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Insight Report: Nursing Shortages Demand 'Disruptive' Action

Analysis  |  By Jennifer Thew RN  
   January 24, 2017

Nurse leaders say the standard recruitment and retention methods of sign-on bonuses, pay increases, and retention incentives won't be effective in improving the current nursing shortage.

Nursing shortages are like bad pennies—they keep turning up.

Imbalances in RN supply and demand occurred in the 1980s, the late 1990s, and the early 2000s. Now hospitals and health systems across the country are starting to see the effects of another shortage.

During nursing workforce roundtable sessions at HealthLeaders Media's invitation-only 2016 CNO Exchange at the Bacara Resort in Santa Barbara, CA, many of the more than two dozen nurse executives in attendance said they are dealing with a very real nursing shortage at their facilities and systems. But this shortage may be quite different than those past.

Recruiting and Retaining an Effective Nursing Workforce

"I'm looking across the whole country, from the East Coast to the West Coast, watching what's happening in our different markets, and I do believe that the nursing shortage we're going through now is unlike any we've seen before," said Kathleen D. Sanford, DBA, RN, FACHE, FAAN, senior vice president and CNO at Englewood, Colorado–based Catholic Health Initiatives.

CHI operates in 18 states and includes 103 hospitals, community health services organizations, accredited nursing colleges, home health agencies, living communities, and other facilities and services that span the inpatient and outpatient continuum of care.

What Makes This Nursing Shortage Different
By 2020, nearly half of RNs will be at traditional retirement age, the U.S. Department of Labor reports. As these seasoned professionals retire, their experience, knowledge, and skills, which are essential to achieving the goals and outcomes of an increasingly value-based healthcare industry, will go with them.

Add to the mix a multitude of new nursing opportunities created by changing care delivery models and the career philosophies of younger nurses who crave change and typically move on to new opportunities every one to three years, and there is cause for concern.

"I believe, and my team believes, that unless we do something totally disruptive, our communities are going to be harmed very shortly by this shortage," Sanford said.

Money Isn't the Answer
At the Exchange, there was much discussion about what works and what doesn't when it comes to recruitment and retention. There was agreement that the old standbys of sign-on and retention bonuses aren't necessarily the best solutions to address this new shortage.

"We just keep trying to throw money at ways to retain staff, and that is not retaining Millennials," said Barbara Jacobs, MSN, RN-NEA, RN-BC, CCRN-K, vice president of nursing and CNO at the 415-bed Anne Arundel Medical Center in Annapolis, Maryland.

"We're going to have to think of something completely different around retention, because what motivates the millennial nurse is not really pure dollars."

What does motivate nurses to at least stay in an organization?

"Relationships, feeling valued, knowing that you're doing work that's meaningful," said Pamela Dunley, MBA, MS, RN, CENP, who recently transitioned to president and CEO at Elmhurst Memorial Hospital in Illinois.

Autonomy Matters
Dunley has given Elmhurst's nurses a sense of independence and control by using shift bidding to fill open shifts. "It was really a big [change] for the nurses because they got control over what they wanted to do versus you either floating them or asking them to work another shift," she said.

In addition to the autonomy and shift differential, nurses can also earn points for covering a shift. "It's like your credit card. You can gain points and you can buy things with your points," Dunley said.

"It helps the nurse feel a sense of control, and they don't mind signing up for extra shifts because they feel like, 'Oh, I'm in charge here. I can decide what I want to do.' Some of my nurses have gone to Europe on the points. They've saved them up."

More of the discussion from the CNO Exchange sessions on the nursing workforce can be found in the CNO Exchange 2016 Insights Report.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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