Solutions to the Nursing Shortage for Chief Nursing Officers in 2019

By Shari Dingle (Sandifer) Costantini, RN, MBA

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January 28, 2019

Avant Healthcare Professionals hosted eight chief nursing officers and nurse executives from a variety of U.S. health facilities to participate in Avant’s annual CNO Roundtable. A reoccurring issue of discussion was how nurse executives combat the nurse shortage in their states.

“What are the most effective strategies you have implemented in your facilities for alleviating the nurse shortage?” said Shari Dingle Costantini, Founder and CEO of Avant Healthcare Professionals. Even though the severity of the nurse shortage varies from state to state, the chief nursing officers and nurse executives came up with the top nine solutions to alleviate nurse staffing shortages in any facility.

New graduate sign-on bonuses with a 3-year commitment

On average, healthcare organizations budget $10,000 per sign on bonus for each hired nurse. The CNO and nurse executive participants discussed that nurses who receive sign on bonuses typically work less than one year before leaving the organization. The retention rate of nurses who receive immediate sign on bonuses is not as high as expected. The CNOs and nurse leaders at the Avant CNO Roundtable came up with a sign on bonus plan with a 3-year commitment for new graduate nurses. The breakdown of the sign on bonus plan to improve retention would follow:

  • $2,500 after 6 months of the new nurse’s date of hire
  • $2,500 after 12 months of the new nurse’s date of hire
  • $5,000 after 3 years of the new nurse’s date of hire

Related story: Bridging the Gap between Experienced Nurses and New Grad Nurses

Tuition reimbursements

Another incentive to improve the retention rate of new graduate nurses is to offer tuition reimbursements in annual installments. Chief nursing officers and nurse leaders suggested that a $5,000 reimbursement after one year of employment for a new graduate nurse and $5000 each year moving forward would be attractive enough to improve the retention rate.

International Nurse staffing

Partnering with an international nurse staffing company like Avant Healthcare Professionals is a strategic way to build an expert core staff while limiting turnover and disruption. International nurses are staffed for long-term assignments which help stabilize staffing and mitigates patient care issues that come with low nurse staffing.

“We must start being more aggressive about workforce planning. International nurse staffing needs to be part of that robust plan.” – Head of Global Nursing, HEE

“I’m jealous because I only have four Avant nurses right now and I want to get up to 30 nurses.” – CNO of a 155-bed healthcare facility

Scholarships for ADN to BSN for fulltime employee staff

Encouraging fulltime nursing staff to advance their nursing careers by offering scholarships is an innovative way to combat the nurse shortage locally. Chief nursing officers and nurse executives at the Avant CNO Roundtable suggested that hospitals partner with local colleges and universities to provide a scholarship program for nurses with an ADN on staff to receive a BSN. Offering this financial investment for fulltime staff will increase employees’ commitment and loyalty to stay with the organization, as well as increasing the organization’s pipeline of qualified registered nurses.

Speed up the hiring process for registered nurses

Nurse leaders and CNO participants at the CNO Roundtable discussion said that the hiring process for registered nurses is unnecessarily long. Participants suggested a more efficient way to hire registered nurses by decreasing the time it takes to hire RNs. The suggested hiring format includes that all nurse managers should be involved in the interviewing process with a specialty nurse and an RN. The candidates will have a first and second choice of what unit they would like to work in. The nurse managers will make the hiring decision for the hospital and the time from initial interview to offer should be approximately 10 days.

Nurse externship/internships for increasing retention

Focusing on combatting the nurse shortage with internal organizational resources has proven to be successful for one chief nursing officer at the CNO Roundtable. One facility grew patient observers through their CNA externship program. The facility matches two externship nurses with one fulltime staff nurse’s assignment. The CNO participant noticed her own nurse getting more involved in teamwork with this externship model which could help improve retention of nurses who are getting restless in their role. Giving nurses on staff a mentor role could refresh their jobs and increase the likelihood of the nurse staying with the organization.

Related story: Innovating Your Nurse Retention Program for Success

Implement an acuity-based staffing system

One chief nursing officer suggested implementing an acuity-based staffing system to optimize the nonproductive time that hospitals use in their staffing model. An acuity-based staffing system regulates the number of nurses on a shift according to the patients’ needs, and not according to the number of patients. This nurse executive’s facility was able to increase their nonproductive time for extra paid time off days for their nursing staff by 23 percent with this acuity-based staffing model.

Recruit heavily from nursing schools

Recruiting from nearby nursing schools seems like a no-brainer. However, there’s a lot more involved than having a healthcare organization show up at the college’s career fair for a day. Developing collegial relationships with nursing programs will help new graduate nurses develop their clinical skills faster and close that experience gap.

“Travel nursing has been used to staff full units because of the shortage. Hospitals are now going into high schools and asking students if they’re interested in a career in nursing and asking if they want to shadow a nurse.” – Shari Dingle Costantini, Founder and CEO of Avant Healthcare Professionals

Define and improve culture in the facility

Implementing more team events as part of the organizational culture will facilitate in increasing unity among staff. In one CNO’s hospital, a team is assigned to come up with activities that the whole organization can participate in to help increase staff retention.

There is no straight forward solution to addressing the nurse shortage. The U.S. nurse shortage will require a comprehensive approach that includes many innovative strategies such as offering tuition reimbursements, implementing nurse externship programs and speeding up the nurse hiring process.

This CNO Roundtable discussion on the solutions to the nursing shortage for chief nursing officers in 2019 was hosted by Avant Healthcare Professionals’ annual CNO Roundtable.

About the Author

Shari Costantini

Shari Dingle (Sandifer) Costantini, RN, MBA is a renowned expert in the healthcare industry, with 29 years of experience in strategic leadership, nursing and international nurse staffing. As a registered nurse and accomplished business owner in healthcare staffing, she offers a unique perspective and keen insights into a wide range of issues affecting medical staff today and is an authoritative source on issues concerning international workers.

About Avant Healthcare Professionals

Need nurses? Avant Healthcare Professionals is the premier staffing specialist for internationally educated registered nurses, physical therapists and occupational therapists. Avant has placed thousands of international healthcare professionals across U.S. facilities to help improve the continuity of their care, fill hard-to-find specialties, and increase patient satisfaction, revenue and HCAHPS scores. Avant is a Joint Commission accredited staffing agency and founding member of the American Association of International Healthcare Recruitment (AAIHR). Avant Healthcare Professionals is a member of the Jackson Healthcare® family of companies.


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