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Sites For more information The Bureau of Health Profession’s Division of Nursing, part of the U.S. Department of Health & Human Services Health Resources and Services Administration, is conducting its seventh national sample survey of registered nurses. The survey, conducted every four years, examines salaries and geographic distribution of nurses, as well as racial, ethnic and age components of the nursing workforce. The January 2000 "Nurse Recruitment and Retention Study," put together by the American Organization of Nurse Executives, has the most recent statistics on recruitment and retention. For a copy, call (312) 422-2800.
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Diane Sussman Feeling unwanted? These days, nurses don’t have to go far for a remedy – just read the want ads. While not exactly at the level of Silicon Valley, where high salary job offers come sweetened with stock options, gym memberships and the keys to a BMW, nurses are being enticed with an unprecedented array of signing bonuses, relocation reimbursements and incentive packages. From small hospitals in Maine to large ones in Houston, recruiters are involved in bidding wars and hiring techniques that haven’t been seen since the 1980s, when the number of nurses dropped to a critically low level. "It’s an awful time to be a recruiter," admits Joyce Philip, vice president of human resources at Anne Arundel Medical Center in Annapolis, Md. "An awful time." Show ’em the money The ads tell it all, promising "top salaries, $1,000 to $5,000 signing bonuses, 401(k) plans, relocation assistance, prime locations and deluxe housing." One traveling agency even advertises "assistance finding insurance for your pet." Employers with more scenery than money use a different approach, showing off-duty nurses at the beach, on the slopes or walking in the woods. "You work hard. Shouldn’t it be easier to play?" reads one ad, while another extols working on the shores of a beautiful beach bathed in Florida sunshine. According to the American Organization of Nurse Executives’ recruitment and retention study, American health care facilities spend an average of as little as $1,000 to as much as $3.5 million each year on recruitment, including signing bonuses, relocation fees and referrals. St. Mark’s Hospital in Salt Lake City began offering big bonuses several years ago, said recruiter Darin Thompson, as well as relocation assistance. The hospital pays $5,000 signing bonuses for ICU nurses, $1,000 to $3,000 for RNs with two or three years’experience, and up to $3,000 toward relocation costs. In return, the hospital asks for two years of full-time service. Some Nevada and California hospitals are reportedly paying even more – as much as $8,000. Others save their recruitment dollars for referral bonuses, which range from $100 up into the thousands. At Arundel, employees who refer new staff receive bounties of $1,500, Philip said, with half paid at the end of the new hire’s probation period and half after a year of service. "Referral bonuses work better than signing bonuses," she said. "If you refer someone, you are invested in that person." Arundel also woos new graduates with tuition reimbursement of as much as $3,000 for the previous year’s tuition. A spotty shortage Not every nurse can walk into a recruiter’s office demanding big bonuses. At this stage, the shortage remains principally confined to specialty areas such as ICU, OR and OB-GYN, experts say, and to certain geographical pockets such as inner-city areas and isolated rural communities. "There seems to be this sense that we don’t have enough nurses, but mostly what we have is a selective shortage in the ICUs and high-stress areas," said Julie Fairman, Ph.D., RN, FAAN, assistant professor at the University of Pennsylvania School of Nursing in Philadelphia. Unlike past shortages, the present shortage involves supply and demand, with causes that include growing numbers of elderly, an aging nursing population, a huge influx of people to the Western states, rising acuity in hospitals and a broadening of job opportunities in health care. This last reason is proving particularly problematic for hospitals. "What you see are hospital jobs going unfilled, but jobs in other areas, like pharmaceutical companies and insurance companies, are not," said Bobbi Gorenberg, DNSc, RN, director of the School of Nursing at San Jose State University in California. "It’s 9 to 5, it’s flexible and the salaries are good." "You’re talking about a generation that places a premium on flexibility," said Janet Coffman, MPP, director for workforce policy at the Center for Health Professions at the University of California, San Francisco Medical Center. "You’re talking about companies with a flexible environment, nobody telling you what to wear and an endless supply of junk food." Beyond the bonus Even in boom times, only a small percentage of nurses qualify for signing bonuses, leaving the vast majority to evaluate a job offer the old-fashioned way – salary, raises and benefits. On that score, the news is good – sort of. On one hand, salaries have been consistently rising. According to the Bureau of Health Profession’s Division of Nursing, Health Resources and Services Administration, the average salary for a full-time hospital staff nurse in 1996 was $40,096, compared to $36,618 in 1992. The average ambulatory care nurse earned $32,571 in 1996, compared to $27,949 in 1992. "With regard to teaching, nursing still appears to be a good career opportunity," said Peter Buerhaus, Ph.D., RN, FAAN, associate dean for research at the School of Nursing at Vanderbilt University in Nashville, Tenn. But salaries don’t look as good when compared to the high-tech or business sectors, where students fresh out of school are being offered starting salaries of $35,000 to $60,000. "If you’re talking about the salaries of RNs with an associate degree, they are comparable," Coffman said. "If you’re talking about a new grad with a BA degree, then I think you have a different answer. "It’s one thing to say nurses are getting signing bonuses, yet at the same time hear stories about someone who goes to the local technical college for a year and makes $150,000 a year," she said. "It makes it hard to promote nursing, which takes more skill and more education." Furthermore, not all nurses are enjoying rising salaries. "If you look at wages, it’s all over the map," said Donna English, MPH, RN, deputy director of nursing research at the Division of Nursing. "We do know that nurse practitioners and nurse anesthetists do well, in excess of $60,000. But if you’re a nurse working in a nursing home, where salaries are traditionally low, I’m not so sure you would have seen much improvement." Numbers on the way It’s hard to talk about salaries when government data is 4 years old and predates the current shortage. The Division of Nursing is compiling 1996-2000 data and expects to have results available by the end of the year, English said. Given the shortage and the market, she fully expects salaries will have risen even further. "That is our expectation," she said. The numbers may show that, despite rises, real wages haven’t kept pace with inflation and the high cost of living, as was the case in California. In the 1990s, real wages for nurses actually dropped, because salaries did not keep pace with inflation, said Coffman, who conducted a study of wages. "It’s not enough that the dollar amount goes up," English said. "We have to adjust for inflation. We just have to see." Of course, signing is one thing. Retention is another. At St. Mark’s, several nurses signed a two-year contract and received their signing bonus only to break the contract before it expired, Thompson admits. "It happens," he said. The nurse loses a portion of the bonus but the hospital loses a hard-won employee. Such defections underscore the other side of the dilemma: working conditions. "A bonus won’t make a nurse like the job," Gorenberg said. "The hard part is retention." "The historic reasons of religion or duty don’t go very far these days in keeping people in the profession," Fairman said. "Ultimately, nurses will stay someplace because they feel respected and that they are being treated well. |
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