The Art of Attracting and Retaining Nurses: Q&A with Talent Advocates from Incredible Health

Right now, nurses are leaving the bedside at the speed of light. We know it’s happening, but it’s much more difficult to tease apart all the reasons why and make bedside nurses want to stay.

There has been lots of talk about bringing new nurses into vacant bedside roles - sign-on bonuses, travel contract pay, crisis pay, etc, but there seems to be a hollow echo in the room discussing how we retain the nurses who have been here all along. 

There has been lots of talk about bringing new nurses into vacant bedside roles - sign-on bonuses, travel contract pay, crisis pay, etc, but there seems to be a hollow echo in the room discussing how we retain the nurses who have been here all along. 

I had the opportunity to talk with 3 Registered Nurses from Incredible Health, a staffing agency that gets nurses into permanent jobs in 20 days or less. (You may be familiar with them as I’ve spoken with co-founder and CEO, Dr. Iman Abuzeid on the podcast.) This post is not sponsored so this is a real discussion on a very real issue. Hospitals need to step out of the box when it comes to keeping nursing jobs filled with the right nurses - and then giving them reasons to stay.

Talent Advocates Molly Rindt, Erika Haywood, and Jack Kluesner took some time to answer my questions on the critical topic of retaining experienced nurses in patient care roles. 

In this blog post we’re going to address ways hospitals can do just that, and how those of us still on the units and at the bedside can have an influence on this as well. 

Click this image to find out what Incredible Health is doing to keep nurses in jobs they want. Learn more about their newly released Retention Product Suite and how it’s going to change the game.

The Retention Product Suite helps nurses make more informed employment decisions by flipping the script, with hospitals applying to nurses, not the other way around, enabling busy nurses to field multiple interview requests and complete thorough job searches. Busy nurses can complete a thorough job search and consider multiple employers to find the best role for them, which drives job satisfaction and retention.

“Most healthcare workers haven’t even recovered from what the pandemic has already dealt to them. Can you expand upon what sorts of things our frontline workers are facing and need protection from as we move forward?”

Jack: We are facing a lot of uncertainty. As much as we want this pandemic to be over, it isn’t yet. The variants are out there and there are a lot of people and healthcare workers that are still skeptical about the vaccine. Due to the vaccine mandates within health systems, we may lose a decent part of our workforce. Most places are already short-staffed, so how does that play out going forward? We may encounter a feedback loop where less staff means a tougher place, leading to an even tougher recruitment landscape.

“While we may lose front-line workers related to vaccine mandates, are we seeing nurses expressing a desire to leave over not wanting to weather another wave of caring for the COVID sick?”

Jack: I am sure the answer to that varies a lot on where you are located and which unit you work on. For example, I work in the PICU in Idaho so I don’t see nearly as many cases as an adult. I can’t imagine the stress some of the adult floor nurses are going through, it has to take a major toll. I don’t know if another Covid hospitalization wave will increase the vaccine rate, but I sure hope it does. 

 Molly: I speak with nurses daily who are looking for non-bedside roles or even looking to transition away from COVID floors. At the same time, there are a lot of nurses who prefer to stay in their current roles because they feel like they would be abandoning their coworkers with this recent surge.

I speak with nurses daily who are looking for non-bedside roles or even looking to transition away from COVID floors. At the same time, there are a lot of nurses who prefer to stay in their current roles because they feel like they would be abandoning their coworkers with this recent surge.

- Molly

 Erika: Yes. I have spoken with many nurses who are wanting to leave the bedside for this reason. They are looking for a change. They want to continue to help people and make a difference. They share their experiences about “losing more than they are able to save” as far as patient’s lives are concerned and that takes a serious toll on the nurses holistically. 

“Better ratios would certainly lead to less burnout and turnover, but staffing ratios often are decided by high-level leadership, with profits being a direct contender to their implementation. Nurses have been crying out for better staffing ratios for decades. What will hospitals gain profit-wise by implementing safe staffing ratios? ”

Jack: This is the question everyone thinks about all the time. High level leadership has one perspective, nursing managers have another and lastly, bedside nurses have their own considerations. As a person in that third group I do understand the need to be efficient and use resources wisely. There’s nothing wrong with having those conversations. But, I think the higher you get in your career, the farther removed you are from the intensity or urgency of quality staffing ratios. 

 I can give you two examples just in my unit. We used to have a resource staff member who never took patients and would help our pediatric intensive care unit (PICU) as well as the Peds floor. They were pediatric advanced life support (PALS) certified and always PICU trained, so if necessary, they could take patients when needed. Today, that role is gone and I have had to admit an intubated patient with my current assignment. Normally, I would report my current assignment to the resource and take the critical patient, but now it's more of a “let’s see what we can pull off” type of attitude which is unfair to our staff. 

