Addressing the nursing shortage: Recruitment, retention, and care
Addressing the nursing shortage: Recruitment, retention, and care20 April 2022 | 12min
With nurses being key players in delivering patient care, health systems need to have strong recruitment and retention strategies in place, particularly at a time when the nursing shortage is expected to grow.
Compensation is not just about money, it’s about understanding what is important to your nursing team on an individual level and ensuring their compensation package is in line with their needs
C-suite leaders can adopt simple strategies to create a culture of caring that will drastically improve nurse retention and recruitment
The State of the World’s Nursing 2020 report published by the World Health Organization (WHO) estimated that there will be a shortage of 6 million nurses worldwide by 2030.1 With nurses playing such a key role in delivering high-quality patient care, this is a critical time for healthcare systems to focus on nurse recruitment and retention.
Join us as we continue the conversation with LeAnn Thieman to discuss simple strategies that top-tier hospitals are using to recruit and retain their nursing staff. She will also discuss the future trends in nursing and how this may impact decision-making at the executive level.
Bridging the nursing shortage gap
HT: In your experience working with so many different types of healthcare systems, what have you seen healthcare systems doing to help bridge this nursing shortage gap?
LeAnn Thieman: Many healthcare systems have had to rely a lot on traveler or contract nurses which is extremely expensive and can impact your current staff. Some hospitals raise the salary of their nurses, which is one tactic, others give a stay-on or retention bonus. The bonus can be financial, however, it’s important to ask the individual what they want as a bonus. Sometimes they want extra days off or a better benefits package depending on what currently exists. Most people want schedule flexibility. In the United States, nurses are working 12-hour shifts, so they might work three grueling long shifts and then have four days off.
With their four days off, the first day they spend resting. So having a lot of flexibility with their schedules is most appealing. Some hospitals are forward-thinking, offering wellness or well-being programs, designed to let employees know that you truly care about them and are doing individual things for them, calling them by name, sending cards to their homes for birthdays or anniversaries.
It’s a lot of extra work, but a handwritten note can make a nurse stay on another year. It’s one thing to say to your staff, “go take really good care of yourself.” It’s another thing entirely to provide programs that give them the strategies and tools to care for their minds, bodies, and spirits every day. This is key to retention.
Recruiting strategies and conditions
HT: What strategies or conditions have you seen implemented by top-tier hospitals that lead to high nurse recruitment and more resilient nurses?
LeAnn Thieman: Some hospitals recruit their nurses through ads, however, the competition is high. Many hospitals offer a sign-on bonus, which gets very competitive because, generally speaking, there will be another hospital that has a slightly higher bonus. Certainly, compensation is a big deciding factor for which position to take and due to the shortage, nurses can often pick and choose where they want to work.
Hospitals now must show that no one else does what they do, which can be as simple as culture. Offering a culture of caring that is not just a job but is also reflected in their mission statement is a great strategy. Hospitals that do invest in programs that offer tools for self-care and appreciation, and make that a part of their orientation and their onboarding, have a competitive advantage.
They are able to say, “Here’s the app to our program we offer. We’re going to help you download it right now. We sincerely truly care for you.” Potential nurse candidates have to be able to see how they’re going to be treated and be convinced that what this particular hospital does is above what the rest are offering. It’s not always the money, it’s the culture.
Reimbursement for their education is another strategy. Young nurses especially are eager to learn. There are different levels of nursing and different certifications of nursing, so offering to reimburse them for their education and advanced learning will be a strong benefit.
For instance, if nurses are looking at a specific area they wish to specialize in following graduation, such as obstetrics or cardiac, they will consider this and say, “who’s going to help me grow?” They want to develop and will look at what systems are in place to help them do that as well as help their state of well-being and resilience. We must keep the passion for caring alive.
Education as a recruitment and retention strategy
HT: You mentioned that the lack of access to education was a contributing factor to the nursing shortage. Have you seen any healthcare systems getting involved in developing their own training programs?
LeAnn Thieman: Yes, I often recommend hospitals to go out in their community to recruit people. Going into high schools and talking about how great it is to be a nurse. I also recommend that hospitals encourage their nursing assistants to advance their education. There are great stories in hospitals of someone who worked the coffee cart and always wanted to be a nurse or the environmental service person with a heart of gold who was encouraged and became a nurse.
