INSIDE

JCAHONews flash! Find out what theJCAHO is considering for its 2007Patient Safety Goals on p. 5.

Quality improvementLearn how to successfully conduct surveys as a way toimprove patient satisfaction on p. 6.

Interdisciplinary care corner If your facility is preparing for aMagnet survey, don’t miss out onthe vital tips offered on p. 8.

Patient care All nurses have a role to play inend-of-life care. Learn how to fulfill this patient educational andadvocacy responsibility on p. 10.

RetentionThe Planetree Alliance’s patient-centered model of care istaking root in hospitals across thecountry. Find out more on p. 11.

bullying or harassment at work,and 95% of all people don’t reportbullying because they don’t trusttheir complaint will be handledproperly. The most common formof dealing with harassment andbullying is to leave the workplace,leading to huge staff turnover ratesand increased expenses.

Recognize the typesHorizontal violence includes all actsof unkindness, discourtesy, sabo-tage, infighting, scapegoating, andcriticism. Examples include

• belittling gestures (e.g., deliber-ate rolling of eyes)

• verbal abuse (e.g., name calling,put-downs)

• gossiping and destructive/nega-tive talk

• sarcastic comments• disinterest and discouragement• elitist (“better than”) attitudes

regarding work area, education,experience, etc.

Develop strategies to combat the problem All members of the workplaceshould work together to addressand eliminate the oppressive natureof horizontal violence. To beginputting strategies in place to dealwith this issue, consider followingthese tips:

Learning objectives: After readingthis article, you will be able to1. define horizontal violence and its

types 2. list seven tips for combating horizon-

tal violence and 13 steps creating asafe, happy workplace

Horizontal violence can be de-scribed as many things: nurse-to-nurse conflict, bullying, hostility,verbal abuse, intimidation—the listgoes on. But whatever the term, itis a prevalent and often destructiveelement of workplace culture.

For nurse managers, the “disease”of horizontal violence is of particu-lar concern because it lowers themorale of staff, damages groupcohesion, and ultimately affectspatient care. But there is a cure! Bybetter understanding the phenome-non and enacting practices to pre-vent its occurrence, nurse managerscan easily learn how to replace theviolence with kindness.

Learn the factsHorizontal violence is defined asovert, or covert, nonphysical hostili-ty used by employees against oneanother. According to the NewZealand–based group WorkplacesAgainst Violence in Employment(WAVE), 30%–50% of workplacestress-related illness is caused by

Communication

Horizontal violence: Know thedisease, discover the cure New strategies to keep your staff on the same team

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> p. 2

Vol. 5 No. 11November 2005

S t r a t e g i e sF O R N U R S E M A N A G E R S

Communication (cont.)

Page 2 Strategies for Nurse Managers—November 2005© 2005 HCPro, Inc.

www.hcpro.com

Hostility

Recognize and acknowledge that horizontal vio-lence exists in the workplace

Address the workplace culture issues that allowhorizontal violence to exist

Have management adopt a continuous, consis-tent, integrated approach to promote a culture

of cooperation and address instances of horizontalviolence

Provide regular education for all staff on the sub-ject of horizontal violence (e.g., what it is, how

to address it, etc.)

Institute mechanisms that enable and allow staff to safely address issues of horizontal

violence

Produce a statement outlining desired workplaceculture attributes, values, and behaviors and dis-

play it in prominent places throughout the institution(see p. 3 for a sample statement)

Talk to all staff about the phenomenon—breakthe silence

Create a safe, happy workplace Successful strategies come from the top and requirean ongoing commitment to cultural change concern-ing horizontal violence.

As a nurse manager, consider putting the followingsteps into action:

1. Gain knowledge about horizontal violence and itscauses, conduct regular meetings with a designatedcommittee, and institute a program to address thisissue; supervise its operation and success.

2. Undertake a formal, thorough analysis of yourunit’s culture.

3. Ensure there is a process for dealing with this issuein your workplace and follow it.

4. Have a policy about harmonious workplace rela-

tions. Support and encourage students, new staff,and general staff.

