Correctional Workforce Project, Phase II: Recruiting and Retaining Health Care and Education Staff

Editor’s Note: This is an edited version of the executive summary of the Phase II Workforce Project Report, commissioned by the American Correctional Association.

Informed observers unanimously share the view that health, mental health, and educational services must and will play an ever-increasing role in America’s correctional institutions.

As part of Phase II of its Workforce Project, the American Correctional Association conducted a survey of correctional health care professionals, mental health treatment professionals and correctional education staff in the spring of 2008. That survey focused on administrators of adult correctional agencies, including state and federal departments of correction as well as jails. A subsequent supplemental survey in the fall of the same year focused on directors of juvenile correctional agencies. Phase I of the project was completed in mid-2004 and focused primarily on correctional security staff. Both phases of ACA’s Workforce Project were funded by the U.S. Bureau of Justice Assistance and the reports were prepared by Workforce Associates Inc. of Indianapolis.

Who responded? A total of 48 replies were received from administrators of adult agencies, and nine replies were recorded from directors of juvenile agencies. The small number of juvenile corrections directors who responded to the supplemental survey robs that survey’s results of statistical significance but, insofar as those results tend to corroborate those received from officials of adult agencies, they are of interest and are included in the report. Altogether, valid responses were received from 33 states, the District of Columbia and the Federal Bureau of Prisons.

Survey Focus

Both the main and the supplemental surveys focused specifically on the recruitment and retention of professionals who deliver health care, mental health treatment and education in correctional institutions.

·             •  For each group of these professionals, the surveys sought to learn how easy or
        difficult it was to recruit and retain talent;

·             •  Where difficulties were perceived, they sought to uncover the main reasons for those
        difficulties;

              •   The surveys also sought to discover whether and to what extent correctional
        agencies were outsourcing these professional services; and

·             •  Finally, an attempt was made to uncover “promising practices” known to the
        respondents in the areas of recruitment and retention. This portion of the surveys was
        not particularly fruitful; just five of the adult agency respondents and none of the
        juvenile agency respondents indicated that they were aware of such practices and
        offered to share their knowledge thereof.

Recruitment is difficult for a majority of all occupations for both types of agencies as is shown by the following table. Retention of these professionals is also challenging but much less difficult than recruitment.

    •   Nurses are hard to recruit and retain.

o   Registered nurses (RNs) are the most difficult occupation for adult agencies to recruit and retain.

o   Licensed practical nurses (LPNs) and/or licensed vocational nurses are difficult to recruit and retain.

·            •  Educators are the least difficult of all these occupations to recruit and retain.

What causes the difficulties?

Respondents were asked why they thought it was difficult to recruit and retain correctional employees in each of the occupations considered in the surveys.

Labor market factors are the main reasons causing difficulty in recruitment. Three of the first four potential reasons relate to the labor market conditions prevailing in the local or statewide environments of respondents’ agencies. They are:

·             •  Noncompetitive salary scales and benefits;
     •  Competition with other local employers; and
     •  Shortage of qualified candidates in the work force pool.

The other potential reasons are a mixture of factors relating to candidates’ perceptions of the nature of work in correctional institutions and circumstances of the work. The tables below pertain only to the responses from the survey of adult correctional agencies as the number of responses from juvenile directors was too small.

A very important finding. For every occupation considered in the survey it appears that one of the three economic factors is the main cause of recruiting difficulty. For four of the five occupations (educators being the exception), it was noncompetitive salaries and benefits that was deemed the most important culprit. Competition from other local employers was cited as the number one reason for difficulties recruiting educators.

After the labor market factors, it was the location of correctional institutions that bedeviled recruitment for all occupations except educators. For those, it was the work schedule of correctional institutions that made hiring difficult. Educator was also the only occupation that respondents perceived to be deterred by personal safety concerns from accepting employment in correctional institutions.

Quite a few respondents thought that job applicants lacked a realistic knowledge of professional career opportunities in corrections and also that a negative stigma attached to such careers played a role in discouraging qualified candidates. On the other hand, very few respondents attributed much importance to shortcomings in their institutions’ recruitment practices or in working conditions or an absence of career prospects in corrections.

Labor market factors also account for much difficulty in retention. Two labor market conditions were provided among the possible reasons for difficulty in retaining workers in correctional institutions:

·              •  Competition from other local employers; and
      •  Inadequate pay and benefits.

One or another of these labor market conditions were tagged among the most important reasons for employee retention for three of the five occupations considered. 

Onerous hours and shift work was cited as the most important reason for recruitment difficulty in two occupation categories, doctors and dentists, and psychiatrists. This reason was frequently cited also for educators. Lack of occupational prestige was a very close second for doctors and dentists, and psychiatrists.

Stress and burnout was the third most frequently cited reason why nurses leave correctional employment.

Outsourcing plays a modest or minor role in the provision of health, mental health and educational services. Outsourcing plays a modest role in the provision of health and mental health services and a minor role for educational services for adult agencies. 

·               •  Only about half the respondents indicated that health and mental health services were
         provided to any extent by outside providers.
       •  Fewer than 25 percect of respondents said that educational services were
         outsourced to any extent.
 

Health professionals are hard to recruit elsewhere, too. Corrections is not alone in its struggles to recruit and retain health care professionals. Practically every study done of the health professions, within any region or industry, generates a similar set of responses. The 2007 National Physician and Nurse Supply Survey collected 402 completed responses from hospital administrators across the country in the early months of 2007. The results of this survey included the following:

·                •  With respect to nurses:

o   89 percent of respondents were currently seeking to employ nurses.

o   86 percent said recruiting nurses was either “extremely” or “somewhat” difficult and challenging.

o   46 percent said that the process of recruiting nurses was more difficult than two years ago, while 31 percent said it was less difficult and 21 percent perceived no change.

