Maine hospitals get creative to find nurses

Sept. 30--LEWISTON -- For a while, they tried bringing nursing students pizza.

It was a way for the St. Mary's Health System's talent acquisition team to connect, to introduce themselves, to say, hey, St. Mary's has some jobs openings for you, future nurses. A lot of openings.

They attended local college coffee-and-doughnut hours, too. And blanketed job fairs, where they tried to stand out from all the other talent acquisition teams from all the other hospital systems.

They offered to help pay for school for current employees interested in getting into nursing and for nursing students who would agree to work at St. Mary's for a while after graduation.

They offered signing bonuses up to $10,000.

"We exhausted every recruitment strategy we could think of," said Lisa Cramm, system manager of talent acquisition for Covenant Health, which owns St. Mary's.

So with 70 to 75 openings -- 20 at its nursing home alone -- St. Mary's decided to try something more bold.

It went to the Philippines.

In August and September, 13 experienced Filipino nurses joined the staff at d'Youville Pavilion, filling more than half its 20 openings. It's the closest the nursing home has been in a year to a full staff of permanent nurses.

Nursing director Marissa Varney called it "a blessing."

"It will be good for our patients, first and foremost," she said. "We've used travelers (short-term contract nurses who travel from place to place), but they're only here for 13 weeks. Sometimes they extend it for another 13 weeks, but it's not the same. Having the continuity with staff, having the patient know who's taking care of them, it's big. It's huge."

It's no secret that Maine has a nursing shortage now and a crisis looming not too far off. Maine needs hundreds of registered nurses now. It's predicted the state will be short 3,200 by 2025.

That's gotten some organizations worried. If pizza parties and signing bonuses aren't helping, what will?

For some it means getting more creative: partnerships between nursing schools and hospitals, salaries for students, drastically shortened training to entice second-career folks, extra money and time for nurses to pursue their own pet projects in the hospital.

For St. Mary's, it means looking outside the country.

AGING NURSES, AGING PATIENTS

Maine hospitals began getting concerned about a nursing shortage more than a decade ago. Baby Boomers were just starting to reach retirement age and a tremendous number of Maine nurses were among them.

Then the recession hit in 2008, and real estate values, the stock market and retirement accounts sank. Many people put off retirement.

That helped keep nurses in their jobs back then. But the economy has improved. Ten years later, nurses are returning to those retirement plans and, now in their 60s and 70s, aren't likely to put them off again.

According to a statewide study commissioned by the Maine Nursing Action Coalition, nearly a third of registered nurses in Androscoggin, Oxford and Franklin County are over 55. In Sagadahoc, Lincoln, Knox and Waldo counties, nearly half are.

"We came out of the recession with an even older nursing workforce," said Lisa Harvey-McPherson, co-chair of the Maine Nursing Action Coalition. "And so we have this accelerated retirement, retiring out of nurses, and we don't have enough younger nurses to replace them. That's the basic math."

That statewide study predicts Maine will need to replace almost 11,000 registered nurses by 2025 but will have fewer than 7,800.

Such a shortage has the potential to affect everything in Maine medicine, including how well patients are cared for, the number of beds available in nursing homes and the cost of medical care, since hospital systems will have to increase wages to compete for the limited pool of workers. And Maine's aging population means more people, not fewer, will need nursing care in the future.

Even now, hospitals are struggling to fill openings.

Brewer-based Eastern Maine Healthcare Systems, which has hospitals and nursing homes around the state, needs about 300 nurses. About every third EMHS job opening is for a nurse.

Portland-based MaineHealth is the largest health system in the state and the parent of Franklin Memorial Hospital in Farmington and Stephens Memorial Hospital in Norway. Leaders there can't provide a precise figure for nurse openings because the number changes so rapidly -- particularly right now, which is hiring season for new graduates. But Chief Nursing Officer Marge Wiggins said MaineHealth has 4,000 nurses system-wide and is "hiring by the dozens."

Central Maine Healthcare in Lewiston has 736 nurses and counts itself lucky that it only needs to find 49. If CMHC didn't have its own nursing school -- the Maine College of Health Professions -- leaders are pretty sure those openings would be much worse.

"We are blessed to have the college as a part of our system," said Mary-Anne D. Ponti, chief nursing officer for the system. "They're a tremendous feeder for us."

And then there's St. Mary's, which averages 70 to 75 open nursing positions at any given time. St. Mary's leaders have gotten increasingly desperate, particularly when it comes to openings at the 200-bed d'Youville, where a 20-nurse gap is big.

