NursingLink

Pick Your Perks: Subsidized Apartments, Three Day Weeks, Concierge Services?

What a life nurses get offered these days.

Car needs fixing? Drop the keys off at a concierge desk at work and someone will take care of it. Coming from out of town and shocked by housing prices? One hospital offers apartments at discount rates. First-time home-buyer? Another hospital will help you with the down payment.

Desperate for nurses, hospitals offer to pay for their education, give $5,000 sign-up bonuses and provide another bonus after they’ve worked there a few years. All this, and a nurse only has to work three days a week, starting at $50,000 to $60,000.

No South Florida hospital offers all these enticements, but each is scrambling to find unique ways to attract nurses in an attempt to deal with a shortage that is only getting worse.

’’We put together a committee close to a decade ago’’ to end the shortage, says Linda Quick of the South Florida Hospital and Healthcare Association. “And the vacancy rate is still huge.’‘

Baptist Health South Florida – the five-hospital system in South Miami-Dade – has 377 vacancies, which amounts to 12 percent of its nursing workforce.

’’The situation has gotten worse for a number of reasons,’’ says Ralph Egües Jr. of the Nursing Consortium of South Florida, which was formed to deal with the shortage. “The one that’s probably easiest to understand is the cost of housing.’‘

DESPERATE TIMES

’’This is the hardest I’ve ever seen it,’’ says Divina Grossman, who has been dean of the nursing school at Florida International University for nine years. “It’s really bad.’‘

Polling 1,818 healthcare employers, a survey released in January by the Florida Center for Nursing showed that there were at least 5,000 nursing vacancies in the state. With only 37 percent of those surveyed responding, this means the overall vacancy rate may be closer to 15,000. The average Florida hospital had 30 vacancies for registered nurses.

At present, Florida ranks 37th among states in registered nurses per capita, a rate ’’exacerbated by its standing as the oldest state in the nation,’’ said a November report from the Nursing Consortium of South Florida. The average age of a registered nurse in the state is 47.5. In southeastern Florida, two in five are over 51.

With the graying of baby boomers and the state’s continued population growth, the shortage will inevitably keep getting worse. The National Center for Healthcare Workforce calculates that Florida will need an additional 61,000 full-time registered nurses by 2020—50 percent more than the 123,904 nurses who are projected to be working.

So why wouldn’t nice benefits and good pay attract more to the nursing profession?

One answer is that it’s not easy work – long shifts on your feet and considerable stress in what can be life-and-death situations, exacerbated by the shortage that means nurses are often asked to do more and act faster. But for those who like working with people, the profession also offers huge job satisfaction in helping patients get better. In patient surveys, nurses always get the top scores – well above doctors.

FEW OPENINGS AT SCHOOLS

The real answer for the shortage is the same now as it has been for a decade: Many are interested in becoming nurses, but they can’t get the training. In fact, South Florida’s nursing schools are about as tough to get into as Ivy League schools: ’’We have a ratio of something like 1,000 applicants for every 100 slots,’’ says Egües. “And these are qualified applicants.’‘

Nursing schools are trying to expand, but they’re hindered by lack of faculty for the classroom and clinical slots for training in local hospitals.

Nursing faculty members generally have master’s or doctoral degrees – and with the nursing shortage, these highly educated nurses can earn considerably more in hospital settings. ’’That’s absolutely true,’’ says Pam Hardesty, who has a Ph.D. in nursing and is the chief nursing officer for Aventura Hospital. ``Pharmacy also reports to me.’‘

Some hospitals help by paying faculty salaries. Debbie Mulvihill, chief nursing officer for Baptist Health South Florida, says the system spends almost a million dollars a year for nine faculty who teach students studying for degrees at Miami Dade College and Barry and Nova Southeastern universities. The HCA hospital chain sponsors faculty at FIU and Florida Atlantic University. Holy Cross pays for an FAU faculty member.

All the government-funded schools – both the state universities and the community colleges – have a wary eye on Tallahassee these days, where the Legislature is discussing budget cuts in education that could force nursing programs to lower their enrollments.

’’There’s shell shock going on’’ as schools contemplate cuts in their nursing programs, says Brian Keeley, chief executive of Baptist Health.

