Written by Aisha Ainsworth

Providing exceptional health care requires exceptional people. Hospitals depend on the skills and abilities of every hospital employee, from the C-suite to support staff. Finding and keeping that talent is critical to running a cost-effective organization.

Texas hospitals often are looking for ways to innovate and improve care. From genomics to data analytics to machine learning—new opportunities are being tested and applied across the care spectrum. One of the most promising areas for innovation, however, is how hospitals recruit and retain their nurse workforce.

Texas Hospitals Navigate the Job Seeker’s Market

The competition to offer the best salaries, benefits and job perks to draw and hopefully retain good employees is stiff among Texas hospitals. With an ongoing nurse workforce shortage, “Texas hospitals are competing to recruit from a limited pool of young talent new to the dynamics of our industry,” said Sally Hurt-Deitch, RN, FACHE, vice president of care services and chief nursing officer at Tenet Healthcare Corporation, a Dallas-based health care system. Because young staff can choose from job opportunities outside of health care that offer higher salaries and better hours, gaining a competitive edge in the war for talent sometimes requires creativity. In addition to the work itself and work hours, financial incentives are important factors in job consideration during recruitment, the ADP Research Institute found in a recent study.

Many Texas hospitals offer generous sign-on bonuses. Some offer heftier bonuses as a way to recruit nurses from other hospital systems. One facility might offer an employee a $10,000 sign-on bonus—$5,000 for the employee and $5,000 for the employee to repay the sign-on bonus from the employer with whom he or she previously agreed to work.

The Hospital Corporation of America, the nation’s largest publicly traded hospital system, announced earlier this year its plan to invest $300 million in employee benefits. While the funds will be used for tuition reimbursement, student loan repayment and extra family leave for all of its employees, the benefits largely are designed to attract nurses.

Data from the U.S. Department of Labor’s Bureau of Labor Statistics confirmed increased employment in the health care industry, with job gains in ambulatory health care services increasing by 10,000 and 12,000 within hospitals in September alone, yet nurses routinely are leaving their posts.

Financial gains may lure workers to a job but may not be enough to retain the workforce. Considering the rapid rate of retirement for baby-boomer nurses, Texas hospitals experience considerable turnover for first-year registered nurses—21 percent in 2017—compared to 25 percent for all RNs and 34 percent for nursing assistants in the same year, according to the Texas Department of State Health Services’ 2017 Hospital Nurse Staffing Study.

With the U.S. unemployment rate at a 10-year low, it’s a job seeker’s market in many industries. If financial incentives don’t attract and hold employees’ attention, hiring managers and human resources professionals are left to consider other variables. Astute Texas hospitals are doing just that.

Finding Common Ground in Overarching Ideals

High rates of nurse turnover and vacancies hurt hospitals’ bottom lines and could negatively impact patient care. The cost for hospitals to replace a nurse, including pre-hire recruitment and factors such as unstaffed beds, overtime and productivity loss, can range from $97,000 to $105,000, according to the Journal of Nursing Administration.

Given the restlessness of the job market, it may seem counterintuitive for employers to invest significant time and energy in variables that make employees individuals—their aspirations, relationships and values. Research in the field of behavioral economics, however, indicates otherwise, as retention and employee engagement seem to go hand in hand.

According to Gallup, Inc., the top predictors of engagement at work aren’t salary or title, but rather more nebulous factors, such as clear expectations from and a strong relationship with direct managers, establishing friendships at work and feeling empowered and supported in both professional development and career advancement.

For CHRISTUS Health System, a faith-based not-for-profit health system comprised of 600 facilities across the U.S., leadership and culture influence retention, and the health system is demonstrating those values from the top down to retain its nursing staff. “We strive to build a culture that nursing staff at all levels want to be a part of,” said Cris Daskevich, FACHE, CEO of the Children’s Hospital of San Antonio and senior vice president of maternal and pediatric services for CHRISTUS Health . Hiring the best and the brightest is important, but CHRISTUS makes a point to recruit “nice, good people, and we have to be a model of that for staff,” Daskevich noted.

