As hospitals and health systems vie for nursing talent, many organizations have turned to compensation as well as perks beyond pay. The question of whether these rising labor expenses are sustainable appears to be multifaceted and dependent on an organization's vantage point. But in the most populated state in the U.S. — and in one of the least populated — one thing is clear: nursing recruitment and retention requires approaches that must consider other factors such as licensing, housing and overall environment.
To delve deeper into how organizations in Vermont and California are handling nursing recruitment and retention, Becker's interviewed human resources leaders at Burlington-based University of Vermont Medical Center and San Diego-based Scripps Health.
Vermont
Vermont is the nation's second smallest state based on July 2020 U.S. Census data, with a population of 623,347.
At the same time, the state is expected to see a reduction in nurse licenses because Vermont began participating in the nurse licensure compact in February, meaning nurses will not need a Vermont-specific license if they come from one of the other compact states, said S. Lauren Hibbert, director of the Vermont Office of Professional Regulation. Data from the National Council of State Boards of Nursing's electronic information system, Nursys, showed Vermont had 20,882 active registered nurse licenses as of April 4.
All this affects nurse recruitment and retention at University of Vermont Medical Center, according to Mary Broadworth, the hospital's vice president of human resources.
She said the University of Vermont Health Network, the academic health system that includes the hospital, is also one of the larger employers in the state, meaning many people in the state have worked in healthcare or have a family member who works in healthcare or in the network. She also noted the COVID-19 vaccination rate.
"We are a highly vaccinated state, so early in the pandemic I think there was a migration to Vermont from other states from people relocating, and our travel nurse population was willing to come to Vermont because it was a safe haven from a COVID numbers perspective," Ms. Broadworth said.
Still, she acknowledged there are hurdles when it comes to nurse recruitment and retention, including a lack of housing options because of migration to the state.
"We have a housing shortage, pretty much no inventory," Ms. Broadworth said. "And there aren't a lot of other industries for career advancement in the state. For example, we have someone who moves up [to Vermont] with a partner, the partner is challenged to find a job outside of healthcare."
With all this in mind, the University of Vermont Medical Center has focused on developing and growing the current workforce by collaborating with the state on workforce development programs.
Ms. Broadworth said programs include a phlebotomy tech program, a pharmacy tech program, a radiology program, all designed to partner with local technical schools to get more people in healthcare and on a path to becoming a registered nurse. The hospital also trains nurses in the state who need experience at a level 1 trauma center.
"We're hosting a lot of learners all the time," she said "We want to continue to grow our own, but we will be challenged from a numbers perspective given the growth of the healthcare needs in Vermont and our retiring nurse population."
To relocate talent to Vermont, the hospital has also allowed highly specialized nurses to come back to Vermont from their retirement location in Florida to work at the hospital for the summer during the pandemic.
"We have a seasonality here that's unique to us," Ms. Broadworth said. "We're working through all of those ways we can be flexible with the talent. With RNs, the highly specialized skill is so hard to get. We're trying to be more flexible about per diems and other ways they can balance what they want to do from a schedule perspective."
Unionization is also a key factor. Before the pandemic, University of Vermont Medical Center entered a scheduled organized process with the union representing its nurses to do a staffing collaborative.
Ms. Broadworth said this means the hospital and union going specialty by specialty to see what appropriate staffing would be.
"We have alignment about what that should look like, but the challenge is hiring to that agreement," she said. "We use travelers to fill that gap, but we're committed to filling roles with full-time staff."
Regarding compensation, University of Vermont Medical Center agreed to an extension of the union contract because of the pandemic. After the extension, the hospital proposed wage increases in advance of scheduled negotiations on the next contract, which meant nurses saw pay increases starting in February this year that would normally not have occurred until October.
And in terms of housing, the University of Vermont Health Network announced in March that it is investing $2.8 million to help finance housing in South Burlington that can be used for its workers. UVM Health Network officials told Becker's on March 10 that the health system will take a 10-year master lease on 61 new one-, two- and three-bedroom apartments that are being built, then make those units available first to its workers, potentially at a subsidy for eligible employees.
California
Compared to Vermont, California, the largest state by population, has 470,687 active registered nurse licenses, according to Nursys.
Amid these and other factors, Scripps Health focuses on competitive salaries, among other elements.
"They have to be competitive in the area you're recruiting to," said Eric Cole, the health system's corporate senior vice president of human resources. "Obviously, in California our salaries are higher than other parts of the nation. So we may attract nurses from other places, but we're competitive within southern California and the San Diego area."
At the same time, he said Scripps does not necessarily match the highest in the marketplace when it comes to sign-on bonuses. Those are determined based on where the health system's most critical shortages are.
Another benefit Scripps focuses on is allowing people who want to float within a site or across the health system to do so, as well as opportunities for seasonal workers.
"We think that's important because once we can lock a nurse in who wants to work in Southern California/San Diego, and Scripps in particular, wherever you are with regards to your professional growth, we want to make sure we have an opportunity there," Mr. Cole said.
He said Scripps focuses on retainment by including nurses in decision-making processes in terms of redeveloping how patient care is provided.
The health system also offers tuition reimbursement, scholarships and other measures to help people continue their education, along with professional development opportunities.
"If you come in as a med/surg nurse or a new graduate, we have cohorts to upskill you into ED, ICU, maternal child health, OR, different areas," Mr. Cole said. "The cost of living is so expensive and it's hard to recruit into San Diego, so we want to take those already in San Diego and grow them within the organization."
Additionally, with a limited pool of registered nurses, he said Scripps has a hiring process that "allows us to communicate our opportunity quickly [and] snag that candidate with on-demand video applications. The candidate controls the interview process within 72 hours. It's important we reach out to someone who has already expressed interest and bring them into Scripps as quickly as possible."
Like University of Vermont Medical Center, Scripps has tapped into the traveler market during the pandemic to fill staffing gaps. However, Mr. Cole said the health system tries to use its internal nursing pool to fill gaps first.
Overall, "we utilize where we are. We utilize the reputation of the organization. We utilize those that already work here and the strong team you join when you come to the organization," he said. "It's really highlighting our strengths and making sure the nurse understands the organization they're joining and the reputation. We believe reputation is important. And the development opportunities. People want to continue to develop themselves."