Frustrated by the nursing shortage? Try these tactics instead of bonuses

Even cruises don’t work — Here are some creative ideas

Do you have high vacancy rates for nursing positions in your ED? Sources interviewed by ED Management say they are feeling the pinch of a nationwide nursing shortage and are finding it nearly impossible to recruit and retain staff nurses.

Even with unprecedented sign-on bonuses of up to $10,000, many EDs are unable to attract and hire qualified nurses, reports Cindy Asche, RN, BSN, nurse manager of the ED at Medical City Dallas Hospital. "One of the EDs in our system even promised nursing applicants cruises, and it still had vacancies," Asche says.

The supply of emergency nurses will only get scarcer over the next few years, predicts George D. Velianoff, RN, DNS, CHE, executive vice president of nursing for the Emergency Nurses Association in Des Plaines, IL. Aging nurses are retiring, while fewer students are enrolling in nursing schools every year, Velianoff explains. 

To make matters worse, demoralized nurses are leaving the profession, he says. "You can’t force mandatory overtime, staff at minimal critical levels, abuse your work force, and expect nurses to stay and be happy," he argues.

Many EDs already struggle to keep staff nursing positions filled, Velianoff says. "Some are using a greater percentage of assistive personnel, including paramedics, but these measures have shown to increase wait times and length of stay."

To avoid being short-staffed, you’ll need to find more creative solutions, urges Asche. "It looks like the nursing shortage is not going to get better any time soon," she warns.

Here are some effective ways to recruit and retain ED nurses:

  • Make sure you hire the right nurses.
    Hiring nurses who will fit into the work culture of your ED is key, says Nancy Bonalumi, RN, MS, CEN, director of emergency services for Pinnacle Health Hospitals in Harrisburg, PA.

    "Technical skill is important, but an even more important factor is hiring someone with the right attitude," she says. "Nurses can learn skills such as starting an IV or drawing blood, but also consider attributes such a teamwork, courtesy, and customer service skills."

    During the interview process, recruiters evaluate a nurse for his or her "fit" into the Pinnacle Health culture, says Bonalumi. A structured interview process assesses eight attributes of the organizational culture: customer service, courtesy, open communications, trust and understanding, empowerment, ability to meet financial commitments, control of one’s own destiny, and "Pride in Pinnacle."

    Those assessments help ED managers judge how well the nurse will fit into the department, Bonalumi says. "An effective method for determining cultural fit is asking employees to describe a time when they were very successful/unsuccessful in resolving a conflict, a work experience they are most/least proud of, or similar situations," she adds.

    By hiring the right nurse, you increase the likelihood of retaining that person, she says. "Turnover costs can be very high if employees are hired only for technical skill. Failure to recognize work culture can significantly affect your bottom line."

  • Start a career ladder.
    At Tallahassee (FL) Memorial Hospital’s ED, a career ladder was designed to help nurses who wanted to stay in the clinical area but also wanted to advance financially and in status, says Cynthia Wright, RN, MS, education coordinator for the ED. "The program encourages nurses to precept new nurses and do quality assurance and cost-saving projects," Wright explains. 

    Points are assigned for each task, and nurses are given a quarterly supplemental check ranging from $200 to $800, depending on the number of points earned, Wright says. "The nurse keeps track of what she does in a booklet and submits it to a nursing committee yearly after her department head reviews it."

    The committee agrees on acceptable criteria for the career ladder, including new ideas proposed by nurses, she says. "Each interested nurse is given a packet which provides ideas for earning points. If a nurse has a new or innovative idea, she writes it into her packet."

  • Solicit positive comments about colleagues.
    At Norwalk (CT) Hospital’s ED, a nurse manager started a "feel-good" program adapted from a grade school project. Every two weeks, she posted the names of five staff nurses in the staff lounge.