5. Foster an environment of open collaboration,exploring, and healing of issues, rather than fault-finding and blame.

6. Support workers’ autonomy and initiative and pro-mote a learning culture.

7. Educate employees on how to promptly reportincidences of victimization; support and encouragepeople to do so.

8. Monitor staff morale and address issues that nega-tively impact upon morale.

9. Ensure that staffing is adequate, rosters are fair, andallocation to areas is fair within your unit/institu-tion; ensure that all staff have an equal opportunityfor advancement and education.

10.Engage in self-awareness activities and reflectivepractice. Ask for feedback from staff about yourmanagement practices and not just from closeassociates.

11.Institute open, honest, and supportive dialoguethrough peer review—strategies that are process-based, not personality-based.

12.Revise and articulate core values of your institutionand healthcare. Consider making one core value atopic at each team meeting.

13.Finally, make sure that appropriate counseling services in the workplace are available. Informa-tion about these services should be displayed in aprominent place. �

Source: Hastie, Carolyn, RM, RN, IBCLC. “Horizon-tal violence in the workplace,” www.acegraphics.com.au/articles/hastie02.html. Adapted and reprint-ed with permission.

< p. 1

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Page 3Strategies for Nurse Managers—November 2005 © 2005 HCPro, Inc.

Communication statement

Sample statement of commitment to coworkers

www.hcpro.com

As your coworker with a shared goal of providing excellent service to people and families, I com-mit to the following:

I will accept responsibility for establishing and maintaining healthy interpersonal relationships withevery member of this staff. I will talk to a coworker promptly if I am having a problem with him orher. The only time I will discuss it with another person is when I need advice or help in decidinghow to communicate with the coworker appropriately.

I will establish and maintain a relationship of functional trust with every member of this staff. Myrelationships with each member will be equally respectful, regardless of job titles or levels of edu-cational preparation.

I will not engage in the three Bs (bickering, back-biting, and belly-aching), and I will ask mycoworkers not to as well.

I will not complain about another team member, and I will ask my coworkers not to as well. If Ihear a coworker doing so, I will ask him or her to talk to that person.

I will accept my coworkers as they are today, forgive past problems, and ask them to do the samewith me.

I will be committed to finding solutions to problems rather than complaining about them or blam-ing someone, and I will ask my coworkers to do the same.

I will affirm my coworkers’ contribution to quality service.

I will remember that no one is perfect, and that human errors are opportunities not for shame orguilt, but for forgiveness and growth.

__________________________ _________Signature Date

Source: Carolyn Hastie, RM, RN, IBCLC. Reprinted with permission.

Page 4 Strategies for Nurse Managers—November 2005© 2005 HCPro, Inc.

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Nursing in the news

Study links workplace ethical climate to nurse retention

A new study published in the June 2005 Journal ofNursing Scholarship found that the ethical climate ofthe workplace plays a significant role in nurse retention.

The study, conducted by Sara E. Hart, PhD, RN, aresearch assistant professor and postdoctoral fellow atthe University of Kansas School of Nursing in KansasCity, surveyed 463 randomly selected acute care RNsin Missouri in 2003 and 2004.

Defining ethical climate as “organizational conditionsand practices that affect the way difficult patient careproblems, with ethical implications, are discussed anddecided,” the survey asked nurses to answer questionsabout ethical issues that arose between four segmentsof the workplace: nurses and nurses; nurses and pa-tients; nurses and physicians; and nurses and managers.

For all relationships, respondents were asked to agreeor disagree with statements about their facility’s ethi-cal climate, including the following: • Hospital policies help me with difficult patient care

decisions• Physicians ask nurses for their opinions if there are

questions about care• Safe patient care is given on my unit• Nurses and physicians respect each other’s posi-

tions, even when they disagree about what’s best• Feelings and values of all parties involved in a

patient’s care are considered

Hart’s study revealed that ethical climate accounted

for 25.4% of the variance in nurses’ intent to leave acurrent position and 14.7% of the variance in theirintent to leave the profession.