Through CHRISTUS’ nursing governance, nurse leaders have the opportunity to participate with the chief nursing officers and physicians across the system to help make strategic decisions that guide patient care and operational planning. Young nurses know their role and work is valued because “they are part of a strong team that is recognized and has influence on leadership’s decision making,” Daskevich explained.

To create a culture in which nursing staff can thrive, CHRISTUS created nursing retention councils. Front line nurse staff have the opportunity to participate on the councils, connect with peers and make recommendations to ensure the health system facilitates an environment in which nurse staff can grow and advance.

While the organization values market-competitive compensation, above all, CHRISTUS seeks to foster a culture that is “focused on patient care and extending the healing ministry of Jesus Christ,” Daskevich explained. When an organization models its values from the top down, “you can see and feel nursing staff’s commitment to those values in their work every day,” Daskevich recounted.

Catering to the Individual

Like CHRISTUS, Memorial Hermann Health System, one of the largest not-for-profit health systems in southeast Texas, is keenly aware of what it takes to recruit and retain quality nursing staff. Memorial Hermann’s retention strategy is wide ranging and highly personal.

At its simplest, the health system supports a staffing structure that enables nurses to set schedules that work with their lifestyle. A smart move, as participants of ADP’s Fixing the Talent Management Disconnect study reported that work hours were the second highest reason (excluding compensation) to stay at a company. Memorial Hermann employs a multipronged, evidence-based approach to retention that is ingrained in leaders across the 19-hospital system.

To ensure fitness, prospective applicants for Memorial Hermann’s nurse residency program undergo a pre-hire assessment that Catherine Giegerich, RN, FACHE, chief nursing officer at Memorial Hermann The Woodlands Medical Center, considers “a gift.” While recent nursing graduates may express interest in a particular specialty like critical care, some aren’t completely aware of their own challenges related to a specific specialty. The gift of the assessment is “giving them insight into themselves,” Giegerich explained.

Memorial Hermann requires a two-year commitment of the 250 newly licensed registered nurses who are accepted into the residency program. The system reinforces residents’ sense of loyalty to the organization by hosting residency reunions and offers nurse fellowship programs that allow nurses to gain sub-specialty education, making them better qualified to pursue the area of nursing they want to practice.

The first group of 241 nurse residents began in 2015. After fulfilling their two-year commitment, more than 80 percent remain within the system. In subsequent groups, the program continues to be an effective tool for retention. For example, in the third group of 395 nurse residents, more than 86 percent stayed beyond their two-year commitment.

The high retention rates of nurse residents at Memorial Hermann could be due in part to the investment nurse leaders make in their staff. Giegerich and her colleagues understand the stakes are high. Employees can be recruited by the competition with little, if any, increase in compensation. Leaders have to engage employees often to retain quality staff.

Through regular communication, nurse leaders ensure seasoned staff actualize their full potential by helping them gain experience that will strategically position them for their dream job. A nurse can declare interest in one of the health system’s three “workstreams”—education, clinical practice or administration. If a nurse wants to be an educator, he or she will have the opportunity to precept new hires or nursing students. The “exposure both prepares you and challenges you to think about whether this is still the path you want to follow,” Giegerich explained. Through the workstream process, nurses gain competencies in and insight on their declared interest so they can be successful in the job they ultimately want.

Texas hospitals are layering competitive salaries and benefit plans with tailored person-centered strategies to increase nurse recruitment, engagement and retention. Nurses are engaged as advocates on behalf of the patients, families and communities they serve, and Texas hospitals are taking new steps to be better advocates for nurses’ professional development and futures. Supporting and retaining quality Texas nurses means ensuring Texas patients have access to reliable and quality care—Texas hospitals’ No. 1 goal.