Nursing shortage has been an issue for sometime now in the country. The causes are varied and have been discussed in many articles in the recent past.
The purpose of this article is to explore the strategies US Hospitals are employing to overcome the nurse shortage.
The remedy of a problem is dependent on its cause. This is no different here. Since the causes of shortage of nurses are varied the 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 the country , dissatisfaction among nurses because of shift work, mandatory overtime, insufficient pay, lack of a career ladder are some of the common causes.
Many nurses are choosing Temp. work as it pays more money and allows some control over work hours and benefits.
In the private sector the turnover is higher then in the govt. sector.
Hospitals are doing all sorts of things to recruit and retain the nurses.
Financial incentives to recruit nurses are temporary fix in general. These do not guarantee retention of the nurse in the 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 the hospitals, nurses themselves as well as the government and the nursing organizations will be needed. Image building , making the profession attractive are the sort of things which will take time but will have lasting effects.
For the short term it is the hospitals which have to deal with the 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 the 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 the 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
• 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 the 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
• 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.
• Flexible Spending Accounts.
• Employee Health Services
• On-Site Fitness Centers
• Lectures, Training & Workshops
• Massage Therapy
Vacation, Leave & Time Off
• Paid Time Off (personal, sick, holidays) with annual cash-out option
• Extended Illness Bank
• Family & Medical Leaves
• Personal Leaves
• Bereavement Leave
• Paid Military Leave
• Sunshine Fund (no interest loan & donations to employees in need)
• Pension Plan with Employer Matching Contributions
• Adoption Benefit (up to $4,000)
• Credit Union (free checking, low cost loans)
Traditional benefit packages are not always sufficiently alluring to nurses. It is possible that employee benefits could be used more effectively to retain nurses and reduce costly staff turnovers
One example is payroll reduction program commonly known as 125 Reimbursement Plan. Using this plan the employee can allocate a pre tax dollar amount per year which is anticipated as potential expense to cover health and welfare expense.
The employer avoids having to match FICA tax and workman compensation expense by reducing the amount of income upon which these figures are calculated.
Not only does the employee net take home pay increases but the employers matching FICA taxes and related pay roll expenses are reduced (consult your tax advisor for more details on this program).
• Annual Employee Survey
• Roundtables with CEO, VPs
• System and Divisional Townhall Meetings
• Staff Meetings & Committees
• Reward & Recognition Task Force
• Roving Cart (suggestion box)
• Nurse Week Activities
• VP Rounds on Nursing Units (all shifts) during Weeks On-Call and for Special
• Employee of the Month and Year Awards
• Employee Service Awards
• 5&10 year plaques
• 15 year dinner
• 20+ year banquet
• Special Performance Awards – Recognition at Annual Employee Service Awards
• Celebrate, Motivate and Decorate Task Force
Collaborative efforts between health care organizations, societies, hospitals , private sector.
• In San Diego, six hospital systems have committed $1.3 million to support a program called, “Nurses Now”, which will add faculty and additional student slots to San Diego University.
• The American Hospital Association News reports that in Laredo, Texas, a hospital CEO worked with Texas A&M University to develop a four-year bachelor’s program and is providing $425,000 in scholarships to local students over the next five years.
• In Morris County, New Jersey, the Board of Freeholders offered scholarships to students who agreed to work in a long term care facility.
• The Dallas-Fort Worth Hospital Council raised $600,000 to expand student enrollment at local schools.
Magnet Hospitals: This elite class of hospitals generally do not have problem with high nurse turn over and recruitment. These classes of hospital (only 1-2 % of all US Hospitals) attain and keep this designation only if they meet stringent standards and ongoing 4 yearly evaluations.
“The label ‘Magnet hospitals’ originally was given to a group of U.S. hospitals that were able to successfully recruit and retain professional nurses during a national nursing shortage in the early 1980s. Studies of Magnet hospitals highlight the leadership characteristics and professional practice attributes of nurses within these organizations… Hospitals selected met the following criteria: 1) nurses within the hospitals considered them good places to practice nursing, 2) the hospitals had low turnover and vacancy rates, and 3) the hospitals were located in areas where there was significant regional competition for nursing services.” (JONA, January 1999). Magnet designated health care organizations consistently outperform their peers in recruiting and retaining nurses, resulting in increased stability in patient care systems across the organization.
Foreign nurses/Importing nurses.
Philippines is the largest source of foreign nurses. Nurses from many other countries including Europe have come recently and in last many years to work in the US.
WWW.CGFNS.ORG is a US based agency that has the authority currently to screen foreign nurses for eligibility for state licensing boards and work visas.
Acquiring the services of foreign nurses is not new in the US. Recently the number of non-US origin nurses has increased significantly.
A number of hospitals are using programs to hire foreign nurses. This is not an easy task as the process is tedious and takes months and may be years.
CGFNS (Commission on graduates of foreign nursing schools) is one source of information for this process. Hospitals generally use recruiters specializing in this area and immigration lawyers to hire foreign nurses. Foreign nurses have to show that their training is adequate, they are proficient in English language and are eligible for visa otherwise
To summarize it seems that the major influences on recruitment and retention are salary and raises, benefits, shift rotations and scheduling flexibility , staff communications , tuition reimbursements, type of nursing care delivery system, nursing leadership, reputation of the hospital and responsive management.