Recruitment and Retention: Combating the Nurse Shortage

Briefings on Evidence-Based Staff Development, March 16, 2010

Market-savvy healthcare organizations have implemented workforce development strategies to address the existing and projected labor shortages. This helps organizations determine where the strategic priorities lie.

The recent economic downturn will have lasting effects. The recession, which officially started in December 2007, has affected the job market.

Picture the current state of the nursing shortage as a tsunami. The first thing that happens in a tsunami is that the water on the beach rushes away from the shore. Nurses are filling current vacant positions en mass. Nurses who had planned to retire, work only part-time, or reduce their hours find they have had to change their plans. They are staying and taking on full-time, rather than part-time, positions (Buerhaus, 2009). "As RN spouses lost their jobs (70% of RNs are married) or worried that they might be laid off, many non-working RNs rejoined the workforce" (Buerhaus).

With RN vacancies being filled at an exceptional rate, organizations might have an urge to ease their recruitment and retention efforts. This is exactly the wrong strategy to take. As the economy begins to adjust, the tidal wave will hit. The impact of the tsunami wave depends on how quickly the economy recovers. If the economy recovers quickly, jobs will be rapidly added back to the market. Many nurses who had to come back to work or work more hours to supplement the family income will leave the job market (Buerhaus). Nurses who postponed retirement may stay in the market a little longer than anticipated to rebuild their retirement incomes, but they will also leave (Buerhaus).

What about the new graduates coming out of nursing school? In a down economic climate, employers are able to be more selective when posting positions. When employers were faced with a lack of experienced nurses applying for jobs in specialty areas (e.g., emergency room or neonatal ICUs), they had no choice but to take on new graduate nurses (Clavreul, 2009). If the economy recovers at a slower pace, nurses will not leave the workforce. This means that new graduates will continue to have difficulty finding jobs unless they are willing to be flexible and work in a more generalist role. Whether the economic recovery is fast or slow, it will have long-lasting effects on healthcare organizations.

Organizations cannot afford to simply react to the workforce shortage. Instead, they must take proactive steps to reduce the effects of the shortage on their organization and take an aggressive stance in terms of recruitment and retention strategies. The financial viability of an organization depends on it.

Case in point: The cost to fill an RN position due to turnover is between $82,000 and $88,000 (Jones, 2008). RN vacancy rates have an even greater financial effect on organizations. Costly approaches to filling the void include using agency/traveler temporary nurses, mandatory/voluntary overtime, closing patient units, and/or diverting patients to other facilities (Jones).

Buerhaus, P.I. (2009). "The shape of recovery: Economic implications for the nursing workforce." Nursing Economic$ 27(5): 338–336.
Clavreul, G.M. (2009). "Why nursing school grads have trouble finding jobs." Retrieved November 3, 2009, from Trouble-Finding-Jobs.
Jones, C.B. (2008). "Revisiting nurse turnover costs: Adjusting for inflation." Journal of Nursing Administration 38(1): 11–18.

Editor's note: This article is based on information found in the book Nursing Orientation Program Builder: Tools for a Successful New Hire Program. For more information, visit

This article was adapted from one that originally appeared in the April 2010 issue of Briefings on Evidence-Based Staff Development, an HCPro publication.
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