NOVEMBER 1988, VOL. 48, NO 5 AORN JOURNAL

Current Recruitment, Retention Strategies

hat a nursing shortage exists in this country T is not new. And with the rising demand for nursing services, the shortage may get worse before it gets better.

So, how are nurse managers and recruiters dealing with the shortage? What have they done to attract nurses? What have they done to retain nurses?

What follows is a list of some strategies recruiters and managers have tried. This is not meant to be an all-inclusive list, just some ideas that others have tried. The information was garnered from several sources: newspaper and magazine articles, a questionnaire sent to a random sample of OR ~ ~ p e ~ i s o r s (AORN members), and phone conversations with nurse managers and recruiters.

Salary increases. Most nurse managers and recruiters pointed to salaries as a major incentive for nurses, and most offer a salary competitive with other health care facilities in the area. Also, an increasing number of hospitals offer clinical career ladders.

St Luke’s-Roosevelt Hospital Center in New York City, an 891-bed facility, is trying to entice nursing students in their senior year to join the staff. Students who join are paid a $356-a-week salary for a 10-week student nurse assistant program.

Overtime incentives. As a tie-in with salary, some hospitals advertise lucrative incentives to work overtime. At Presbyterian Hospital, New York City, the 1,291-bed hospital offers registered nurses bonuses of $1,OOO for working more than 34 hours of overtime during a four-week period. With the bonus, an hourly wage for overtime can top $50.

Nurses working for the Franciscan Health System of New Jersey can earn bonuses and still take vacations if they agree to give up one of their summer vacation weeks. Nurses who agree receive overtime pay during the week plus a week of vacation to use later.

Flexible schedules, One type of flexible schedule that surfaced in many areas was a weekend-only type of working schedule. For example, at Seton Medical Center, Austin, Tex, a 491-bed hospital, nurses can work two 12-hour shifts on the weekend plus an eight-hour shift some other time during the week and receive a full- time salary and benefits (40 hours of pay for 32 hours of work). Another option is to work four night shifts and be paid for five.

“It’s a way for us to fill those time slots,” said Kitty Burton, RN, nurse recruiter at Seton Medical Center.

At Bronson Methodist Hospital, Kalamazoo, Mich, a 456-bed hospital, administrators offer a per diem pay schedule to attract nurses with families and nurses going to school. Nurses paid per diem must agree to work at least 32 hours every two weeks. Although they do not receive benefits, the hourly wage is higher. If per diem nurses want full benefits, they need to work at least 48 hours every two weeks.

“We have a number of family-oriented females,” explained Gail Durant, nurse recruiter, Bronson Methodist Hospital. “Working per diem allows them to get the kids to school, work a four-hour shift, then pick them up after school.”

Tahoe Forest Hospital District, Truckee, Nev, a 42-bed hospital, advertises that it pays $2 more per hour to per diem nurses than its competition. In addition, if a per diem nurse works six or more shifts per month, he or she gets a premium pay of $1 per hour for each hour worked.

Other flexible schedules include working three 12-hour days for three weeks and four 12-hour days the fourth week, job sharing, and 10-hour days.

Child care. This seems to be a popular strategy to retain younger nurses. Offers range from free care at or close to the health care facility to partial or full reimbursement for other day care.

Recruiting and/or signing bonuses. These

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AORN JOURNAL NOVEMBER 1988, VOL. 48, NO 5

‘Be responsive to nurses. Throwing money at the situation

is not always the solution.’

bonuses ranged from $500 to $2,000. Some paid just a recruiting bonus or just a signing bonus, others paid both.

Bonuses for recruiting a nurse usually are not paid until the nurse has worked at least six months; some facilities require a one-year stay. To keep nurm after paying them a starting bonus, one hospital pays half the bonus when the nurse starts and the other half at the end of the first year.

Tuition and education reimbursement. Many hospitals offer payments to cover education costs that pertain to relicensure. Options include outright tuition reimbursement payments (partial or full), low interest loans for tuition, and loans with repayment based on a work commitment.

Maid service. Full-time nurses at Callaway Community Hospital, Fulton, Mo, a 46-bed hospital, receive free housekeeping service twice a month. Because the hospital is close to Columbia, Mo, it faces stiff recruiting competition from the large urban hospitals in that city, said Mary Vanorden, director of marketing at Callaway Community Hospital. To compensate, the hospital organized a nurse recruitment panel, which included staff nurses, to brainstorm recruitment/ retention ideas. One of the ideas presented was free maid service.

Advertising. For hospitals in geographically desirable locations, location can be an advertising bonus. “We have no problem with recruiting because of our location,” said Kathy Green, nurse recruiter, University of California Davis (UCD) Medical Center, Sacramento, a 439-bed facility that advertises its close proximity to San Francisco, the California wine country, and Lake Tahoe. “But you have to market what you have. For example, smaller communities might advertise the lack of traffic and air pollution.”

Benefts package. At the UCD Medical Center, nurses are offered 100% medical and dental insurance coverage, including dependents, from the day they start. It is a bonus for new nurses

or relocating nurses-they can receive benefits without a waiting period.

Uniform allowances, four week vacations, 12 paid holidays per year, generous sick leave pay, and free parking were other benefits mentioned.

Training programs. Wisconsin has a unique statewide program for training welfare recipients to be registered nurses. Under the program, qualified recipients of Aid to Families with Dependent Children (AFDC) can qualify for 24 months of free training along with expenses for transportation and child care.

State officials have allocated more than $30 million for education and job training over the next two years. Officials are hoping to attract several hundred of the more than 90,OOO AFDC recipients to the nurse training program.

Recognition. The UCD Medical Center has a Committee for the Advancement of Nursing that, among other items, offers recognition awards to nurses.

At Bronson Methodist Hospital, nurses can participate in shared governance and take part in quality assurance and management decisions. According to Durant, it gives nurses positive input into nursing care. “Nurses must feel they have some control over

the quality of care the hospital provides,” she said. “It is important to them.”

Vanorden of Callaway Community Hospital expressed similar sentiments. “Be responsive to nurses,” she said. “Listen to what nurses say. Throwing money at the situation is not always the solution.

“Continuously monitor the market situation. How it is working, what you are doing,” Vanorden said. “What works in your area may not work in all areas. You have to present the hospital as a good place to work.”

PHILIP K. LAMMERS ASSISTANT EDITOR

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