led the Yankees to 10 American League pennants and nine World Series victories. Maybe it was because he was an amazing athlete. Or just maybe his amazing attitude had something to do with it. Either way, it gives you something to think about, doesn’t it – before you meet someone for the first time today?

Patient Satisfaction Scores

As many employees know, IASIS has begun using a new patient satisfaction survey, which ranks satisfaction on a scale from 1 to 4, with 4 indicating a patient is very satisfied. Each quarter, hundreds of patients are asked a series of questions over the telephone. Three separate surveys are conducted, one for inpatients, one for outpatients, and one for emergency department patients.
Congratulations to Palms of Pasadena Hospital in Florida, which had the highest overall score in all three surveys for the most recent quarter!
At the end of the survey, each patient is asked to rate the overall quality of care and services received from the hospital. As shown in the company-wide results below, a large number of our patients say they are satisfied or very satisfied with the quality of care we provide.

Neil Ellis is a member of The Hostess Program. 2 Ways Palms of Pasadena Makes Patients Happy 1 Volunteer Ambassadors visit each new patient the day after admission, to ask how the hospital stay is going. They leave a card with the name and phone number of the hospital’s patient representative, so the patient can call if problems arise. If issues come up during the visit, the patient rep is notified for immediate action. 2 The Hostess Program uses specially trained staff to personally deliver and set up patient meals, ensuring food arrives hot. Hostesses usually visit patients five times a day, so patients receive lots of special attention, while nurses are freed up to focus on other areas of patient care.

Five-foot-six and 383 pounds – that’s a figure Annie M. couldn’t live with. Believing that her life was at stake, Annie turned to the only alternative she hadn’t yet tried to shed the many excess pounds that weighed on both her body and her heart. Annie had a gastric bypass at Palms of Pasadena Hospital, and over the next year-and-a-half, she lost 200 pounds.
As the number of overweight Americans soars, so has demand for bariatric surgery.
IASIS hospitals have responded to the need by providing bariatric services, with programs in six hospitals already and two more to be added later this year.
“Obesity is no longer viewed as simply a lack of willpower on the part of patients. It is recognized as a life-threatening illness,” says Sandra McRee, IASIS chief operating officer. “By offering bariatric surgery, and programs that support weight loss patients, we deliver another important health service to the communities we serve.”
Obesity increases a person’s risk of diabetes, heart disease, stroke and certain cancers. It’s described as epidemic in the U.S., where over half of the adult population is categorized as overweight. And obesity costs about $93 billion a year in medical expenses – nearly the same amount spent on costs associated with treating smokers.

Surgery Limited To Morbidly Obese
Not a quick fix, bariatric surgery is a major, high-risk operation, limited to people who are morbidly obese, usually at least 100 pounds overweight. The complication rate is high. Patient care is intense, with a multidisciplinary team required to conduct the numerous tests and counseling sessions before and after surgery.
Despite the risks, demand for bariatrics continues to increase and IASIS hospitals are ramping up to meet the demand.
At Mid-Jefferson Hospital in Nederland, Texas, people come from as far as 100 miles away to attend informational seminars and at St. Luke’s Medical Center in Phoenix the waiting list for surgery is three to six months long.

IASIS hospitals with bariatrics programs Palms of Pasadena, St. Petersburg, Fla. Town & Country Hospital, Tampa, Fla. Salt Lake Regional Medical Center, Utah Tempe St. Luke’s Hospital, Ariz. St. Luke’s Medical Center, Phoenix, Ariz. Mid-Jefferson Hospital, Nederland, Texas Odessa Regional Medical Center, Texas* Southwest General, San Antonio, Texas* *scheduled to open soon

Bariatric Services Require Investment
Offering bariatric services requires an investment in recruiting physicians and purchasing specialized equipment to handle patients, from oversized beds to larger hospital gowns.
“Our staff had to be trained in how to handle the larger patients without straining themselves, and we’ve gotten things like an electric wheelchair in admitting, so we don’t have to push the patient,” says Susan Kay RN and director of specialty surgical services at Palms of Pasadena Hospital in St. Petersburg. “We’ve also had sensitivity training for employees.”