Reimbursing tuition is also a tremendous recruitment and retention strategy and a great way to develop your staff. Some hospitals offer their nurses the opportunity to teach courses in nursing schools or universities, and some hospitals even help to fund the university financially to help them train the nurses. In the United States, some have invested in building nursing school programs which is what we need to meet the nursing shortage.
The good news is that in 2020 there was a 5.6% increase in nursing school enrollment at the baccalaureate level compared to 2019.2 Sometimes after national or international tragedies when people see others serving and giving so much, people want to make a difference too, so they sign up.
Top three recommendations for c-suite leaders to overcome the nursing shortage
HT: Particularly for c-suite leaders, what are the top three actionable items you would recommend to them to overcome the nursing shortage, recruitment, and retention challenges?
LeAnn Thieman: My top recommendation for healthcare and c-suite leaders is number one to take care of themselves. I know that wasn’t a part of your question, but that’s what I say to them first. They are benevolent people who often do not care for their bodies, minds, and spirits, and they can’t continue to give from an empty well.
One of the best recruitment tools is that culture of caring. While it is important to have financial benefit packages and wages, examining your culture and demonstrating it through your interview process or marketing, for example, is more important. For instance, would you like to work for somebody who during their interview has a sober face and talks about all their policies and what they’re looking for? Or, would you like to work for someone with a smile, energy, passion, and compassion who tells you about the programs they have to help take care of you and about the appreciation events that they have?
You must set yourself apart as an organization that cares not only about its patients but also about its staff. One statistic shows that 36% of nurses thought that they were not being respected by their seniors.1 It’s difficult working with critically ill patients but showing appreciation for them in even the smallest ways will go a long way. You can write an editorial in your local newspaper to praise your staff at little to no cost, for example. Showing that appreciation through your culture or well-being programs is key.
The recruiting power behind the “culture of caring”
LeAnn Thieman: C-suite leaders need to look at their mission statement and recruitment page. When you go online, every website for a healthcare organization has an About page and a retention page as well as information about how you can apply and get more information. What’s the language on that? You can’t just say you have a culture of caring, you must establish a culture of caring and then be able to speak to it. Leaders need to demonstrate that they are coming from that same place, that passion, that compassion, it can’t be just about the money.
Make sure that culture is apparent in your statement when you’re trying to hire people. In the interviews, show what sets you apart and why someone should work for you? What is your culture of caring? What have you established? Once this is defined and an integral part of your organization, then you can use it as a recruitment strategy.
To show the joy in healthcare and to bring that to your content and your verbiage on your advertisements and websites and interviews is effective. That “this is a joyful place to work. We are changing lives. We are saving lives” tone. Right now, nurses are just slogging through thinking, “I just have to get through this.” Even the leaders are thinking, “What do you mean joy? I’m just barely hanging on here.” There are so many simple ways that you can add that joy. That must be something that you’ve established through your leadership first.
Creating a culture of care
HT: What simple things can healthcare executives implement throughout their hospitals that would elevate this appreciation and show nurses the value that they bring?
LeAnn Thieman: On the job, nurses appreciate food, being addressed by their name, eye contact when spoken to, and being asked how they’re doing. Having stay-on interviews are another example. We often have exit interviews, and ask, “What will it take to make you stay?” Instead of waiting until workers are leaving, schedule interviews to ask them, “What will it take to make you stay?” Everybody is different and what makes someone stay longer may be different from someone else.
It’s time-consuming, but anytime somebody gets a signed card in the mail with their name on it that says, “I love and appreciate you,” that just goes so far beyond anything they would ever expect.
It can be the simplest thing. I love hospitals that have celebrations. In one hospital, three staff members, each playing a different instrument would go around to different units. When a nurse got an award, they would go play 60 seconds of a tune and say, “Congratulations.” Bringing that joy and the little things go a long way. Other ideas you can do to show appreciation include having an appreciation gala once a year and family picnics.
How the culture of care is being adopted
HT: Do you find this culture of caring and awareness is more or less being adopted throughout healthcare systems in the U.S.?
