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3 Areas that Illuminate a Disconnect Between Nurses and Health Systems

Analysis  |  By Carol Davis  
   June 13, 2023

Nurses want flexibility and health systems aren't giving it to them.

Nearly all—94%—of 100 health system executives surveyed described the severity of the nursing shortage in their health systems as “critical,” and 68% indicated they don’t have enough nurses to manage another large-scale health crisis, a new report says.

That may be because health systems aren’t delivering what nurses want.

The 2023 Healthcare Executive Report, released today, is the first-ever public study of health system executives by healthcare career marketplace Incredible Health and reveals the challenges that healthcare organizations face.

It revealed three areas that identify a misalignment between health systems and nurses.

1. Average nurse tenure and experience are at issue in hiring.

More than a quarter of nurses in their system have less than a year of experience, reports 40% of the surveyed executives. That contrasts with what hospitals are looking for when hiring nurses, with previous experience and qualifications tying at 43% for the top factor they consider.

They also reported that 53% of nurses had an average tenure of less than five years at their institution.

2. Disconnect between health systems and nurses.

What nurses look for in an employer and what employers offer to hire and retain nurses are misaligned, the report says.

Health systems reported 80% of younger nurses requested more flexible scheduling, yet only 11% of health system executives surveyed actually offer more flexible schedules. Instead, hospitals are focusing more on compensation rather than flexibility as a hiring differentiator, the report says.

Similarly, though one-fourth of nurses point to limited career advancement training and opportunities as a reason they would leave nursing before retirement, many health systems are not prioritizing these programs and opportunities as a hiring and retention method.

Sign-on bonuses continue to be the primary method to attract nurses, with 35% of hospital executives saying they are still offering them, followed by increasing salaries for nurses (26%), and improving patient-to-staff ratios (16%).

But sign-on bonuses and higher salaries, only 33% of nurses feel fairly compensated in their roles.

3. A wide generation gap.

With the U.S. nursing workforce made up of four generations—baby boomers, Gen X, millennials, and Gen Z—with an average age of 52 years, it’s not surprising that 95% of health system executives have noticed generational differences in their approach to work and career growth.

While 35% point to conflicts between generations on teams, most differences lie in what younger and older generations request from their employers, the report notes.

Besides far more flexible schedule requests from younger nurses, large gaps also exist in:

  • Compensation demands: 78% of younger nurses request increases vs. 48% of older nurses
  • Seeking more specialized roles: 54% vs. 14%
  • Requiring more career advancement opportunities: 74% vs. 8%

Nearly 80% of executives noted a reduction in loyalty and tenure with younger nurses, in contrast to 21% in older nurses. 

Travel nurses remain a go-to solution

Nearly all (93%) of health systems employ travel nurses to keep up with patient demand, with 75% of respondents saying that temporary nurses make up a quarter of their nursing staff. Executives are eager to change this dynamic, as costly temporary staff significantly affects the health system’s bottom line, along with the culture in nursing units.

Some 96% of the executives reported plans to prioritize permanent nurse staff over temporary staff, with 55% of respondents not increasing the number of travel nurses within their hospital systems over the last year. 

“The good news is that healthcare executives, specifically those charged with hiring nurses,” said Iman Abuzeid, MD, co-founder and CEO of Incredible Health, “are embracing the opportunity to change their hiring and retention methods to improve patient care and the nurse experience.”

Related:  80% of Nurses Plan to Remain on the Job Until Retirement

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.


The severity of the nursing shortage in their health system is “critical,” say 94% of health system executives surveyed.

Average nurse tenure and experience are at issue in hiring.

Most generational differences lie in what younger and older generations request from their employers.

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