By Kelly Gooch

Hospitals and health systems are using a myriad of recruitment and retention techniques as they brace for a nursing shortage — from bonuses and tuition reimbursement to career development opportunities and partnerships with educational institutions.

A nursing shortage is expected nationwide as baby boomers age and the need for healthcare grows.

According to the Bureau of Labor Statistics' Employment Projections 2014-2024 released in December 2015, registered nursing is listed among the top occupations in terms of job growth through 2024. The RN workforce is expected to grow from 2.75 million in 2014 to 3.19 million in 2024, an increase of 439,300 or 16 percent.

At the same time, the healthcare industry is about to see a surge of retirements among baby boomer nurses, according to the results of an annual survey of registered nurses.

According to the survey, nearly two-thirds — 62 percent — of registered nurses over age 54 are considering retirement within the next three years.

"This data confirms what we've known anecdotally and allows us to finally put dimensions and a timeline around a predicted retirement surge," Marcia Faller, RN, PhD, said in a prepared statement.

But the harm to the healthcare industry goes beyond the numbers. The loss of this intellectual asset may be acutely felt in terms of quality of care and patient satisfaction. To withstand this loss, healthcare providers need help in preparing for the nursing workforce of the future."

In light of these trends, here is how five health systems have worked to recruit and retain nurses.

1. Scripps Health (San Diego, CA). Scripps Health currently has more than 400 open positions identified as crucial to patient care. Most of these open positions are clinical, and almost half are for RNs.

The system deals with a nurse shortage in various ways. For instance, Scripps Health develops existing staff through education and transition programs, says Jack Blake, senior director of talent acquisition. In these programs, new nursing graduates can work in a medical-surgical environment for about a year, get acute care experience and then be offered educational transition programs so they can work in operating rooms or intensive care units.

Scripps Health also does some seasonal workforce planning. The system hires nurses to work during certain times of the year, such as holidays or flu season, when there is a surge in admissions and discharges. These nurses receive financial incentives to do the short-term assignment.

Additionally, Scripps has a dedicated resource staffing group that floats between the system's five acute care hospitals.

"By creating our own resource pool we have trained, flexible staff available to deploy and cover both short and long term temporary needs," Mr. Blake says. "The time it takes for the employees to be fully productive on the unit is much shorter than if we brought in resources from outside our system."

Scripps also has weekly recruitment events, especially to fill internal registry positions and float positions focused primarily on bedside care.

"Everyone's competing for experienced RNs that can be scarce in the market. What we've decided is that we would rather grow our own staff by providing opportunities for less experienced RNs to develop their careers," Mr. Blake says.

2. Mission Health (Asheville, NC). At Mission Health, unprecedented patient volumes has created a nursing shortage and led the system to rely on travel nurses to fill staffing gaps. As far as permanent positions, the system has about 260 open RN positions, as well as about 67 certified nursing assistant positions.

To fill these open positions, Mission Health offers sign-on bonuses of $5,000 to $10,000. In return, depending on the bonus amount, the nurses must commit to a minimum length of employment. Mission Health also offers employees a referral bonus of between $1,000 and $5,000, depending on what position the person is recruited to.

The system also has partnered with Asheville-Buncombe Technical Community College to create a scholarship for people interested in becoming certified nursing assistants. Eight scholarships are offered each year to Mission Health employees, employee dependents or others who qualify, covering the full cost of certification to practice as CNAs.

Additionally, Mission Health has hired an RN liaison who is partnering with system recruiters to ensure Mission Health is meeting the needs of that specific applicant pool.

From a retention perspective, Mission Health's hiring of more support staff, such as CNAs, provides an environment in which nurses can work at the top of their license, making it more attractive for nurses, Kathy Culhane Guyette, MSN, RN, senior vice president of patient care services and president of regional member hospitals, says.

Mission Health also hired a vice president whose sole focus is working methodically with all departments — nursing in particular — by unit to identify hassles that affect nurses' work. Once identified, the system can then develop mechanisms and tools to eliminate those hassles and bring back joy to the workplace. "It just kicked off in December and we're pretty excited across the health system about what we're going to be able to accomplish with the dedicated team that's going to do this," Ms. Guyette says.