Hart explained that the survey results suggest realimplications for healthcare organizations, as well asreal ways to improve the ethical climate and, in turn,improve retention.

“The things that come to the forefront of my mind areproviding more control over practice and not having a hierarchical work environment—instead having ateam approach to patient care where everyone is con-sidered equal,” she said.

In the workplace, Hart added, the person most ableto effect these changes is the nurse manager. “Nursemanagers are on the front line with nursing staff, sothey can gather information they need to substantiatean ethical issue,” she said. “They also have the man-agerial power to take it to the next level. Although Iwould like to see higher administration take notice ofthe ethical climate . . . the nurse managers must bringit to their attention.”

In an effort to increase the ethics education receivedby nurses, Hart suggested including in the curriculamethods for handling more common ethical conflictsnurses face on a daily basis with coworkers, physi-cians, managers, and patients’ families. �

Source: NurseZone.com

Telephone: 781/639-1872,

Ext. 3157

E-mail:awaddell@hcpro.com

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are great ways to get recognized as a nursingexpert. Visit the HCPro Web site at www.hcpro.

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JCAHO

The JCAHO identifies 2007 Patient Safety GoalsSafety culture, rapid response considered; standards changes announced

Assessing a culture of safety, using technology such asbar coding to identify patients, and implementingrapid response teams are among the potential 2007National Patient Safety Goals the nation’s hospitalaccreditor will consider at a mid-month meeting, offi-cials said September 1.

In addition, the JCAHO will draft leadership standardsregulating the assessment of a safety culture, RichardCroteau, MD, JCAHO executive director for strategicinitiatives, said during the Hospital Executive Briefingsin Rosemont, IL.

If the commission approves the standards for fieldreview, the draft will be posted to the JCAHO Website, www.jcaho.org.

Six potential goals revealed Some of the topics the Sentinel Event Advisory Groupconsidered included • assessing a culture of safety • reducing worker fatigue • using technology such as bar coding to help identi-

fy patients

The JCAHO proposed the safety-culture goal for the2006 set, but the commission wanted more time toevaluate the requirements, including how to use assess-ment tools and address patient harm, Croteau said.

Putting forth the proposal helps draw more attentionto the issue of patient safety, Croteau said. “A cultureof safety is a culture where risk is acknowledged andwe work to reduce harm.”

Hospitals can start to involve patients in their carenow, Croteau said. A benchmark is the Dana-FarberCancer Institute in Boston, which has former patientssit on numerous committees to provide a differentperspective on certain issues, he said.

Ceiling placed on goals The JCAHO will attempt to limit to two the number ofnew goals each year, Croteau said. The limit will helphospitals manage priorities, including existing goals.

The commission also wants to keep the number ofgoals stable each year, meaning certain goals wouldretire into the standards to make room for newrequirements, he said. �

Editor’s note: To learn more about the HospitalExecutive Briefings conference and what organiza-tions can expect from the JCAHO in 2006, includingunannounced surveys and standards changes, checkout the October Briefings on JCAHO, an HCPro, Inc..publication. For more information or to order, callcustomer service at 800/650-6787 or visit www.hcmarketplace.com.

Nurstoons by Carl Elbing

www.nurstoon.com

Page 6 Strategies for Nurse Managers—November 2005© 2005 HCPro, Inc.

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Quality improvement

Can’t get no satisfaction? Try patient surveysHow patient feedback can improve your facility

Learning objective: After reading this article, you will beable to1. describe what the JCAHO’s element of performance

(EP) #3 requires and the four additional areas thatshould be added to the requirement

Keeping your hospital’s patient satisfaction survey con-cise and to the point is a strategy that will help keeppatients’ attention when taking the survey and helpthe organization get more meaningful responses.