By having proper staffing ratios the hospital system is creating a culture of safety and efficiency. It also allows us to bond with our colleagues so when those emergent situations do arise we feel comfortable and safe on how to handle them as a team.

-Jack

Another example is our certified nursing assistant (CNA) staffing. We have a minimum requirement of patients that we must meet to be able to schedule a CNA for the full 12 hours. And on our floor, the CNAs do a lot. If we don’t get them for the full 12 hours, then that backs up the next shift, which then can lead to unstocked rooms, unorganized areas on the unit, etc. We love our CNAs and they do great work, but we need to give them time to work too.

By having proper staffing ratios the hospital system is creating a culture of safety and efficiency. It also allows us to bond with our colleagues so when those emergent situations do arise we feel comfortable and safe on how to handle them as a team.

Erika: I remember when I’d be lucky to have 10-15 minutes to sit and rest in a 12 hour shift. Add to this that because of low salaries in some cases, nurses are taking on second jobs, and just really struggling to get ahead while still trying to meet the demands of their crucial job. Employers really need to take this issue seriously for the health of their nurses, and for their own sake to keep their staff happier, and more engaged with their job.

“How do Meal Relief RNs “work”? Many of us have never even heard of such a thing, let alone seen it work in our facilities. How do these nurses maintain safety while working with so many patients?”

Molly: We have seen some hospitals create these “Meal Reliever” roles because meal breaks are often the first thing that gets cut if you’re short-staffed. You may have a float RN but they’re going to be assigned to patients, too, and then nobody gets lunch, because who can handle covering not just their own patients but another nurse’s as well? These Meal Relievers basically go from nurse to nurse during their shift and cover for them while they take a break.

Jack: We do not have a Meal Reliever RN position, but we used to have a resource position that would help out for lunch breaks. I actually think it is a great way to learn about a lot of patients quickly. It helps that someone on the floor has been in each room in case something emergent comes along.

“What are some suggested steps nurses can take to trial or lobby for this role on their unit or in their institution?”

Jack: I think you should go to a variety of people including your direct manager (charge nurse or assistant nurse manager), director of the unit and even the CNO. The squeaky wheel gets the oil most of the time and if you have quality data and evidence that the role is necessary and improves patient care while reducing costs then you have a fantastic case.

Being able to allow nurses to truly work in a specialty they are passionate about can have positive impacts - the nurse is happier and potentially so are the patients they take care of and improving the work environment.

-Erika

“What are some common examples of cross-trainings? How does this support ambitions while still meeting the staffing needs of the various units? Are there examples of this model working?”

Molly: In nursing school, many of us were told “you can change your specialty as many times as you want,” but in reality, it’s very hard to change specialties, even within your existing organization. A lot of nurses start off in Med Surg because that’s where they’re told to start, but then they’re stuck and can’t move to ICU, ED, L&D, etc.

There are some instances of formalized programs for this at employers, but they are unfortunately few and far between. Nurses often need special approval from managers to cross-train with a different unit. So, we tend to see nurses having to change employers in order to get experience in the area they’re interested in.

Jack: Cross-training or “floating” is common in most hospital systems and I think can be a benefit to nurses. If you are able to pick the floor you would like to float to then you can have some ownership of what kind of nursing you want to do and learn more about. The cons are that you may have to float more than you would like in certain cases, especially if the floor you float to gets busy. 

Erika: Being able to cross-train could help many nurses stay in the profession. Some nurses may have dreams of working in Labor & Delivery, but those are sought out after and it can be difficult without prior L&D experience. Being able to allow nurses to truly work in a specialty they are passionate about can have positive impacts - the nurse is happier and potentially so are the patients they take care of and improving the work environment. There isn’t always a clear avenue to transition into another specialty/unit. Having the opportunity to allow internal nurses to be considered for openings in a new unit may help, especially if wanting to continue to retain nurses, this will help nurses feel supported and heard. Which can be hard to come by.

I would say nurse managers should work to understand what is most important to their individual nurses. For example, my nurse manager knows that if she nails my schedule then I am good to go.

“How do leaders foster healthy environments in a way that is genuine and meaningful after we’ve seen so many attempts that are cliche and insulting, like the oft-laughed-at pizza parties and ill-thought-out nurses’ week gifts that have become insulting jokes on social media? ”

Jack: I would say nurse managers should work to understand what is most important to their individual nurses. For example, my nurse manager knows that if she nails my schedule then I am good to go. She knows I have a busy schedule outside of work, but that when I am on the floor, I am present and ready. In other cases, the nurse could be big on education, so giving that nurse opportunities to go to conferences or speak to other floors educators could be helpful. 

