The U.S. is facing a serious nursing shortage.
It’s a situation that’s only expected to get worse with the aging baby boomer population, the continued dearth of nurse educators and long waiting lists at nursing schools.
The U.S. Bureau of Labor Statistics predicts the number of RN vacancies will be nearly 1.2 million between now and 2022. While a nursing shortage may bode well for nurses, it is a problem for employers who face stiff competition when trying to recruit, hire and retain qualified nurses.
So what can nurse recruiters, hospitals and health systems do to stay on top of the game and achieve better staffing levels? Employing innovative strategies to attract, hire and retain nurses is essential to combating the nursing shortage, according to several experts in the field of nurse recruiting.
More data-driven hiring needed
John Sullivan, Ph.D., a professor of management at San Francisco State University, and an internationally known human resources expert and thought-leader from the Silicon Valley, said he is not optimistic that the nationwide nursing shortage will end soon. He believes recruiting and retention decisions in healthcare are not as data driven as they are in many other industries.
Sullivan said healthcare organizations need to ask many questions of nurse interviewees and newly hired nurses to track the effectiveness of their recruitment strategies.
“When a nurse chooses an employer, why does he or she choose to work there, and not at another hospital?” he said. “After you hire people, find out why they took your job over another. You’ll also want to ask RNs that turned you down — why?”
Sullivan said it is also important for employers to know how nurses search for work. Do they prefer attending job fairs, reading newspaper ads, searching online, or seeking referrals from friends and colleagues? This can help recruiters focus on those avenues where nurses most commonly seek employment, he said.
Referrals lead to quality hires
“By far, the highest quality nurses and the greatest volume of hires typically come from direct referrals,” Sullivan said. “Top performers usually have a great network of colleagues who are also high performers. It behooves recruiters to ask their best nurses, ‘Who was the best person you worked with? Who was your best nurse manager?’”
Sullivan said another way to identify quality nurses is to ask the employment references who recommended outstanding nurses to suggest other possible candidates. These individuals often are aware of other qualified nursing candidates, he said.
Jack Blake, senior director of human resources and talent acquisition with Scripps Health in San Diego, said in addition to the nationwide nursing shortage their health system is facing nurse recruitment competition from two other regional health systems.
He said changing the hiring mindset of nursing managers is essential to employing new nurses.
“The line of thinking from a manager’s standpoint needs to change from the commonly held and current view of ‘Why should I hire you?’ to ‘Why would a nurse want to work in my unit or department?’” Blake said. Managers need to know how to sell their organization and department, as salaries alone are typically not the only factor in recruiting and retaining nurses, he noted.
“It’s not all about the money,” Blake said. “Some people leave for higher pay, then come back.”
Blake said many nurses want the opportunity to transition into other specialty areas, such as the ICU, ER and OR. “The question we faced is: How do we identify our own RNs who want to move into a specialty, rather than steal nurses from competitors?”
To address this issue, Blake said Scripps Health implemented an in-house training program to help build employee loyalty. “Employees appreciate when we invest in them,” he said.
Nurse leadership development helps retention efforts
Laura Wightman, system chief nursing officer at Regional Health in Rapid City, S.D., said to retain quality nurses it’s important to have good nursing leaders and a positive culture within the organization. Many nurses leave their jobs due to poor managers and pervasive workplace incivility, especially during a nursing shortage, she said.
“Many organizations overlook the first-line supervisor, who usually has the most interaction with nurses,” she said. “To help reduce turnover, we hone in on leadership development, from executives to directors to managers to charge nurses. Better performing leaders help with staff retention. We had an 8% improvement with retention after implementing our leadership development program.”
Regional Health began its leadership development program in March 2016 and initially focused on leaders at the level of director and manager. In November 2016, the program expanded to include charge nurses, Wightman said.
Regional Health also conducts in-services for all departments and all shifts, addressing expected standards of behavior, Wightman said. She noted they also teach staff how to deal with bullying by empowering them with improved communication skills. Wightman teaches the in-services, and over the past three months has conducted an average of one-to-two sessions per week.
“My goal is to present to every nursing department throughout our organization, including hospitals, clinics and nursing homes,” she said. “In addition to a formal presentation, we’ve developed a professional-image policy for nursing that addresses attire, personal appearance and the expected behaviors, such as collegiality and a caring attitude. The culture needs to be excellent if you want people to stay.”
Wightman said many nurses are also looking for loan forgiveness and scholarship programs. “We started a BSN completion program for current employees, offering full payment for a BSN as a retention strategy,” she said. “Our first program had 40 applicants for 20 slots.”
Regional Health also has an internship program for existing employees looking to move into specialties such as the OR, OB and ICU, according to Wightman.
The health system offers an externship program for up to 35 nursing students each summer. “The students work with different preceptors in different areas,” Wightman said. “This is one way for us to see which students are good workers and talented.”
Strong onboarding programs are key
An onboarding program, called Route 365, initially started with nurses but now includes all employees of Regional Health.
“Turnover rates can be high for first year staff due to many reasons, some work-related but others, too, such as an employee’s spouse (being unable to) find work, housing challenges and school concerns for employees with children,” Wightman said. “We regularly connect with the new employee before their first day, after they start and throughout their first year of work to see if things are going well and, if not, why not?”
Having good managers, helping managers grow as leaders, having a strong onboarding process and continuous leadership development are integral to attracting and retaining nurses, according to executive nurse recruiter Rae Ellen Douglas, managing partner and director with Kaye/Bassman International in Columbus, Ohio.
“Setting realistic expectations for nurse managers is also important,” she said. “Some have so many meetings they’re not visible or accessible to their staff, creating distance between staff and management.”
Also, having realistic nurse-to-manager ratios, such as 25 employees to one manager rather than 50 or more per one manager, makes staff feel they have someone who is more approachable to go to for work-related concerns. This is extremely important during a nursing shortage because nurses have so many other employment options.
“I’ve seen some organizations return to using sign-on and retention bonuses to attract and retain RNs; and, at some urban hospitals, offers of free parking and gym memberships,” Douglas said. “We’re also seeing improved ratios regarding the number of RNs assigned to nurse managers, going back to 20 or 25 full-time employees per manager, as opposed to higher numbers.”