The entire questionnaire should ideally be 15 questions,says John Rosing, MHA, FAHCE, practice director ofaccreditation and regulatory compliance services forThe Greeley Company, a division of Marblehead,MA–based HCPro, Inc., the publisher of SFNM.

Go above JCAHO requirements Standard PI.1.10, element of performance (EP) #3,requires hospitals to collect data on patients’ percep-tion of care, treatment, and services provided, includ-ing specific needs and expectations, how well thehospital met those needs, how the hospital can im-prove safety, and the effectiveness of pain management.

Although the JCAHO only outlines four areas forwhich hospitals should collect satisfaction data, organi-zations should add more, Rosing says, including

• wait times • communication • comfort, including room temperature, noise, and

distractions • staff attention to a patient’s needs

Fairlawn Rehabilitation Hospital in Worcester, MA, partof the HealthSouth group of rehab facilities, asks ques-tions about admissions and registration procedures,nursing care, pain management, physicians, food andfacilities, discharge, and overall satisfaction, saysPatricia Garvey, MSN, RN, director of quality man-agement and education.

Present info to the board Garvey presents information gleaned from surveyresults to the hospital board of trustees each quarter.Her “quality grid,” or scorecard, allows the board tomeasure Fairlawn’s success and performance againstother HealthSouth rehab facilities, she says.

Use the results Garvey distributes survey results to the directors respon-sible for various departments at the hospital, she says. Ifthe results fail to meet those of other HealthSouth facili-ties, she will ask for a corrective action plan.

Garvey also uses the results to let staff know patients

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Quality improvement (cont.)

Management

Prepare staff for unannounced surveys

Learning objective: After reading this article, you will beable to1. list seven tips that nurse managers and their staff should

practice during JCAHO surveys

The following tips, provided by Elizabeth DiGiacomo-Geffers, RN, MPH, CNAA, BC, a health-care consultant in Trabuco Canyon, CA, will helpnurse managers and their staff be prepared during anunannounced JCAHO survey: 1. Surveyors typically arrive between 8 a.m. and 8:30

a.m. Ask to see their identification, notify the CEO,and escort the surveyors to the CEO or a designat-ed second in command.

2. Make sure the CEO or designee asks to see a lettersigned by a JCAHO executive that explains the sur-veyors’ purpose for the visit.

3. Call a designated code so everyone knows toassemble in a “command center.”

4. Have a senior leader serve as an ambassador to fol-low the surveyor.

5. Have a scribe take notes on the survey and whatinformation the surveyor will look for, such as aquality manager or JCAHO coordinator.

6. Have a runner, or someone who can quickly grab apolicy or chart if the surveyor requests it.

7. Keep track of every medical record the surveyoruses in tracer activities and all human resource andmedical staff files reviewed. This will enable theorganization to accurately review any issues thatmay arise during or after the survey. �

Source: Briefings on JCAHO, August 2005, HCPro,Inc.

have a positive perception of care, she says.

Management should be interested The medical staff also has a regulatory interest in pa-tient satisfaction. JCAHO standard MS.2.10, EP #5 re-quires medical staff to provide oversight in the processof analyzing and improving patient satisfaction.

Senior management should look at and evaluateresults from satisfaction surveys, Rosing says. Leadersneed to assess the results and then determine whatchanges should be made in the context of the organi-zation’s current climate.

Help exists Using an outside vendor to conduct the survey andcompile the results gives hospitals the added bonus ofhaving benchmarks against other organizations, Rosingsays.

Hospitals may struggle to write their own surveys,Garvey says, as it’s difficult to validate and test them.“I think it’s worth the commitment of money [to use avendor] because it’s valid and reliable,” she says.

Satisfaction goes national CMS is planning its own patient satisfaction survey,which includes questions about communication withphysicians and nurses, pain control, staff responsive-ness, and discharge information. The 27-question sur-vey will supplement existing questionnaires already inuse at hospitals, and Medicare will be able to collectstandardized data on patient perceptions to post on itsWeb site, www.medicare.gov.

