During a Chief Nursing Officer roundtable discussion convened in January by Avant Healthcare Professionals, participants cited nurse recruitment and retention as a key issue faced by nearly every facility and system. The complex problem of the nursing shortage is expected to worsen over the next decade, which means CNOs must continue to focus on retention efforts and must consider innovative ways to address the unique challenges of retaining millennial nurses, in particular.
Evolution of a crisis
The United States has endured numerous nursing shortages across the decades. The 1930s saw an acute decline in practicing nurses toward the end of the Great Depression, and when thousands of nurses joined the war effort in the 1940s, civilian hospitals again experienced a serious shortage of nurses.
After World War II, the Baby Boom generation fueled growth in the nursing population, thanks in part to the 1964 Nurse Training Act, which provided funding for nursing education, and to the improved nursing salaries offered by hospitals after the passage of Medicare and Medicaid legislation around the same time. This influx of nurses helped alleviate the minor nursing shortages that came and went throughout the rest of the 20th century, but a crisis began brewing around the year 2000 due to increasing demand coupled with dwindling supply.
Today, a confluence of events is pushing the U.S. into the greatest nursing crisis it has yet seen. As Baby Boomer nurses retire, they remove themselves not only from the clinical workforce but from faculty positions at nursing schools. Without enough faculty members, those schools can’t educate enough nurses to replace the ones who are retiring. Furthermore, the Baby Boomer generation in general, including those retired nurses, will create an influx of patients to the system at precisely the time when there aren’t enough nurses to provide them with care.
A focus on recruitment and retention
Particularly in markets where multiple hospitals and health systems must compete for a shrinking pool of nurses, recruitment and retention must continue to be a major focus for CNOs. Collectively hospitals spend billions of dollars each year on signing bonuses, increased nurse salaries, student loan repayment and other incentives to attract and retain nurses, but with an average turnover cost of around $48,000 per bedside RN, retention clearly benefits any hospital by saving money over the long term.
CNOs report feeling challenged by the new generation of millennial nurses, however, when it comes to retention. These nurses may need help to see the benefit of staying with a single organization long-term, and they may value non-financial perks like personalized job coaching and on-site daycare as much as having their loans paid off. Savvy CNOs will in order to better retain millennial nurses.
Nurse executives also should consider low-cost strategies to boost nurse retention. Tactics like incentivized shifts that accrue points to be redeemed for small but meaningful rewards can make a positive impact on retention rates.
“We worked with one hospital to customize our scheduling software to highlight incentivized shifts to reward nurses for choosing them,” said Shane Parker, RN, co-founder and Chief Nursing Officer of Shift Wizard. “The nurses who chose those shifts through the self-scheduling system earned points that were later redeemable for rewards like a premier parking space or early access to shift choice or to be entered into a drawing for tickets to see the local major league baseball team. These incentives didn’t cost the organization a lot of money, but the nurses were very pleased with the organization’s creativity in providing them with fun opportunities to earn something extra for their efforts.”
Long-term strategies to address the nursing shortage
Developing extensive nurse recruitment and retention strategies is a must for every CNO today, but those efforts only address the immediate impact of the nursing crisis. Over the long term, organizations will need to look at devoting resources to basic nursing education, partnering with universities and other nursing schools and plotting a long-term plan to stabilize the nursing population over the next several decades. Through a combination of immediate financial investment, staff engagement strategies and low-cost incentives, hospitals and health systems can position themselves for ongoing success in nurse recruitment and retention.
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