Chartis: Rural hospitals losing 'arms race' for nurses amid major staffing crunch

Rural hospitals are finding that signing bonuses aren’t enough to attract new nurses or keep staff from leaving for more lucrative opportunities as a staffing crunch continues to impact care, a new survey finds. 

The survey, released Tuesday from the Chartis Center for Rural Health of more than 100 rural hospital leaders, also shows that lingering reluctance to take the COVID-19 vaccine continues to stress facilities.

Rural facilities are searching for new strategies to shore up their staff as they face increased competition from more urban hospitals.

“It’s an arms race a rural hospital cannot win,” Michael Topchik, national leader for the center, told Fierce Healthcare. “They just don’t have the competitive clout.”

The survey found that 56% of respondents had up to five open nursing positions, and 17% had openings between six and 10.

Chartis added that 48% of staff departures in 2021 were due to nurses leaving for much more pay at nurse staffing agencies, and the second reason for departures was to leave for another hospital. 

“Pandemic-related burnout ranks third, and retirement ranks fourth,” the survey said. 

The entire hospital industry has faced a staffing crisis due in part to rising prices for temporary nursing staff to shore up capacity to fight the COVID-19 virus. 

However, rural hospitals are at a disadvantage as they cannot compete with more urban facilities for higher pay rates, Topchik said. 

Efforts by rural hospital leaders to respond to this crisis—chiefly signing bonuses—aren’t doing enough to attract or retain nurses. 

“Nearly 70% of survey respondents say their hospital has turned to sign-on bonuses in the ballpark of $16,000 to $20,000, a majority (39%) are in the $1,000 to $5,000 range, followed closely by 34% in the $6,000 to $10,000 range,” Chartis’ report said. 

But the signing bonuses weren’t enough to compete with those offered by more urban facilities, and it caused a problem with morale as existing nurses were angry over newer staff getting such high bonuses.

“Every time you engage in the arms race everyone just ups the ante,” Topchik said. “What they were doing instead was incentives for retention.” 

Topchik was surprised that a reluctance to comply with a federal COVID-19 vaccine mandate wasn’t more of an issue, with the survey listing it as the fifth highest reason for nurse turnover. 

The Centers for Medicare & Medicaid Services’ mandate went into effect this past January. In rural hospitals that implemented a mandate prior to January, 67% found that less than 2% of personnel chose not to comply with the mandate and left. 

All told, the staffing shortages took a toll on patient care. The survey found that 36% of respondents said a lack of staff prevented the hospital from admitting patients in the past two months.