More US hospitals are addressing nursing shortages by improving working conditions rather than giving nurses financial incentives.

An article in the Washington Post (September 13, 2008) examines how hospitals across the U.S. have begun addressing nursing shortages "by introducing technology to dramatically reduce paperwork, offering more flexible hours, reducing caseloads, paying for advanced training and giving [nurses] more authority" instead of using financial incentives to lure nurses.

Five years ago hospitals "waged intense bidding wars" to fill vacant nursing positions, including offering "huge signing bonuses and even sport-utility vehicles and vacations to the Bahamas." However, such practices often exacerbated turnover because nurses would stay long enough to earn the incentives and then move to other hospitals with better incentives.

The Post profiles several techniques hospitals have used to recruit and retain nurses, including:

- A "state-of-the-art data system" at Inova Fairfax Hospital, which allows nurses to reduce the amount of time they spend filling out paperwork. In addition, Inova Fairfax offers a concierge service that offers movie tickets, dry cleaning and car detailing, among other services, to serve "busy nurses trying to juggle their professional and personal lives."

- The ability to set their own hours, contribute to decisions on what type of equipment should be purchased and whether patient-staff ratios should be altered at Children's Mercy Hospitals and Clinics in Kansas City, Mo.

- Encouragement to conduct research projects that often turn into new care plans at Georgetown University Hospital in Washington, D.C.

The high cost of losing nurses is encouraging hospitals to invest in the new practices. According to Pat Rutherford, vice president of the Institute for Healthcare Improvement, it costs between $50,000 and $100,000 to replace one nurse, not including salary, because of overtime payments, payments to temporary nurses and the recruiting and training process for a permanent replacement.

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