When it comes to hiring and the healthcare workforce, there are various factors and narratives to consider. It is clear that workforce challenges remain top of mind for industry leaders. At the same time, research points to significant healthcare employment growth and hints that the Great Resignation is a storyline that no longer applies to hospitals the way it once did.
Amid this context, one thing is clear: Hospitals and health systems are rethinking hiring, executives told Becker's. Today's talent landscape requires them to think as strategically as possible in terms of job descriptions, the application process, and training and onboarding workers at competitive wages. They are also facing financial pressures to reduce contract labor expenses compared to pandemic levels.
Supply and demand
It is worth noting that hospitals have long struggled to meet the demand for nurses, according to Wendy Horton, PharmD, CEO of Charlottesville, Va.-based UVA Health University Medical Center.
The Bureau of Labor Statistics estimates that employment of registered nurses is projected to grow 6% by 2032, with about 193,100 openings for registered nurses projected each year, on average. Agency officials expect many of those openings to result from the need to replace registered nurses who transfer to other occupations or exit the labor force via retirement.
At the same time, increased demand for healthcare services due to an aging U.S. population, population growth and a greater insured population following the ACA may still leave healthcare organizations with worker shortages.
"When I think about our recruitment today versus pre-pandemic, we were already behind," Dr. Horton said. "Then the pandemic [happened], and then coming out of that.
"So here we are today. We have all the people to [replace who left during] the pandemic and are coming out of that where we were already not fully staffed."
She said University Medical Center, like other organizations, is also growing, leading to increased demand for clinical care.
"We're growing at the same time as we're trying to catch up. And I think it's this dynamic of how to care best for patients, how to catch up [with] the clinical care that was deferred. And then how to prepare for the future in a workforce that in some cases is inexperienced."
Revamping the hiring process
At University Medical Center, this preparation includes expediting the hiring process.
"Gone are the days where you can … sit there and wait three weeks [after receiving an application]," Dr. Horton said. "We need teams that are really on it and getting back to applicants right away."
The University of Virginia has a new human resources website designed to make it easier for candidates to apply. Additionally, there are clinical intake teams at University Medical Center led by experienced nurses to help recruit new nurses and answer questions about the job.
Dr. Horton said her organization has also had to be "bold and courageous" in terms of maximizing opportunities for flexibility.
"We're trying to really cater to [workers'] needs," Dr. Horton said. "There are individuals that want a day schedule. There are individuals that want more money, but they're willing to work nights and weekends. So how do you redesign your offerings to cater to different segments and offer the most flexibility possible to motivate and engage the largest number of workers?"
Compensation plays a role, too. For example, Escondido, Calif.-based Palomar Health reduced its reliance on traveling and agency staffers after offering $100,000 sign-on bonuses to new nurses and $100,000 retention bonuses to current staff nurses over three years.
University Medical Center has been offering sign-on bonuses to nurses ranging from $5,000 to $25,000.
And now, "in line with our commitment to becoming the best place to work and a market leader in hourly compensation, we've recently invested an additional $26 million to support nursing compensation at University Medical Center," Dr. Horton said. "As a result, we are adjusting our approach to maximize the hourly compensation rate of nurses, which has led to a reduction in the amount of some of our sign-on bonuses to an average of $5,000."
Additionally, University Medical Center is focused on engaging with nurses earlier in their training experience. This includes a nurse extern program in which nurses in their third year of a four-year program spend the summer at the facility in advance of graduation, Dr. Horton said.
"It's a win-win," she said. "They are getting more experience at an academic medical center and that exposure over the summer and then also building and cultivating relationships.
"We are finding that that's helping onboard nurses sooner, but also nurses get to have more clinical experience coming out of their programs. We're offering that to different universities across the nation, and people are coming here to Charlottesville for the summer."
The retention piece
For Greg Till, chief people officer of Renton, Wash.-based Providence, a good hiring strategy begins with a successful retention strategy. He said Providence experienced significant turnover during the pandemic, and that churn has decreased thanks to retention efforts.
"If you have a 20% vacancy rate at a hospital, you're never going to be able to fill those positions fast enough," he said. "... Through a lot of hard work, our core leaders have helped us [boost] retention by over 20% in the last year."
In addition to retention efforts, Providence invested heavily in hiring, filling more than 44,000 positions in 2023, 25,000 of which were filled by external candidates. This represented a 15% increase in external hires compared with 2022.
To decrease early tenure turnover, Mr. Till said each new hire was offered a robust orientation and onboarding process, including conversations with leadership about Providence's mission and values and development paths available at the health system.
"We have incredibly innovative development programs that are aimed at helping our lowest-paid caregivers get from minimum wage to six figures in less than six years," he said. "And so those are some of the things that we do very early in a caregivers' life here at Providence to help connect them to our mission, our values, their development, growth opportunities and their leaders."
Mr. Till said Providence has also focused on a more personal hiring process.
"A couple of years ago, we automated several aspects of our hiring process," he said. "We realized given the evolution of an intensely competitive marketplace that we needed a more personal touch. So we invested in a new model at Providence that ensured that every candidate, whether they were an internal candidate or external candidate, felt like they were the star of the show through the entire hiring process."
In addition to providing a better hiring experience, these efforts helped Providence reduce the time to fill by 36% and time to start by more than 25%, according to Mr. Till.
Providence has also implemented predictive hiring, which uses technology and analytics to project personnel needs.
"If we know a nurse is likely to retire from a specific unit in three months, based on the data, we can open a position three months in advance and eliminate the vacancy time that we would have normally if we hadn't predicted that vacancy," Mr. Till said.
New Hyde Park, N.Y.-based Northwell Health has also focused on flexibility in this area. Maxine Carrington, senior vice president and chief people officer for Northwell, has acknowledged that for certain roles, there are criteria that are nonnegotiable from a regulatory standpoint — though advancing workers' education is a helpful part of the health system's approach.
"For some roles, we can look at education and work experience differently," she told Becker's earlier this year. "Even with nursing, you can start at Northwell without your BSN. We require that you get it within a certain period of time, and we'll work with you and provide funding for your education.
"And that's baked into the job description. We've always had some level of flexibility, but we've increased it and we're moving more and more [toward that]."