In for the Long Haul
From bonuses to flexible shift options, hospitals employ creative techniques to retain their most valued commodity—experienced nurses

By H. Cheever Griffin
January 23, 2004

Karen Teatum, RN, was hosting a small party at her home recently when a phone call from a fellow nurse at Arkansas Heart Hospital in Little Rock made the gathering immediately more festive.

The hospital, the caller said, had announced a bonus program for its nurses that would pay them $20,000 over three years. "I was stunned and amazed," Teatum said. "My initial response was, 'Where's the paperwork? Let's get started!' "

Nurses around the country are receiving similar good news these days, as hospitals entice them with everything from more money to greater work flexibility to a variety of other on-the-job perks. This growing wave of largesse on the part of hospital administrators is an attempt to address a challenge that often gets lost amid the publicity surrounding the nursing shortage: nursing retention.

As health care leaders continue working to attract more nurses to the profession, an increasing number of hospitals are acknowledging the urgency of retaining the nurses they already have. "Our No.1 goal these days is retention," said Nancy Ray, chief nursing officer and associate administrator at University Hospital in San Antonio.

Ray and others said that retaining nurses is crucial to the well-being of any hospital-from both operational and financial standpoints.

"It's so important to have longtime nurses," said Leah Golden, RN, resuscitation program educational coordinator at Vanderbilt University Hospital in Nashville, Tenn. "They're the ones who know the system as well as the best way to care for the patients that the hospital commonly sees. In addition, it's a well-known fact that it costs a lot more to train a new nurse than to retain one."

What's also well-known is that retaining nurses in today's health care climate is becoming ever more difficult. Due largely to the nursing shortage, many nurses say they are overworked and stressed out. As a result, some leave the profession altogether. What's more, the shortage has made it easier for nurses to work anywhere they want. This has turned many nurses into free agents who move from one hospital to the next in pursuit of better job conditions.

"It happens a lot down here," Teatum said, referring to the job-hopping trend she's noticed. "I know one nurse who has worked at four hospitals in five years."

Golden sees such a phenomenon as a simple fact of life in the nursing field today-and one that more hospitals need to address. "Many nurses are going to have their pick of hospitals anywhere," she said. "And if they're not treated well, they're going to move on."

Love 'em or lose 'em

Hospitals that are working to keep their staff nurses satisfied are doing so in a variety of ways. One such method is greater financial compensation in the form of bonuses or pay raises.

Teatum said that before Arkansas Heart Hospital announced its bonus program, a series of management changes-and the seemingly constant introduction of policy changes-had created low morale among the nursing staff.

She added that the nurses and doctors enjoy a close relationship at her hospital-and it was the doctors who went to bat for her and her colleagues. "Everyone was unhappy and we let the doctors know about it," she said. "And they essentially told the hospital that there's a problem and that it needed to be fixed."

When the fix came, Teatum said, she and the other nurses were pleased-not just with the money, but with what it represented. "It made us feel appreciated, and it demonstrated to us that the hospital considered us valued members of the team," she said.

To make their nurses feel more appreciated, officials at Main Line Health System in Bryn Mawr, Pa., also used a bonus program. Nursing vacancy rates at the system's three hospitals had been 22 percent, 15 percent and 10 percent, respectively, said Jan Nash, RN, vice president of patient services.

Since giving nurses a $25,000 bonus (paid out over three years), the vacancy rates for all three hospitals have dipped to single digits.

"It's been an extremely successful program," Nash said. "It has helped our nurses feel better about their work and helped our hospitals become more stable and better equipped to move forward."

Nash added that Bryn Mawr also has turned to another method to keep nurses happy on the job: scheduling perks. This includes a reduction in the frequency of obligatory weekend duties and increased pay for less desirable shifts.

"The resource pool of nurses simply isn't large enough to allow them to leave your hospital," Nash said. "You have to be willing to meet their needs."

Officials at University Hospital also are giving nurses more flexible work options, Ray said. Several years ago, with their nursing vacancy rates stuck at about 13 percent, administrators began a concerted effort to make their nurses happier. One of the first things they did was to reduce shifts from 12 hours to eight hours by increasing nurse reserves. They also did away with mandatory floating and overtime. In addition, they made it easier for nurses to explore working in other units.

"Our focus was trying to make their work life less stressful," Nash said, adding that the effort has paid off mightily for the hospital in the form of a vacancy rate that has dropped to below 2 percent.

Other hospitals across the country are giving nurses greater control over their schedules and workloads. At Pourde Valley Hospital in Fort Collins, Colo., for example, administrators created a plan that gives nurses full-time pay for working weekends. In addition, nurses who prefer to work evenings and nights exclusively receive a bonus every six months.

Elsewhere, hospitals are implementing a variety of other measures to keep nurses from leaving. Golden at Vanderbilt University Hospital is also co-chair for the facility's recently created Nursing Wellness Task Force, which is charged with devising ways to create a better all-around work environment for the nursing staff.

The group has implemented programs such as the Take-Your-Break Campaign, which encourages nurses to take time out during their shifts to relax and re-energize. "Nurses get break time, but many of them don't use it," Golden said. "What we're doing is trying to help nurses take better care of themselves by occasionally slowing down during the day."

The group also organized a Nurses Week celebration, during which the hospital treated nurses to facials, massages and jewelry vendors. "We spent a week pampering our nurses," Golden said, adding that the response from the nursing staff was tremendous.

Golden said her nursing task force is busy planning further retention initiatives, as well as starting to focus on what may be the No.1 retention issue for hospitals in the years ahead: how to keep the older-than-40 crowd happy.

Golden contends that as the nursing population grows increasingly older, hospitals are going to have to figure out ways to meet their changing work and lifestyle needs-or risk losing them.

She added that more mature nurses also may need greater work flexibility, as many have to begin devoting more time to their children or their elderly parents. "These nurses have a vast amount of knowledge and experience and we're exploring ways to make sure we keep them," Golden said.

In the end, Teatum said, making sure that nurses are on board for the long haul is in the interest of everyone at a hospital. "One of the reasons the doctors worked to meet our needs is that they want nurses they know and trust," she said.

Added Nash, "Being proactive about retaining your nurses is a lot of work. But the dollars and everything else you invest will pay off in the quality of patient care."

Contact H. Cheever Griffin at cgcommunications@ameritech.net