Improving Nursing Recruitment and Retention at Advocate Health

By Stephanie McDonald, AVP, Emergency Services, Advocate Health 

“I’m sorry, but I’ve already accepted a position elsewhere.” That was a quote our nurse managers and recruiters heard far too often. It was commonplace for the past few years at Atrium Health, part of Advocate Health, as vacancy rates have remained higher than pre-pandemic rates. The impact? We relied heavily on expensive contract labor to bandage over the problem, and we still struggled to cover all shifts in some departments.  

A fresh look at our recruiting and talent-acquisition processes in 2024 highlighted some opportunities. We convened a team to create our new candidate-centric model. Led by one of our esteemed chief nurses, Denise White, the team aimed to develop a strategic alliance between human resources/talent acquisition and nursing leadership to expedite the processing time from application receipt to offer issuance, and to consider alternate positions for applicants when the applied-for position was filled by another candidate. We called this “Flipping the Funnel” — we didn’t need more applicants; we needed to find appropriate roles for individuals who had already shown interest in joining our organization. The team believed these two changes would reduce our vacancy rate and decrease our dependence on contract labor. 

We didn’t need more applicants; we needed to find appropriate roles for individuals who had already shown interest in joining our organization.

There were two primary outputs from the team. First, service-level agreements were established. These outlined each party’s role in the recruitment process and defined parameters for how long each step in the process would take. Second, a business intelligence (BI) dashboard was developed and shared to show how each area is performing to those expectations.  

The results were impactful and immediate. We saw an 18% reduction in our use of contract labor in the first three months and a continued reduction since then. Notably, in the span of one quarter, our time to fill vacant positions decreased by 27.6 days. The candidate-centric dashboard highlights where any bottlenecks exist and allows for coaching and process improvements. Our vacancy rate decreased by nearly 4% in 2024 compared to 2023, and so far in 2025, it has decreased another 3%. The critical partnership between nursing and talent acquisition has been strengthened through this work, and our leadership intends to deploy these changes for nurse recruitment across the entire Advocate Health enterprise. 

Although recruiting nurses is crucial work, retaining them is equally important. Industry experts highlight three factors significant to the current nursing workforce: flexibility, career growth, and safety and well-being. Fortunately, Advocate Health also recognizes these aspects as essential. 

Flexibility: Most nurses across Advocate Health are empowered to self-schedule, creating a partnership between teammate and manager. On top of that, some of our scheduling tools allow nurses to easily see, from their mobile device or computer, open shifts that match their competencies and interests, with the ability to filter for everything from start times and length of shifts, to financially incentivized shifts or particular hospitals and units. This gives the teammate ownership of their time and allows them to experience other areas of the organization.           

Career growth: Clinical advancement programs have been linked to nurse satisfaction and retention. They also formalize a process for providing rewards and recognition. For these reasons, and to increase participation, Atrium Health began integrating its clinical advancement program into the clinical nurse credentialing pathway (CNCP) in 2023. The program offers advancement tracks for nurses to choose from in the categories of education, clinical, leadership and new knowledge. Nurses must have a BSN or professional nursing certification to participate and can choose from various activities to help them advance their levels. All steps are completed and recorded electronically for prerequisite education and self-reflection. Refreshing the program resulted in a greater than 300% increase in participation, and nurse turnover, vacancy rates and satisfaction scores have all improved. We are continuously evaluating the clinical advancement program to ensure improvement through feedback from professional governance. 

Safety and well-being: Unfortunately, the escalating number of workplace violence incidents has many nurses feeling as though the simple act of showing up for work automatically puts them in danger. Advocate Health has prioritized safety in our enterprise-wide strategic plan, bringing it to the forefront of our staff well-being initiatives. We are tackling this by deploying personal, wearable panic buttons to teammates. If teammates feel they are in an unsafe situation and need help, pushing the button alerts security and leaders of their location. Testing has shown us the response is only seconds away, and this definitely improves our teammates’ sense of safety. We have also installed weapons-detection and visitor-management systems across many of our entrances, with a commitment to continue safeguarding all entrances. These, too, allow teammates to feel safer in the workplace. 

The key to nurse retention and recruitment is to stay flexible and quickly adapt to changing needs while continually improving processes. Advocate’s Chief Nurse Executive Betty Jo Rocchio refers to her team’s immediate focus as the “three W’s”: workforce, workflows and work environment. “By embracing new technology and innovative solutions, we can streamline our staffing and scheduling processes, improve the happiness of our nurses, and ensure that they can continue delivering exceptional patient care,” Rocchio says. This forward-thinking approach not only fosters a supportive environment for our current nurses but also positions Advocate Health as a leader in healthcare innovation, attracting top talent and solidifying our commitment to excellence in patient outcomes and employee satisfaction.