Department Focus: Human Resources--Recruit, Then Recruit Again

Many hospitals are realizing that keeping the best talent at the bedside takes a lot more than a signing bonus.

Like many relationships, the one between a nurse and a healthcare organization can sour after the honeymoon phase is over and the gleam of the sign-on bonus or tuition reimbursement wears off. To keep crucial employees incentivized--and away from competitors--many hospitals and health systems are building "re-recruitment" programs.

Franklin Square Hospital Center, a 357-licensed-bed general acute-care facility in Baltimore, partnered with the University of Maryland and area community colleges to launch a nurse extern program for students in their last year of study. The program pairs experienced registered nurses with the new nurses, who participate in the care of patients in a mentoring relationship. Nearly 90 percent of the new nurses stay with the hospital once the students graduate, says Larry Strassner, MS, RN, Franklin's vice president of patient care and chief nursing officer.

Such mentoring relationships help ensure that re-recruitment is successful, says Linda Q. Everett, immediate past president of the American Organization of Nurse Executives and current executive vice president and chief nurse officer of Clarian Health in Indianapolis. Graduates entering nursing today are faced with myriad challenges, from transitioning to a hospital environment to understanding regulation changes, says Everett, and mentoring helps sustain them through that crucial first year.

Strassner, however, adds that Franklin's re-recruitment is successful due in large part to the hospital's emphasis on the "hierarchy of needs": compensation and benefits, predictable income, flexible scheduling and professional growth.

Franklin offers competitive compensation (in the 75th percentile), as well as the opportunity to gain biannual retention bonuses based on days worked and years employed. To keep the flow of income predictable, Strassner makes sure nurses hired for days only work the day shift, and those hired for nights only work nights. "This is a huge staff satisfier," he says, because there is no switching back and forth, which can be disruptive--especially for those caring for children or elderly parents.

For nurses who want to switch shifts, Franklin offers a menu-style system that shows an employee the pay and benefits associated with a specific schedule that he or she would like to work. Once a nurse decides on a new schedule, Strassner can shift the nurse's job plan accordingly. Job plans and compensation structures can also be changed if a nurse decides to actively pursue professional development. With the clinical ladder program, another crucial re-recruitment tool, nurses are provided with a menu list of development opportunities, such as Web-based continuing education, site certification study groups, and on-site RN-to-bachelor's or RN-to-master's programs. Each step correlates to better pay. These offerings have helped Franklin register a 3 percent vacancy rate and a retention rate of 94 percent.

"Ultimately, when the on-boarding is old, the new nurse [still] has to feel valued and enjoy what he or she is doing," says Everett.

-Corey Christman

Signing bonuses may get people in the door, but what retains them relates to the value they feel that they bring to patient care, says Linda Q. Everett, immediate past president of the American Organization of Nurse Executives. Everett lists nine AONE retention principles:

1. Recognize that nurses are meaningful contributors to healthcare.
2. Have an adequate number of qualified nurses working on any given patient care area.
3. Be present. The nurse manager or CNO must be visible in the organization, either physically or easily accessed for information or support.
4. Communicate frequently. With ever-changing policies and procedures, communication is as crucial to patient safety as it is to employee satisfaction.
5. Encourage professional growth.
6. Share in the decision-making. Nurses want to know that leadership is really listening to what they have to say about the working environment and the care they provide to patients.
7. Foster a culture of accountability.
8. Build a collaborative practice. Collaboration results in good working relationships among all healthcare workers.
9. Recognize a job well done. Most hospitals celebrate nurses in May during Nurses' Week, but there are others ways hospitals can recognize nurses throughout the year for the little things that they do: a note in the file, or a congratulatory remark.