LeAnn Thieman: There’s evidence that this culture of caring is expanding. More than one chief nursing officer has said, “We’ve been drowning and now we’re poking our heads above the water to see the damage done, and we see that it’s to our staff.” That damage isn’t just financial. They’re talking about the fact that they’re exhausted and drained out and they are looking for programs to build staff morale, well-being, resiliency, and joy. More institutions in healthcare and other industries have well-being officers to address the fact that so many of their workers have been impacted by this, that they too need tools to care for them.
I have hope that this culture of caring will increase because that’s what employers are really looking for. Often, they don’t have somebody on staff who has the experience to create a program like this and it takes a long time. That’s where a program that is turnkey and ready to implement can be a great relief to organizations, helping them to initiate and start building this culture of caring.
Future trends in the nursing field to address the nursing shortage
HT: What do you think is the future of nursing and what sort of trends do you see in the nursing field in the next 10 years?
LeAnn Thieman: Hope is one of my keywords. I am hopeful for the future of nursing in the United States and around the world. This pandemic crisis has made hospitals and healthcare institutions realize the need to build nursing throughout the world, to invest in nursing schools, to subsidize and help build as many nursing schools as we can and incentivize people to work there so that we can have enough clinical hours and experiences for nurses to develop into the nurses that the world needs.
We need to appreciate every level of nursing and let every person in healthcare work to their highest skill level. In different parts of the U.S. and the world, you have nursing assistants, licensed practical nurses (LPN), associate degree nurses, bachelor’s-prepared nurses, master’s-prepared nurses, etc. In the past 20 years, staffing models had mostly only registered nurses (RNs) doing direct patient care. With the current shortage that is not realistic or achievable. I see the trend coming back to the team nursing model where you have an RN or LPN as the team leader and other less-skilled patient care duties assigned to the nurse’s aides.
We need to expand, appreciate, and develop our nurses from within by asking nursing assistants and other departments to join our profession. To do that, we need to be joy-filled and happily able to recommend it to people, coming from that place of what a privilege and honor it is to touch and save lives. That is a humbling and blessed thing to do and what a privilege it is to serve in that way.
It will take time and effort, but we’ve recognized now, as a nation and as a world, a tremendous need for more nurses. Investing in not only hiring them but also retaining them and making an institution of nursing and healthcare that people want to join that culture of caring. They want to touch and save lives, which is a tremendous privilege.
The U.S. alone has lost half a million healthcare workers after the pandemic and the US Bureau of Labor Statistics says that we will be a million nurses short due to the 500,000 RNs anticipated to retire by 2022 as well as the need for additional expansion.3,4 Not having enough nurses means that we need everybody to help and work at their highest skill level so we can give the optimum care. The bottom line is that giving expert, compassionate patient care is a calling. People will be answering that calling so we can serve a greater level and meet the tremendous needs of medicine today.
If you want to find out more about the global nursing shortage check out Part 1 of our interview with LeAnn: Addressing the nursing shortage: Alleviating burnout and improving nurse satisfaction.
LeAnn Thieman is a Hall of Fame Speaker and author of the Chicken Soup for the Nurse’s Soul series, was “accidentally” caught up in the Vietnam Orphan Airlift in 1975. Sharing lessons from that daring adventure, she proves that healthcare givers strong of mind, body, and spirit deliver better patient care, resulting in improved outcomes, satisfaction scores, and reimbursements. Her evidence-based SelfCare for HealthCare® program reduces burnout and turnover and boosts retention, recruitment, engagement, and morale
- World Health Organization. Report available at https://www.who.int/publications/i/item/9789240003279. [Accessed January 2022]
- American Association of Colleges of Nursing (AACN). Information available at https://www.aacnnursing.org/News-Information/Press-Releases/View/ArticleId/24802/2020-survey-data-student-enrollment. [Accessed January 2022]
- Gooch K. Becker’s Hospital Review. Article available at https://www.beckershospitalreview.com/workforce/healthcare-has-lost-half-a-million-workers-since-2020.html. [Accessed January 2022]
- American Nurses Association. Article available at https://www.nursingworld.org/practice-policy/workforce/. [Accessed January 2022]