·                •  With respect to physicians:

o   86 percent of respondents among hospital administrators said that they were currently seeking to recruit physicians.

o   94 percent said recruiting physicians was either “extremely” or “somewhat” difficult and challenging.

o   51 percent said it was more difficult to recruit physicians than it was two years previously, whereas only 10 percent said it was easier.

Rapid recent job growth for health and mental health professionals. The study summarized here contains graphs that characterize the changing national demand for health, mental health and educational professionals in recent years. For each occupation, the numbers of job postings in mid-2008 compared to early 2005 were as follows:

        •  RNs: Up 45 percent
        •  Physicians: Up nearly 50 percent
        •  Dentists: Up 75 percent
        •  Mental Health Treatment Professionals (MHTPs): Up 75 percent
        •  Psychiatrists: Up by 225 percent
        •  Educators: Down by about 10 percent

Future national labor market prospect for health, mental health and educational professionals

According to the U.S. Bureau of Labor Statistics, the demand for most professionals in the health, mental health and education professions will continue to increase through 2016. These BLS data indicate that correctional agencies will find themselves in even fiercer competition for workers in these occupations than they do now or have in the past.

RNs. Total job openings for RNs by 2016 will equal nearly 40 percent of the entire RN work force in 2006. That is a significantly higher percentage than the average for all occupations (33.7 percent). The nation’s RN shortage is likely to persist well into the second decade of this century. These developments in the nation’s labor market mean that those correctional agencies now experiencing difficulty in recruiting and retaining RNs can anticipate little or no relief.

LPNs/LVNs, dentists and doctors. Job growth for these occupations will be somewhat less frenetic than for RNs in both numerical and percentage terms. Nevertheless, the job market for these professionals is likely to be as tight as, or tighter than, it is at present. That is because a large share of the incumbent workers in these occupations (especially LPNs/LVNs) must be replaced because of retirements, transitions to other occupations and other causes.

Mental health occupations. BLS expects a veritable explosion of jobs for counselors and other specialists in the fields of substance abuse, rehabilitation and mental health. It projects a rapid 34.9 percent growth in jobs for substance abuse and behavioral disorder counselors. Total job openings during the decade will come to more than 60 percent of the total number of job-holders in 2006. Labor market prospects for most other MHTPs are only slightly less bullish.

Of course, what is good news for workers and aspiring workers in these occupations is hardly good news for corrections employers. The latter will see themselves increasingly squeezed between a rapidly growing need for MHTPs inside their institutions and a sharply tightening national labor market for those same professionals outside of corrections.

Educators. The future employment outlook for educators appears less daunting from the employers’ perspective than for health and mental health professionals. BLS projects that the number of secondary school teachers will grow by less than 5 percent between now and 2016. The nation’s labor markets for educators will tighten, not primarily because of job growth but, rather, because of a rising need to replace an aging cadre of teachers and because of exceptionally high turnover for teaching professionals below the post-secondary level. The total number of job openings for educators as a percentage of the number employed in 2006 exceeds the comparable number for all occupations. The correct conclusion is that the difficulty of recruiting and retaining educators depends heavily on the specific circumstances of work schedules, human resource management and location. Creative work regimes and human resource management practices have the potential to alleviate such difficulty even in hard-to-serve locations (e.g., rural communities in which many correctional institutions are located).

Promising Practices

For every occupation the 2008 ACA survey examined, there was a question asking, “Are you aware of any promising practices that are being used to recruit correctional professionals in [name of occupation] that you can share with us?” Those questions elicited a tepid response. In total, five adult agencies respondents said “yes” to the question. The following table shows the distribution of those positive responses among occupations. 

Note: Two respondents replied positively for two occupations.

Attempts were made to follow up by telephone with all five of the respondents who volunteered to share their awareness of promising practices. Although only three of those attempts were successful, they provided a useful list of “promising practices.”

        •  Use “headhunters” to assist in recruitment.

·                 •  Structure internships for student nurses by arrangement with schools of nursing. The
          objectives are to “get candidates in the door” and overcome whatever concerns
          they may have, and to establish personal relationships with potential candidates.

·                 •  Encourage staff to participate in nursing school and other educational classrooms as
          instructors, teaching assistants and resource people. The purpose is to overcome
          misconceptions about correctional nursing.

·                 •  Offer flexible work schedules including part-time work, reduced work weeks (e.g.,
          one day per week), on-call, etc.

·                 •  Outsource all or hard-to-fill occupations with private staffing agencies specializing in
           the provision of nurses and other health and mental health professionals.

·                 •  Conclude retainership contracts with local specialists (e.g., oncologists, surgeons) to
          provide specialized services.

·                 •  Provide student loan repayment assistance as retention motivators.

·                 •  Provide tuition and other financial assistance for student LPNs/LVNs and other
          qualified candidates wishing to study to become RNs in return for agreements to
          take/retain employment. For correctional employers in rural and other hard-to-serve
          locations, this strategy seems to work best when candidates are mature persons with
          residential “stakes” in the local communities.

·                 •  Institute collaborative arrangements with medical schools whereby young faculty
          candidates agree to serve three years as physicians and psychologists in state
          correctional institutions as a step toward tenure-track appointments.

 To read the entire report, please visit ACA’s Web site at http://www.aca.org/workforce/pdf/PI2009_CompleteReport.pdf.

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