|
Like many in her position across the country, Stephanie
Mearns, MN, RN, vice president for patient care services
at the Little Company of Mary San Pedro Hospital in
Southern California, is desperately seeking nurses.
Her hospital has raised nurse salaries " three
times in 20 months, she said. It offers a $10,000 sign-on
bonus for certain positions. The hospital has extensive
retention incentives, including an on-site BSN degree
program, flexible scheduling, tuition assistance and
a professional values program that compensates nurses
who participate in education and nursing leadership
events.
In some ways, the bonuses, salary increases
and retention incentives are working. More new graduates
have come to work at the hospital. One of the sign-on
bonus positions has been filled. But other bonus positions,
in telemetry, have no takers. Mearns must hire registry
nurses and struggle to fill vacancies.
The salary increases and sign-on bonuses are still
"not filling my needs," Mearns said. Nevertheless,
the hospital will continue to offer them. "We have
to stay competitive," she said.
Most hospitals across the country are in a similar
situation, health care consultants and recruiters say.
With no end in sight to the nursing shortage, salaries,
benefits and bonuses are expected to rise steadily for
the next few years, at least. After that, they say,
what happens to salaries will depend on the state of
the economy, the financial situations of health care
institutions and the acuity of the nursing shortage.
All this is heady news for nurses who have seen years
of salaries that barely kept pace with inflation and
few benefits like pension plans or tuition reimbursement.
Many nurses believe the shortage is bringing them the
respect and appreciation they have felt lacking from
their jobs, reflected in increased compensation.
But consultants, recruiters and union representatives
warn both nurses and employers that higher salaries
and huge sign-on bonuses alone won't buy job satisfaction.
If hospitals want to attract and keep nurses, employers
will need to make sure nurses have meaningful work,
give them more autonomy in everything from scheduling
to patient care, and offer them ways to grow in their
careers. Nurses who want to feel satisfied and secure
in their work must look beyond salaries and bonuses
for jobs that offer them these benefits.
The nursing shortage, which began in certain regions
and specialties, has spread throughout the hospital
and the country, and is expected to worsen. Last year,
one in seven hospitals reported a severe shortage of
nurses, with more than 20 percent of RN positions vacant,
according to a workforce report published in the fall
by the American Hospital Association.
On average, the 1,092 hospitals that participated in
the survey reported a 13 percent RN vacancy rate. More
than 40 percent of those hospitals reported paying sign-on
bonuses-up from 19 percent in 1999. More than half reported
that their expenses for RN recruitment and retention
had increased. Even if the demand for RNs does not change,
the report projects a 15 percent RN vacancy rate in
2003.
Rick Wade, senior vice president of the American Hospital
Association, said some hospitals were cutting community
programs and deferring investments in new technologies
and buildings to pay salaries for hospital staff.
Salaries
Nurse salaries vary widely from region to region, although
consultants say this is changing as nurses become more
mobile. Starting salaries are about $26,000 in Mississippi
and about $48,000 in Southern California, according
to nurses who teach or hire in those areas.
Average nursing salaries ranged from $38,456 to $49,088
in 2000, according to Nursing 2001 magazine. On average,
they have increased between 4.5 percent and 6 percent
annually since then, said Robert Roeder, senior compensation
consultant and principal partner at Mercer Human Resource
Consulting.
He expects salaries to continue to rise by at least
5 percent to 5.5 percent a year for the next two years,
although the increase may not be as high in communities
that are not affected by the shortage, such as those
near nursing schools.
Nursing unions are negotiating increases in RN salaries
of at least 5 percent and "often significantly
higher," said Edmund Bronder, senior policy fellow
for United American Nurses, AFL/CIO, the labor arm of
the American Nurses Association. Nurses in New York
recently negotiated a starting salary of $55,000, he
said.
E. Carol Polifroni, Ed.D., RN, associate professor
at the University of Connecticut School of Nursing in
Storrs, said she expects annual salaries on the East
Coast to increase by as much as $15,000-to between $60,000
and $65,000-in the next two or three years.
In California, where the nursing shortage is especially
acute, the California Nurses Association has negotiated
recent contracts that include raises of 14 percent to
20 percent over two years, said Jill Furillo, RN, director
of government relations for the association.
"I think nurses are feeling somewhat empowered
because of the shortage," Furillo said. "We
feel that we have much more leverage."
As the shortage continues, Polifroni expects employers
will offer more benefits such as tuition reimbursement
and retirement benefits, in addition to salary. Few
hospitals offer pension plans, she said, although they
may offer some other type of salary deferment plan,
such as a 401(k).
Benefits
Karen DeLevan, senior recruiting consultant for Texas
Health Resources in Dallas, said she has seen increased
interest in pension plans-and not just from older nurses.
"We're seeing some interest from the Gen-Xers,"
she said. They're looking for plans that might let them
retire early on a lesser amount of money, she said.
"But they're still looking at it."
Pension plans and insurance benefits that carry into
retirement are not only attractive to nurses looking
for jobs, Furillo said. They also make excellent recruitment
and retention tools. "It's an incentive for a nurse
to hang in there," she said.
In addition to traditional benefits such as retirement,
employers may have to offer other special incentives
to attract nurses.
"One of the areas that employers should be looking
at is 24-hour child care," said Judy K. Leavitt,
M.Ed., RN, FAAN, associate professor at the University
of Mississippi School of Nursing in Jackson. "That's
the area that sometimes gives nurses the most difficulty."
For nurses with families, a 24-hour child care program
might be more attractive than a high-end salary, she
said.
DeLevan said she doesn't receive as many requests for
child care as she used to, but she is hearing from nurses
who want family benefits, such as scholarships for dependent
children. Polifroni said paid sabbatical leaves, like
those offered to university professors, or at least
more vacation time, might attract nurses to a job.
