Help wanted in hiring RNs: Hospitals outsource recruitment of permanent nurses with hard-to-find skills

When Princeton HealthCare System was having trouble finding qualified registered nurses for its behavioral health and home healthcare operations, staffing firm Cielo devised an online recruitment fair. The virtual event attracted many candidates from across the country, and the Plainsboro, N.J.-based one-hospital system was able to fill the positions with strong hires.

Marcia Telthorster, Princeton's vice president of human resources, said the online fair was something she wouldn't have known how to do on her own. “People would look at the newspaper in the old days,” she said. “That's not how it's done today.”

Experienced RNs are in high demand and have many more types of job opportunities than they used to. Outpatient care, travel nursing, care management and health information technology have given nurses alternatives to the physically grueling hospital environment. It's particularly hard to find replacements for retiring nurses in operating rooms, intensive-care units and emergency departments, jobs that require advanced skills and critical thinking, said Rhonda Anderson, CEO of Cardon Children's Medical Center, Mesa, Ariz., and an editorial board member of the journal Nursing Economics.

To gain an edge in hiring, some health systems now use recruitment process outsourcing firms, or RPOs, such as Cielo, rather than their own human resources departments. RPOs generally are contracted to handle the full range of hiring duties for non-executive positions, including initial outreach, interviewing, reference checks, and new employee orientation.

Hospital HR executives say they don't have the time or resources to build and maintain relationships with nursing candidates across the country and around the world, and that RPOs are able to spend more time and deploy more sophisticated technology on recruiting than they could.

“You can lose someone from the first interview to the offer because there's always someone else in their ear,” said Janet Elkin, CEO of Supplemental Health Care, a Park City, Utah-based RPO and staffing firm. “That's where we come in, to make sure that we keep (the candidates) warm and that they actually end up at the (client) hospital.”

Many large staffing firms, including San Diego-based AMN Healthcare, have an RPO component to their business. While a staffing company helps hospitals with their temporary staffing needs, RPOs find permanent candidates for hospitals' open positions.

For many hospitals, a major draw of RPOs is their technological expertise. Recruiters employ targeted text-messaging campaigns, mobile applications, browser-based advertising, hospital-specific social media pages and other forms of digital marketing, and real and virtual career fairs to reach nurses and other professionals. Firms such as AMN maintain giant databases of candidates, far larger than any single hospital or system could create.

“We can, and need to, spend millions of dollars in the most current technologies and approaches,” said Susan Salka, CEO of AMN. “It wouldn't make sense for one hospital or system to make the kind of investments we make.”

RPOs sell clients on their ability to identify and maintain relationships with RNs who have specialized skill sets and who may be willing to change jobs and relocate. Ian Reynolds, talent acquisition manager at Dallas-based Parkland Health & Hospital System, said his system asks its contracted RPO, Supplemental Health Care, to find nurses with high-demand skills. “They have more bandwidth there,” he said.

Prices for RPO services vary widely based on the number of positions that a client needs to fill, the level of skills and experience required for the positions, and whether the RPO is being hired for the long term or just a single project. Though using an RPO may seem like a luxury, many hospital administrators said they would be hard-pressed to find qualified candidates as quickly and cost-effectively as their RPOs do.

“It would be an enormous expense to bring their talent managers in-house and supply the technology,” Telthorster said. “It would exceed the money I have available to do this.”

Most RPOs deploy staffers both on- and off-site for their healthcare clients. In most cases, the recruiters use an e-mail address provided by the hospital client. Candidates don't necessarily know they're being recruited by an outside firm.

Contracted recruiters spend their days checking in with their pool of candidates to monitor their satisfaction in their current job and discuss other opportunities. Recruiting firms often use big-data analytics to track where nurses are moving to understand where to focus their marketing dollars. Sometimes they profile and track individual nurses to lure them back to their hometown. Some firms search overseas and work through the immigration visa process to recruit foreign nurses.

“We live in a day and age where people are very open and willing to relocate,” said Melissa Knybel, vice president of operations for Randstad Healthcare, the Atlanta-based U.S. healthcare division of the Dutch RPO and staffing provider. “We can provide a level of expertise to candidates about the West Coast or the Northeast, even as we're talking to someone down South.”

The goal for RPOs is that when a client organization lists positions it needs filled, the firm already has lined up candidates who are qualified and available. “When you work with us, we're really educating a talent community of nurses about our clients so that they get to know us, like us, and then (come to us when) they are ready to decide to move,” said Jill Schwieters, president of Cielo's healthcare business.

RPOs say clients include health systems of varying sizes. Many larger systems, however, have the resources to do this type of nurse recruiting themselves. They set up what's essentially their own RPO that sources candidates, reviews applications, and refers candidates to individual hospitals for review by local hiring managers, said Judy Thorp, the managing director leading the human resources practice at Huron Healthcare. “It's much more cost-effective” for larger systems, she said.

Thorp said none of her clients fully outsource their recruitment because they like to be directly involved in the recruitment process, though many use external recruiters for certain positions. In recent years, she has noticed many hospital HR departments strengthening their talent management teams and focusing on metrics such as the duration of onboarding and the amount of time it takes to fill positions. “Since talent is the most critical asset for them within the organization, they feel it's critical for them to have a hand in it,” she said.

But she said smaller hospitals and systems may find it beneficial to outsource recruitment for hard-to-find positions.

Part of the reason some hospitals have trouble filling RN positions is that they prefer experienced nurses, who are in high demand, over new nursing graduates. New nurses are expensive to train and need more supervision. But as hospitals pass over recent graduates for experienced RNs, they're leaving behind young nurses whose professional development will be stunted, said Joanne Spetz, an economics professor at the University of California at San Francisco's Institute for Health Policy Studies.

“It's like we simultaneously have a shortage and a surplus, and that's weird,” said Spetz, who studies the economics of the nursing profession. “It is a little frustrating in that the hospitals have been really reluctant to hire new graduates, and they're preferring expert nurses.”

RPOs have a solution for that, too. AMN has invested in a residency-type program to facilitate training of new nurses, which it calls the New Graduate Per Diem Program. Working with the Gotham Cos., a staffing firm in New York, AMN recruits a cohort of roughly 50 graduates of four-year nursing schools who train and work as temporary staff at New York-Presbyterian Healthcare System for about a year. AMN facilitates their training, covering the nurses' pay for their first two months of orientation and then placing them at the hospital as per-diem staff at a discounted rate.

At the end of the residency, New York-Presbyterian can opt to hire the nurses, or they can stay with AMN or Gotham as per-diem nurses. AMN can offer the nurses who have completed the program to other healthcare organizations as experienced candidates who have worked at a major hospital.

Randstad's Knybel said a good RPO doesn't stop searching for nurse candidates until they find the right one for a client. A hospital “can drop $10,000 in advertising and different recruiting events, but that's not guaranteed to give you results,” she said. “With an RPO, you don't pay until you get what you want.”