Beyond Compensation: How CNOs Can Treat Culture as a Benefit

Nurses are considering more than just compensation, says this CNO.

Compensation is not the only factor that nurses consider when choosing a health system. Benefits packages, workplace culture, safety, and flexibility all play a role in the decision-making process.

CNOs should take a look at their health system’s offerings to make sure they are attractive to new nurses and that they are staying competitive in the industry.

During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Robin Steaban, Chief Nursing Officer at Vanderbilt University Hospital, spoke about  innovative perks to attract and keep nurses, and how workplace culture and safety play a role as benefits alongside compensation.

Diversifying offerings

First and foremost, health systems need to stay market competitive with both compensation and benefits packages. According to Steaban, that is the minimum a health system can do, along with making sure that employees are fully aware of all of the offered benefits.

“Today’s workforce is so much different than it has been historically,” Steaban said. “So diversifying what’s available for your employees is really important.”

It is crucial that CNOs understand the different needs and desires of their staff. Steaban explained that many nurses who are entering the workforce for the first time do not need healthcare coverage because they are still covered by their parents.

“So how do you create programs that are a little bit diverse for them so that they can still achieve some benefit?” Steaban said.

Flexibility is also a huge need in today’s workforce, and Steaban suggested creating some positions in a health system with associated compensation that offer various degrees of flexibility. This could include an internal travel resource pool where nurses can have more options, or even for working in different hospitals within the health system. The key is to diversify the work and match compensation to it.  

There are some newer benefits that health systems should consider offering, including wellness benefits, loan forgiveness, tuition assistance, and compensation for certification or advancement programs.

“All of those things help people change their compensation level and benefits in multiple ways [during] employment,” Steaban said, “versus just straight compensation.”

Culture as a benefit

Workplace culture plays a large role in nurse retention and overall satisfaction. A strong workplace culture will make nurses feel less alone and more like a part of a team, enabling them to ask questions without being judged.

“Every day I run into nurses, and I ask [them] what keeps them here,” Steaban said, “and nine times out of ten they say [their] team.”

Steaban emphasized that people will not stay in a work environment where they do not feel safe or where they cannot practice safely. Because of that, the relationships nurses have with physicians and other technicians are also extremely important.

Nurses also need to have a voice and feel heard and responded to. CNOs should provide opportunities to influence their health system, and they should help nurses be successful, advance their careers, and have the experiences that want to have at work.

“There should be forums and places where nurses can really impact the direction of the organization and the standards of care,” Steaban said, “[so they can] really put their fingerprints on their own work life.”

According to Steaban, CNOs should remember that health systems are businesses with the goal of helping patients, and that change must happen, or the business will fail. Nurses should be included in that change, and change management is a vital part of that.

“At the front line of the care continuum are those nurses,” Steaban said, “if they understand why, and they can put their fingerprints on the process a bit, they’ll appreciate that.”

Presenting culture

CNOs need to show the culture of their health system to potential candidates so they can see the benefits of working there. According to Steaban, this starts with demonstrating on first contact with a new nurse that the health system is not only interested in the work being done, but about the candidate as a person. Candidates should also be connected with the team they would be working with, so they can get an idea of what the culture is in that unit.

“Words are cheap,” Steaban said. “The actual experience of the culture is what will either glue them to you or not.”

Nurse leaders should manage the culture across their organizations and make sure that everyone is walking the walk, not just talking the talk, Steaban explained.

“Make sure that your culture is not just on a sheet of paper, or words of a mission or vision,” Steaban said, “but it’s actually the truth of what people experience when they start working.”

Flexibility

As more nurses are looking for flexibility as a benefit, health systems should evaluate where they can put programs into place to accommodate their nurses’ needs. At Vanderbilt University Hospital, Steaban says they are working on a way for nurses to contribute and describe what flexibility they need, since it is different for everyone.

For nurses going back to school, weekend programs can be beneficial, so that nurses can attend classes Monday through Friday and then work on the weekends. Likewise, for nurses with young children, mid shift assignments are helpful if they need to drop off and pick up their kids from school at the correct time while still being able to work.

Steaban says they also have a robust PRN program, where nurses are able to choose the days they want to work and they can fill in where the organization has needs and have ultimate flexibility over their schedules.

“Self-scheduling is still something we do debate all the time, [and] whether it sometimes can create a lot of stress for nurses,” Steaban said. “You actually get to pick your shifts and you can [give] yourself some time off by putting your shifts [in] early in the schedule or late in the schedule.”

There are also travel program options or short-term programs where a nurse can decide if they want to work frequently for a short period of time and then take extended periods off, so they can craft their life like they want.

“That’s really hard to do on a unit,” Steaban said, “but you can do it as an organization, [and] say we’re going to use those nurses to fill in where we have some gaps, but they’ll work a 13-week contract or 6-week contract.”

However, CNOs should still be weighing the nurses’ flexibility with the quality of patient care, according to Steaban. Nurses need to be spending enough time with their patients to develop relationships with them and fulfill care obligations.

“What’s hard for me is our ultimate responsibility is to our patients,” Steaban said. “If your nurse is changing every two or four hours, I worry about our clinical obligation to patients.”

Career advancement

Nurses are also looking for career advancement opportunities as a benefit. At Vanderbilt, Steaban said they have a career advancement program for staff nurses, with peer mentors who can help walk them through the program.

Steaban also recommends offering certification courses as a way to help nurses specialize in their practice. Continuing education credits are also important for nurses to make sure they meet the criteria for certifications and so that they can uphold standards of care.

“Offering certification courses, offering to pay for [them], [and] paying for the completion of that certification testing [are] all really important,” Steaban said, “and then aligning compensation with those accomplishments.”