 Some floors are massive so it is really tough, but if I was a nurse manager I’d be keeping a small document on each nurse and attempting to check in once a month to make sure I was covering their goals. And honestly, some nurses just want to be asked what their goals are and that's enough.

“What are some examples of mentorship programs and are there such programs for nurses who are not new grads?”

Any mentorship program that ACTUALLY opens communication channels and allows for face-to-face interactions between leaders and the nursing staff can be a huge success.

Erika: I was fortunate enough to have a great leader in my last role. Knowledgeable, supportive, yet would still give you good feedback. And most importantly, if I brought any issues to her, she was able to escalate that for me.

Molly: On the other hand, at one hospital where I worked the night shift I never saw my manager, ever. She worked 9am-5pm while I worked 7pm to 7am. Having worked other positions where the manager really made an attempt to get to know the nurses - it made me want to do better in my job. You can’t just be a face behind a desk.

“Many of us shift workers choose it because we like the absence of management, but one of the downfalls is the lack of recognition or problem-solving. Any helpful advice for those of us night shifters that need advocacy from managers and admin we may never see or even meet?”

We’ve also heard about some cases where older nurses feel they’re being pushed into retirement earlier than they’d like. This is so unfortunate, not just because of the already-short staff, but also because younger nurses have so much to learn from others who’ve been there, done that. It could partially be a result of the higher cost of paying these more senior nurses vs cheaper, less experienced staff. Sometimes it’s related to the challenges of keeping older nurses up to date with all the new tools and technologies. Whatever the case, we need to figure out how to better utilize ALL our nurses, no matter their age, in whatever way we can.

Whatever the case, we need to figure out how to better utilize ALL our nurses, no matter their age, in whatever way we can.

Jack: If you don’t have a night shift manager or director you can go to then I do think you have to make time during the day to meet with the right people. It’s amazing how many people are willing to meet with nurses who reach out. It can take a while to find the right person or people you want to work with, but the payoff is huge. I’d say if you are looking to find a mentor then I would try to meet with at least one person a month at my facility to learn about their job and how their expertise can help you and your career.

Molly: Having a night shift liaison would be a good start. Several hospitals have a night shift assistant manager role. Both are a great way to help advocate for the night shift nurses. 

Erika: Definitely share the interest in meeting the managers and admin. If you are able to, try to attend any of the day events if possible and set timeout to meet with them or share concerns.  I would like to see the managers and admin make the effort as well to meet and support those doing shift work. Having a liaison can be very helpful especially long term and helps bridge the gap between day and night shift workers. 

If you don’t have a night shift manager or director you can go to then I do think you have to make time during the day to meet with the right people. It’s amazing how many people are willing to meet with nurses who reach out.

-Jack

“How would you encourage or guide nurses who work in places that lack these mentorship programs?”

Jack: I would look at other facilities' mentor programs and see what else is out there. It’s possible you can create the program yourself and how cool would that be! Mentorship is so important to job satisfaction that I’d tell any nurse to always reach out to people and even other nurses at other facilities.

“What are debriefings like at hospitals that do them well (my hospital failed to do them in a timely fashion so night nurses handled this themselves off the clock)?”

Molly: In my experience it’s been hit or miss, although some hospitals do it better than others. If a hospital doesn’t handle debriefings well, nurses should definitely encourage their leaders to help implement a better process.

Jack: I’ve been lucky enough to have some good debriefs. Obviously, the timing is always hard. Do we try to do a debrief right after an event and one a week later? Are people ready, emotionally? There are so many factors that contribute and many different types of people. In my experience, one formal debrief is usually good, but if you have people checking in on you after the fact, that is amazing. Getting a text from another nurse or a manager acknowledging that “it was a tough moment” really helps.

“Who typically facilitates debriefings and how do staff receive support for long-term patient-related traumas - i.e. pandemics, long-term patients, repeated exposure to suffering and death?”

Jack: On our floor (PICU) a death or tough case usually facilitates a debrief. Traumatic events are good ways to make sure lines of communication are open. In our case, the MD usually facilitates it along with a nursing manager. I think this approach is effective and I am proud of how people support each other in our unit.

“What are some effective incentive programs you’ve seen and how do they vary based on the budgets/incomes of the hospitals (i.e. successful large hospitals versus small local hospitals)?”

Erika: Better salaries and really good benefits are really the main benefits that ultimately matter to most nurses.

Molly: I’ve actually had a lot of nurses react negatively to certain incentives like sign-on bonuses. If there’s a big sign-on bonus, that can communicate to nurses that it’s an urgent, hard to fill position. Candidates might think, “So what am I getting myself into?” It almost feels like a bribe. 

