The purpose of this article is to explore strategies US Hospitals are employing to overcome nurse shortage. The remedy of a problem is dependent on its cause. This is no different here. Since causes of shortage of nurses are varied possible solutions proposed are many too. Nurse shortage stems from lesser number of students choosing nursing as profession , Uncertainty created by a wrong research report in 1988 by a reputable organization predicting impending nurse oversupply (resulting in students deciding not to chose nursing), more nurses choosing to work in out patient setting creating a mal distribution of nurses in some areas of country , dissatisfaction among nurses because of shift work, mandatory overtime, insufficient pay, lack of a career ladder are some of common causes. Many nurses are choosing Temp. work as it pays more money and allows some control over work hours and benefits. In private sector turnover is higher then in govt. sector. Hospitals are doing all sorts of things to recruit and retain nurses. Financial incentives to recruit nurses are temporary fix in general. These do not guarantee retention of nurse in same facility. Long term planning for this national problem is addressed by federal as well as state level. These will have effect though not in very near future. A serious effort by hospitals, nurses themselves as well as government and nursing organizations will be needed. Image building , making profession attractive are sort of things which will take time but will have lasting effects. For short term it is hospitals which have to deal with nursing shortage.

The latest news is that some nurses who are in army reserves are now being called in for active duty and sent to Germany (3 from our institution). There are not many innovative strategies available to hospitals to deal with shortage of nursing staff. Here are some ways different health care organizations and hospitals are dealing with this nursing emergency: (These strategies are for recruitment of new nurses, new graduates as well for retention of existing workforce. Some strategies are short term and some are long term. Your institution or hospital may already be employing many of these methods.) Commonly employed strategies to attract and retain nurses in organization include: •Signing referral bonuses •Salary incentives •Flexible hours. •Lower eligibility threshold for benefits. •Improvement in working conditions. •Increase recruitment in training programs. •Recruitment outside of prime age. •Identify cost effective and quality based practice models that promote quality patient outcomes and job satisfaction. •Accommodate aging nurse force. •Image building of nursing staff. •Assign responsibilities and challenges for motivated members of nursing staff . •Create role models for junior nursing staff members. •Promote leadership development programs. Baptist Hospital of Miami, Florida is employing following strategies for some time with good success. •Sign-on Bonuses offered to all RNs and Out-of-Area Applicants ($5,000 and $2,500) •On-Campus Recruitment Twice a Year at each of Four Local Nursing Schools •System-Wide Posting of all Job Openings •On-site Child Care Center. •Post Office. •Choice of multiple health plans •Group Legal Insurance. •Leave Sharing (PTO donations to employees in need) •Larger and more frequent advertising in Local Newspaper and Nursing Journals •Special Annual Ads (i.e. Florida Hospital Association Guide, RN Magazine, AJN). •Commercial Internet Postings. •Special Nursing Limited-Time Offer ($5,000 and $2,500) •Nursing Recruitment & Retention Committee •Birthday Cards from Human Resources with 2 Movie Tickets •Employee Activity Committee Events

•Regular Bonuses of $1,000 and $500 •Year-end Raffle for "Trip for Two" •Stepped-Up Publicity of vacancies (posters, brochures, raffle boxes) • Employees Referrals program (RN Hires through employees referral program increased from 28% to 31% after Introduction of Program). •Relocation Assistance offered •Extra Pay Option (in lieu of benefits). •Staffing Incentive Bonus Programs (including $25 gift certificates) •Special Weekend Scheduling Option ($7/hr diff) •Supplemental Weekend Plan ($3/hr diff) •Increased Base Rates and Per Diem Rates •Guaranteed Overtime •Preceptor Honorarium ($200) •Special Call Back Pay (%20 or time and a half) •Thanksgiving, Christmas & New Years Holiday Pay (time and a half)

•Annual Spring Luncheon for Graduating Nurses (all colleges) •Pay for NCLEX Review Course •Nursing Student Clinical Rotations and Practicums at Hospital. •Students Hired as Nurse Care Techs at Top of Pay Scale until Graduation •Nurse Care Techs Recruited into New Graduate Training Program

•Professional Advancement Process (Clinical Ladder). •Leadership Development Program •Mentorship Program •Tuition Assistance •Toolbook for Performance (clinical, professional & personal development courses). •Employee Assistance Program. •On-site Credit Union / ATMs. •On-site Dry Cleaning, Hair Salon, Shoe Repair, Car Wash, Pharmacy, Gift Shop, •Meals-To-Go Program (from Employee Dining Room). . •Dental Insurance. •Vision care. •Life/AD&D/Dependent Life. •Short and Long Term Disability.

In October 1999, USDA approved statement, “Diets low in saturated fat and cholesterol that include 25 grams of soy protein a day may reduce risk of heart disease.” This health claim is based on research showing that soy protein can lower total cholesterol and LDL (“bad”) cholesterol.

Soy foods typically fall into two categories: Traditional and soy protein products (SPP). Traditional foods are soymilk, tofu, miso, tempeh and edamame. Soymilk is made from ground soybeans mixed with water, cooked and then filtered. Tofu is a cooked, pureed soybean that is then offered in different textures. Miso is a seasoning from cooked, fermented soybean paste. Tempeh is cooked, fermented soybean cakes, and edamame is whole, green soybeans. SPP’s are made from soy protein concentrate, soy flour or ISP (see below). Examples are soy burgers, cereals, etc.

Textured soy protein (TSP) is probably what many people unfamiliar with soy products think of when they hear term ‘soy foods’. TSP, also known as Texturized Vegetable Protein, is made from compressed soy flour or other soy ingredients and is used as an extender in other foods products. It is available as a dried and granular product that is rehydrated with boiling water. It takes on a texture similar to ground beef or stew meat.