Medicare anticipates nationwide implementation of thesurvey in early 2006. Go to www.cms.hhs.gov/quality/hospital/ to view the survey.

Patient satisfaction survey companies The following companies provide services to helphospitals conduct patient satisfaction surveys: • The Gallup Organization• NRC+Picker• Press Ganey Associates, Inc.• Professional Research Consultants �

Source: Briefings on Quality Improvement andData Reporting, August 2005, HCPro, Inc.

Page 8 Strategies for Nurse Managers—November 2005© 2005 HCPro, Inc.

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Interdisciplinary care corner

Survey anxiety? Don’t stress—tell stories

It’s a simple concept with a clear message: Tell yourstory.

“The one thing we told staff [during Magnet surveypreparation]: Tell the appraisers what you do,” saysFaith Coles, RHIT, executive assistant of administra-tion at Centra Health, Lynchburg, VA. “That’s whatthey’re here to learn about.”

This philosophy helped Virginia Baptist andLynchburg General, the two hospitals in Centra’shealth system, pass their rigorous, two-day Magnetsite survey this May. Nursing leadership coached stafffor the visit with impromptu surveys and educationalbrochures, but their main message was to be honestabout their daily roles and responsibilities.

Centra’s two surveyors visited with various hospitalgroups to verify that they were living the Forces ofMagnetism as they stated in their written application.“If they notice something [questionable] in your docu-ments, they’ll refer to it at the survey,” says Coles.“They want to know that you’re living the Forces—they can tell if you fake it,” says Golden Bethune,RN, MSN, CNAA, BC, CNO at Centra.

But there were many signs of Magnetism at Centra asthe appraisers met with many departments. About amonth prior to the visit, the appraisers sent an outlineof things they needed to do, such as rounding onnursing units, and groups with whom they needed tomeet, including nursing and non-nursing departments.Coles created a schedule incorporating the surveyors’needs (see p. 9), and says that although they metwith board members, RN executives, and medicalstaff leadership, the stories they wanted to hear mostwere from staff RNs.

Unit roundsThe appraisers split up each day to conduct the sur-vey at both campuses. Nursing leadership arrangedfor staff RNs to escort the appraisers during their unittours. The following are questions the surveyorsasked staff:

• What do you like about working at Centra?• How do you feel supported administratively?• Do you participate in professional development

activities?• What is your RN-patient ratio?• What quality projects are you working on?

Bethune says the surveyors asked a lot of questionsrelated to the ANA’s Code of Ethics and Centra’s par-ticipation in the National Database of Nursing QualityIndicators.

It’s not just about nursingAppraisers also spent their time meeting with non-nursing departments. Here are some of those othergroups that the appraisers visited and examples oftheir questions:• Board members. How did you learn about the

Magnet process? How have you been involved?• Personnel department. How many grievances

have been filed against you? What were the out-comes? What do you do to recruit and retain staff?

• Medical staff leadership. How do you collabo-rate on clinical issues?

Bethune says the groups responded fine to the ques-tions because they were kept well-informed through-out the journey.

Other groups that appraisers met with includeCentra’s community partners, research committee,schools of nursing, an interdisciplinary team, patientsafety committee, staff development group, andpatient relations.

Coles has an important tip for organizations on thejourney: “One of the surveyors told us, ‘Magnet doesnot mean you’re perfect, it means excellence in whatyou do.’ ” That message proved true in July, as Centrareceived Magnet status for its commitment to nursingexcellence. �

Source: Magnet Status Advisor, October 2005,HCPro, Inc.

Page 9Strategies for Nurse Managers—November 2005 © 2005 HCPro, Inc.

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Survey agendaSam

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Page 10 Strategies for Nurse Managers—November 2005© 2005 HCPro, Inc.

