Section 3 | Building the Team
Recruitment and Retention Strategies
Like most topics covered in this guide, the challenges that existed before the pandemic in recruitment and retention remain, but have been amplified by the ongoing nature and toll of the pandemic on the workforce. Combined with broader demographic and social changes, many traditional expectations of employers and employees have been upended.
The recruiting landscape has changed both as a result of larger demographic shifts as well as the impact of COVID-19 and the “great resignation.” As organizations look to recruit new team members, they may be competing with different industries and settings, increased expectations for flexibility and the ability to work remotely, as well as better work-life integration and resources to support employees’ families. Demographic changes in particular will likely contribute to an extended challenge in recruitment. The recruitment pool has been impacted by demographic shifts including:
- The dramatic drop in 16-24-year-olds who traditionally occupy entry-level roles;
- Pandemic-related reductions in immigration that have resulted in four million fewer new immigrants over the past two years; and
- The reluctance among those over 55 to return to work at the same rate as others. (EMSI/burning glass)
Efforts to increase diversity of the health care workforce were challenged prior to the pandemic and those challenges have been further exacerbated by it, which is addressed in greater depth in Chapter 7
At the same time, addressing the ongoing impact of COVID-19 on the current workforce also is a key priority. As mentioned in Section 1 of this guide, we must continue supporting the well-being, safety and mental health of a workforce that has experienced a seemingly unending trauma over the past two and a half years so they can continue to care for our communities. Over a short period of time, some employers have taken major steps to better accommodate the needs of their workforce, such as expanding hybrid and remote work, increasing support for family life integration and personalizing employee health benefits.
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Top Takeaways for CEOs
1 The landscape has changed; we can’t expect the same results with a onesize-fits-all approach to recruiting.
2 Health care workers are worn out— addressing well-being, as well as supporting flexibility and family life, are key to maintaining a strong team.
3 A well culture, where team members feel valued, is essential to retaining a committed workforce.
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- When refining a recruitment approach, we recommend you consider the composition and demographics of your workforce as well as national trends, as noted in Section 2 of this guide.
- As you evaluate your organization’s offerings, review the landscape of creative ideas from others in health care to spark ideas that can be tailored to your circumstances. Keep in mind that the rapid change and seismic shifts in how we work as a result of the pandemic may require some radical thinking in terms of benefits, flexibilities or approaches. It will certainly require a more nuanced and multi-channel set of solutions that address the variation in generation, life stage and support needs of a diverse workforce.
- Adjustments to recruitment and retention efforts will take time and iteration, so ensure you develop an approach that involves multiple stakeholders and includes voices from human resources, clinical, operational, facilities, quality, technology and provider experience teams. All efforts must include clear connection to and alignment with diversity, equity and inclusion efforts.
- Include your board in regular discussions regarding the workforce needs of the organization and their role in driving retention.
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As mentioned in the data and analytics chapter, identifying what data you currently collect and what might be most useful will help guide your strategies. Understand what data can inform your diversity strategies.
- Consider a survey, such as the AHA’s Voice of the Workforce survey (to be released later this fall) or other engagement surveys to understand what benefits, flexibilities and workplace dynamics may be impacting decisions to stay
Evaluate the uptake of current benefits and if possible, stratify that usage by your employee demographic data, diversity characteristics, tenure, role and other available metrics to understand where there may be opportunities.
- Review opportunities for remote work, cross-training, shared labor pools and other strategies that might increase flexibility for staff.
As highlighted in Chapter 1 on well-being, recognition provides a strong opportunity to support retention efforts. Consider identifying resources needed to develop or partner on a formal recognition program.
Understand what tools and data are available to better predict needs and opportunities to deploy teams across the organization
Assess resources available (including executive time and attention) to address potential changes and identify priority areas for either broad action or piloted interventions to best support spread and scale.
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Addressing challenges with recruitment and retention must be multi-factorial to address the needs of your unique employee population and will require a tailored approach. These efforts will also need to be prioritized and in some cases piloted before full implementation to ensure ongoing equity, safety and outcomes.
As with efforts to address well-being, activities will need to address a spectrum of needs and barriers and will fundamentally require a strong organizational culture to grow and sustain. As a starting point, addressing benefit design, workflow and team composition may be areas where your front-line teams and managers can provide key improvement input.
- Consult with your benefits committee to identify potential benefits of interest to your employees or opportunities for a “cafeteria”-style approach that might provide greater variety in benefits.
- Through focus groups, discussions with front-line leaders and other input methods, identify opportunities for different structures, workflows or team compositions that might support better balance and engagement of the current workforce.
- Review current schedule flexibility available in different units and departments and consider where additional flexibility might be built in.
As noted by the recent Nursing Think Tank recommendations, creating opportunities for more flexibility within the confines of shift-based work both in roles and time frames requires some creativity and varying models, but can address some of the challenges of addressing staffing fluctuations.
