t’s hard to find a nurse who’ll move to West Virginia.
That’s what Doug Mitchell realized after becoming the chief nursing officer of WVU Medicine in late 2015. Early on, he had to hire 200 nurses to staff the nonprofit health system’s new $200 million expansion of its Heart and Vascular Institute. Traditional incentives — signing bonuses, overtime pay, flex scheduling — were all on offer. But they weren’t cutting it.
“Morgantown is a delightful place, but a lot of times, when people outside the state think about West Virginia, there’s a negative connotation,” Mitchell said. So WVU Medicine tried an additional tactic: free accommodations. For job applicants from out of town who didn’t want to relocate, the hospital leased a 44-bed dorm and began offering it free of charge to long-distance commuters.
So far, several hundred nurses — including ones from Ohio, Pennsylvania, and Maryland — have stayed at the dorm before returning home.
“We can’t let a lack of nurses limit us,” Mitchell said.
Hospital administrators, long accustomed to the world of hiring incentives, are making more enticing offers to nurses than ever before. Five-figure signing bonuses have replaced four-figure ones. One Texas health system dangles the prospect of free nursing degrees to train existing staff or volunteers as nurses, while a Missouri health system offers an enticing loan forgiveness program. A Kentucky hospital even gave new nurses who came aboard a chance to win a 2017 Ford Mustang convertible.
By 2022, the American Nursing Association predicts the U.S. may need more than 1 million new nurses to both care for a growing number of older Americans and replace retiring nurses. Nursing schools, citing their own shortage of teachers, each year are being forced to reject tens of thousands of qualified applicants from baccalaureate and graduate nursing programs.
“The incentives speak to the severity of the shortage,” said Alexi Nazem, co-founder and CEO of Nomad Health, a tech startup working to address the national shortage of medical practitioners. “But hospitals aren’t just trying to solve the problem of a shortage, but also of turnover. It’s hard to hire. It’s also hard to retain people.”
All of this has happened amid a shift in the profession: More inpatient nurses are flocking to outpatient work — leaving hospitals with a desperate need for staff to care for the rise in patients in the era of Obamacare. The end result is that some hospitals have cut back on available beds, or even shuttered full hospital units, as was the case for one Nebraska hospital in early 2017.
Issues driving the shortage
Pikeville Medical Center, in eastern Kentucky, saw its need for nurses boom after expanding last year into a 320-bed hospital. It was already hard to hire nurses. So administrators offered a $25,000 signing bonus — as compared to the bonuses of $5,000 to $10,000 many hospitals offer these days — and the convertible giveaway. There was a catch: Nurses had to sign a five-year contract and would receive the bonus incrementally over that time. But spokesperson Kevin McIver says Pikeville Medical Center now has around 700 nurses.
“[It] helped us recruit over 300 qualified nurses at a time when other hospitals were experiencing dire shortages due to the national nurse shortage,” he said.
As educational standards for nurses have changed, tuition fees can also be an attractive perk for job applicants.
Several years ago, Irving-based Medical City Healthcare launched Texas 2-Step — an education initiative that would allow employees and volunteers of the 13-hospital system a chance to earn a free associate degree in nursing. Employees must agree up front to work for two years as a registered nurse at one of the system’s facilities. Jenifer Tertel, vice president of human resources at Medical City Healthcare, said the program has trained over 300 nurses and 80 percent are still with the organization.
“This is the biggest part of our workforce,” Tertel said. “We want to give [employees] every opportunity to grow and develop as a nurse. In providing for our own nurses, we believe that drives better care for our patients.”
Still, some nursing experts believe these sorts of hiring incentives fail to address the underlying issues driving the nursing shortage. Seun Ross, director of nursing practice and work environment for the American Nurses Association, said incentives like these are a stopgap for rural regions with few other options. And in metro areas, she said, hospitals “pilfer” nurses from competitors, resulting in “the same nurses shuffling back and forth” without the overall number increasing much.
Instead, Ross thinks the focus should be placed on boosting resources available to nursing schools so they can hire more teachers who, in turn, can train more students. She also said hospitals must invest in the experience of nursing — buying cutting-edge equipment and cultivating an inclusive work culture — in order to get the most out of their nurses.
“If you invest in nurses with signing bonuses, you might keep them a few years, but they’re going to leave if the work environment sucks,” she said. “If you invest in nurses already there, they’re going to bring their friends.”
Mitchell believes doing both — incentives for nurses up front and investing in the practice of nursing — is the best way to move forward. In the case of WVU Medicine’s leased dorm, traveling contract nurses get an extra perk that lets them feel well-rested, potentially improving on-the-job performance. And for some nurses, staying in the short-term opened their eyes to Morgantown’s small-town charm. At least eight nurses have gone on to rent apartments or buy homes there to move closer to a job they enjoy.
“The incentives let someone give you a try,” Mitchell said. “But you keep nurses around, not through incentives, but by treating them well and staying true to your mission. We have to do whatever it takes to fulfill our mission as a not-for-profit hospital.”