"We just could not entice new grad nurses to move over to senior health," Cramm said.

Because they have their choice of jobs, nurses in Maine are generally more interested in working in a hospital, where they can focus on emergency medicine, labor and delivery or any number of other specialties. By comparison, long-term care has the reputation for being somewhat dull.

Nurses in the Philippines, it turns out, were OK with that.

'WE NEED YOU'

While St. Mary's couldn't find nurses, nurses 8,000 miles away couldn't find jobs.

The Philippines had more nurses than work available. And the jobs they could find weren't great, particularly at government hospitals, where nurses might earn $200 to $600 a month and have to wash and re-use gloves and gauze.

Some figured their best option lay in another country.

D'Youville happened to have a couple of longtime staff members who were originally from the Philippines, including Varney, the nursing director. When it became clear St. Mary's couldn't find nurses close to home, they suggested searching overseas.

"They just kind of tossed it out there," Cramm said. "We started researching."

This spring, the hospital system signed with PassportUSA, an international health-care staffing agency. The agency presented a pool of 30 candidates. Relying on resumes and phone interviews, St. Mary's initially offered jobs to 14.

The nurses didn't have to take the job. Some had worked in other countries, such as the United Arab Emirates, and they could have continued that work. Some had multiple interviews in United States and could have chosen to work somewhere other than St. Mary's.

"Before the interviews, I prayed with my husband," said Christine Tan, 30, who interviewed for nursing jobs in both Pennsylvania and Lewiston, and asked God to help lead her to the right choice.

But while they could have said no to the job offers, for some it was the realization of a dream. They'd wanted to live and work in the United States for years.

"Even when I was a child, I already dreamed of coming here," said Millicent Moreno, 30.

One of the 14 dropped out for personal reasons. The other 13 said yes to St. Mary's.

The agency handled their work visas and dealt with the logistics of getting them to Lewiston, including finding them apartments, getting them cellphones and making sure they were comfortable driving in America. The nurses began arriving last month, some with spouses and children in tow.

At d'Youville, they received a hero's welcome.

"They are very hospitable here," said Moreno, 30. "We feel that we are working with family."

They come with the same kind of training and required licenses as American nurses. They speak English. They're from a country whose population is largely Catholic, so they're familiar with the essence of St. Mary's, a Catholic hospital system.

There has been some adjustment. Many of the Filipino nurses had experience with hospitals, where one nurse might be responsible for five patients. At d'Youville, which provides long-term rather than acute care, two nurses might have 40 patients between them.

"For me, I was shocked," said Janelle Bacani, 30.

Some have also been surprised by how small Maine's population is.

"I was used to seeing a lot of people in the Philippines. (In Lewiston) I'm happy every time there's a car passing by our house. I go, 'Oh, I see people!" Tan said with a laugh.

But while they marvel at how few people there are, they also appreciate it.

"My husband likes a quiet place where we can raise kids," Tan said.

The Filipino nurses have been embraced by many at d'Youville, especially those staff members whose jobs are made a little easier by the sudden influx of 13 new co-workers.

"I'm so thankful," said Misty Marston, a nurse at d'Youville. "They're so pleasant and hard working. I really appreciate having them."

One recent afternoon, a couple of staff members greeted three of the Filipino nurses with "Hi, girls!" as they walked down the hall. One staff member stopped Moreno to let her know her shoe was untied.

"Don't trip and fall," she told Moreno. "We need you."

St. Mary's may soon get more than those 13. Some of the nurses' spouses are trained medical professionals, as well, and are planning to join St. Mary's on their own -- possibly as nurses.

"Soon, all of our husbands will start working here," Moreno said.

The nurses will stay at St. Mary's for three years under contract. After that, they can go somewhere else through the international staffing agency, or they can stay on at St. Mary's. Just a month in, some are already talking about staying, raising their children in Lewiston, bringing family to Maine.

This is a kind of pilot for the hospital system, but Cramm can already see more international hiring in St. Mary's future -- and maybe not just for its nursing home.

"Because it's worked out remarkably well at this point," she said. "Obviously we're still in the early stages, but if it continues to be so positive the way it has been, I am confident this will be a strategy we'll use again."

MONEY, TIME, A PODCAST

Of the largest hospital systems in Maine, only one other is looking for nurses overseas right now.