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Patient care

Promoting advance directives Nurses play an important role in end-of-life care

Learning objective: After reading this article, you will beable to1. list four steps to follow when discussing future medical

conditions with patients

The Patient Self-Determination Act mandates thatinformation about advance directives be presented toadult patients admitted to federally funded facilities.Thus, every nurse, at some point, will face questionsand concerns from patients and their families regard-ing advance directives. It’s important that you andyour staff are educated and informed about advancedirectives and that you are prepared to communicatecorrectly when questioned by patients and their fami-lies about important end-of-life decisions.

Nurses’ knowledge of advance directives A recent study by the Western Journal of NursingResearch determined that nurses who had been edu-cated and were knowledgeable about advance direc-tives were more likely to discuss them with patients.

In a study published in the Oncology Nursing Forum,nurses expressed a lack of confidence in their ability to• discuss advance directives with patients/families• answer questions regarding advance directives • advocate for patients • implement institutional policies and procedures• speak about the laws governing advance directives • mediate disagreements between patients and fami-

lies regarding end-of-life decisions

Nurses’ role in discussing advance directives To help nurses fulfill their patient educational and ad-vocacy role, Linda Briggs and Elaine Colvin, auth-ors of the article “The Nurse’s Role in End-of-LifeDecision-Making for Patients and Families,” publishedin Geriatric Nursing, have identified the following stepsin discussing future medical conditions with patients:

1. Exploring and understanding: The patientshould be educated about his or her medical condi-

tion and the treatment choices available if the patientis unable to participate in treatment decisions.

2. Reflecting on possible decisions: The patientexamines his or her personal values and how thosevalues translate into individual healthcare goals.

3. Decision-making: The patient plans his or herend-of-life choices and makes decisions that are con-sistent with the individual’s medical conditions andvalues. The patient also discusses these choices withfamily members and healthcare providers.

4. Documenting the choices: The patient reduceshis or her decisions and choices concerning end-of-life care to writing an advance directive. �

Source: This excerpt is from the book Evidence-BasedAdvance Directives: A Study Guide for Nurses, writtenby Dinah Brothers, RN, JD. Published by HCPro, Inc.

To register, call our Customer Service Department at 800/650-6787 or visit www.hcmarketplace.com.

Audioconference:Join us November 8 for the live audioconference,“Shared governance: How to create and sustain a cul-ture of nurse empowerment,” featuring Tim Porter-O’Grady, EdD, RN, FAAN, from Atlanta-based TimPorter-O’Grady Associates, Inc., and Kim S. Hitchings,RN, MSN, from Lehigh Valley Hospital and HealthNetwork in Pennsylvania. Pay just $239 for an unlim-ited number of listeners! Agenda items include• elements of effective shared governance models• a process to implement shared governance• the Magnet Recognition Program’s® shared gover-

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Page 11Strategies for Nurse Managers—November 2005 © 2005 HCPro, Inc.

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Retention

Discover the fruits of Planetree

Putting patients first may sound like the standard mar-keting slogan to be heard at any of the nation’s hospi-tals, but an ever-growing number of facilities across thecountry have decided to take that statement to heartand invest in a patient-centered model of care that putsas much emphasis on the caregiver as the patient.

About 100 hospitals and healthcare facilities are nowpart of the Planetree Alliance, and all have made acommitment to follow the Planetree philosophy toimprove the experience of patients and staff.

The rootsPlanetree’s origins stem from the 1978 experience ofAngelica Thieriot, a San Francisco woman who washospitalized for several weeks with a life-threateningmedical condition. Although Thieriot received excel-lent medical care, she was dismayed by the rest of hertreatment. She felt she was treated as a body in a bed,not a person.

After recovering, Thieriot noted that her hospitalizationwas more stressful than her condition, and foundedthe nonprofit Planetree organization, taking the namefrom the planetree, or sycamore, under whichHippocrates taught his students.

The organization aims to serve as the catalyst for thedevelopment and implementation of new models ofhealthcare that focus on the holistic nature of healing,with emphasis on nurturing body, mind, and spirit.

The first Planetree unit required a commitment fromadmitting physicians to agree to direct communicationwith patients and families, with patients actively en-couraged to ask questions and participate in theircare. Visiting hours were abolished, so patients couldbe surrounded by the comfort of family and friendswhenever they wanted, and families were directlyencouraged to participate in care. This is one of thecore principles of the Planetree philosophy.

