Nursing CE Central
It takes roughly three months for healthcare leaders to recruit a single registered nurse, according to a recent industry staffing survey.
The 2024 NSI National Health Care Retention & RN Staffing Report, which included responses from more than 400 hospitals across 36 states, and also reviewed staffing, turnover, and recruitment at both the hospital and RN levels. Healthcare leadership named recruiting and retention as top priorities.
“It is what keeps CEOs, CNOs and CHROs up at night,” the survey stated. “Since turnover has a direct correlation to staffing and is a leading indicator of future financial pressure, and patient and employee satisfaction, it is easy to understand why healthcare executives are concerned.”
To address these issues, hospital systems and industry professionals are making a marked effort to understand what leads to turnover and how to improve recruitment and retention.
RN turnover at the height of the COVID-19 pandemic reached 27.1% but has declined in the years since. In 2023, turnover dropped 4.1%, the survey found, with the national turnover rate at 18.4%.
Personal reasons, relocation, and career advancement were the top three reasons RNs resigned, according to survey respondents. Other reasons were scheduling, retirement, salary, education, commute, working conditions, and workload/staffing ratios.
“To better understand how hospitals met their short-term RN staffing needs, respondents were asked to identify strategies utilized,” the survey stated. “The top five most common strategies to staff the bedside include: asking RNs to volunteer for overtime, authorizing critical staffing pay, flexing part-time or per diem employees, relying on travel/agency nurses and utilizing the internal staffing pool.”
Volunteering for overtime could also contribute to burnout, initiating a trickle-down effect of nurses leaving their position — or the profession as a whole — according to the 2021 Nurse Burnout Survey conducted by Nursing CE Central.
The NSI survey’s RN Recruitment Difficulty Index experienced a slight decrease overall, but the average recruitment time for an “experienced RN ranged from 59 to 109 days.”
The medical/surgical specialty has been the most difficult to hire for, followed by operating room, critical care, step-down, and telemetry nurses. However, recruitment time varied by geographical region.
In North Dakota, researchers investigated what influences graduating nursing students and practicing nurses to remain in the state and with their employer. The 2021 study in the “Journal of Nursing Regulation” found that “similar factors” influenced both nurses’ reason to remain with their employer or work in a rural or urban setting: competitive pay and benefits, positive work environment, career goals, and personal goals and reasons.
“The findings from the current study reflect the critical need for states and healthcare facilities to implement policy changes and measures that encourage recruitment, retention, work satisfaction, and intent to stay in their nursing workforce,” the authors stated. “Healthcare facilities rely on the supply of graduating nursing students and practicing nurses to fill position vacancies.”
A 2021 review in “Nurse Education in Practice” also stated that nursing student retention is “a costly concern” that affects supply and demand of nurses.
“Successful retention strategies require consideration of social and academic institutional systems with attention to student integration in a program,” the authors stated, finding that “whole-program retention strategies” were most effective.
The American Nurses Association offers a seven-step recruitment guide for organizations looking to establish a strategy:
In Texas, the recently developed Rural Nursing Recruitment & Retention Program (RNRR) aims to help the state’s nursing workforce. The program will provide eligible, rural facilities with “funds to incentivize nurses to work, or continue to work, in their facility by providing a stipend-assistance program.”
Facilities that receive funds will issue the stipend to a nurse who “agrees to work full-time for a minimum of 36 consecutive months,” according to the Texas Department of Agriculture.
Eligible facilities include hospitals, rural health clinics, nursing homes/assisted living facilities, and public health departments. Applications must be received by June 27.
Earlier this year, NYC Health + Hospitals launched its own recruitment campaign, branded as “Nurses4NYC,” to help fill more than 9,600 openings in the hospital system, according to a March 2024 news release.
“NYC Health + Hospitals is actively encouraging and promoting our vision of health equity as part of our overriding mission to help New Yorkers live their healthiest lives,” Natalia Cineas, NYC Health + Hospitals senior vice president and chief nursing executive said in the release. “As a part of our vision, we are working diligently to recruit, retain and support a diverse and inclusive nursing workforce.”
New hires have the following opportunities available to them:
Millennials are the largest population in the nursing workforce, and a 2022 systematic review on retention strategies and barriers for this population found that work environment and “relationships between nursing leadership and the bedside nurse” were key factors in retention.
“A preliminary scan of the evidence indicates that creating a healthy work environment that is collaborative, fair, flexible, challenging, and provides opportunities for growth may keep millennial nurses engaged,” the reviewers stated. “Having nursing leadership that models these values and leads by example may help millennial nurses to feel safe and supported.”
And nearly 60% of hospitals have a retention strategy in place, according to the NSI survey.
“Hospitals are protecting newly hired RNs through customized orientation, enhanced sign-on bonuses and nurse residency programs, among others,” the survey stated. “To protect existing staff RNs, hospitals have increased pay by 3.2%, offered retention bonuses, hired additional support staff, modified the RN care delivery model, etc.”
A sense of belonging and a supportive workplace “played a role in why nurses stay” with an employer, according to a study published in the October 2020 edition of “Applied Nursing Research.”
Though an industry survey indicates a slight decrease in the amount of time it takes to recruit registered nurses, the industry still faces workforce shortages that will need to be addressed through recruiting and retention strategies. Both healthcare organizations and government agencies are trying to fill those needs with stipends and other incentives. But industry research shows that appreciation, support, and proper compensation are key factors in recruitment and retention.
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