Managed Care Coverage Increasing
Fueling demand for weight loss surgery is an increased willingness by managed care companies to cover the expense, as they realize the potential long-term health benefits.
Besides in-house surgery programs, some IASIS hospitals have contracted out bariatric services. At Town & Country Hospital and Tempe St. Luke’s Hospital, IASIS has teamed with the WISH (Weight Intervention and Surgical Healthcare) Center, which will also partner with Odessa Regional Medical Center and Southwest General Hospital later this year.

Find Out More
American Society for Bariatric Surgery
www.asbs.org

A little imaginative thinking is getting some welcome attention for the Utah hospitals. Four fresh ideas have patients, employees and the whole community taking notice.

‘Chopsticks’ in the Lobby
Okay, they aren’t really playing “Chopsticks” in the lobby of Davis Hospital and Medical Center, but they are playing the piano. Music regularly greets visitors and employees, thanks to a newly donated piano and some very talented volunteer players.
“Music has a calming effect and it sets a nice tone as people enter our hospital,” says Mike Jensen, CEO at Davis. “It shows our patients we want them to feel comfortable.”

The lobby isn’t the only place Davis has made big changes. The hospital celebrated its recent completion of a major expansion project by placing a huge, lighted Jumbotron sign across the freeway. The sign flashes rotating messages promoting hospital programs. “This is something people are talking about,” according to marketing director Lora Kier. “The messages are constantly changing so every time people drive by, they look to see what’s new. It’s a great way to reach a lot of people in the community.”

Marketing With Wheels
An ambulance that sat unused for four years is now working overtime, spreading the good names of the Utah hospitals.
Davis, Jordan Valley, Pioneer Valley and Salt Lake Regional joined forces to clean up the old ambulance. They added their logos, and now use the vehicle as a marketing tool at health fairs, schools and community events.
“It’s a way to get the word out about our hospitals,” says Doug Boudreaux, marketing director for the Utah market. “It is definitely getting noticed. When I was driving it down the road the other day, a couple of cars pulled over to let me pass!”

Extra Security for Newborns
Salt Lake City Medical Center has a new, high-tech way to keep newborns secure: an ankle tag that alerts staff if a baby gets within 10 feet of an exit door. Although infant abduction is extremely rare, the system offers extra peace of mind to new parents.

The dust is still settling in West Valley City, Utah, after a one-man demolition crew tore into a wall of Pioneer Valley Hospital. At the controls was none other than IASIS Chairman and CEO David White. White set off a $12 million renovation and expansion project that will update every floor of the hospital. “I guess I pulled down a little more than they expected,” said White, “but I’m making no apologies. On exciting projects like this, I can’t hold back. I want to get the new construction going.” A major part of the renovation is 16,800 square feet of new ER space.

Name Acclaim
There’s a new name for high-tech robotic surgery systems at two IASIS hospitals. Introducing SAM and Rosemary, the names selected by local students during Name the Robot contests in Arizona and Texas. Park Place Medical Center and St. Luke’s Medical Center held the contests to acquaint area residents with their new da Vinci surgical systems, which allow surgeons to operate by remote control. At Park Place, they selected the name SAM, which stands for Surgical Assisting Machine. At Mesa General, two fifth-graders (pictured above) came up with the name Rosemary – a combination of the names oftwo famous women in the history of American medicine. Rosalyn Sussman Yalow won the Nobel Prize in 1977 for her research in radiation and nuclear medicine, and Mary Walker was a Civil War surgeon. Students in both contests were awarded prizes.

Easy to Swallow –
Camera in a Pill
Here’s a video rated R, for revolutionary. Town & Country Hospital in Tampa is now offering the M2A® Capsule Endoscope, which condenses a video camera, light source, miniature transmitter and batteries into a pill no bigger than a vitamin. Patients with gastrointestinal problems swallow the sealed capsule and it records the entire 21 feet of a small intestine. “This is much more convenient than the surgery that we would usually have to undertake to diagnose problems in the GI tract,” says Dr. Israel Crespo, a gastroenterologist at Town & Country.