    "Everyone who worked in the ED was invited to jot a positive note about the person" underneath that person’s name, says Laura J. Roepe, RN, MA, CEN, former administrative manager of emergency nursing services and currently a clinical systems analyst for Tyco Healthcare, a division of U.S. Surgical Corp.

    The project’s goal was to show that the staff could find at least one positive thing to say about everyone in the ED, she explains. "After two weeks, I type out all of the comments onto a certificate and give it to the individual."

    The project boosted nurses’ morale, says Roepe. "It was quite uplifting for the individual to read how others felt about him or her. It also illustrated that their colleagues value them not only for clinical expertise, but also their personality."

    Positive feedback is vitally important for nursing staff, she says. "The stresses of hospital nursing are enormous."

    There is no downtime anymore, Roepe says. "Since there is not the opportunity to interact with other nursing departments, the staff within the ED need to become a functional, enjoyable family unit. Morale-boosting keeps us focused and happy."

  • Send nurses to conferences.
    At Tallahassee Memorial Hospital, all full- and part-time ED nurses are rewarded for their hard work with the opportunity to attend national and local conferences. A random drawing for one assistant nurse manager and one charge nurse is done to select nurses to attend the annual Emergency Nurses Association conference, Wright says.

    The money comes from the ED budget and is supplemented by educational grants given by pharmaceutical companies, she says. "There is no set number of nurses sent, it depends on the money available. Instead of pizza parties, we put money into this."

    Tons of ideas for how to make things better’

    Sending staff nurses to the Emergency Nurses Association meeting helps the ED stay current with clinical and technological trends, she says. "Nurses come back with tons of ideas for how to make things better."

    Last year, the hospital sent a nurse who hadn’t been to a national conference in 20 years. "That’s commonplace in nursing, whereas in other industries, it’s customary to send employees to conferences in their field two or three times a year," Wright says.

    Scheduling is difficult when several nurses are gone for the duration of a conference, she notes. "But this is a priority, so everybody works to make this happen. Nurses know that they may go next or have gotten to go, so they have incentive to help somebody else go."

    It costs about $1,000 to send a nurse to a national conference, but the ED reaps benefits, she stresses. "If the hospital gives them something, they give more back to the hospital. Since we started this program, I’ve seen more participation, in terms of teaching and helping out in the department, and more willingness to be flexible."

  • Develop a leadership program.
    The department of nursing at Norwalk Hospital developed a leadership program to assist in retention, says Roepe. Nurses apply for the leadership role in their respective departments, are interviewed by the manager, and are evaluated by all of the staff for their leadership potential, she explains.

    The selected nurse leaders meet every other week as a group to solve unit problems, and they meet monthly with the other unit leaders to discuss mutual problems, Roepe says.

    There is no monetary reward, except pay for attending the meetings, she notes. "But nurses take pride in knowing they are helping to make the ED and the facility better," she says. "It is also a way to develop leadership behaviors in staff nurses, therefore being able to promote from within when available." 


  • Cindy Asche, RN, BSN, Emergency Department, Medical City Dallas Hospital, 7777 Forest Lane, Dallas, TX 75230. Phone: (972) 566-7670. Fax: (972) 566-8678. E-mail:
  • Nancy Bonalumi, RN, MS, CEN, Emergency Services, Pinnacle Health Hospitals, 111 S. Front St., Harrisburg, PA 17101. Phone: (717) 782-3275. Fax: (717) 782-5735. E-mail:
  • Laura J. Roepe, RN, MA, CEN. E-mail:
  • George D. Velianoff, RN, DNS, CHE, Emergency Nurses Association, 915 Lee St., Des Plaines, IL 60016. Phone: (800) 900-9659 or (847) 460-4105. Fax: (847) 460-4005. E-mail:
  • Cynthia Wright, RN, MS, Emergency Department, Tallahassee Memorial Hospital, 1300 Miccosukee Road, Tallahassee, FL 32308. Phone: (850) 431-5081. Fax: (850) 431-6425. E-mail: