Recruiting, staffing, and retaining nurses who are knowledgeable, skilled, and experienced is an evergreen concern for healthcare organizations. As the demographic makeup of the U.S. nursing population changes, this need becomes even more pronounced.
Nineteen percent of the nation’s nursing workforce was 65 years of age or older as of 2020, making this the largest age group within the nursing profession.  One-fifth of nurses are likely to retire by 2027, setting the stage for a dramatic transition in which the most experienced nurses leave the healthcare profession and recently graduated nurses begin taking their place. Given the critical role nurses fill in every hospital and health system, maintaining a high level of care delivery during this sweeping transition is a high priority within the healthcare industry.
The industry still finds itself recovering from the economic effects of the COVID-19 pandemic: supply-chain disruptions, severe inflation, and staffing shortages in many departments. Within the field of nursing in particular, low morale and increased burnout, fatigue, and stress were well-documented even before the pandemic. Respecting the occupational strain nurses face is a high priority among leaders of hospitals and health systems.
Against this backdrop, the industry is formulating new strategies to overcome the challenge of onboarding nurses effectively. The hospitals and health systems that rise to meet this challenge have an opportunity to set themselves apart in the race to recruit and retain new nurses ― and in turn set themselves apart as leaders in care delivery for years to come.
Recruiting and onboarding
The demand for qualified nurses is acute. One solution to overcoming the loss of nursing experience, and ensuring standards for care delivery remain high, has been a move by many healthcare organizations to increase the educational requirements of new nurses.
The American Association of Colleges of Nursing (AACN) reported in its latest survey on The Employment of New Nurse Graduates that 77 percent of employers strongly favor nurse candidates with 4-year Bachelor of Science in Nursing (BSN) degrees from an accredited program over those with an Associate Degree in Nursing (ADN).
The most successful onboarding and continuing education programs are evidence-based and personalized to support new graduate nurses as they transition from the classroom to clinical practice. However, many onboarding programs for nurses lack evidence-based research support to measure the vital components such as critical thinking and clinical judgment that are necessary as part of an effective onboarding program for the new graduate nurses. 
Integrating an evidence-based, personalized approach requires thoughtful planning. It also involves additional costs for access to such evidence-based content that can be provided through a tailored learning platform. This frequently becomes a lower priority as financial hardships worsen across the industry.
Yet, effective onboarding remains a vital tool to recruit the most qualified nurses. It is perhaps even more important within hospitals and health systems who cannot recruit the most qualified nurses, as they must invest more time and money in getting these nurses up to speed in critical areas of the job.
Retaining nurses and Continuing Medical Education
Continuing Medical Education (CME) is much more than a line item in a budget. It’s an essential tool for ensuring a hospital or health system’s best practices are in line with the current research in every field of care delivery.
Typically, CME is provided to healthcare professionals by third parties: large conferences that cater to experts in a specific branch of medicine, scholarly publications and periodicals, and online learning tools and other electronic media. In an era of tighter budgets, investing in CME remains vital to the mission of delivering quality care. Yet CME often avoids fiscal scrutiny when hospitals and health systems are entrenched in their habits ― attending the same annual conferences, renewing the same monthly subscriptions, etc.
Here too, a human resources concern emerges. Retaining qualified nurses and providing them with quality CME goes hand-in-hand. Educational opportunities are a tool ― like daycare, flexible hours, and being treated the right way ― for hospitals and health systems to retain nurses when they cannot offer a higher salary than their competitors. Given the occupational forces facing the nursing profession, subtracting from their CME budget would be detrimental to institutions, nurses and the patients they serve.
Choosing the most effective and cost-efficient CME model requires collaboration among a hospital or health system’s supply chain and clinical educational leaders to gather multiple options for each component of CME. In some cases, online learning platforms can replace more traditional methods of CME. In other cases, “the way we’ve always done it” might be the smart choice. While time-consuming, a deliberate and collaborative approach will yield the best results.
Since managing the cost of the components of CME is essential to a hospital’s overall budget, it’s critical for leaders to scrutinize how they are educating and onboarding nurses. In this area, being effective and efficient with every dollar are among the top priorities facing healthcare leaders today.
 Smiley RA, Ruttinger C, Oliveira CM, et al. The 2020 National Nursing Workforce Survey. Journal of Nursing Regulation. Supplement| Volume 12, Issue 1, S1- S96, April 2021. DOI:https://doi.org/10.1016/S2155-8256(21)00027-2
 Davis C. One-fifth of Nurses intend to leave the workforce by 2027 (Analysis) Healthleaders, April 14, 2023. Online. Last accessed on September 11, 2023
 A Call to Action: Exploring Moral Resilience Toward a Culture of Ethical Practice. American Nursing Association. Online. Last accesses on September 11, 2023
 Valdes EG, Sembar MC, Sadler F. Onboarding New Graduate Nurses Using Assessment-Driven Personalized Learning to Improve Knowledge, Critical Thinking, and Nurse Satisfaction. J Nurses Prof Dev. 2023 Jan-Feb 01;39(1):18-23. doi: 10.1097/NND.0000000000000805. Epub 2021 Oct 20. PMID: 34678802; PMCID: PMC9835669.
Featured image: Nurse and patient. Photo courtesy: Unsplash. Used with permission.
How to Cite
Hilton M. Hudson, MD, FACS1
Recruiting and Retaining Nurses: A Critical Challenge Facing the Healthcare Industry – Onco Zine – The International Oncology Network, August 1, 2023.
1 HPC International