WESTMINSTER -- If you ask hospital administrators to list the top 10 problems they have to deal with, retaining their nursing staff is among them.
However, Carroll County General Hospital finds itself in the enviable position of escaping the high turnover rate that other Baltimore-area hospitals experience.
Last year the turnover was 7 percent, according to the hospital -- half the metropolitan rate of 13.9 percent and the state rate of 14.2 percent.
"Those are impressive figures, and Carroll County General Hospital should be proud of them," said Catherine Crowley, the director of the Maryland Hospital Association's Center for Nursing and Allied Careers.
Crowley said that nurse turnover goes through cycles, but has been declining since 1987. Turnover rates in the 1980s were as high as 25 percent.
"People who come here from other hospitals are impressed with the caring attitude and the friendly environment. They always comment on how everyone is so friendly," said Judy Sneeringer, the nurse recruiter for Carroll County General.
She said her job has become much easier in recent years. A lot of trained nurses have moved into Carroll County, giving her a large pool of potential employees. But more important, CCGH has worked to become a more attractive place for nurses to work.
Sneeringer said that in the past three years, it has been much easier to recruit nurses for the hospital because the management decided to increase their pay to be competitive with other hospitals in the area.
The hospital's management has also created an attractive work environment, said Linda Harder, a vice president for planning and marketing.
Improvements range from mundane elements such as scheduling to more esoteric factors of professional development.
Perhaps the most important change in the nursing profession has been the "clarification" of the nurse's role in medical care, Crowley said.
"The nurse has always done valuable things for the patients, but some of these duties have been switched to others," she said.
Instead of having nurses doing everything from making beds and bathing patients to dispensing medicines, monitoring machines and filling out forms, the purely custodial and clerical duties have been transferred to nursing assistants, orderlies and clerks.
At CCGH, this has resulted in nurses having more responsibility for patient care, said Sneeringer.
"At our hospital we don't have interns and residents checking the patients," she said. "You get opportunities to do things here that you don't get at other hospitals."
Sneeringer gives much credit for the emphasis on professional development to two administrators -- Deanna Dell, the vice president for nursing, and John Sernulka, the hospital's executive vice president.
They were instrumental in creating "clinical ladders," which allow nurses to be recognized and rewarded financially.
In the past, nurses had to become administrators in order to receive more money. Under this system, nurses get more professional training and better pay while still working directly with patients.
When nurses have more responsibility, they get more fulfillment from their jobs, Sneeringer said.
"We have the expectation that you are good, and that gives nurses the opportunity for professional development."
Scheduling has been changed so that a nurse can work any variety of shifts. In addition to the three standard eight-hour shifts, the hospital created shifts to accommodate modern lifestyles.
Sneeringer said a weekend option shift enables nurses to work 12 hours each on Saturday and Sunday and receive pay for 36 hours. Nurses working this shift are considered full time and eligible for all employee benefits -- sick pay, pension and health -- insurance.
Another special shift is a daily 7 p.m. to 11 p.m. part-time shift that allows mothers to stay home with their children until their husbands come home.
Even the day shift has been designed so that it is attractive to working mothers. It ends at 3 p.m., which allows them time to get home to meet children returning from school.
Sneeringer said other hospitals have tried to hire away nurses from CCGH, with little success.
She cited a nurse who lives in Frederick County and was offered a position at Frederick Memorial Hospital. She refused it, though she would have saved more than an hour of commuting time.
"Most of the nurses live in the area, but we have some that commute great distances. One person comes in from Hagerstown to work three 12-hour shifts," Sneeringer said.
With nurses staying on the job longer, Sneeringer is finding that she doesn't have to work as hard as she used to.
"When I started in this job, we had a vacancy list that was three pages long, and now it barely fills half a page," she said.