Transcription:
Creative Ways to Address Workforce Shortages

Scott Webb: Recruitment and retention are challenges for all hospitals, especially during COVID, but even more so at small rural hospitals like Norton County Hospital. And joining me today to discuss staffing challenges and the work that's being done by a recruitment and retention committee to ensure the patients receive the best care possible is Sonya Cap. She's a registered nurse and Chief Clinical Officer at Norton County Hospital.

From the plains of rural Northwest Kansas to you, this is Health in the Heartland presented by Norton County Hospital, where medical experts aim to empower health at any stage of life. I'm Scott Webb. Sonya, thanks so much for your time today. I know you've led this recruitment and retention committee for Norton County Hospital, maybe you could explain the idea behind forming the committee and who serves on it.

Sonya Cap: Absolutely, Scott. Thanks for having me on the program. I really appreciate it. And I'm excited to be able to let the Norton community know what we're doing here at the hospital to try to improve recruitment of staff across the board and retain all those wonderful staff that we already have. You know, as you know, in the healthcare world of today, finding and keeping excellent staff is a challenge anywhere. And, in the small rural areas, like where we are, it's even harder. It's difficult to get people that just want to move out here. Although with COVID, it has improved a little bit because people want to get out of the big cities and come to smaller areas. But we just struggle. We struggle like any small community hospital in the area does with finding candidates, finding people that want to work.

And of course, as you know, employment and unemployment is the big hot topic everywhere. Getting people to work is difficult no matter what field you're in, but the healthcare field has got a lot of specialized parts to it and finding the right candidates is always a challenge. So, your question of why we decided to form this committee is it kind of started back with the strategic plan that Norton County did back in 2018. In that strategic plan, it involved the community. The community comes together. They do a survey. You know, they identify the areas that they feel like need to be addressed by the hospital to meet the needs of the community.

It's a big, long process, but part of that strategic plan was recruitment and retention. And I was chosen as the lead of that committee. It involved community members. We had someone from economic development. We had the chamber. We had some other area businesses in town. We had the regional economic development representative on it. And so the focus from that committee was not only the hospital, but kind of Norton as a whole. How do we improve candidates that want to move to Norton, people that want to come to Norton and live here and work in the community? So that strategic plan committee was a broader range than just the Norton hospital, because it was for the community, right?

And, then when COVID hit, we had done quite a lot of work already with that committee. Some of the things that we had done as far as the community goes is we developed the website expansion of the chamber, and they completed their directory. The Norton County brochure was developed. We had enhanced relationships with area schools, increased housing incentives through economic development, and did some research into some scholarship opportunities and, you know, we're able to get those out.

The chamber also, just this last year, they did a full job fair for all of the businesses that wanted to come to it. That was awesome. And so that was all kind of part of that strategic plan. What they helped the hospital with was developing a tuition assistance program and a loan repayment program and a hiring bonus program. They wanted to see all of those. So they actually came to the board and one of the board members was actually on this committee as well. Anyway, they came to the board and, you know, suggested specifically for Northern County Hospital, that would be a good thing. So we started working on that.

And then the time for that committee kind of came to an end and COVID came in the middle of that. And so we weren't really able to meet. And about that time, I thought, you know, we need to bring this home a little bit closer. And we need a recruitment and retention committee just with the hospital employees. So long answer to your question. But that's why we developed it here is because we've got all these great ideas, we've got these things going on in the community. Now, how do we really focus it, pinpoint focus it just to the hospital?

Scott Webb: Yeah, I see what you mean. Really interesting to kind of take all this in. And you mentioned the staff surveys and I wanted to ask you, you know, why was this such an important step in the process?

Sonya Cap: For the community assessment, surveys are always a part of that. So the survey goes out, which a state university, they've held this the last two years, developed this survey and it gets sent out to any community member. And then those results are tallied and they kind of show us the direction to go. And so that's the community assessment. Like I said, the survey is just really important to know what are the top priorities? You know, what's on the minds the community members? You know, what does the hospital need to really focus on to meet the needs of the community? We don't know what the needs of the community are unless we ask them. And so that's what a survey is for is to ask them.

We did the same thing with the retention and recruitment committee here in the hospital. After we had met a few times and we just started talking about what do we need to do, what do we focus on, we just felt scattered. We didn't have a clue what really mattered to everybody. We had a good diverse team on the committee, but still it wasn't representative of what everybody wanted. So we developed our own survey. We had gotten some input from staff. You know, All the committee members had gone back to their department, they asked for input. You know, "What do you think would make a difference? Why do you stay here?" They talk to people that worked at other places and said, "What makes you want to go to work there? What do they do that we don't do?" And so we came up with a whole list of things and we turned it into a survey monkey and we sent it out to staff. And we actually got more than half of the staff, which is pretty good, actually, answered the survey and we tallied those up and kind of knew where we should focus our attention on the most.

Scott Webb: That's amazing that you got more than half the staff to respond. That's always one of the biggest problems with surveys, is just getting enough responses that the data is meaningful, right?

Sonya Cap: Yeah.

