Most would agree the nursing shortage has worsened over the past few years. With the pandemic, many nurses became overworked and burned out. Some felt unsafe in the profession with limitations in personal protective equipment. Nurses also felt moral distress as they cared for patients dying without the support of family or friends. Ultimately, nurses have left the bedside to find other work options or left nursing altogether. What solutions might change this pattern?
Background
Although the number of nurses in the U.S. is significant, the nursing shortage is not a new problem. Over the 20th century, societal and technological advances in healthcare and wars increased the need for nurses. More people were seen in hospitals. The birth rate rose after World War II, increasing the demand for women’s health and pediatric nurses. Nursing has been traditionally a women’s occupation. Eventually, however, employment options for women increased, leading to fewer considering only nursing or teaching. More and more men are entering nursing. The older population has surpassed the number of nurses available (Zavoronkova et al., 2022). The need for more nurses continues to rise.
Schools of nursing are doing their part to educate more nurses. The American Association for Colleges of Nursing (AACN) reported in April 2022 that enrollment in nursing programs has been steady. In fact, the organization reports many qualified potential students are turned away each year. Limits are due to minimal clinical practicum sites, limited classroom space, and school budget cuts. Also, a faculty shortage is a concern for schools.
Possible Solutions
What else is being done to recruit nurses and maintain staffing numbers? Some interventions include grants and scholarships to assist students in nursing programs. Grants are also available to nurses who wish to advance their nursing education, especially if they consider teaching. Programs for educational loan forgiveness for nurses are also available. Programs of varying lengths have been available to nurses since the 1940s. As of 2020, over 50% of nurses are graduates of 2-year associate degree nursing programs (NCSBN, n.d.).
Another issue impacting the nursing shortage is low retention rates. The most recent NSI National Health Care Retention and RN Staffing Report indicates turnover rates have increased by 6.4% over the last year. With the cost of replacing a nurse averaging $46,100, the loss of the nurses to agencies to recruit and hire is extremely costly. What initiatives assist in retaining nurses? Nurses’ wages have been competitive. Work on creating a healthy work environment, with standards spearheaded by the American Association of Critical-Care Nurses, has been implemented in nursing. Yet, turnover has continued to increase.
Another strategy used by healthcare agencies is the recruitment bonus. Many have probably seen advertisements over the past few years offering sign-on bonuses for nursing willing to start employment. These bonuses can vary from $3000-15,000. They come with stipulations, such as the nurse staying at the agency for a certain length of time. Yet, the shortage of nurses remains.
The Retention Bonus?
One strategy that may be a better option is a retention bonus. What if nurses received a retention bonus for their service over a year? This bonus would be paid to the nurse for dedication to the agency over time. It would not be a slight hourly wage increase but a more significant one-time bonus. (The annual wage increase would continue, of course.) A retention bonus could begin as low as $2000 for one year of service and gradually increase over time. Would nurses feel more appreciated and remain in their position if they received such a bonus?
Some nurses are now discussing this option, and a few organizations are adding it. Nancy Hagens, in the New York State Nurses Association (NYSNA) website, shared the thought of a nursing retention bonus, also posited by NYSNA members Steven Bailey, RN and Aja Sciortino, RN. Morgan Curry reflects on this option in her online blog at Nursing CE Central. These articles suggest bonuses of $3000 per year. Although paying all nurses a bonus each year sounds high, if the cost of replacing one nurse is $46,000 and turnover rises, the cost-benefit ratio to an agency may favor a retention bonus for all nurses. Indeed, guidelines for receiving the bonus must be defined so that those who are underperforming are not rewarded. But, rewarding those who demonstrate professionalism and deliver high-quality patient care is appropriate.
While sign-on bonuses get nurses in the door, what can keep them there? Rewarding nurses for their value and dedication to their employment at the agency could increase satisfaction and retention. While a monetary gain isn’t the only factor that causes a nurse to stay in a job, a bonus and other healthy work environment initiatives add benefits to ensure the retention rate increases. Ensuring nurses are rewarded for their service and satisfied in their jobs is a priority in battling the nursing shortage.