Rachel Norton has been a critical care nurse for 14 years. She's worked as a staff nurse at a hospital, as a flight nurse and, currently on an as-needed basis for a system in Denver. And every so often, she takes on travel nursing assignments, sometimes spending a month at a new hospital when there's a need.
Norton's flexible nursing career is one that's become more common in the past year as staff nurses have taken lucrative travel nursing contracts, reduced their hours or left the workforce altogether from burnout or for early retirement. And nurses aren't alone.
Across the healthcare industry, healthcare providers are clamoring for workers. Jobs numbers for the sector fell again in June, in a rollercoaster of peaks and dips over more than a year that has yet to fully recover from the massive losses early in the COVID-19 pandemic. And, while hospitals and other providers have seen some recovery, nursing homes have been on a nearly steady downward trend since 2020.
"Everybody is looking for caregivers," said Namrata Yocom-Jan, president of Seniors Helping Seniors, an in-home care franchise that is trying to fill more than 1,000 caregiver jobs across the country. "I think the caregiver shortage has been front and center in home care for the better part of five years now. It certainly also has been exacerbated by COVID-19."
Nationwide, providers like Seniors Helping Seniors are offering hiring incentives and, in some cases, retention or referral bonuses to attract and retain staff and address a workforce shortage the American Health Care Association and National Center for Assisted Living is calling "a legitimate crisis."
At Seniors Helping Seniors, which has more than 100 franchise partners in 30 states, franchisees are offering workers a sign-on bonus of $100 to $500, with a percentage of that bonus being donated directly to the Alzheimer's Association. The idea is attract workers but also bring in people who want to help charity, said Seniors Helping Seniors COO Daniel Jan.
"There are other companies providing bonuses but there are no companies that provide a greater good component to the recruiting bonus. I think what that's going to allow us to do is recruit a different kind of individual," Daniel Jan said.
For Seniors Helping Seniors caregivers, the hourly rate averages $12-13, which is an increase of about $1.50 over the past year. Raising salaries usually means raising rates to clients though, so it's a balance to maintain margins, Daniel Jan said.
"Because caregivers are so vital to our seniors, we want to make sure they're compensated well. But we also have to make sure we're making a margin as well," he said.
Nebraska Medicine is offering undisclosed bonuses to roles it calls "critical talent." These are positions the system has trouble recruiting for and where it has shortages, such as emergency department nurses, medical assistants and certified nursing assistants, said Frank Venuto, chief human capital officer at Nebraska Health.
"To compete, we had to offer hiring bonuses," Venuto said.
While bonuses are nothing new to attract for high-demand roles, the number of bonuses and the price tag on those incentives is higher, Venuto said.
"The reality is we need to appropriately staff our patient care units and other areas within the organization," Venuto said. "It does eat at our margins. We know that, and we plan for it. That's why we're driving for cost efficiencies in other areas so we can afford the labor costs."
The system constantly works to build its pipeline of new talent, Venuto said. Nebraska Health offers scholarship opportunities for those in minority communities and will directly help pay off a student's debt if they work for the system.
DCH Health System in West Alabama is offering $15,000 signing bonuses to nurses in med surge and the emergency department, as well some hiring bonuses to nurses in critical care and women's services, who commit to working full-time at one of the system's two largest facilities for a year. The program started in the spring and already has encouraged students who won't graduate until 2022 to sign on.
DCH Health has offered bonuses before but never as high, said Lori Royer Sommers, human resources director of compensation, employment and workforce development for DCH Health.
"This is the largest amount we've done for a one-year period," Royer Summers said. "I think what happened during COVID is a lot of nurses left to travel. We're hoping bonuses help."
The system, too, is offering $6,000 bonuses to employees who refer full-time registered nurses.
Norton, who also works with Vivian Health, a job marketplace for healthcare workers, said some hospitals in her area are offering as high as $25,000 signing bonuses to potential employees, while others are providing new hires with medical benefits on their first day on the job.
"I think the sign-on bonuses are a really great way to attract staff, especially if there are staff in the area," Norton said. "I would like to see hospitals offer at least a portion of it to the highly experienced nurses with no strings attached."
Bonuses that come with time commitments can sometimes be seen as a red flag to nurses who worry they will be trapped in a workplace with a staffing shortage, Norton said.
"Are you going to get there and be super short staffed? Those are he types of things that make you want to leave a place," Norton said.
For many nurses, workplace culture can matter more than a one-time bonus, she said.
"That's a struggle nationwide for hospitals, especially as we come out of the pandemic. Nurses have left the bedside because they're burnt out. It's almost like no amount of money could entice them back to the workplace," Norton said.
An added benefit
David Coppins, co-founder and CEO of IntelyCare, a workforce management solution for post-acute facilities, said employers can't rely on one-time bonuses to retain workers.
"Instead, they should listen to employees and provide them with meaningful benefits while paying them what they deserve," Coppins said. "Making this kind of investment can go a long way to ensure that workers feel protected and appreciated."
Nurses have told IntelyCare they want increased health and malpractice insurance, retirement plans, wellness services, childcare discounts,and help with necessities like groceries, Coppins said.
Some companies, like home healthcare startup Papa, are trying to offer other benefits to get workers to join their ranks.
Papa introduced a hybrid office at its Miami headquarters, provides paid parental leave, offers a 401K match and gives workers a monthly lunch stipend and a Spotify account. The company is looking to add another 400 employees to its workforce by the end of the year.
"We think beyond hourly rates; we really think about earnings," said Papa CEO and founder Andrew Parker.