Be Prepared for "As the Worm Turns" in Employment

February 15

This economy has given us one thing for which to be grateful—some of the lowest vacancy rates in the last 30 years. New RN graduates can't find jobs because older, experienced RNs have stayed on the job long after they had planned to go PRN or retire. Other healthcare professionals have been afraid to change employers because just last month (October, 2009) 700 jobs were eliminated in acute care settings in the United States and the sense of uneasiness is palatable. Entry-level workers, who averaged tenure of 4-6 months before the recession began in December, 2007, now stay on the job an average of 16 months, in large part because there are no other jobs to be had.

Healthcare continues to be the only sector to gain jobs overall—29,000 in October—but the majority of the jobs are being created in long-term care, physician offices and urgent-care centers. Overall 559,000 new jobs have been created in healthcare since the recession began while over seven million have been eliminated in all other sectors.

But things are beginning to change. In October, healthcare was the only sector but not the only area, to claim job creation. The first harbinger of employment recovery is growth of temporary jobs and last month, for the first time, temporary jobs increased by 34,000. Even the most conservative economists agree that job creation will begin sometime in the first two quarters of 2010. Slow creation at first and then much greater movement within the next two quarters and healthcare should lead the way.

We will all be grateful for the economic change that will drive new jobs, but it will also mean that Human Resources will almost overnight go from being able to actually breathe and hire logically to facing frenetic hiring patterns. It won't be one thing that will drive the chaos but several, including:

  1. A rush of resignations resulting because a spouse or partner secured a job and employees feeling they can look at other opportunities without the worry of being laid off or left with no job at all within a family.
  2. Additional movement will result when Baby Boomer employees feel they may retire as planned or at least reduce hours or go PRN.
  3. Healthcare professionals look for new opportunities at much greater numbers during the last week of January, February and the first week of March than any other time of the year. After the holidays and with the kids back on a schedule, the female driven healthcare workforce, grab the time to make a career change. There is almost always a spike in resignations at this time, but with the economy turning that spike will be greater than average.
  4. Non-healthcare specific positions for which healthcare recruits, will continue to drive not hundreds of applications, but thousands due to the economy, and the associated work will continue to be time consuming and challenging.

But, two of the biggest reasons for an increase in resignations will be the fact employees are outraged at how they have been treated during the economic downturn along with their expectations once the economy turns around. According to a study by, 57% expect "a raise, promotion or bonus" for having gone without pay increases, working longer hours and increasing their productivity. Nine out of ten employees questioned in the survey believe the worst is over and that the economy is on the upswing. Additionally the majority of those believe their organization could have done more to make them feel secure when times were the most difficult.

"My nurse manager knew how much I needed my job and it was like she enjoyed grinding me down" said an ICU RN from a Dallas hospital recently. "I always knew I was just a commodity to her and not really valued. As soon as I can get out from under her dictatorial management style, I am out. It was as though she enjoyed her new found power over everyone and she let us all know we needed to do what we were told period. I can't wait to let her hear from HR that I resigned. I'm not even going to tell her."

Managers continue to be the most important element in keeping employees content and productive. For the first time ever in 2008 the most important reason employees gave for staying or leaving a job was having a clear career path. Always before, the number one reason was having a good relationship with an immediate supervisor. But most healthcare facilities have clear career paths that range from internal transfers to tuition reimbursement. Nonetheless the only way employees can take advantage of those paths is to have a supervisor who allows a direct report to grow professionally even if it means losing a top performer from the department but not from the facility.

Communication and trust from the supervisor is also vital in limiting the resignations. All supervisors must be trained on how to provide those all important elements along with how to treat all employees with dignity regardless of the turmoil around them because of the economy.

It is also very difficult to manage the expectations of employees when things begin to look better and it takes careful communication to paint a realistic picture of the economy and what that actually means to the bottom line. In healthcare, the economy may improve, but it will be a long time before that improvement will mean "raises, promotions and bonuses". It is best to start communicating that now before the expectations build developing an impossible to attain situation and instigating feelings on the part of the employees of being duped by management.

The fact that Generation Y is the largest group of employees, having eclipsed the Baby Boomers in 2008, will also play a vital role in the changing employment situation. Generation Ys don't stay on the job the way Baby Boomers have and they also don't have the desire to stay with an employer against all odds. Generation X, a much smaller, but vital employment group, will also resign as soon as they feel the opportunities and trust have evaporated for them personally.

All of this creates a potentially disastrous recruitment and retention situation for 2010 within healthcare. But organizations can limit their exposure for employee loss if they remember that regardless of generation or type of position and skill set there are things that are important to all employees. These include:

  1. Fairness—allowing employees to be involved, informed and respected on the job and within the organization's culture.
  2. Stretch—having a steep learning curve with tools to do a great job.
  3. Community—having a sense of purpose and feeling able to contribute to something bigger than themselves.

There is no other working sector that can provide these three basic elements better than healthcare. Consequently healthcare will continue to create jobs at a higher rate and hopefully the individual facilities will be able to quickly develop a practice environment, driven by trained and compassionate supervisors and senior management, that will remember that employees are human and vulnerable and desiring to do a great job and stay with an employer who treats them well and provides them with the tools to feel good and safe.

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