Steps to PlanetreeThe process of becoming a Planetree hospital tends to

take about three years and requires a strong commit-ment throughout the facility, says Susan Frampton,PhD, president of Planetree.

“We always recommend that a hospital that is thinkingof joining Planetree go and visit an established Plane-tree hospital first,” Frampton says. “Have a chance totour it, talk to the staff, talk to the leadership, so thatthey have a good idea of what this work is all about.”

Planetree consultants work with hospitals to create aprogram unique to that facility’s needs, and provideeducation and guidance. Annual fees for PlanetreeAlliance membership vary depending on the size ofthe facility, but usually range from $12,000–$25,000.Additional consulting work can also be arranged fromPlanetree staff.

Planetree’s impact on nursingPlanetree focuses on improving patient care andimproving staff satisfaction.

“I see the nurses come out of Planetree retreatspumped up,” says Darryl McCormick, senior vicepresident of human resources at Stamford Hospital, aPlanetree hospital in Connecticut. “What I think is dif-ferent now is that [Planetree] is truly a cultural trans-formation. Nurses are part of an environment that isgoing to be changing.”

McCormick points to another measure of how adopt-ing the Planetree philosophy has improved StamfordHospital. A few years ago, the hospital conductedemployee satisfaction surveys that saw disappointinglylow results. After adopting Planetree, a new surveywas conducted and showed that employee satisfac-tion had almost doubled.

“In new employee orientation, people will tell us theywanted to come here because it’s a Planetree hospi-tal,” says McCormick. �

Source: Patient Care Staffing Report, October 2005,HCPro, Inc.

The annual turnover rate for LPNs decreased a signifi-cant 6.97%, from 21.28% in 2004 to 14.31% in 2005.The annual turnover rate for RNs decreased 1.15%,from 14.75% in 2004 to 13.60% in 2005.

The complete 330-page report is available for $350from HCS. To order, call 201/405-0075 or go towww.hhcsinc.com. �

Source: Hospital & Healthcare Compensation Serv-ice, www.hhsinc.com.

Page 12 Strategies for Nurse Managers—November 2005© 2005 HCPro, Inc.

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Compensation and turnover data

Base pay on the way up, turnover rates on the waydown for RNs and LPNs

The national average salaries of both RNs and LPNsincreased in 2005, according to the 35th annualHospital Salary and Benefits Report, published by theHospital & Healthcare Compensation Service (HCS).

The base pay for RNs is now $27.34, up $2.69 from2004, while the base pay for LPNs is now $17.69, up50¢ from last year.

The survey provided compensation data on morethan 158,800 employees nationwide, with more than368 hospitals participating. Nationally, survey partici-pants reported using RN agency/registry staff an aver-age of 1,525 hours per month, representing a slightincrease from 2004.

The use of LPN agency/registry staff, however,decreased almost 50%, from 720 hours in 2004 to 363hours in 2005.

Strategies for Nurse Managers

Editorial Advisory BoardShelley Cohen, RN, BS, CENPresident Health Resources UnlimitedHohenwald, TN

Sue FitzsimonsSenior Vice PresidentPatient ServicesYale-New Haven HospitalNew Haven, CT

David MoonExecutive Vice PresidentModern Management, Inc.Lake Bluff, IL

Bob Nelson, PhDPresidentNelson Motivation, Inc.San Diego, CA

Tim Porter-O’Grady, EdD, RN, CS, CNAA, FAANSenior PartnerTim Porter-O’Grady Associates, Inc.Otto, NC

Dennis Sherrod, EdD, RN Forsyth Medical Center Distinguished Chair of Recruitment and Retention Winston-Salem State University Winston-Salem, NC

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Job title 2004 2005 Percent increase

RN $24.65 $27.34 10.94%

LPN $17.19 $17.69 2.90%