Every Sunday, a bidding war for nurses among Orange County hospitals comes to a head.
In one newspaper want ad, La Palma Intercommunity Hospital offers $3,500 as a sign-on bonus for registered nurses. In another, Tustin Hospital ups the ante with a $5,000 payment for supervisors and $7,500 for operating-room nurses.
“There are acute shortages of critical-care nurses and labor and delivery nurses,” said Marni McCartney, director of Tenet Healthcare Corp.’s career center, which recruits and trains nurses for Santa Barbara-based Tenet’s nine Orange County hospitals. “Even with the money and the gimmicks, the reality is that it will get worse before it gets better.”
Registered nurses are in short supply around the country and OC is no exception. A recent Vanderbilt University study projects the ranks of registered nurses nationwide to peak in 2007 and begin declining after that. By 2020, the nursing workforce’s size will be 20% below projected requirements for that year, the study predicts.
Part of the problem is nurses are aging faster than hospitals are able to bring in new recruits.
“The thing that is just staggering is that 30% of all registered nurses in California are over 50,” McCartney said. “Only 10% are under 30. That is the big reason why this is not going to go away.”
In OC, hospital officials are offering big hiring and referral bonuses and are going as far as Canada in search of new nurses. But OC recruiters say the situation isn’t as bad here as other places,one Texas hospital reportedly is offering free maid service as a perk for new nurses.
“I didn’t get anything like that!” said Larissa Murphy, a registered nurse who works as Children’s Hospital of Orange County’s blood and marrow transplant coordinator.
A Nurse’s Market
Still, Murphy said it is a nurse’s market out there. When she was recruited back to CHOC after two years away, officials showed a high degree of interest in her needs and concerns, she said.
But the bonuses, referral fees and higher salaries are pushing up operating costs for hospitals already feeling the constraints of managed care.
“It puts a strain in all directions,” said LaDonna Butler, chief operating officer at Saddleback Memorial Medical Center in Laguna Hills.
Butler, a registered nurse, said the bidding war for nurses could lead to some tough choices for hospitals. They might not be able to give as many annual raises, buy new equipment or fill some support staff positions because nurses are commanding more, she said.
The latest figures from the California Employment Development Department showed OC registered nurses earning a mean annual wage of $50,810 in 1998, a number that’s gone up since then. New nursing graduates alone are getting jobs paying $42,000 to $50,000 a year, Butler said.
Bonuses are the key recruiting tool for OC hospitals. Tenet Orange County uses sign-on bonuses ranging from $3,000 to $5,000 for experienced, full-time nurses. Tenet’s nine area hospitals employ 2,200 registered nurses.
Connie Worden, nurse recruiter at UCI Medical Center, said her hospital pays a $3,000 sign-on bonus for critical care, pediatric and pediatric critical care nurses. UCI Medical Center, which employs about 550 nurses, also relies on its role as a teaching hospital to attract new nurses.
Officials also are looking outside the area for nurse candidates. Worden said she and recruiters from other local hospitals recently traveled to Florida looking for job candidates.
Last year, Worden herself took a recruiting trip to Toronto.
“I’m still getting phone calls from Canada,” she said.
St. Joseph Health System, which has three Orange County hospitals, is staking out job fairs in its search for nurses and other hospital employees, said Cindra Syverson, St. Joseph’s vice president of human resources. St. Joseph officials are scheduled to go to 10 job fairs and industry conferences this year alone, she said. Many of the company’s hospitals also offer signing and referral payments.
CHOC, which counts 434 nurses, is looking at offering referral bonuses but has stayed away from the sign-on bidding war being waged by other facilities.
“We haven’t had to do more hot and heavy stuff,” said Kathleen Penzes, director of hospital services at CHOC and a registered nurse herself. “We’ve been able to fill pretty well without bonuses. People tend to want to work here. It’s not as hard to draw pediatric nurses.”
Maureen Berry, the California Nurses Association’s chief Orange County representative, said many of the members of her group are looking for more than sign-on bonuses. Some nurses are leaving hospitals and going to other healthcare industry segments because of constraints they faced at hospitals from managed care programs.
Declining payments from managed care companies and other payers have rocked hospitals in recent years. In OC, the situation has played out in St. Joseph’s decision not to accept new HMO patients and in Anaheim-based KPC Medical Management’s financial fissures.
Perks Play Big Role
But smaller medical organizations also are feeling the bite of the nurse shortage.
“I can’t even put an ad in the paper,” said Claire Biggins, administrator of Pulmonary Consultants, a specialty medical group with four Orange County offices. “I can’t compete with the bonus packages and the deals (that hospitals offer).”
Instead, Biggins said she uses the Coalition of California Nurse Practitioners’ Web site for hiring nurse practitioners and word of mouth for hiring registered nurses.
“I hate to say it, but I try to steal from the hospitals,” she said.
Biggins said she believes Pulmonary Consultants’ advantage is that it offers “business hours.”
“The hospitals can’t offer that,” she said. “We don’t work weekends.”
That appeals to many nurses, she said. The nursing workforce is 90% female, and many nurses have children.
Georgia Beams, administrator of Allergy and Asthma Associates of Southern California in Mission Viejo, represents another smaller medical group facing competition from big hospital salaries. Beams said she tries to sell nurses on her group by touting flexibility and other rewards.
“The big thing is our benefits package,” said Beams, whose organization employs 25 people.
“The way a medical practice can be competitive is with soft dollars,” she said. “You try to be creative, give them a day off here or there.”