Scott Webb: So you had such a great response rate. And so what did the staff say in terms of recruitment retention and so on? You know, because as you mentioned, kind of what you knew before was just maybe anecdotal. So now that you actually had the surveys and the data in hand, what was the staff saying?

Sonya Cap: It was interesting and it really wasn't a surprise maybe because I had felt this from the staff, but it was nice to have it confirmed. They picked their top 10 and then they rated those top 10. You know, what's your number one, all the way down to 10. And the one most picked and the one rated top was to improve employee's feelings of being valued and appreciated. And so that's a big thing in itself, right? So what does that mean? You know, what happens to make you not feel valued? What happens to make you not feel appreciated? You know, how do we dig down on that? Obviously, we want to work on that because that was the top thing.

The other top things that they talked about was basically a better PTO structure. PTO is paid time off. So, maybe more PTO or, you know, just the different ways that it's accrued or having your birthday off. It was a better PTO structure. And then the third thing was a wellness incentive, possibly tied to insurance premiums. So it was interesting to know that the staff wanted to be recognized or to have help being healthier, which I suppose working for a hospital, we should be recognizing that. Now I say it on online here, that really shouldn't be surprising at all, but then it was neat to see that.

So those are the three things. There was other things, but we wanted to concentrate on three and then we'll get those knocked out and then we'll take the other three or maybe we'll do another survey, depends on how long it takes us to do these things. So those were the three things that the committee after they looked at the survey. And then of course, we communicated that with the staff in various ways and we continue to do that, you know, to let them know, "This is what we're working on. This is what we've done. This is where we're at," so we continued to get feedback from the staff. Otherwise, you don't get anything. They just think, "Well, that was..." you know. "We did the survey, great. But nobody's doing anything with it." So that communication feedback is important.

Scott Webb: Yeah, I think that's often the reason why folks don't do surveys is because they think no one's really listening. So obviously, great to let them know that we've heard you. We're going to take on the top three, at least for now. And, you know, action is being taken. That's awesome. And as you say, if you do another survey, now they're going to say, "Oh, wow. They really listened to us last time. So it's really worth our time, you know, to complete these surveys." And so that kind of touches on the area of retention. And we also want to talk about recruitment. And you mentioned this a little bit in terms of incentivizing that, you know, I know there's a massive nursing shortage in this country and it probably extends well beyond nursing in hospitals, but especially nurses. So when we think about recruitment and incentives and things, how are you addressing those concerns?

Sonya Cap: Right. As you say, it's difficult. You know, it's difficult to find them. A lot of nurses, especially now, they're joining agencies, travel agencies because they make a lot more money. And the rate right now for a critical need is $210 an hour to go to an agency to get a nurse in this facility. We can't do that. We can't afford it. We don't have the ability to do that. So, it's a struggle right now. It really is to get the nurses that want to just stay in one area, you know, and that the big dollar signs aren't calling to them in any way, shape or form.

So the first recruitment team that involved the community members, they wanted us to look at a tuition assistance. The board member that was on the team, she was actually an a nursing educator. And she said, you know, it was a long time ago, she was retired now, but she said, "They struggle with tuition." And we've known this, that, you know, tuition is difficult. So, we started working on a tuition assistance program. That was not hard to do. There's a lot of them out there. You know, there's criteria, there's only so much that you can pay toward it. Government regulates all of that. That wasn't difficult. We have a legal consultant that we worked with and we got a tuition assistance program. And then for a brief amount of time, we actually hired a recruiter. She was on kind of a per diem basis. You know, we paid her if she found somebody for us, but she was from the Wichita area and it was very difficult for her to help us recruit. But she did give us some ideas and one of them was a loan repayment program.

And that is a program where if you have a student loan, the facility pays a set amount each month to that student loan lender, that lender. And you're not really out anything, you know, with the hiring bonus, sometimes you pay that bonus to the staff and then, you know, within a few weeks, if they leave, you're out that money. But the loan repayment program, you just pay it as they go. And, you know, if they choose to leave, then you're only out the money that you spent while they were working for you. So it's a great thing and it's not done a lot around here. So I don't know of very many other facilities in our area that do a loan repayment program. It's one of those, you know, niches that not a lot of people have. So, what we've done is tiered that. You have to be working in the field that you got the loan in. So like if I was working as a nurse, but my loan was in business, it wouldn't qualify. And then we have tiers. So if it's an associates program, you get so much money. If it's a bachelor's program, you get so much money. You have to apply for it, you have to be accepted and that's one of the things that the R&R committee for the hospital does, is they review those applicants. And they say, "Yeah, this fits" or, you know, "No, it doesn't." And then, payments are made from the hospital directly to the lender. And it just kind of helps during this time.

So those are two programs that we have, and then we did get a hiring bonus. The interesting thing with the hiring bonus is, we really wanted to do it and we took it to the board, the board of trustees who has, you know, the final say on anything of a great financial impact to the hospital. And they were concerned that we would pay someone to come and work for us, but we weren't recognizing our own staff.

