What Nurses Want from a Hospital

By Carol Harrison, RN, BSN, MSN, Ed.D

Numerous hospital recruiters from the Mobile area and throughout Alabama request time every year to address the senior nursing class at Spring Hill College regarding employment in their hospitals. Rather than having students only look forward to the tasty free lunch the recruiters were bringing, I recently incorporated an assignment where students would compare the benefits and qualities of each agency and briefly summarize the attributes of the hospital of their choice.

The students were surprised to discover that most of the recruiters thought that they were only interested in salary, when in reality, their primary issues were:

It is crucial that hospital recruiters know what new graduates want in their employment settings and implement strategies to attract and retain qualified candidates. In a 2003 article in Nursing Economics, Connie Curran found that "for all of the money spent on nurse recruitment, job fairs, advertisements, open houses, and recruiters, if your institution is like 75 percent of the hospitals we studied, your recruitment materials will be slow to arrive, lack personalization and distinction, place hurdles and obstacles in front of the applicant, and have no follow-up."

From my perspective, although the majority of the recruiters were very professional and knew their agency well, some did not know the salary, benefits and mission/philosophy of the hospital. It is imperative that they send someone from the hospital that fully understands the agency they are representing.

The majority of the recruiters expressed the opinion that they were surprised that the first question the students asked did not have to do with salary. Since representatives are spending the time and effort to recruit, perhaps a few student comments will assist them in knowing what is important to a new graduate:

Ask a nurse
A graduate in her early '20s says the first thing she did when searching hospitals in a particular area was to recruit a friend to interview nurses. The answers helped her discover that one hospital was the best because of the respect that the nurses get treated with, as well as less stress because of shortages. Another hospital that she contacted was offering sign on bonuses and offered to pay $300 for an RN-National Council Licensing Exam review course. Although the offer was enticing, she decided to listen to the advice of the nurses who knew more about the hospitals than she did.

Hospitals should consider whom they bring as a messenger. One of the hospitals from outside the city brought one of our recent graduates and the students developed an affinity with this young nurse and asked her several pertinent questions.

Another factor to consider in the recruitment arena is what nurses are saying about the hospital as they leave. Representatives from hospitals should encourage positive exit interviews with nurses who are leaving in order to maintain a good image of the hospital and employees. In fact, the majority of hospitals in the Mobile area are conducting exit interviews with nurses and have gathered data to assist the hospital with future recruitment and retention issues.

Status questions
Several of the senior students commented on the impact of teaching, Level I trauma center, and Magnet hospital status influencing their choice. For one student, doing her practicum at a teaching hospital was important because she realized the benefits of this setup. She thought that the nurses were more autonomous and a doctor was always available. But more importantly, she expressed the observation that the attitude is one of learning, one in which questions are welcome, and mistakes are explored in a positive way.

Another graduate related that she found one hospital most appealing because it was a Level I Trauma Center and a teaching hospital along with good benefits and educational prospects. Although the cost of living was higher in other cities, one student selected it based on the fact that it was a Magnet hospital, which she thought was an amazing achievement for a hospital because none of the hospitals in the city she was assessing had this title. She also, felt that there were more opportunities and greater learning experiences for her. The majority of the students agreed with Linda Drake, Carol Dimon and Frances Wheatley in their 2001 Nursing Standard article, "individuals do not wish to be bribed into nursing with one-off payments, or tricked into nursing my misleading advertising campaigns."

Benefits, Not Just Salary
Several students commented on the typical array of benefits as being influencing factors in their decision. Since the majority of students at Spring Hill are interested in pursuing a graduate degree after working a minimum of one year in a hospital, tuition reimbursement surfaced in several comments as being important to them. One young student commented that the things that are important in her place of employment are health and life insurance, retirement, tuition reimbursement and distance from home.

Salary, of course, is crucial, however, it was not as essential as health insurance to some students at this time in their life. Only one student mentioned that the high starting salary was the first issue she addressed when choosing a place of employment. However, we need to remember as Elaine Graf and Diana Halfer in a 2002 Chart article stated, "compensation needs to be market competitive. Nurses want to feel that their work is being fairly compensated and that their workplace is continually reviewing market conditions and making appropriate adjustments."

A student moving out of town noted that one hospital offered a $2,500 sign on bonus and relocation assistance. Another student observed that the hospital she chose hires new graduates right after graduation as PCA/RNs at a good rate that increases after a license is received and the benefits begin 30 days after your first day of employment. Input from another student stressed the importance of variety of learning experiences, a place that can offer her the most stability with insurance and assist her with furthering her education. After reading student comments and hearing questions they posed to recruiters, it appears the majority of the students are interested in benefits that include health insurance, retirement benefits and tuition reimbursement.

More learning
When initiating their affiliation with a hospital, orientation time was extremely important to several students as evidenced by comments and questions about the length and flexibility of orientation sessions. They were also eager to know that if they did not feel comfortable in a particular area, they had the opportunity to transfer to another unit. Many of the students inquired about opportunities for advancement. One student was attracted by the fact that the hospital is known as a renowned academic and research institution and the orientation period is thorough and flexible.

While taking the senior seminar course, students are also doing their practicum/internship. Only one hospital has approached me about recruiting students to do their clinical experience at that hospital, when in reality, agencies should be wooing students at this point. Nurses need to place their best nurses with practicum students and make them feel welcome on the unit. A student who did his practicum in a medical-surgical setting related that since he did his practicum at this hospital, he would choose them because it gave him the advantage of getting to know the nursing staff and become familiar with the mission of the hospital. He felt that the salary at this hospital wasn't the highest in the city but that for the short term, fitting in with the nursing staff that he already knows and respects and being comfortable in his work environment is most important.

The whole package
One student seemed to base her choice on the fact that, although she did her practicum at this hospital, the primary factors related to her decision were competitive salaries, a good nurse/patient ratio, good retirement and insurance benefits, and various other amenities. What surfaced in her comments was the fact that the hospital offers holistic care to patients and employees and the reputation of the hospital in the community is good. She commented that she fell in love with the hospital during her practicum experience and observed that the nurses had great rapport with one another and with the families and children to whom they provide care and healing.

Recruitment keys
It is imperative that recruiters initiate contact with prospective graduates while they are in school. Encourage students to work at your agency in order to feel an affiliation with the hospital, nurses and staff. A couple of my students were seeking employment this summer at a local hospital that would have been close to their homes. The personnel office never responded to their applications. Another hospital, several miles away, was thrilled to hire them as student nurses and they have commented on the friendly and open atmosphere of the registered nurse who hired them.

As mentioned earlier, entice students to do their practicum/internship at your hospital. Once they work regular shifts in one hospital for several days, they begin to feel comfortable in their environment and form bonds with the individuals on the unit. In addition, if scholarship monies are available from your agency, stipulate that students will be required to work a specific period of time as reimbursement for the scholarship monies. They will appreciate the monetary assistance and once they are hired, you can pursue retention measures to retain them.

Salary is important, especially in a competitive market, but that it is not necessarily the primary variable that students are assessing prior to choosing their place of employment. As recruiters, you need to not only do exit interviews, but also conduct entry sessions where you can compile information regarding why they chose your agency. Times change and the needs of the students vary from year to year, so keep a pulse on what is attracting them to your agencies and don't assume that you know what they are looking for in the job market.

(Adapted from: HealthLeaders News, August 23, 2004)