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Veteran Nurse Blasts Recruiting Via Cash Incentive

Posted by Leo Jakobson on May 03, 2007

Thanks to the wonderful world of Google News’ search capabilities, I came across a fascinating Letter to the Editor published today in the Regina Leader-Post, a daily newspaper in Saskatchewan, Canada. In it, a nurse with 30 years experience in hospital critical-care units takes a scalpel to a cash-based incentive program the provincial health care authority is using to recruit nurses in this scarce specialty. Recruiting and retaining nurses is a topic Incentive has covered a number of times in the past year, including last month’s Playbook case study ["Nursing a Referral Program"] and our April 2006 cover story ["RN: Retention Necessary"]. I found the lengthy letter an interesting take on the downside of cash-heavy recruitment programs—from an insiders perspective—that so many hospitals have turned to in the face of a systemic shortage of nurses plaguing much of the world, including the U.S. and Canada. In her letter, Pamela Richaud, a surgical intensive care unit (ICU) nurse in Regina, Saskatchewan, says that a C$10,000 bonus being offered to nurses who will take a critical-care certification course and agree to work two years in a provincial ICU is causing “dissention” between unit veterans and the newcomers.

Money is an issue—veterans of the ICU don’t get a C$10,000 bonus (or, under their contract, any extra money for working in a high-stress specialty like critical care), and the fact that the province is picking up the cost of the critical care course and paying nurses’ salaries while they are taking it adds C$15,000 to its value, according to Richaud. But it’s not the main issue, Richaud writes. “Lifers” like her will have to put in extra work training and supporting the new nurses once they pass the critical care course, without any guarantee that those recruits will help relieve the shortage in critical care nurses over the long term. “In my experience, monetary incentives to recruit staff, in the long term, are not effective for retention,” Richaud writes. “I remember New Zealand nurse recruits come, stay through their two-year commitment, then leave.” The letter is, in some ways, a perfect indictment of cash as a recruiting tool: existing employees will resent not getting it and the people recruited are joining the company in question for mercenary motives. Even worse, in a profession like nursing, with serious, long-term staffing shortages, cash bonuses are in many ways an anti-retention tool. When the commitment required to earn the bonus is up, why not look for a new one? After all, a $10,000 bonus every two years over the course of a 30-year career adds up to an extra $150,000. That amounts to an early retirement. And in fact, when Incentive looked in-depth at the retention efforts of Griffin Hospital in Derby, Conn., last year, after it came in fourth on Fortune magazine’s “Best Places to Work” list, much of the program came down to creating a positive work environment that could stand up to big cash recruitment offers. The formal incentive component—$25 cash bonuses if a department hit goals set each quarter—was tied to measurable clinical outcomes or patient satisfaction measures that have a direct effect on the bottom line. Staff turnover was less than half the national average. And Oklahoma City’s Integris Health, which we looked at last month, filled 500 jobs in highly competitive specialties over the past six years by offering existing staff bonuses for recruiting new hires, including cash and entries into a drawing for prizes like a two-year lease on a car. “It is a retention tool,” says Jason Eliot, Integris’ system director of human resources. “Referred employees stay longer.” Writing from Saskatchewan, Richaud filled in the flip side of his comment, warning potential ICU nurses: “If money is the primary incentive to work critical care, maybe you need to re-evaluate your decision.”


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oh they should know what they are getting into. they are going to get paid for their work once they join anyway

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