EMHS also recruits internationally, using staffing agencies to connect with nurses from Nigeria, Ireland, Jamaica and other countries over the past few years. Thirteen have been hired permanently. Twenty-six are working at EMHS under an agency contract and may be hired by the hospital system after about two years or so. Eleven are set to start in the coming months.

"We're always looking locally, but the necessity, at this point, is that we look not only outside the state but outside the country," said Catharine MacLaren, vice president for talent and diversity.

But while St. Mary's and EMHS are the only large hospital systems in Maine searching for nurses overseas, they certainly aren't the only ones trying to get creative.

CMHC formed an "earn while you learn" program, giving student nurses a job within the hospital system so they can more easily earn a living while going to school.

For nurses who are already on the job, Ponti, CMHC's nursing chief, earlier this year created a regular podcast to keep them informed about staffing, salaries and other issues.

CMHC has come under fire from unhappy employees in recent months, in part because they say there hasn't been enough communication.

"I heard that loud and clear from the staff," Ponti said.

In July, Ponti also began running "Monday Mornings with Mary-Anne," coffee-and-doughnut hours held in different parts of the system every two weeks to give nurses an easy way to ask her questions, raise concerns or generally feel heard in a way they may not have felt in the past.

"'This is working, Mary-Anne, this isn't,' as an example," Ponti said. "This is an opportunity to connect."

At MaineGeneral, officials have started a summer internship program that pays student nurses to job shadow in operating rooms, cancer care, long-term care and other areas. The goal: Get students excited about finishing their nursing degree and about all the possibilities at MaineGeneral.

MaineGeneral also gives current nurses time to pursue their own quality improvement projects, like finding a way to stop patients from falling or eliminating bed sores. The hope is nurses will feel more fulfilled and engaged and will advance in their careers.

And maybe the $3,500 to $5,000 they get for completing their projects will help, too.

"It's a win-win because they get that incentive, but the organization benefits because projects all contribute to high-quality care," said Chief Nursing Officer Jennifer Riggs.

Some MaineHealth hospitals now pay people an hourly wage and benefits to attend a nine-week certified nursing assistant course -- there's a shortage of CNAs in Maine, too. If they work at MaineHealth as a CNA, they can get some help taking the next career step; MaineHealth will help pay for nursing school.

And because Maine also can't find enough nursing professors -- teaching doesn't pay as well as nursing, and colleges need a lot of teachers to meet the low student-teacher ratios required of clinical courses -- MaineHealth is partnering with Saint Joseph's College in Standish to provide all the clinical teachers for Maine Medical Center staff who want to become nurses and have enrolled at Saint Joseph's.

"With that, St. Joseph's is actually able to expand the number of students it can accept. That's not going to solve the nursing shortage, but if we do this in multiple programs, it will help a little bit," said Wiggins, the chief nursing officer. "We're constantly looking with ways to partner with the schools."

Nursing schools, too, are looking for innovative ways to address the state's nursing shortage.

Earlier this month, leaders from the University of Maine System announced an ambitious five-year plan to double the system's nursing school enrollment from 1,900 students to 3,800. They want to, among other things, waive tuition and fees for needy students who attend Augusta, Fort Kent and Presque Isle campuses and expand nursing education opportunities in Rumford, Brunswick and other towns.

System leaders said some of their plans, including expanding science labs and nursing simulation spaces, are pending voter approval of a $49 million bond that will be listed as Question 4 on the ballot this November.

The Maine College of Health Professions -- CMHC's school in Lewiston -- is promoting its two-year program that allows students to become nurses with an associate's degree rather than a bachelor's. For people looking to change careers or who need a flexible schedule, the college offers night and weekend classes for that associate's degree.

"Many people have established lives and they're not in a position to just devote every (bit of) energy to get themselves educated," said Monika Bissell, president of the college.

The school also plans to slash the time that military medics, paramedics and others with medical experience have to spend in school to become registered nurses. Starting next summer, those who complete a 10-week course can skip the entire first year of college.

The school is also considering reducing the time it takes to earn a bachelor's degree in nursing for those students who already have a bachelor's or master's degree in another field.

"What we educate them about is not the general education, the core gen ed, as much as it is the clinical," Bissell said.

Many in nursing say no single effort will solve Maine's looming crisis, but they believe all of them together have a chance.

"I am 100 percent convinced there is nothing Maine can't do when we put our mind to it," said Ponti, who has worked in nursing for 38 years. "Together, yes, that's my goal. Because, you know what? I'm going to want to retire one of these days. And I want to make sure that my successor and nursing leadership successor and bedside staff are all in place to do it."

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