QUALITY: Happy Nurses, Healthy Patients

Nurses just want to have ... autonomy.

Facing a worsening nursing shortage, often accompanied by poor morale, some hospitals are trying retain nurses not with cars, cash, and Bahamian junkets but by making their jobs more satisfying. And that can also improve the quality of patient care.

With more than 100,000 open nursing jobs last year—and the numbers expected to surpass one million about 15 years from now when aging Baby Boomers will need more nursing care—the nursing shortage is a serious problem for hospitals. A story in Sunday's Washington Post said the practice of luring nurses with signing bonuses and incentives turned out to actually boost turnover, because nurses would change jobs to keep accumulating bonuses

Replacing a nurse can cost up to $100,000 because of temps, overtime, recruiting and training the new nurse. That doesn't include salary. So hospitals took another look at what they can do to keep their nurses. And the answer, at least in part, is giving nurses more control over patient care and opportunities to get more advanced training. Some are doing research into problems they observe, coming up with new care plans that improve quality.

That can be better for patients too. One of the nurses profiled in the Post story, Jennifer Dimmick, now spends more time helping heart surgery patients learn how to take care of themselves and avoid complications when they go home. The program addressed a problem, identified by the nurses themselves, with a high hospital readmission rate for heart patients. "Autonomy is a big thing," Dimmick told the paper. "It's important for me to know that what I do matters."

The American Nurses Association has a credentialing program for hospitals that promote quality nursing and become "magnets" for good nursing. And good nursing means better patient care. Linda Aiken, a nationally known researcher on nursing at the University of Pennsylvania said that the magnet hospitals have lower death rates and fewer complications, which also helps contain costs.