Another key factor impacting the current workforce, particularly in health care, is the availability of child and elder care. While not a solution for every organization, studying opportunities to develop or partner with community care providers could address a key stressor for health care workers.
- STUDY
Childcare Stress, Burnout, and Intent to Reduce Hours or Leave the Job During the COVID-19 Pandemic Among US Health Care Workers - ARTICLE
To Retain Nurses and Other Staffers, Hospitals are Opening Child Care Centers
Organizations in locations with challenging real estate markets may also want to consider opportunities to purchase, partner or co-develop housing for their workforce. While a long-term undertaking, some markets may remain challenged to find suitable options for new recruits.
Like most academic medical centers, UVA was plagued by staffing shortages. At the start of the pandemic, the staff rallied and focused on caring for patients. Then after COVID-19 cases subsided, senior leadership evaluated the workforce and realized that it was obliterated. They were tired, burned out, and some had left the profession. But most importantly, the medical center did not have the support teams needed to help their nurses. Leadership began critically thinking about how to care for patients in the here and now, and how to get creative in staffing.
- CASE EXAMPLES
Recruiting and Retaining an International Workforce
Building a robust nursing workforce is hugely important in providing quality care to patients, but poses unique challenges in rural Ohio. In this conversation, Fisher-Titus’s Stacy Daniel, director of clinical programs, and Katie Chieda, chief nursing officer, share how their team concentrated on recruiting international nurses to ensure that they remained a strong, independent health system for years to come.
- CASE EXAMPLES
Recruitment and Retention Strategies: Housing
Consider creative models of recruiting, including apprenticeships to expand career opportunities for your current staff and educational partnerships to build relationships with those just beginning their careers. Before the pandemic, health care organizations were exploring apprenticeships and other programs to support current employees in growing their health care careers. These opportunities can provide recruiting potential to bring in those looking for change.
- EXAMPLES
Apprenticeship Examples from Across the Country - CASE STUDY
Apprenticeships Answer Emerging Workforce Demands: Staten Island Performing Provider System
Programs like those developed by Mary Washington Health Care and Germanna Community College allowed nursing students to engage with and start their careers while completing their education. Consider outreach to schools with which you operate clinical rotations to identify creative additional work opportunities.
Management of the COVID-19 pandemic required healthcare leaders and frontline workers to rapidly innovate and adjust to a new reality that has forever transformed nursing education and practice. Throughout the pandemic, key stakeholders in Alabama lobbied for transformations in clinical training practice that ultimately improved students’ exposure to clinical environments and alleviated the pressure on practicing nurses and other healthcare workers during pandemic hospitalization surges. The present article highlights the key partners and regulatory innovations that led to these successes in Alabama.
- ARTICLE
Innovations in Academic/Clinical Partnerships During COVID-19 to Prepare a Ready Nursing Workforce
As you consider encouraging health care careers, consider partnership opportunities with high schools and middle schools to share the value of a career in health care. Job shadowing, career days and other creative approaches are being deployed across the country to bring the broad spectrum of health care careers to interested students.
- CASE STUDY
From High School to RN
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Prior to the pandemic, successful practices in team-based care, from the front lines to the C-suite, demonstrated a strong culture that supported retention efforts. The toll of the pandemic has been significant on the health care workforce, but efforts to bolster strong teams and peer networks have shown to be protective.
- MODELS
A Model for Clinical Partnering: How Nurse and Physician Executives Use Synergy as Strategy - TOOLS
Team training tools have been shown to increase communication and engagement — explore the full video library of trainings here.
Many state and local associations have developed partnerships and opportunities to support workforce development locally. Identify opportunities to partner.
- TOOLS
Caring Gene — a partnership among health care leader associations in New York, this effort seeks to recruit those interested in caring for others to health care careers.
Missouri Health Careers — a resource site to help those interested in health care careers identify opportunities and education.
- MODELS
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As the workforce shortages continue to challenge our teams, leaders — especially those on the front lines — will need additional support, training and education. Whether adapting to a hybrid workforce, managing adjusted workflows or new team compositions, or leading virtual care teams, ongoing efforts will be needed to ensure all leaders have the right skills, competencies and tools to succeed.
As you review potential changes to accommodate workforce needs, ensure you are identifying related leadership education and support needs along the way.
Prepare your core management and leadership teams to support change activities while not ignoring their own needs. Leader burnout can erode the health of the entire team.
- EDUCATIONAL PROGRAMS
Next Generation Leaders Fellowship — designed for emerging health care leaders to provide skills needed to move into senior leadership roles.
AONL Education Programs — from individual programs to longitudinal fellowships for front-line, emerging and senior nursing leaders, these programs provide the skills and competencies needed to lead the team of the future.
AHA Leadership Experience Program — trains leaders in leading themselves and their teams through change while supporting well-being. - TOOLS
Physician Leadership 360: A tool to help emerging physician leaders identify strengths and opportunities in their leadership.
- EDUCATIONAL PROGRAMS