Health systems successfully reduced turnover last year by experimenting with $100,000 bonuses, professional development programs and education payouts, among other strategies.
Despite these efforts, systems are still looking for additional ways to shore up their staffing levels. Hospitals continue to grapple with high staffing costs and low operating margins, and more are seeking ways to invest in the career longevity of their clinicians.
National turnover for registered nurses sits at a rate of 22.5% and results in hospitals losing, on average, between $6.5 million and $10.5 million annually, according to 2023 survey data from NSI Nursing Solutions, a nurse recruitment firm.
Here are several approaches health systems used to retain their clinicians in 2023 and their results.
Offering big bonuses
Palomar Health’s short-term plan to offer $100,000 bonuses to clinicians and new hires was crafted with two goals in mind: incentivize current employees to stay, and reduce its reliance on travel nurses.
A year after offering the incentives, the system has made significant headway on both fronts.
In 2023, more than 1,000 nurses employed by Palomar Health signed up for the bonuses, which require a three-year commitment for the full payout, said Julie Pursell, chief human resources officer at the Escondido, California-based health system.
Additionally, around 175 new hires, some of which were formerly travel nurses, received $100,000 sign-on bonuses after the system opened up the incentives to potential employees.
Around 18% of healthcare job listings offer sign-on bonuses, at an average of nearly $11,000, according to recent data from Adzuna, a job search engine.
Palomar Health went from paying 350 travel nurses at the beginning of 2023 to contracting with less than 100 this year.
“The biggest thing for me was [to] take even a fraction of those millions of dollars that we were spending on travelers and convert those to dollars that we could spend on our employees,” Pursell said.
The system spent $16 million on bonuses last year, considerably less than the $60 million it typically spends on travel nurses, Pursell said.
The bonuses were also a quicker way to get extra money into employees’ pockets compared with changing the system’s overall hourly compensation rates, she said.
However, as Palomar Health is still competing with local facilities that offer higher wages and different benefits, the bonuses did not solve all of the system’s retention and recruitment challenges. Still, Pursell said the incentives signaled to employees that the system recognizes their value.
“It has definitely conveyed the message that we are going to continue to be focused on our employees and retaining that top talent as best we can,” Pursell said. “And becoming a place where employees want to come and stay forever.”
This year, rather than continuing the $100,000 bonuses, which were a one-time deal, the health system is trying out smaller financial incentive packages to fill specific positions. They are also working to better connect with employees and help them feel more engaged through communication and clinical support.
Building professional development programs
For El Camino Health, based in Mountain View, California, professional development opportunities for clinicians have lowered the system’s turnover rate and increased retention rates among certain nursing groups.
One of the health system’s most popular programs trains nurses in certain care settings, like ambulatory or post-acute care, on the necessary skills to provide safe, high quality acute care services, said Cheryl Reinking, the system's chief nursing officer.
“We knew that during the pandemic period, some nurses didn't have the opportunity to get positions in acute care because a lot of hospitals shut down their new graduate programs,” Reinking said. “So we started the bridge to acute program, and retained nurses who might have been at risk of leaving the profession completely.”
Launched in 2022, the intensive, six-week clinical program pairs nurses with experienced supervising clinicians on acute care units to gain hands-on experience and in-person support.
Among the 55 nurses who made the transition to acute care, more than 90% have opted to stay with the health system.
El Camino Health’s recent graduate program has also helped retain employees. The program, which accommodates 10-12 new nurses at a time, mentors employees for their first full year at the health system. This has helped less experienced nurses feel more confident in their clinical abilities and more secure in their role at El Camino Health, Reinking said.
“Normally, we have a turnover rate that's less than 5%,” she said. “At the height of the pandemic, our turnover rate went as high as 12%. That was two years ago. It's now down to 7%.”
This spring, the system plans to hire a nurse retention specialist who will be tasked with examining data on what matters to clinicians to provide a comprehensive road map for staffing growth, Reinking said.
Covering education costs
As an independent rural facility without the resources or backing of a larger health system, Jersey Community Hospital has taken advantage of numerous partnerships and opportunities to boost retention among its 450 employees.
In 2021, the hospital launched an apprenticeship program with a local community college and job agency, allowing two to four full-time employees to take a two-semester course and become registered medical assistants.
Tuition is covered as part of the ongoing program, and employees are paid by Jersey Community Hospital to both attend class and work 40 hours a week at the facility.
Jersey Community Hospital has been able to close most of its open positions with apprenticeship program graduates, said Beth King, CEO of the Jerseyville, Illinois hospital.
The hospital is also a registered site for nurses and advanced practice providers to receive student loan forgiveness from the Health Resources and Services Administration. Several Jersey Community Hospital nurses have applied for the loan repayments over the last two years, according to King. That helps with retention since clinicians must remain working at the facility to be eligible for loan repayment, she said.
Following the intense peaks of the pandemic, Jersey Community Hospital has managed to halve its turnover rate, bringing it under 10%, and is not currently using any travel nurses.