Keeley recently went to Tallahassee to meet with Gov. Charlie Crist to argue that nursing programs should not be cut because ‘we are stimulating the economy. Healthcare is driving this economy for the next couple of years, including housing and construction, and we should be stimulating it, not cutting back. We need to have nurses. Hence it’s logical that healthcare should be `held harmless.’ Don’t cut it out of nursing.’‘

LOOKING ABROAD

Baptist has been extremely aggressive in attempting to find nurses. ’’We have something like 150 nurses from the Philippines we wanted to bring over,’’ Keeley says.

But those nurses have been held up by the immigration process that was tightened after 9/11, and they are likely to come over only in a slow trickle.

Trying a different tack, Baptist Health has become a partner with the International University of Nursing in St. Kitts, sponsoring 10 students, all of whom are U.S. citizens. Meanwhile, at home, Baptist has spent $11 million on nursing scholarships since 2002, Mulvihill says. More than 500 students every year receive their clinical training at Baptist’s hospitals.

To lure nurses from elsewhere in the United States, Baptist has purchased the 100-unit Sherwood apartment complex on North Kendall Drive at 107th Avenue. The renovations are expected to be finished by the end of this year. ’’We’re giving it a new name—the Palms,’’ says Keeley. ’’We want something tropical for all those nurses from Omaha and all those places were it’s cold with gray skies.’’ Rents will be ``below market.’‘

What to do about affordable housing has been tricky for all the hospitals in South Florida.

HOUSING CONCERNS

’’We saw a lot of nurses resigning, moving away from this area—to North Florida, Tennessee, Georgia, the Carolinas. It’s mainly the cost of housing,’’ says Luisa Gutman, vice president of human resources at Holy Cross Hospital in Fort Lauderdale.

That trend has ebbed recently because of the stagnant real-estate market. ’’Our own people cannot sell,’’ so they cannot move, says Gutman.

Grossman at FIU says the faculty situation is also getting worse because of South Florida’s high cost of housing and insurance. ``I’ve just lost three people. They say they can no longer afford to live in the area. Two moved to Georgia, one to Alabama.’‘

Since the nursing shortage is nationwide, Grossman says, faculty frequently find they can get the same pay elsewhere, but the cost of a house in the Carolinas might be a third or half of what they pay here.

Mount Sinai provides on-campus ’’affordable’’ studio apartments for nurses who need housing. Holy Cross contemplated providing discount housing for new nurses but decided against it, says Gutman. One issue was fairness. The hospital was concerned about how veteran employees would feel if new ones were to get special breaks.

DOWN PAYMENT HELP

Mercy Hospital has gone in a different direction. For first-time home buyers, some nurses can get $10,000 from the hospital to help with the down payment, says Margaret Gibson, manager of employee relations. All employees can qualify for $5,000 if they’re buying their first home.

To combat rising gas prices, Mercy also is offering all employees ’’a commuter benefit’’ – subsidizing 80 percent of a Metro or Tri-Rail pass. Gibson says about 300 of Mercy’s 2,300 employees are taking advantage of that program.

In fact, many hospital jobs are now hard to fill, including those for pharmacists, respiratory therapists, occupational therapists and radiology technicians. That’s why hospitals are trying to dream up benefits that all employees can take advantage of.

At the Memorial hospitals in the South Broward Hospital District, managers are making lives of all employees easier by offering a concierge service. Drop your car keys by the desk and you can have your car washed, the oil changed or repairs made. The car will be back in its parking spot when you’re ready to leave after work, says Ray Kendrick, the Memorial system’s chief human resources officer.

You can also drop off dry cleaning, get gifts wrapped (for free), make travel reservations, pick up a gift card (for Toys R Us or whatever) or get a sitter to wait at your house for the water-heater repairman. Employees pay for work done – car repair, the house sitter – but Memorial system pays for facilitating the ease of the service, says Kendrick.

For Memorial nurses, that means their free time won’t be jammed with chores. And plenty of free time they have. Memorial nurses, like most in South Florida, generally work three 12-hour shifts a week. That means they can have four days of leisure or pile up the overtime, which is readily available because of the shortage.