3. Main Line Health (Bryn Mawr, PA). While some hospitals and health systems have dealt with a nurse shortage, Main Line Health has enjoyed a nurse surplus over the last three to five years. The system sees significantly less turnover than some other hospitals, likely because its five acute care hospitals, as well as its HomeCare and Hospice division, have a Magnet designation from the American Nurses Credentialing Center, according to Barbara Wadsworth, DNP, RN, senior vice president and CNO of Main Line Health.

"Our nursing staff is heavily engaged and participative, so we created this environment of excellence, which I think leads to the best place to give and receive care," Dr. Wadsworth says.

Nurse turnover for all five Main Line Health acute care hospitals ranges from 5.4 percent to 8.1 percent, and the average length of employment of a nurse at Main Line Health exceeds 13 years. Overall, the system has about 3,000 nurses and only 150 open nurse positions.

There are multiple ways Main Line Health works to prevent a shortage. For instance, it offers a residency program for new nurses, and the nursing team works closely with physicians to advance the clinical quality and safety of a particular unit, such as the emergency department or intensive care unit, Dr. Wadsworth says. "They're working collaboratively to create this environment where we have transparency, communication and collaboration and then we're working much more like a team," she adds.

Additionally, Dr. Wadsworth and Main Line Health's CMO, Andrew Norton, MD, travel to all of the system's hospitals regularly, so nurses see them and may ask questions or talk through issues. Main Line Health President and CEO Jack Lynch also participates in nighttime rounding at all hospitals, and Dr. Wadsworth sends out a newsletter to nurses every two weeks and makes herself available to employees via social media accounts. "There's a lot of things we do to ensure the staff has access [to system leaders]," she says.

4. Duke University Health System (Durham, NC). Throughout Duke University Health System, the vacancy rate, or number of open RN positions, is roughly 3 percent, according to Mary Ann Fuchs, DNP, RN, Duke's vice president of patient care and system chief nurse executive. The system has between 100 and 200 RN positions open at any given time.

To help fill these positions, Duke offers a comprehensive compensation package for incoming RNs. That comprehensive compensation package is in addition to other incentives for recruitment, such as tuition reimbursement and loan repayment programs.

Duke also tries to be creative in how they staff and schedule nurses, according to Dr. Fuchs. The system has a float pool of 200 full-time employees who move to various facilities depending on patient volumes.

Additionally, Duke pays for staff to go to work-related conferences and pays a bonus if employees want to get certified in a particular nursing specialty. Through Duke's clinical ladder program, nurses also can advance to levels with higher compensation based on experience and expertise in leading different projects. So a nurse coming into the organization is able to earn 11 percent above their base salary on the clinical ladder.

As far as other techniques in retaining and recruiting staff, Dr. Fuchs notes that Duke is Magnet-recognized, which is attractive to nurses. She also says Duke has a shared governance model, so staff is engaged in decisions that impact how they deliver care each day "They're very important decision-makers in our policies and procedures," Dr. Fuchs says.

5. Mercy Health-Cincinnati (Cincinnati, OH). Mercy Health-Cincinnati has made multiple efforts to address its nursing shortage in the last year. The system currently has 179 RN openings across five acute care facilities, compared to close to 400 RN openings a year ago. Mercy Health's vacancy rate for RNs was running about 9 percent in the Cincinnati market about a year ago, while the rest of the market had a vacancy rate closer to 5 percent, according to Pat Davis-Hagens RN, BSN, the system's CNO.

In addition to becoming more competitive on nurse compensation, Mercy Health-Cincinnati also decided to create its own pipeline of nurses by working with academic partners. The system developed a co-op program for the junior and senior nursing students, through which the students work as patient care assistants two days each week and shadow a nurse one day each week. They earn college credit, a salary and valuable experience. Participating schools include including Northern Kentucky University in Highland Heights, Miami University in Oxford, Ohio, Xavier University in Cincinnati, Mount St. Joseph University in Cincinnati, and the University of Cincinnati.

"We have to work closely with the academic world to make sure what they're doing is preparing and exposing student nurses to the right areas to help us be successful through the shortage," Ms. Davis-Hagens says.

Additionally, the system uses knowledge bonuses for hiring. Nurses receive that bonus if they come to the organization already equipped with the skills and experience they need and don't require a lot of training or supervision. Mercy Health-Cincinnati also offers tuition reimbursement and has created a nurse mentor program.

"For us to provide the best patient experience, we have to provide the best employee experience." Ms. Davis-Hagens says.