They are making headlines across the country and prompting more than a few people to reconsider career choices—the generous sign-on bonuses hospitals and healthcare systems are offering as they compete for a limited number of nurses.
In El Paso, Texas, the Hospitals of Providence recently upped its $20,000 sign-on bonus for RNs to $30,000 as it sought to recruit graduates of the nursing program at the nearby New Mexico State University campus in Las Cruces.
In South Dakota last year, Monument Health offered sign-on bonuses of $40,000 for intensive care and operating room nurses. The numbers are even more impressive when one considers that Bureau of Labor Statistics estimates that the median annual pay for registered nurses in 2021 was $77,600.
But while financial incentives may be enticing and bring new nurses in the door, research shows that they are but one—and far from the most important—piece in the complicated puzzle of nursing recruitment and retention. Building and retaining a nursing workforce requires hospitals and healthcare systems to consider larger systems and culture issues.
A longstanding problem
Nursing can be a physically and psychologically demanding profession, characterized by long shifts and competing priorities. It is not surprising that retention of nursing staff is a problem which has plagued hospitals since long before the pandemic. A 2017 survey of healthcare systems identified an annual turnover rate among RNs of 14.9%.
COVID only exacerbated the situation. In 2022 testimony presented to the Employment and Workplace Safety Subcommittee of the Senate Committee on Health, Education, Labor and Pensions, the American Hospital Association (AHA) cited an annual turnover rate among nurses of 18.7% in 2020. By November of 2021 32% of nurses surveyed by McKinsey expressed an intention to leave their current positions.
In the McKinsey study, nurses choosing to leave positions were most likely to cite “insufficient staffing levels” among their reasons. Inadequate reimbursement ranked second, only slightly higher than “not listened to or supported at work.” Among nurses choosing to stay in their positions, adequate compensation ranked eighth among deciding factors, immediately after “feeling valued by organization” and “feeling valued by manager” and well below the top motivators of a “safe environment” and “work/life balance.”
Nursing annually ranks as being perceived as the most honest and ethical profession in a national Gallup poll. But the pressure of this public trust and expectation may add to the psychological pressures of continuous giving that leads to compassion fatigue. Overall, Nurses experience higher rates of depression, anxiety, and suicide than the general population.
Strategies
The AHA has promoted a four-prong strategy to establishing trust and resiliency in nursing teams. Based upon research conducted by Oliver Wyman consultants, the approach includes continually asking staff what matters to them, taking visible action to respond to staff concerns, modernizing staffing models to allow for greater flexibility in scheduling, and scaling up the adoption of technology.
Research has also identified the importance of providing mentorship and support programs for new nurses, who, even before the pandemic had a turnover rate of 17.5% in their first year after graduation. Regrettably, providing effective mentorship can stretch already limited personnel.
Policy solutions
The pandemic brought national attention to the physical and psychological stresses faced by healthcare providers, including members of the nursing profession. Congress has taken steps to address these. The Dr. Lorna Breen Health Care Provider Protection Act, named for a frontline physician who took her own life, became law in March. It directs the Department of Health and Human Services (HHS) to “award grants to hospitals, medical professional associations, and other health care entities for programs to promote mental health and resiliency among health care providers” and to conduct a campaign to encourage health care providers to seek support and treatment for mental health concerns.”