The base pay rate for nurses just out of school is about $22 or $23 in most South Florida hospitals. But that doesn’t mean much. Many hospitals offer sign-up bonuses that can start around $2,000, though they can vary widely. Ruth Schwarzkopf, chief nursing officer at Tenet’s West Boca Medical Center, says a few months ago she went up to $8,000 to attract nurses for labor and delivery, night shifts and telemetry units.

Most hospitals offer considerable differentials for nurses willing to work the 7 p.m. to 7 a.m. shifts, and West Boca pays up to $37 an hour for those willing to work the night shifts on the weekends.

Because the sign-up bonuses enrich new hires, some hospitals worry that long-term employees might feel slighted—or might feel that they have to switch employers in order to maximize pay.

Some – including West Boca and Mercy – have responded by offering retention bonuses. Gibson at Mercy says nurses with two, five and 10 years of experience qualify for retention bonuses from $3,000 to $10,000. Some West Boca nurses earn points through incentive programs that bring them ’’a nice big check of $6,000 or $7,000,’’ says Schwarzkopf.

SCHOLARSHIPS ABOUND

All of this, of course, is for nurses who already have their education and licenses. For students, almost all hospitals now offer scholarship programs in which they pay all or part of a student’s tuition and expenses in return for a work commitment, which is generally two or three years.

In recent years, as the lack of nurses has become even greater, many nursing schools have added special programs for those who already have bachelor’s degrees in other subjects. They offer crash courses that compress two or two-and-a-half years of the regular training course into a year or 15 months.

Miami Dade College’s program has even converted a lawyer into an ER nurse. Another recent Miami Dade graduate, Nanci Mitchell, 62, is a former schoolteacher. She just went to work for Kendall Regional. ’’Some days have been frustrating. Most days are exhausting, but it’s a good kind of tired,’’ she says.

HER THIRD CAREER

At the University of Miami, Tiffiny Wilson, 27, is having her one-year program paid by the medical school in exchange for a commitment to work at the new UM hospital or UM’s Sylvester cancer center.

Wilson, mother of two, has a degree in graphic communications from Florida A&M. She was an office manager for a while and then an elementary school teacher. Her mother is a nurse, and relatives are doctors, pharmacists and nurses. ’’I was pretty much the hard-headed daughter’’ who didn’t want to follow in their footsteps, she says.

Miserable as a teacher of students who often didn’t appreciate her efforts, she looked again at all those family members who were both making substantial salaries and taking care of people who were grateful for the care.

’’I feel passionate about this,’’ Wilson says, but the one-year program is ’’very, very intense.’’ She gets up at 4:45, drops her children at her grandmother’s at 5:15 and then drives to Jackson Memorial, where she does her clinical training until 3:45 p.m. ’’I think it’s worth it,’’ particularly since UM is picking up the $30,000 tab.

One challenge will be keeping people like Wilson in the nursing workforce. Quick at the South Florida hospital association points out that thousands of licensed registered nurses in the state are not working as nurses. They’ve found spots working for insurers reviewing claims or managing chronic cases or doing home healthcare.

MOVING UP THE RANKS

In fact, Quick and others note one reason for the shortage is that women in healthcare – 89 percent of South Florida nurses are females – now have much more mobility than did their counterparts in bygone eras. Many now become doctors or upgrade their nursing education, to enter specialties like nurse anesthetist. ’’And I know five in our area that are now chief executives or general counsels of hospitals,’’ says Quick.

That means it’s still hard to get nurses working as nurses. ’’It’s a dreary picture,’’ says Pegge Bell, dean of nursing at Barry University. She will have three faculty openings next year. ’’Nobody is moving to South Florida. I’m having to grow my own’’ teachers by helping them get advanced degrees.

As it is, ’’we steal from other schools, or they steal from us,’’ says Bell.

Keeley at Baptist Health says the system needs to fix itself, spending the money to get enough faculty and open up slots for as many nursing students as it needs to end the shortage.

’’Otherwise, we’re just moving the chairs around the deck of the Titanic,’’ Keeley says, forcing hospitals to pay ever-increasing sign-up bonuses to steal from each other.

That’s precisely what’s happening. The average annual turnover rate for registered nurses involved in direct care at Florida hospitals is 22.8 percent, according to a January survey from the Florida Center of Nursing.

’’And that,’’ says Keeley, “drives up healthcare costs for everybody.’‘

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