If you feel like nursing is in crisis right now, you’re not alone.
In fact, a biannual survey of US nurses by AMN Healthcare released last year highlights just how dire things are, especially in hospitals: among nurses who work in hospitals, just 15 percent plan to stay in their current role this year. The other 85 percent plan to look for work elsewhere, including in per-diem roles or as travel nurses.
This resonated with me in part because we just published a roundup of labor market data, featuring details on who’s hiring where, for what positions, and at what wages. The data showed that, in 2023, there were 3.1 million job listings for RNs. That number seemed too high: the US only employs about three million nurses. We dug deeper and found that 44 percent of those postings – nearly half – were for agency roles.
To us, this suggests a vicious circle: hospitals (and other employers) are struggling to retain nurses, so they turn to agencies to fill the gaps; those agencies offer short-term relief for a high price tag, leaving less money to pay full-time staff. Those staff then burn out and look for higher-paying work – often at agencies.
Obviously, this is a complex, multifaceted problem. No magic bullet will solve it. But more visibility into the data behind hiring and salaries for RNs may help. Here’s a look at how.
1. Wage data can chip away at the nursing crisis
It’s an oversimplification to suggest that, if you simply paid RNs more, the labor crisis would be solved. But it’s also true that wages play a role in the larger picture.
For example: when hiring, it’s standard practice to consider wages being paid by direct competitors (i.e., other care providers in your geographic area), but it’s less common to consider all “talent competition” – that is, competition for RNs from employers that don’t provide the same services as you.
When comparing agency employers vs. non-agencies, the salary question becomes significant: the median annual salary in 2023 for non-agency RNs was $92,102; for agency roles, it was $112,778.
And agencies aren’t the only talent competitor hospitals need to consider. Educational institutions – even those in different parts of the country – may be competing for the same RNs. An influx of federal funding for nursing educators and a population that’s comfortable with remote learning means you may now be competing for labor with a university four states over.
Other possible talent competitors: insurance companies, which employ RNs in all kinds of roles and senior living and skilled nursing facilities. Work in these contexts may be lower-stress or more flexible than hospital work and often at least as well paid.
Thus hospitals struggling to retain nurses must consider the full universe of their talent competition when setting RN wages. Even if you’re not immediately able to offer higher wages, knowing exactly what you’re up against will make it easier to predict turnover.
Further, knowing exactly what talent competitors are offering (including wages and benefits) may give you leeway to expand non-salary benefits to attract and retain top talent.
2. Non-salary strategies can help attract and retain talent
As I mentioned, there’s more to the picture than salaries. In the AMN study, nurses also cited extreme workplace stress and fears of getting sick at work as reasons they were considering leaving their current role.
The report also included case studies of organizations that have found ways to address those concerns. Three pilot programs are worth highlighting:
- Task reallocation. One pilot found that 40 percent of RNs’ tasks could be safely reassigned to other workers – presumably those with less expertise who command lower wages.
- Virtual care supplementation. Another pilot wove more virtual care into everyday tasks: real-time digital patient communication, remote patient monitoring, leaning on off-site specialists for imaging review, and more. This eased the burden on in-person nurses and provided them opportunities to work partially remote schedules.
- Additional staffing coordinators: Yet another pilot involved working with a specialized staff coordination team (in addition to nurse managers tasked with daily scheduling). This group reviewed daily needs and assigned members of a flex team as needed.
All of these strategies enable more efficient allocation of resources, which both eases the burden on RNs and may free up resources that can be used to set more competitive wages. Such efforts might also prove valuable should states pass staffing ratio laws currently being considered.
3. Communication about wages can ease labor woes
Another empowering figure we found in our end-of-year labor data analysis: job listings that include salary information get filled faster than those that don’t. For RN job listings in particular, jobs with salary data filled 31 percent – or 10 days – faster, on average.
Over the course of a year, this difference could be substantive, as it would mean fewer periods of under-staffing, which would mean both less burden on remaining staff and less need for expensive agency supplementation.
Already, five states mandate salary data in job listings, and more are considering such legislation. The advantage of upfront salary communication is clear today, but it may diminish as the practice becomes more common.
Still, it’s an immediate opportunity for employers not already including salary data in job postings: add that information, and expect a shorter hiring process.
Better nursing retention improves everyone’s life
Hospital CEOs and nurses may be the ones feeling the nursing labor shortage most acutely today, but if it continues, it will impact everyone in the country, as we’re all participants in the healthcare system.
I’m under no illusion that the problem we face can be resolved by using data more strategically in the hiring process, but I also recognize the urgency here and believe we need to pull every lever available to address the underlying problems. To that end, better access to and utilization of labor market data can and should be part of the solution.
Photo: Wavebreakmedia, Getty Images
