It’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.”

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  • LPN’s are nurses also and are some of the best nurses you will find and are very dedicated and dependable. LPN’s have trained a lot of the RN’s. If LPN’s were hired or given the chance in the hospital setting, you would not have such a shortage.

  • This can’t be true because just last month there was a strike at a major hospital in Boston and the hospital found over 300 nurses to fill in.

    • Those nurses belong to a specialized group of traveling nurses who are willing to cross picket lines in exchange for substantial reimbursement.

  • As a recent new graduate RN, I can say that getting into a facility with a new grad program is extremely difficult. There are a lot of graduates, and not enough spaces. Because of this, many end up going into home health, SNFs, etc., and bypass hospitals altogether. This, coupled with retiring nurses and high turnover rates, will continue to affect the amount of skilled nurses in hospitals.

  • I have an Associate degree in Healthcare support, pharmacy tech classes, phlebotomy classes, my CNA, one semester short of CMA. Which hospital system in Texas is training employees to be nurses? I am very interested. I will relocate from Indiana to Texas.

    • Check out Texas Health Resources. It’s a large hospital system in north Central Texas. It’s a good place to work, great benefits and good support for new nurse grads. They have a program for non nurse employees to get their ADN at a junior college in Dallas. Best Wishes.

  • I have retired from an administrative career which is the only way I can afford to be a nursing educator. I am paid less than the new graduates that I am preparing. I recently completed my PhD and will receive a 2,000 dollar raise for an Investment that was well over 6 figures. Don’t look for a flood of nursing educators anytime soon.

    Part of the issue is that as part of a university, the university is looking pay scales of all professors and not looking at opportunities that nurses have in the market.

  • Nursing instructors get paid less than hospital nurses in my area. But the highest paid personnel in most states are their medical school faculty. Do you think there is a short sightedness here? Oh yeah, nursing instructors are genreally women.

    • In New England anyway.
      In ‘Trump Country’ the incessant yammering and whining that no one is cutting them a break and ‘we need to reopen the coalmines’ and yadda yadda… yet there are nursing jobs that go begging.

    • Actually nurses in the Boston area average $120,000 yearly. Look it up on the Bureau of Labor Statistics.

    • @veingraft $120,000 as a Nurse Practioner?
      In the south and unfortunately the average RN yearly wage is $35,000-$48,000. RN college in associates degree cost is on average $30,000. The RN instructors get paid lower end of $35,000 per year.
      If you want RN bachelor’s degree you will pay an additional $25,000-$30,000 on top of the $$30,000.
      Throw in the highest cost of hospital or clinic healthcare insureavce premiums of $600 or more, not counting copay and deductibles, you might as well go work for a gas station.
      Glad Boston will pay their RN what their worth.

  • Nice article, thank you.

    Regarding “the need for staff to care for patients in the era of Obamacare,” why not be more explicit and provide some context for readers? ie, “the need for staff to care for the many additional people who now have access to health care under the ACA.”

  • Location, location, and where is less management style abuse.
    First check your State Nursing Act. If it’s from the 1990s and not updated in favor of Nurses and their health in the long term as care givers, step away.
    Secondly, Nurses and staff pay way more in health insurance than any other company sponsored plan. Keep that in mind when caring for the patient that is paying less than you are in premiums. Also ask your hospital employer insurance provider “am I considered high risk?” If you are, step away. This hurts your bottom line to help pay off inflated college or university costs. Many RNs desire to have a 4 year degree however the extra $25,000-$35,000 student loans from associate to bachelor degree isn’t worth it unless your hunting down the nurse practioner degree.
    Nurses need forced breaks, lunches longer than 30 minutes where the lunch facility is just a 10 minute walk away and back for any shift.
    Pay, know your worth! Remember the next Nursing class is around the corner and replacement is some areas would rather have a cheaper face than experience floating around, sad but true.
    Be careful how you approach this great profession as the facility with high turn over is for a reason.
    Doctors with egos tend to be very abusive so be ready to address it when it happens. Do it at peace time for many reasons as you will want to throat punch them when they have learned well in medical school how to demean you in front of your peers or patients vs educate and learn!

    • Mark and Bobby above excellent points, would also add, national mandatory staffing for RN:Patient ratios in all areas of practice and all jurisdictions, NO EXCEPTIONS, because the greedy hospitals, insurance companies, and pharma do not give a crap about the people like nurses who are the backbone of healthcare ANYWHERE on this planet!

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