1. Offering large bonuses

In 2023, leaders at Palomar Health developed a short-term plan to offer $100,000 bonuses to clinicians and new hires. The goal of the bonuses was to incentivize current employees to stay and reduce the system's overall reliance on travel nurses.

According to Julie Pursell, Palomar's chief human resources officer, over 1,000 nurses signed up for the bonuses, which require a three-year commitment for the full payout. In addition, around 175 new employees, some of whom were originally travel nurses, received $100,000 sign-on bonuses after the organization opened up incentives to potential employees.

After offering these bonuses, Palomar cut its number of travel nurses from 350 at the start of 2023 to fewer than 100 so far 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.

In 2023, Palomar spent $16 million on bonuses compared to the $60 million it typically spends on travel nurses, Pursell said. She also noted that the bonuses allowed the system to get extra money to their employees more quickly compared to changing the organization's overall hourly compensation rates.

Although the bonuses did not solve all of Palomar's recruitment and retention challenges, Pursell said the incentives showed employees that the system recognized 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," she said. "And becoming a place where employees want to come and stay forever."

Instead of continuing the $100,000 bonuses this year, Palomar is testing out smaller financial incentive packages to fill certain positions. The system is also offering communication and clinical support to help connect and engage with employees.

2. Creating professional development programs

At El Camino Health, professional development opportunities have helped the organization reduce its turnover rates while increasing retention rates among certain nursing groups. According to El Camino CNO Cheryl Reinking, one of the most popular development programs trains nurses in certain settings, such as ambulatory or post-acute care, on how to provide safe, high-quality acute care services.

"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."

So far, 55 nurses have gone through the program and transitioned to acute care. Among these nurses, 90% have chosen to stay at the health system.

El Camino also has a recent graduate program, which offers mentorship to 10 to 12 new nurses during their first full year at the health system. According to Reinking, the program has helped the system retain employees by helping new nurses feel more confident in their clinical skills and more secure in their positions.

"Normally, we have a turnover rate that's less than 5%," Reinking 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 year, El Camino plans to continue its retention efforts by hiring a nurse retention specialist who will examine data and create a road map for staffing growth.

3. Covering employees' education costs

Jersey Community Hospital, which is an independent rural facility, utilizes partnerships and other opportunities to boost retention of its 450 employees.

In 2021, the hospital partnered with a local community college and job agency to launch an apprentice program that allows two to four full-time employees to take a two-semester course and become registered medical assistants. The program covers tuition, and the hospital pays employees to attend classes and work 40 hours a week at the facility.

According to Jersey Community Hospital CEO Beth King, the hospital has been able to fill most of its open positions with graduates from the apprenticeship program.

Aside from the apprenticeship program, nurses and advanced practice providers can also receive student loan forgiveness from the Health Resources and Services Administration at the hospital. Offering loan forgiveness has helped with retention since clinicians have to be working at the facility to be eligible for the repayments, King said.

Since the pandemic, Jersey Community Hospital has managed to halve its turnover rate to under 10% and is currently not using any travel nurses.

Commentary

According to Advisory Board's Allyson Paiewonsky, though large financial bonuses are appealing to workers, they're unsustainable and will not address an organization's long-term workforce challenges.

But investing in professional development programs and covering education costs have the potential to be more effective in the long run. These investments will help organizations build their workforce pipeline and may also instill organizational loyalty among employees.

To help your organization make progress on clinician recruitment and retention goals, Advisory Board has resources:

In this expert insight, the Radio Advisory podcast team compiled five episodes that dive into short- and long-term challenges of the ongoing workforce crisis and offer strategies for leaders to combat them.

There are also several resources targeted specifically at recruiting and retaining nurses. For example, this toolkit explains how to retain first year nurses while this cheat sheet outlines how to build a flexible nursing workforce with the help of nontraditional work options and cross-specialization. In addition, this article details must-do strategies for C-suite leaders working to turn the tide of the RN exodus.

We also offer specific recommendations on how to stabilize the RN workforce. These recommendations will help you balance the needs and expectations of your RN workforce with both organizational and market realities.

Other helpful resources include how to become a physician employer of choice, how one hospital started an oncology nurse residency program, and how technology can help solve the workforce crisis. (Devereaux, Modern Healthcare, 1/31)

Leaders are searching for new solutions to support clinicians and fill staffing gaps at their organizations in the face of clinician burnout and labor shortages. It can be daunting to identify and understand all the technologies available to address workforce challenges. Download our comparison charts to evaluate these technologies and their benefits.