This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

  Today in health IT nurse compensation and retention and what it can do about that. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping health IT staff current and engaged. Have you signed up for CliffNotes yet? We designed it for you.

If you don't have time to listen to every episode, which we know you don't, you can sign up for CliffNotes on our website this week, health.com, click on the subscribe button, and you'll receive an email 24 hours after each episode airs. It will have bullet points, it will have a summary. It will have one to four video clips that you can just watch a segment of the show and decide whether you wanna watch the whole thing.

So I highly recommend it. We design it for you. Hopefully you'll take advantage of it. All right. Here's today's story. This is a landmine, and it's not my intention to address nurse pay. It's my intention to swing this conversation over to health IT and technology. Know my intention before you get upset.

I'm not going to address nurse pay per se. I will talk about it a little bit because it's part of the story. Why am I addressing this? As you might imagine, given the nature of what I do, I read a lot. . Of social media and recently I came across a post by Chris Caulfield and it was good post. So Chris highlights this thing that's happening and it says $40,000 sign-on bonus for nurses.

This sounds good, too. Good to be true. The listed hospitals in South Dakota, the lowest paying state for nurses in the US are they trying to put a bandaid on a hemorrhaging wound? What are your thoughts? And so I, I like this post 'cause I like posts that get you thinking, get you, uh, thinking about a problem that you may not have thought about before and thinking about in different ways.

And before I looked at the comments I wanted to figure out what did I think? And my first thought was, some state has to be the lowest paying state for nurses in the country. So I don't have a problem that South Dakota is the lowest paying. Place for nurses in the country. It doesn't have a lot of corporate headquarters.

If you just looked at pay in general across South Dakota, it would strike me that a lot of the jobs, it might be the lowest paying place for plumbers in the country might be the lowest paying place for teachers and electricians. It, it wouldn't shock me just 'cause there's not a huge amount. Of urban areas in South Dakota, they don't have ports.

There's just not a lot there. So their economy isn't gonna support them. Trying to do pay equity with California and New York or Georgia for that matter, just doesn't make any sense. So I, again, I don't have a problem with them being one of the lowest paying places for nurses. And the challenge they're having is how do you attract people to that location?

That's the next thing I ask myself. What's the problem they're having? The problem they're having is . Everything went to remote work for starters, and we're in the middle of a pandemic, so two things happen. One is traveling nurses, . Can essentially sign on to some of these programs and receive significant pay increases.

Now it's short term for sure, but they can be assigned to New York during the surge and they get assigned to Louisiana during the surge and then go to Florida during the surge and then go to Seattle and Washington during their surge, and they can make significant amount of money that way. The other thing that's happening is if they're really smart,

And they've picked up the technology and they know the EMR implementation really well. They could get picked up for some other program, and so you could have nurses and, uh, informaticists who are making New York money and living in South Dakota or making California money and living in South Dakota. If you can imagine, that's a really high standard of living.

If you are getting 140, 120, uh, or even a hundred thousand dollars. To work in South Dakota, that puts you in a, a pretty high bracket, I would imagine, in in those states. And so that's what's happening. And so they're losing their nurses to traveling programs. They're losing their nurses potentially if they're technology savvy, to other organizations in higher paying states who are doing EMR implementations or optimizations.

And they're still working from home. So they have all the benefits of working from home. They don't have the stresses of going into the office anymore, and they are making essentially upper echelon pay living in South Dakota. So that's the problem they're trying to address. I don't even have a problem with the $40,000 sign-on bonus.

It does create some pay equity challenges. You have existing nurses, how are you taking care of those nurses and whatnot. So that's, those were my initial thoughts. And then I started running through . Some of the comments and it, it had things like, Hey, you know what? There's probably stipulations around that 40 K sign-on bonus, and I, I didn't think about that, but of course there's stipulations.

Nobody's gonna give you a 40 k sign-on bonus, and you can leave tomorrow and take the 40 K with you. So some people are saying, Hey, it's probably paid out over time. Yeah, that would make sense to me. It's probably paid out over two, three, maybe even four years. The other thing is that there's probably other stipulations in it if you get fired for cause.

You may have to repay the bonus or what you've received in the bonus. If you leave early, you're not eligible for the remainder of the bonus. So yeah, there's probably stipulations in it. And that makes sense. People talk a lot about the fact that nurses are essentially taking advantage of, and they should read the contracts.

They should hire lawyers to read the contracts. They're really down on the health system that's doing this. I'm not down on the health system that's doing this. They have a need for nurses and they're trying to solve that problem. They're down on 'em 'cause they. Believe that they have a nurse shortage because they're not paying them enough, and that may or may not be the case.

I haven't looked into it in enough detail, as is usually the case in social media. Anyway, I thought that was interesting to bring up, and so I thought about that from an IT perspective. Here's the so what on this? There is a role for it to play. Let me start by saying that pay equity review every five years is a must for every organization, but I'm going to specifically talk about it at this point.

You'd be surprised how off kilter you can get in just five years. One exception here leads to another until every new hire is making about 20% more than your loyal, existing staff, and you run the risk of losing them. Pay equity is important and assume your staff know. What each other is making. They may not, but I found it better to assume it.

Assume full transparency. And that is just the way to go. Assume everybody knows everybody's salary. So if somebody got the list and they looked at it, they would say, oh, that makes sense. Not, oh, I can't believe. Now, anytime you get a salary list, you say, oh, I can't believe, but it should make some sense to them.

All right, so assume full transparency, but you have to do that. That pay equity review at least every five years is what I've found. Next thing I would say is nurses are sometimes an overlooked group when it comes to EHR implementations. If not overlooked, at least overshadowed. If this is the case, you could be contributing to the problem of retention.

money isn't the only reason people leave organizations sometimes it is a poorly designed system workflow and extra time. They know that they are wasting because they didn't have that same problem at the previous system where they worked. The EHR was better at the last hospital they worked at. You have to get the nurses a seat at the table, let them help prioritize your work items on your optimization.

You might think I'm crazy and say, Hey Bill, this just doesn't happen. But I've talked to too many nurses who don't feel like they have a voice. Give them a voice or ask them if they feel properly represented in health IT decisions. I think you'll find that I'm not crazy. Finally, you have to round, get out of the chair and spend time with the clinicians that are utilizing your systems.

Listen and act on what you hear. It is not only part of the job, it is the job. Engage the users of your technology. That's all for today. If you know of someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week, health.com, or wherever you listen to Podcast Apple, Google Overcast, Spotify, Stitcher, you get the picture.

We are everywhere. We wanna thank our channel sponsors who are investing in our mission to develop the next generation of health leaders. VMware Hillrom, Starbridge Advisors, McAfee and Aruba Networks. Thanks for listening. That's all for now.