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Lucrative RN Enticements Leave Rural Washington Hospital Struggling to Keep Nurses

Analysis  |  By Carol Davis  
   March 08, 2021

Summit Pacific CNO aims beyond sign-on bonuses to retain and recruit experienced nurses.

COVID-19 has created multiple challenges for rural hospitals, but it's been particularly bleak for nurse staffing, which was in short supply before the pandemic.

Tori Bernier, chief nursing officer (CNO) at Summit Pacific Medical Center in Elma, Washington, is all too familiar with the challenge of retaining nurses in a small, rural hospital.

When a large, nearby hospital system offered high-dollar enticements such as large sign-on bonuses, Summit Pacific lost several nurses, and when others left to take advantage of lucrative travelers' pandemic wages, Bernier knew that Summit Pacific needed to focus on other strategies to recruit and retain experienced nurses.

Summit Pacific is a standalone critical access hospital with a 10-bed acute care unit with telemetry, a 10-bed emergency department, diagnostic imaging, lab, urgent care clinic, and wellness center. Its nursing staff is comprised of about 35 RNs, along with a few CNA techs and a handful of LPNs.

Bernier joined Summit Pacific in September 2020. Coming from larger health systems in Oregon, such as Kaiser Permanente and St. Charles Health System, she knew the nurse staffing challenges faced by both large and small hospitals.

"Unfortunately, the larger hospitals have also had a really hard time staffing, even with a larger pool, because the demand is higher," Bernier says. "Some nurses are retiring early, and some are changing positions, so emergency room nursing, in particular, has been hit hard."

To combat those factors, larger systems have been offering big financial incentives to draw nurses to their organizations and away from smaller, rural hospitals.

"In our local area, within 30 miles of here, a bigger hospital system decided to open up some emergency department room and they offered very large sign-on bonuses. We're talking tens of thousands of dollars, and that's very attractive to be only 30 miles away and be able to get that sign-on bonus," she says. "So, unfortunately, we lost quite a bit of our emergency department nursing because of that."

That leaves small, rural hospitals like Summit Pacific at a disadvantage. 

"They're using incentives like that and it causes a shortage in all the rurals," she says. "We're growing really great nurses in rurals and then when shifts like this happen in the nursing economy, the only thing [bigger hospital systems] can do is dangle this big carrot and, unfortunately, that's hard to pass up for some nurses."

And because COVID-19 has made nurses more in demand than ever, some nurse-staffing agencies have offered traveling nurses as much as $12,000 weekly—a situation that has prompted the American Hospital Association (AHA) to ask the Federal Trade Commission (FTC) to investigate reports of anticompetitive pricing by agencies.

Benefits beyond the bonuses

Offering sign-on bonuses and recruiting high-priced travel nurses might lure nurses away from rural hospitals but it can also have some disadvantages.

Pacific Summit offers sign-on bonuses, but to experienced nurses only, Bernier says.

"Otherwise, we end up with a lot of nurses who are very inexperienced, and it can be a real safety issue," she says.

She's also careful about using too many travel nurses.

"We recruited travelers, but we were very picky about that; they had to be travelers with extensive experience," she says. "We want our caregivers that are here to feel good about the people they're working with."

Instead, Bernier works to find nurses who are looking for the other benefits that Summit Pacific can offer, she says.

"When we do recruiting, we really highlight the difference that Summit has; we're a smaller hospital that that can make decisions rather quickly and be a little bit more flexible in some areas," Bernier says. "We also talk about where we are. It's beautiful here and this lifestyle attracts some people to be in this small, rural setting."

Elma, with slightly more than 3,000 residents, lies within Grays Harbor County, known for lush forests and miles of beaches. Elma is located about 40 miles from the Pacific coast and 30 miles west of Olympia.

"We also talk about our healthy work experience," she says. "When we say we want to help build the healthiest community, we mean it and it starts with us, so our caregivers are given a lot of benefits around health and wellness that others may not get." 

A focus on retention

Part of Bernier's retention strategy is to help Summit Pacific's nurses avoid burnout by providing flexibility in staffing, keeping staffing at healthy levels, and fostering a sense of community.

For example, she encourages enough rest between shifts.

"Sometimes caregivers opt to take lots of extra shifts; that's totally up to them. But we also really congratulate and support those who say, 'You know, I'm going to do just my shifts and I'm okay with that.' Nurses are at different stages in their lives. Some people have babies at home; some people are empty nesters; some are brand new grads … so you have to be flexible with where the person is at."

Summit Pacific shows appreciation to its nurses and other employees by creating family-friendly events for them and the small community, she says.

"Last year, the hospital rented the drive-in theater for our staff to all go and enjoy and then at Christmas, it partnered with a laser light show, not only for our caregivers but for our community," she says.

Such events let nurses know that Summit Pacific cares about their well-being, even if it can't pay the same wages as the large health system 30 miles away, Bernier says.

"We really do try to pay attention to that," she says, "and make sure they understand."

“Nurses are at different stages in their lives. Some people have babies at home; some people are empty nesters; some are brand new grads … so you have to be flexible with where the person is at.”

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


Rural nurses frequently are enticed away from small hospitals by large sign-on bonuses or high travelers' wages.

Part of CNO Tori Bernier's nurse retention strategy is to provide staffing flexibility, keep staffing at healthy levels, and foster a sense of community.

Summit Pacific shows appreciation to its nurses and other employees by creating family-friendly events.

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