Like so many highly skilled professions, nursing — particularly those who work in settings like the emergency room or operating room — is experiencing a shortage of workers. But unlike the other professions in similar talent droughts, nurses can’t be wooed with the promise of remote or hybrid work.
Instead, hospitals are trying a number of methods to retain and attract nurses, including signing bonuses, student loan forgiveness and a shorter, more flexible workday.
“Flexibility is a word that has come up a lot,” said Amy Pisciotta, a managing director at the executive recruiting firm Ferguson Partners’ and leader of its healthcare practice.
“Organizations that were wholly unwilling to do that before with their nursing staff are becoming much more flexible with their shifts. They’re saying, ‘Instead of you having to fit our schedule, we are willing to fit yours.’ That is a fundamental shift.”
It’s something Yale New Haven Health Systems [YNHHS], which has five hospitals across Connecticut and Rhode Island is trying. In late 2021, the hospital system started offering four and six-hour shifts, a significant move from the industry-wide standard 12-hour schedule. Nurses on those shorter shifts are paired with others working the same hours and tag-team to make up a 12 or eight-hour day. One learning from this new schedule is that more people opt for the six-hour workday since it optimizes patient care.
With a four-hour shift, “You blink your eyes and it’s time to leave,” Beth Beckman, YNHHS’s chief nursing executive, told WorkLife. “We’re open to making life work with their work-life.”
Flexibility is something the National Nurse Think Tank, a collaboration of front-line nurses, nursing leaders, HR representatives and hospital executives, is studying. The group published a “tool kit” of priorities and recommendations to improve staffing within 12 to 18 months. One of the major conclusions: The need to “build a flexible workforce with flexible scheduling, flexible shifts and flexible roles,” according to a report from the group.
One of the recommendations is to staff up and down based on seasonal, geographic and demographic needs. To achieve that, the report suggests tapping retired nursing to pick up assignments based on demand.
Why is there a shortage?
The nursing shortage has existed for decades, well before anyone heard the term Covid-19.
One cause is the aging population that requires more healthcare, creating a greater need for RNs. Along the same lines, a significant chunk of Baby Boomer nurses reached retirement age in recent years.
The pandemic took the shortage to new levels. Nurses suffered from burnout, mental health breakdowns after witnessing so much morbidity, feelings of helplessness and isolation. For the most part, infrastructure to treat those issues didn’t exist. As a result, many migrated from working in hospitals to less emotionally and physically demanding practices such as ambulatory outpatient centers.
But there’s another, perhaps more frustrating, factor preventing interested — and qualified — students from entering the profession: There are simply not enough faculty available to teach at nursing schools. The shortage of professors — entry-level educators are required to have a Masters of Science in nursing and many institutions require a doctorate — has reached such dramatic heights that the University of Florida’s College of Nursing, for example, turns away two “qualified” students for every one that they admit.
The school currently has 20 open faculty jobs, according to its dean, Anna McDaniel.
That’s indicative of what’s happening nationally. The American Association of Colleges of Nursing reported nursing schools turned away 80,407 qualified applications from baccalaureate and graduate nursing programs in 2019 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. Most respondents cited faculty shortages as a top reason for not accepting all qualified applicants into their programs.
Getting nurses into hospitals
There’s a huge push among hospitals to offer financial incentives. Signing bonuses are on the rise. In July 2019, the number of nursing roles offering a signing bonus on the job site Indeed was 6.2%. That jumped to 18.1% this July.
Another tactic is assistance with student loans. Last month Yale New Haven Hospital System began offering full-time nurses on its staff a direct payment of up to $4,000 a year, paid monthly through EdAssist. It caps at $20,000 over five years. They also began providing counseling and financial coaching for the Public Service Loan Forgiveness, which wipes student debt after 120 on-time, consecutive payments.
“The $4,000 a year really sets them up for perfect payment for the first half of their 10-year requirement,” Beckman said. “We’re going to help them by paying their student loan for five years, but also help them understand how to get through the full forgiveness.”
While all of this helps, Amanda Bettencourt, Ph.D, president of the American Association of Critical Care Nurses, says it’s triage, not a long-term solution. She pointed to the results of its 2021 National Nurse Work Environment survey as evidence that more needs to be done: 67% of the participants said they plan to leave their current position within the next three years.
And while compensation certainly helps, there are other factors that would go a long way, she said, such as on-site childcare, retirement planning solutions and mental health support.
“Hospitals need to retain nurses, not just recruit nurses,” Bettencourt said. “This means understanding and addressing the factors that drive nurses to leave, such as unhealthy work environments. Focusing on improving the health of the work unit, offering flexible shifts, including nurses in the decisions that affect their work, creating opportunities for professional development, and recognizing expert nurses for their mentorship are all strategies that can reduce nurse attrition.”