1. Burke, Diane MS, RNC

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There is a significant nursing shortage in the United States, and few healthcare facilities have been immune to this phenomenon. Clearly, multiple strategies and innovative options must be developed to address this serious nursing issue. In my opinion, a well-designed flexible sign-on bonus program is one effective strategy to recruit high-quality registered nurses. Once they join an excellent healthcare team, the professional environment is an incentive to stay. Through effective strategic recruiting and planning, nursing leadership teams can successfully reverse a previously negative trend for recruiting, and more importantly, retaining RNs.


My facility currently employs 428 RNs to staff its 325-bed acute care facility. There are only 20 vacancies (<6% vacancy rate), and we have virtually eliminated use of agency nurses, but this was not always the case. Several years ago, we had a 40% turnover rate, with a vacancy rate approaching 20%, and had 80 agency nurses on staff. Between July 1999 and December 2000, however, we used a recruiting strategy primarily based on a lucrative recruiting sign-on bonus of $12,500. The bonus was disbursed as $5000 upon hiring, with the remainder distributed over a period of 36 months. Unfortunately, most RNs recruited under this plan did not remain with the organization, and turnover rates were extremely high in the 6 months following the initial disbursement. This plan resulted in RNs joining the staff simply for the financial incentive, without a stake in the success of the organization or support of the hospital's mission and vision.


Subsequently, we developed a recruiting strategic plan (referred to as the "Recruiting Cafeteria Plan") that continued to use a sign-on bonus, but not exclusively. It now emphasizes employee retention and organization mission. The strategic plan involves a new compensation structure, behavioral-based interviewing, increased local and regional graduate nurse recruiting, and a sign-on bonus with a "back-loaded" disbursement structure. RNs are given the opportunity to select one of the programs from the Recruiting Cafeteria Plan; these include employer-assisted housing, rental assistance, sign-on bonus, internship or short-term employment agreements. Relocation assistance up to $3000 is included. Sign-on bonuses range from $5000 to $7000 depending on other aspects of the plan that are chosen. If one of the plans with the sign-on bonus option is selected, the payments are distributed at 90 days, and again at 12, 24, and 36 months (as opposed to initially upon hiring). As another option in the cafeteria plan, we continue to participate in a collaborative venture with Fannie Mae, which assists RNs with down payment and closing costs in the purchase of a new home in the community. To date, this program has assisted 12 RNs, of which 11 remain employed with us. Conceptually, the employee has community ownership as a result of purchasing a home in the community in which he/she is employed. Rental assistance programs include a lease deposit of $500 and $200 per month for 1 year. Deposits for utilities (water, electricity, and gas) up to $200 can also be provided. Payments for a week of temporary housing while locating property to purchase or rent are also offered. New graduate nurses who are recruited from outside the region are provided housing for the first 90 days.


The components of the plan are designed to make it easier to relocate to our community, and decrease the burden of finding housing immediately before exploring the community and having the ability to choose a more permanent place to live. In addition to long-term recruitment strategies, we also developed an innovative approach to fill other vacancies. The "Winter Texan RN" program was designed to attract experienced nurses to commit to a 13- to 26-week contract. The Winter Texan nurses are provided housing for the length of their contract and a significant hourly wage.


Our recent data indicate this new approach to identifying and recruiting RNs has resulted in a substantial decrease in RN turnover and vacancy rate. Based on the overwhelming success of our program, I would have to say that sign-on bonuses as part of a comprehensive recruitment strategy can work quite well. A facility with excellent healthcare and a professional work environment will contribute to recruited nurses staying long after the sign-on bonus period has elapsed, but the sign-on bonus is a significant motivator in getting qualified nurses in the door.