Rita Jasso, RN, was at a crossroads. About to finish nursing school and after interviewing at three hospitals, it was time for the 40-year-old to decide where she would spend a significant chunk of her waking hours.

One of the hospitals stood out, with its large bonus package, and another top contender was Methodist Hospitals of Dallas, where she'd worked as an LVN for more than two years. Jasso already was enrolled in the hospital's 401(k) plan, and the benefits covered preventive care, a perk she had not found in many other health packages.

"I realized I could work somewhere else and make a lot more money, but I didn't want to because I liked the people and benefits at Methodist," Jasso said. "It's not just about the salary. I work for my benefits."

Although some nurses are lured by fat signing bonuses and other short-term benefits, several hospital human resource executives touted Jasso's longer-term perspective in evaluating job offers. They contend that the truly lucrative offers are those with benefits that are often dismissed.

Troy Bond, a regional director of human resources for Tenet's Gulf States region, said nurses who regularly leave their jobs for signing bonuses elsewhere can lose hundreds of thousands of dollars in future 401(k) retirement funds. Companies sometimes require new employees to wait a year before enrolling in a 401(k) or 403b plan for nurses who work at nonprofit hospitals.

If a nurse changes jobs several times, this could mean losing several years of retirement income while waiting to enroll in the new plan, he said.

Nest eggs cracked

For example, consider a 25-year-old nurse who earns about $40,000 a year and sets aside 8 percent for her 401(k) plan. But because of job changes, he or she loses five years of 401(k) income. By age 50, the nurse would have lost more than $150,000 in retirement income, according to Fidelity.com.

This calculation takes into account a company match of 3 percent and an annual salary increase of 2 percent. If that same nurse were earning $60,000 rather than $40,000 annually, he or she would lose about $250,000 in the same time period.

"The 401(k) is the largest single mistake that people make," Bond said. "It is out of sight, out of mind. It's really >> the hidden cost of job-hopping."

Bond also advises nurses to examine medical benefits before rushing into a job with a higher hourly wage or signing bonus. Some of the most valuable jobs can be ones that offer benefits such as well-child exams and other preventive care. For people who need prescription drugs every month, look for plans that offer 90-day supplies of medications.

If, for example, the deductible is usually $20 a month for prescription drugs, the three-month supply can save an employee hundreds of dollars in a year, Bond said.

He also encourages employees to consider using flexible spending accounts because this allows them to take out pre-tax salary dollars and direct them toward uncovered medical expenses.

Read between the lines

When deciding between different health plans, Tim Meeks, vice president of human resources at Methodist Hospitals of Dallas, advises nurses to look beyond just the monthly cost of a particular plan.

For example, a plan that costs $100 per month may seem like a better deal than one that costs $150, but the cheaper plan might not offer important perks, such as long-term disability, or it may skimp on other benefits, such as life insurance.

"It quickly becomes very complex," Meeks said. "Employees should read the benefit plan carefully and look at what they are really getting out of it."

Meeks also recommends that employees take advantage of life insurance coverage, a commonly overlooked benefit. He's seen many people put off getting life insurance when they are young, and by the time they're ready to enroll, they may have health conditions that make it more expensive.

"A lot of people who come on board are often single [or] married and without kids," Meeks said. "In that situation, life insurance isn't critical. But as you have children and get married, you may find out that it is more expensive when you do want to buy it."

Human resources executives also agree that tuition reimbursement can be another lucrative benefit. Nurses may not plan to earn a master's degree when they first take a job, but it can save thousands of dollars if they decide to go back to school later.

Alice Monaghan, RN, a nurse at Good Samaritan Regional Medical Center in Phoenix, opted to pursue a bachelor's degree in nursing at age 55. The hospital covered the $13,000 cost for her to earn her degree.

"I always wanted to say I had a college degree," Monaghan said. "Now, my goal is to have a master's by the time I'm 60."

Her hospital also will cover the cost of her master's degree. Before earning her BSN, Monaghan said, she was sometimes tempted to consider jobs at other hospitals, but in the end she didn't want to give up her benefits. She has worked at Good Samaritan for 35 years and accumulated about six weeks of paid vacation time. She's carried her family on her health insurance plan and was wary about giving up the high-quality coverage.

Start early

Sandy Hughes, director of human resources at Good Samaritan, said another valuable hidden benefit is subsidization of child care costs. The child care facility usually is close to the hospital, and hospitals often will help cover roughly 15 percent of the costs.

"If you have a child who is a toddler, the savings can be tremendous over the years, not to mention the advantage of being close to your child," Hughes said.

Even though the advice about benefits is critical for all nurses, executives such as Meeks said the age group that will gain the most from these tips, unfortunately, are the ones who are least likely to be interested in benefits: 20-somethings.

For them, the advantages of retirement money and life insurance may seem distant, but decisions now about 401(k) and health care plans can translate into hundreds of thousands of dollars by the time they are ready to retire.

"The 20-somethings are the ones that really need to look long term," Meeks said. "Front-end things may be attractive and may lead you to want to grab a sign-on bonus, but they will really benefit if they can discipline themselves to think long term."

Contact Heather Stringer at heathers@nurseweek.com.