So the board kind of pushed back and said, "Before we approve a hiring bonus, we want you to work on a retention bonus." And so it was like, "Awesome. That's great. Yeah, now that you're telling us to do it, we'll do it." So, the CFO at the time and myself and HR, we all sat down and we got a program going. This last October, we gave a retention bonus, financial bonus to every employee that had been employed for more than a year. And it was based on their years of service. So, I think the employee that had been here the longest got like a $2,000 bonus.

So every employee that had been here a year or more got that retention bonus. And once we got that set, then we could post the hiring bonus and that's tiered. So they get certain amount of money on hire, a certain amount of money the 180 days, and then, you know, a year out and a year out after that. And so, again, it's kind of got some cushion built into it if something happens and that employee moves away. But anyway, there's those three things we did to attract new employees was the hiring bonus and the tuition assistance and the loan repayment.

Scott Webb: Yeah. When you mentioned earlier, you know, when you broke down the surveys, that number one on the list was folks just wanting to feel appreciated. And though financial is not the only way to demonstrate appreciation, it certainly is a significant way to do that. And so when we think about the area of retention and those folks saying, "Hey, we want to be appreciated," nothing says appreciation like a $2,000 bonus for someone who's been there a long time. So, that's really great because we're talking about recruitment, retention, bonuses, repaying loans, everything that you can do. And I did touch on, you know, the shortage of nurses, which I know is a constant struggle for hospitals, especially small rural hospitals. But what are some of the other staffing needs that you have right now?

Sonya Cap: Lab, we're short with lab. We have a physical therapist need. And we were advertising for an ultrasound tech, but we're hopeful that we have one. We've got an OB program. We've got three new providers, three new doctors and they all do obstetrics. So having ultrasound capability on an everyday basis is really important to that program. We need a couple of a bachelor's or associate's prepared lab technicians to work. And then it just seems like housekeeping is a revolving door, just really difficult to keep. Those entry level positions are always out there.

Now, the hiring bonus and the tuition assistance are only for certain departments. So it's the ones that are, you know, the most difficult to recruit too. So that's the nursing, the lab, the ultrasound, those places are so difficult to recruit to, so that's where the incentives come into play.

Scott Webb: Well, you know, you definitely got your hands full and it sounds like you're being as, you know, proactive as you can. The committee and surveys and really listening to folks. And probably got kind of a cross section of folks listening to this, maybe current employees, prospective employees, and also members of the community, so finally, as we wrap up here, Sonya, I wanted to have you talk about how everything that you're doing, all of this work, really is, you know, with the effort of benefiting patients and patient care and the community at large.

Sonya Cap: Sure, absolutely. Without the staff that are as highly trained as the ones that we need to have in here, we can't provide that quality care and there's nothing more important to the staff at Norton County Hospital than to be able to provide the highest best quality of care that they possibly can to the patients.

You know, my history before I came here was at a level 1 trauma center in Omaha, Nebraska. All my life, I'd worked there. It's a big, you know, big facility, multi-facility organization. And when I came here to the critical access hospital, you know, the biggest thing that hit me was it doesn't matter whether I work for, you know, a 600-bed facility or a 25-bed facility, the care of that patient is exactly the same and it needs to be exactly the same. And so the caliber of employees that we wish to hire here and stay here are such that we can say without a doubt to the community, that we are giving you the best of the best. Everything that we do is aimed toward making you the healthiest that you can be. And that's on the minds of everybody that works here, everybody that walks up and down the halls is, you know, "How can I make a difference today? How can I provide the best care?" You know, "Do I have the tools I need to do my job? Do I have the support that I need from not only my leaders, but from the community to be able to provide you the care?"

Hospitals in these rural areas are so extremely important. You know, if you have a heart attack in Omaha, you know, within 10 minutes, you're in a hospital. But if you have a heart attack out on the farm and the closest hospital is an hour and a half away, you're in danger. So having these hospitals and being supported by the community and being trusted by the community is so very important. And it's a big struggle. It really is. We want to provide the best care that we can to use. So we want to hire the best people, but the community has to be such that, you know, people want to live here and they want to move here and they want to hear, "Yeah, this hospital is great. You know, we love them. This is a great place to work." No matter what line you're in, you got to be able to hear that and see that and know that. And it all interrelates. And it's all so very important to everybody that lives in any of these counties in the rural areas that have the benefit of a hospital, do everything you can to keep it.

Scott Webb: Yeah. That's well said. And as you say, if you have a heart attack in Omaha, no problem, 10 minutes, you know, you're there, but we need these small rural community hospitals. We need Norton County Hospital. And in order for these hospitals and especially Norton to survive, you need employees, right? And so you're fighting the good fight on so many levels here trying to recruit and retain and provide the best patient care. You're doing good work. We're recording this on a Friday afternoon. I'm sure you're exhausted, but your heart's in the right place and you're doing great work and I wish you nothing but the best. Thank you so much for your time today and you stay well.

Sonya Cap: Thank you. You too.

Scott Webb: That was Chief Clinical Officer at Norton County Hospital, Sonya Cap. Check out Norton County Hospital's open positions by logging onto ntcohosp.com. Thanks for listening to Health in the Heartland. I'm Scott Webb. Stay well.