Payment recognition, effective mentoring, and nurse residency programs can help prevent nurses from leaving their jobs, said nurse leaders and government officials during an online discussion of workforce issues hosted by the Health Resources and Services Administration (HRSA).
The Bureau of Labor Statistics estimates that the healthcare sector has lost close to half a million workers since February 2020, said Elizabeth Kittrie, a DrPH candidate and senior advisor to the associate administrator for the Bureau of Health Workforce at HRSA, who moderated Wednesday’s webinar.
That isn’t surprising given the hardships hospital workers, especially nurses, endured during the pandemic, Kittrie suggested. Approximately 51% of nurses say they are exhausted and 43% report feeling overwhelmed, according to a survey from the American Nursing Foundation.
In listening sessions HRSA staff held with nurses in August, the take-home message was that nurses don’t feel supported, she said.
Asked what hospitals and other facilities can do to hold on to their nurses, Cindy Weston, DNP, APRN, associate dean for clinical and outreach affairs at the Texas A&M School of Nursing in Bryan, Texas, looked to the literature.
Studies suggest nurses can be incentivized to stay in their “home institution” with financial bonuses, increased time off, flexible scheduling, and “community-building strategies,” Weston said.
In the same COVID-19 Impact Assessment Survey, taken a year after the pandemic started (from Jan. 19 to Feb. 16, 2021), family finance and debt were nurses’ top concern. And, 20% of respondents to the survey said they were “worse off” financially because of the pandemic, Weston said.
“So these financial considerations are a very strong driver right now,” she said.
Natalia Cineas, DNP, RN, senior vice president and chief nursing executive and co-chair of Equity and Access Council for New York City Health + Hospitals, agreed that payment issues are clearly part of some nurses’ decision to leave the workforce or to transition to travel nursing, which pays more. Whether through enhanced overtime programs or other opportunities to earn additional income, nurses need to be financially incentivized to stay where they are, she said.
And while rates for travel nurses are likely unsustainable for most organizations, “I think we have to come somewhere in the middle,” she said.
Asked what federally qualified health centers (FQHCs) can do to retain nurse staff when they lack the funding to compete with hospitals paying such high rates, Weston recommended “value-added incentives,” such as continuing education support, paid time off, and more flexible scheduling.
Hospitals can also help support nurses’ other personal needs, such as offering childcare support, eldercare support, and even pet-care support.
“You need to know your individual population, what their drivers are,” she said.
Another strategy to increase retention is to expand opportunities for mentorship. In one study, nurses with a mentor were 25% more likely to stay at their hospital than those not mentored.
At a time when older nurses are choosing to retire, it’s also critical that more experienced nurses have opportunities to pass on their own institutional knowledge and expertise, Cineas said.
In addition to mentorship, giving nurses the opportunity to be heard is also important. And while such practices as shared governance are decades old, New York City Health + Hospitals has expanded the practice beyond its 11 acute care hospitals to include jails, post acute care facilities, and ambulatory care clinics “to ensure that nurses everywhere are empowered to have a voice,” Cineas added.
For newer nurses in particular, it’s important to equip them during training with the “soft” skills needed to combat burnout and be resilient, “to continue to work and push through,” said Tara Spencer, RN, branch chief for nursing education & practice in the Division of Nursing & Public Health at the Bureau of Health Workforce at HRSA.
Adanna Agbo, DrPH candidate, MPH, MSN, RN, branch chief for the Advanced Nursing Education Division of Nursing & Public Health at the Bureau of Health Workforce for HRSA, noted that one of the administration’s grantees has brought in mental health counselors to serve nursing students at the end of each month.
“We want that to be more widespread,” she said, adding: “This is now a culture of resiliency, that nursing organizations or organizations that employ nurses will now imbibe to be able to ensure that not only are we recruiting nurses, but we are able to provide them that support.”
Residencies and the ‘Experience Gap’
Another looming concern webinar panelists discussed is the “experience gap” among nurses as older, more skilled nurses choose retirement. (See also: More Than A Nursing Shortage, A Skills Gap Too)
Spencer, who oversees programs for baccalaureate-level nurses, said the experience gap for entry-level nurses has always been a concern, but those worries have increased during the pandemic.
HRSA has a few programs for registered nurses in primary care and veteran nurses in primary care that require award recipients to complete at least 150 hours of training before they graduate.
Agbo spotlighted nurse practitioner residency programs in which a “new advanced practice nurse has the opportunity to … be able to provide care while learning and while fine tuning their skills.”
For both APRN programs and even nurse faculty programs, mentorships are encouraged, Agbo said. Having a mentor-mentee relationship can help faculty understand the pedagogy and scholarship that all of that entails, as well as how to get promoted and ultimately receive tenure.
Panelists also explored concerns of losing nurse faculty because payment in other sectors is increasingly competitive. Weston said some nurse faculty are, in fact, leaving their roles to pursue higher paying opportunities in the workforce.
Spencer pointed out that HRSA’s nursing workforce diversity programs have recently added an initiative to recruit diverse faculty. HRSA also sponsors a nurse faculty loan repayment program.
“If we are able to increase the number of faculty that we have,” Spencer said, “that will open up enrollment, so that we will be able to train more students and then therefore [bring] more nurses into the workforce.”