Utah Emergency
Nurse of the Year
Heather Campbell, a 10-year employee at Jordan Valley Medical Center, was recently named Emergency Nurse of the Year by the Utah Department of Health, Bureau of Emergency Medical Services. “Heather is a truly compassionate individual who provides excellent care to her patients,” said Jordan Valley CNO Jolisa Catmull.

Health Choice Expands
in Arizona
Health Choice, an Arizona Medicaid managed health plan owned and operated by IASIS, has received a contract award that will expands its operations beyond the two Arizona counties it currently serves. The Arizona Health Care Cost Containment System (AHCCCS) awards contracts by county in a competitive bidding process every five years. Health Choice received some of the highest scores in the recent bidding process and is the only health plan that was awarded an expansion beyond its current market. Health Choice will pick up six additional counties when the contract takes effect October 1.

Inpatient Survey

Outpatient Survey

Emergency Department
Survey

The stomach pouch created by bariatric surgery will hold only about three ounces of food at a time. That’s equal to this small can of tuna above.

	Obesity Facts 65% of Americans are overweight or obese $93 billion is spent annually in America to treat illnesses related to obesity Rise of bariatric surgeries performed in the U.S. 1997 23,000 2002 63,000 Sources: U.S. Centers for Disease Control and Prevention; American Society for Bariatric Surgery

You Told Us... The book you have most enjoyed reading In the last issue of Forum, readers were asked to tell which book they most enjoyed. Kenneth Pratt (below) won the $50 drawing of entries in the “Tell Us” contest.

Kenneth Pratt Nursing Supervisor, Davis Hospital and Medical Center, Layton, Utah Portrait of a Killer: Jack the Ripper – Case Closed, by Patricia Cornwell A fascinating story using science and forensic medical techniques to find the real Jack the Ripper.

Pam J. Bailey Medical Education, Tempe St. Luke’s, Tempe, Ariz. Not as a Stranger, by Morton Thompson This inspiring book gave me my interest in medicine. I loved the book. It was made into a movie with Robert Mitchum and is about how he pursued medicine, and went through medical school. I take care of the interns and residency program in my job now.

Randi Ramos Human Resources Generalist, Palms of Pasadena Hospital, St. Petersburg, Fla. I’ll Love You Forever, by Robert N. Munsch This is a very touching story about the love a mother has for her son. I bought the book for my son, Daniel, when he was about 2 years old. He is now 14 and we still have the book and I still cry when I read it.

Q: As Chief Nursing Officer of IASIS, what do you do?

A: I’m responsible for the clinical operations in all of our hospitals, to make sure we’re providing the highest quality care possible. I’m also responsible for our nurse recruitment strategy.

Q: You travel to all of the IASIS hospitals regularly; what are you looking for in your visits?

A: I look at how we deliver patient care. Communication is key. I go out onto the floors and ask nurses what’s working, and what’s not. And I find out what their questions are. I also pull department heads together so we can work on ways to improve our processes. I’m always trying to get information that will make IASIS hospitals better places to work as well as ways to improve our quality of care.

Q: Do all hospital companies have CNOs?

A: Most hospitals have CNOs, but we’re the only hospital company that I know of with this position at the corporate level. That says a lot about the leadership at IASIS, that they recognize the importance of having someone at the table that understands the clinical side of delivering healthcare. I see my role as a bridge between the clinical and business sides of the company. I’m representing the nurses before the decision-makers, but I’m also helping the nurses understand the resources available from the corporate side.

Q: Other than the labor shortage, what are some of the challenges facing the nursing profession?

A: Meeting the objectives of healthcare delivery in a shortened time frame with limited resources. That means there’s more pressure on nurses to do their work in a compressed amount of time. Another challenge is integrating technology into healthcare delivery without losing the human factor of touch.

Q: What do you like the most about your job?

A: Definitely, the people. At the hospital and corporate level, I work with incredibly talented, gifted, caring people. I’ve never before worked in an organization that demonstrated that every day like we do at this company.

Q: What’s the most challenging part of your job?

A: Managing the multiple priorities when I’m on the road. I travel all the time, but it’s important to me to also always be available. I don’t want to be a barrier to getting things done.