Letter| Volume 27, ISSUE 2, P111-112, April 2001

Hospitals should replace “sign on bonuses” with “retention bonuses”

      Dear Editor:

      As an emergency/trauma department staff nurse and faculty member of a local college, every day of my career I come into contact with nurses who voice their frustration regarding pay rates, outrageous sign-on bonuses earned by new nurses, and the fact that agency nurses make more money than committed staff nurses. (Please do not interpret this as meaning that I oppose the use of traveling nurses or agency nurses, as I do not; I myself was once a traveling nurse. I am merely commenting on a problem to which health care facilities contribute and offering one possible intervention that may help retain staff.)
      Nurses today need retention bonuses, not sign-on bonuses. It is not surprising nor recent news that hospitals are faced with a dire need for nurses as they face nursing shortages. Not only is this shortage occurring now, but it is predicted to become worse. Look around where you work. This shortage is occurring not only elsewhere in the United States but where you are employed, and it is occurring nationally as well as internationally.
      Why aren’t hospitals strategizing to find a better way to attract new employees, retain employees, and reward those who have been dedicated to their facility? Imagine the frustration and expense involved for a facility to place multiple advertisements (week after week, month after month) and hold recruitment fairs, “wine and cheese hiring days,” and “brunch for nurses and clowns for the kids.” These promotions are expensive and make our recruitment efforts sound like a sale at the local automobile dealer. Imagine what would happen if this budget were used to improve nurses’ pay scales and/or provide retention bonuses. Nurses are professionals. We do not need gimmicks. We need compensation and respect for our education and dedication. Today, nurses do more than graduate from nursing school and report immediately to the hospital. Today’s nurses attend statewide and nationwide seminars, earn specialty certification(s), and attend specialty classes; in addition, many of us are earning higher degrees of specialty education. We contribute much more than many people realize. Nurses are teachers, research scientists, practitioners, specialists, attorneys, anesthetists, etc, contributing to the improvement, safety, and efficacy of patient care. As anyone realizes, these classes and our pursuit of higher education cost money. In the long run, yes, further education does benefit the nurse, and the decision to advance his or her education is an individual’s choice, but the choice definitely benefits hospitals and patients as well. Nurses should be rewarded for their hard work, skills, service, knowledge, and commitment.
      Despite the crisis affecting our work environment today, nurses still are dedicated to providing care and service to their patients. It would be nice if our hospital leaders would take courses such as “how to retain your employees” and “how to boost employee morale.” It would not hurt if some courses were offered such as “the correct way to treat your employees and how to retain them.” Maybe nurses should pull together and create an addendum to hospital and state policies (ie, Patients’ Bill of Rights) by implementing the Nurses’ Bill of Rights. I am certain that readers could contribute many statements that could be implemented in our new bill.
      What are the effects of sign-on bonuses? They probably encourage new nurses to jump from hospital to hospital to earn the extra money provided by the bonus, and then move on. Would it not be more feasible and less of a hassle for hospitals to provide retention bonuses to their employees instead? Retention bonuses would encourage dedication to the facility, drastically decrease advertising expenses (ie, marketing firms, layout designs, publications, etc), employee turnaround would decrease, thereby decreasing the need for frequent orientation and training, and nurses, physicians, and management teams would have a better working relationship and understanding because of employees’ long-term involvement and commitment.
      I realize that this entire scenario is all about money to the health care facilities, but what does one suppose it is about for nurses? Yes, hospitals and other health care facilities will do anything to save money, and they should, but it is time for change. The approaches health care facilities are taking to save money are not the smartest and are the most damaging. It is not breaking news that employee morale is low, that patients are increasingly dissatisfied, that service, care, and safety are jeopardized, and that work-related stress/burnout is on the rise. Maybe it is feasible for hospitals to advertise and recruit for the rest of their operation. The idea I am presenting seems fundamental and may be criticized as costing a facility more money, but new directions must be taken. Maybe patient care and service excellence are not priorities for institutions. Maybe a health care facility will soon be the first to implement changes as discussed and pave the path for others to follow. The problem is not going to get any better, only a lot worse. Believe it or not, health care facilities cannot function without us. Isn’t the long-term overall effect worth it? Isn’t it time for implementation and a change?