Most consultants and those who study workforce issues
believe larger hospitals would do well to offer a "cafeteria-style"
benefits package that allows employees to pick and choose
which benefits they want. The amount of their salaries
would vary with the number and type of benefits they
select, and the employer wouldn't have to pay for benefits
that some employees didn't want or use.
Bonuses
Although neither union leaders nor hospital administrators
favor them, consultants and recruiters expect sign-on
bonuses to continue and to increase in the future.
"When I'm posting a job and there's a sign-on
bonus, I get a much better response," said Frank
DiLello, accounts manager of MedHunters.com in Toronto,
an headhunting company for medical staff.
The typical sign-on bonus is between $2,000 and $5,000,
he said, although he's seen bonuses as high as $10,000.
Most are offered by large hospitals, but smaller facilities
are starting to join in the practice. DiLello knows
of a small hospital in New Mexico "in the middle
of nowhere, where every single medical job has a sign-on
bonus" of about $2,000.
Roeder said he recently read about a hospital in Cincinnati
that was offering $30,000 sign-on bonuses paid over
three years for cardiac care nurses.
"Sign-on bonuses attract people," DeLevan
said. "I hate to say it because I don't believe
in them," but she sees the practice continuing.
"We might call it different things," she said,
such as hiring incentives or retention bonuses.
To keep staff happy, some hospitals offer retention
bonuses to qualified nurses already working for them.
Others offer referral bonuses to employees who successfully
bring a new nurse into the fold. Roeder believes bonuses
for employees are a wiser use of money than sign-on
bonuses because they retain nurses already working,
as well as bringing in new workers.
These tactics also help decompress the salaries of
bedside nurses, who would otherwise reach their earning
peak within a few years, consultants said. Many hospitals
also offer salary increases for advanced education and
credentials to encourage nurses to continue their education,
as well as their earning power.
Many nurses believe that the salary increases, bonuses
and new benefits have been long in coming. Nurses' salaries
from the mid-1980s through 2000 were flat, Bronder said.
In the mid-1990s, they didn't even keep up with inflation.
"It's only been in the last couple of years that
somebody could truly raise a family on what a nurse
is making," Polifroni said.
Whether salaries now are at a level that nurses believe
is fair depends on whom you talk to and where they work.
"We still hear the complaining about salary, with
regard to how many hours they're working and the acuity
of the patients," DeLevan said. Mearns said she
still hears nurses say they are underpaid.
But although the first question new graduates usually
ask DeLevan is about salary and bonuses, nurses seldom
list pay as the reason they leave or stay in their jobs.
In surveys of why nurses leave their jobs, salary doesn't
even make the top five, she said.
"They don't stay for the salary. They stay because
feel they're part of a family on the unit. Or they stay
because they have a great nurse manager or because the
administration is pro-nurse. They stay because they
have a say and feel they are being listened to in their
facility, even if they are not paid at the top of the
range."
"Salary matters," Furillo said. But the first
questions the nurses she knows ask a potential employer
are, "What's your staffing like?" "What
is your model of care?" Many hospitals that work
to make themselves attractive to nurses, including at
least one magnet hospital in California, do not offer
sign-on bonuses, she said.
Salaries also do not seem to make a huge difference
in why people go into nursing, said Joanne Spetz, Ph.D.,
of the Center for California Health Workforce Studies
at the University of California, San Francisco. "I
think the overall image of nursing is the biggest factor
in deterring people from considering nursing as a career,"
she said. In one study Spetz heard cited, people viewed
nurses as laid off, on strike or angels of mercy. "Not
exactly the best images for young people," she
said.
Room for improvement
Spetz said surveys and focus group discussions have
shown that nurses are most dissatisfied with working
conditions, flexibility of employers and their benefits.
[The NURSEWEEK/AONE survey reflects this and other issues.
www.nurseweek.com/survey] Improved staffing ratios were
their top issue, she said. They also wanted more control
over their shifts and overtime, more understanding about
their child care needs, adequate sick time and protected
benefits.
Wise employers will offer competitive salaries and
benefits, Roeder said, but they also will make sure
they're providing nurses with an organization for which
they feel proud to work, a good fit with supervisors
and jobs, the feeling of being valued members of a team
and opportunities to expand their knowledge and skills.
If employers don't offer these things, he said, "any
money you throw at this problem is going to be money
you're throwing away."
Joann Genovich-Richards, Ph.D., MSN, MBA, RN, is president
of Sharendipity Enterprises Inc. in Sterling Heights,
Mich., a private consulting firm for strategic planning
and performance for health care institutions.
She worries that as hospitals are forced to pay higher
wages and scramble for nurses, they may begin to divert
some aspects of nursing jobs to less skilled, lower-paid
workers.
"My greatest fear is that we will see other ways
of getting the task done," she said.
DeLevan believes the attempt to use lower-skilled workers
in nursing jobs failed so miserably in the past that
it won't be tried again. She has faith that more young
people-attracted to the idea of helping society-will
go into nursing and eventually ease the shortage. In
the next five years, she sees salaries leveling out
and sign-on bonuses disappearing.
Roeder isn't so sure. "We know there's going to
be a continuing demand for nurses and we're going to
have to pay a price for those," he said. "We're
not sure how we're going to do that. To look five or
six years out, it's pretty scary."
In the meantime, administrators in some hospitals are
finding that although hiring new nurses is a struggle,
they are more in tune with the needs of their existing
staffs.
"I'm more focused on what we are doing to keep
the people we have here," Mearns said.
"They're looking for respect, they're looking
for flexibility in their jobs, they're looking for workloads
that reflect patient acuity. I haven't ever heard them
ask for anything that's so outrageous that we can't
try to fix it."
Contact
Cathryn Domrose at kaguilar@well.com.
|