It can also become a somewhat self-fulfilling prophecy. If you have to routinely offer sign-on bonuses to attract candidates, they could have less loyalty to their hospital. That leads them to turn over more quickly, meaning hospitals need to offer more bonuses for their replacement.

Better salaries and really good benefits are really the main benefits that ultimately matter to most nurses.

-Erika

Providing relocation is often a better option because if they have to move for a role, even just to improve commute, it can be very expensive. Also, nurses who are willing to move for a job are often the exact people you want on the team. They’re motivated enough for the job to have moved, and also likely to want to stay in one place for a while, having just relocated recently.

On a smaller scale, I hear from so many nurses about day-to-day issues like skin irritation/acne from wearing a mask all day, back aches, etc. So a more out-of-the-box incentive that even smaller hospitals could provide is opportunities for free or discounted personal care options like massages, facials, etc.

“In summary, a.) how do larger hospital systems refocus their priorities/budgets/resources to retain and attract nurses and b. How do readers put the pressure on their leadership to see the long-term values in these choices? What are some action steps nurses can take to influence this decision-making?”

Improve communication during the hiring process. Some hospitals move very slowly in their hiring process and therefore many nurses who may otherwise be interested in a job become frustrated and end up dropping out of the running. This is something nurses value in Incredible Health; that we help facilitate this communication all along the way, so that nurses feel heard and supported by someone in their corner. 

• Support nurses career growth goals. Provide cross-training opportunities so they don’t feel they need to leave to get experience in other areas. 

• Improve ratios and add supporting staff (nursing assistants, etc.). Senior staff can support more as well in times of high need. Basically, more support for the nursing staff all the way around. 

• Seek more input from your nursing team and actually listen and take action on their comments. Ask nurses for feedback on things like equipment, or anything else that makes our lives easier, better, faster, more efficient. You can ask every nurse - “what are the barriers in your workday right now?” If everyone is saying the same thing, remove those barriers.

Jack: From a big picture perspective, I think hospitals need to realize pay and schedules are very important to nurses. Yes, we love our patients and we also would love to be able to afford adequate housing without an insane commute. At the end of the day, money won’t make you happy, but it can make life a lot easier and I hope wages for nurses only rise compared to inflation. On the more individual perspective, we need to realize it is about the people. It’s about the nurses, the patients, the management. We need to better understand what makes each of us tick and support each other to achieve our goals. 

 I would add that any non management nurse should figure out a way to at least support certain directives or programs that advocate for bedside nurses. This can be in house programs or new state and federal laws and regulations. It is important to know where the nursing industry and career is headed so you want to at least be knowledgeable enough to speak on the subject. A lot of people talk about becoming a great leader, but I’ve learned that it can be just as important to become a great follower. This doesn’t mean head in the sand type following, but if you see a good nurse and they are advocating for you and a program you deem important, then support that nurse anyway you can!

I’ve learned that it can be just as important to become a great follower. This doesn’t mean head in the sand type following, but if you see a good nurse and they are advocating for you and a program you deem important, then support that nurse anyway you can!

-Jack

Molly: Ask for the hospitals to create a clinical ladder to encourage nurses to expand their knowledge and grow within their roles. Ask for pay incentives for nurses to obtain higher degrees or certifications in their specialty and by joining committees and groups to improve any issues in the unit. 

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We all play a role, from bedside nurse to CEO, and while the power is certainly imbalanced, we are not powerless. This discussion alone can’t remedy the problem before us. Nurses will continue to leave the bedside in the near future. The next actions of our leaders, hospitals, and affiliated companies can slow that loss as the toll of the pandemic wears on bedside nurses. Nurses want leaders to take action to re-structure this profession into one that prioritizes keeping nurses safe, compensated, healthy, and thriving.

Thank you again, to Molly, Erika, and Jack for sharing their thoughts on this issue and answering my many questions. Please check out each of their bios below and click on their names to visit their LinkedIn pages.

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Molly Rindt, RN and Talent Advocate Lead at Incredible Health

Molly Rindt is an experienced nurse with a background in Emergency Medicine. She is currently the Talent Advocate Lead for the West Coast team with Incredible Health, a career marketplace for connecting hospitals to much-needed permanent nursing talent. She enjoys helping and empowering nurses to take care of themselves and do their best work.

Erika Haywood, RN and Talent Screener Lead at Incredible Health

Erika Haywood is an experienced nurse and board-certified nurse coach with a background in adult step-down progressive care units and pediatrics with complex medical needs. She is currently the Talent Screener Lead for the Central Team with Incredible Health. She enjoys helping others find and do their best work. 

Jack Kluesner, RN and Talent Advocate at Incredible Health

Jack Kluesner is a practicing PICU nurse and Talent Advocate with Incredible Health. He enjoys working with his night shift team members and helping other nurses find amazing jobs.

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