There are thousands of children across the United States who have been approved to receive home nursing care hours. But all too often many hours go unfulfilled, because nurses simply cannot be found to fill the hours. The reasons for unfilled shifts are numerous—just a few of them include low pay, poor benefits, challenging systems, nurse discomfort working without backup, and poor training.
It is possible, however, to improve your odds and fill some of your shifts. This article will provide ten very different strategies for finding nurses that will hopefully work for your family. Some are easy and some require longterm systemic change, but all have the power to get you more nurses.
1. Write your own ads.
Even if you are required to use a nursing agency, you can recruit your own nurses for the agency. Nursing agencies often do place ads for specific cases, but they often read like this real ad I found on a classified website, edited to remove identifying info:
That doesn’t sound all too appealing. But if you write your own ad, including a picture of your child and listing all the perks of the job, you might find a lot more interest. One ad I wrote included some of the following: free wi-fi, free off-street parking, adorable well-behaved child, and fun and stable family. The more personable your ad, the more likely you will get replies.
2. Advertise widely.
Another strategy is to post ads in all sorts of unexpected places. While you may need to pay to place some of them, I found companies would often waive the fee if asked. Some of the places you might want to consider include:
- On your Facebook feed—you never know which one of your friends will know someone
- Local neighborhood sites like Everyblock or Nextdoor
- Craigslist and other classified websites
- Nursing school bulletin boards
- Facebook garage sale groups, neighborhood groups, nurse groups, or job groups
- Local newspapers
- Babysitting, caregiver, and nanny companies like care.com, Sittercity, and local companies—most allow you to target special needs providers
- Employment websites
- Radio, especially in smaller communities
3. Get the pay raised.
One of the main reasons nurses choose a hospital environment over a homecare one is pay and benefits. Hospital nurses typically receive as much as double the pay of homecare nurses and a comprehensive benefit package that includes health insurance. Homecare nurses receive much lower salaries and fewer benefits, if they receive benefits at all. Even nursing home nurses tend to earn more and have better benefits. This is in large part because most homecare hours are paid by Medicaid, and reimbursements tend to be lower.
In many states, families have campaigned to get the Medicaid reimbursement rates raised, allowing agencies (or in some cases families) to pay nurses more. Some have had state legislators file bills to raise the rates. Others have worked directly with their Medicaid programs to raise rates. And in some states, families have even filed lawsuits to improve pay.
In some cases, families receive a budget and can spend it as they wish on nursing. Consider different strategies of pay to try to actively recruit more nurses, such as paying more for nights, or having fewer hours but with higher pay.
4. Recruit hospital nurses.
Do you have a favorite nurse at the hospital? Many hospital nurses will happily work a few shifts a month in homecare to earn extra money, especially if they really like a family or child.
Every time you are in the hospital—or even at an outpatient clinic—talk to nurses about picking up a few shifts. It is sometimes handy to have a card or flyer with your information to leave for them.
5. Share nurses with other local families.
I can’t tell you how many times I had a nurse who wanted to pick up some extra hours but the agency claimed not to have anything to offer him or her. At the same time, I had nearby friends who desperately needed nurses. Often, it was simply a matter of the left hand not talking to the right hand. Once we cut out the agency and talked to other local families directly, we were able to get better coverage for all of us.
If you have good relationships with your nurses, you may also be able to get them to talk to other nurses they know from other cases who might want hours.
Finally, sometimes one agency has extra nurses while yours seems to not have enough. If you talk to other families, you may find that some of the extra nurses may be willing to also sign up for your agency. Or, in some states you may be allowed to use multiple agencies.
Sharing information with other families is often an excellent way to find nurses. It can also really help with emotional support and finding resources in your area.
6. Be the squeaky wheel with your agency.
During one difficult stretch with no nurses, I called my nursing agency every single day. Sometimes being the squeaky wheel is the only way to get things done. Not only did the agency work harder to try to meet my child’s needs, but my child was always in their minds as they recruited more nurses.
7. Hang out at nursing schools, nurse training fairs, and nurse job fairs.
The moral of this one is to hang out wherever nurses might gather. Put up a flyer at a nursing school. Talk to professors at the school and see if they will recommend graduating nurses to you. Attend a training fair or job fair and hand out flyers.
8. File a lawsuit.
In most cases, children receive homecare nursing through Medicaid or Medicaid waivers. Medicaid includes a package of services called EPSDT that is required to be provided for all children. EPSDT coverage includes home nursing care, meaning states must pay for it. Not only that, but states are required by EPSDT to arrange the home nursing care and ensure it is being provided.
If your state has approved your nursing care but you cannot find nurses, your state is not meeting its EPSDT obligations. You, or a group of families, can file a lawsuit requiring the state to meet its EPSDT mandate by ensuring you receive your home nursing care hours. This strategy has just started to be employed in states, and judges have thus far sided with the families in all aspects of the cases.
9. Target student (i.e. LPN to RN) or retiring nurses.
Homecare nursing is often a great place for student nurses studying for a higher level nursing degree. It’s also a great place for nurses who are retiring from the hospital but still want to keep working some hours.
Nursing students who are studying to achieve a higher level nursing degree, such as LPN to RN or RN to BSN, often make great homecare nurses. While they usually only last a few years, the more flexible homecare environment often complements their academic schedules quite well. Many student nurses prefer to work night shifts, which allow them time to study or complete online work. They may also like early morning or late afternoon schedules that work with their class schedules.
Similarly, retiring nurses often work out really well in the homecare environment. They tend to have a ton of experience but want a job that is a bit more laid back as compared to the hospital environment. Our best nurses were always hospital retirees who wanted to keep working part time.
10. Make sure your school district funds school hours.
If your child attends school, your school district is required to cover nursing care during the school day for children who need nursing in order to attend school. The Supreme Court decision in Cedar Rapids Community School versus Garret F. guaranteed that schools must arrange and pay for nurses for any child of mandatory school age who requires nursing in order to attend school.
Sometimes getting your school district to pay for and provide some of your nursing is a way to relieve some of the burden of finding nurses for the home environment. In general, nurses working for schools tend to be paid more than nurses being paid by Medicaid. Sometimes schools will even hire your home nurses at a higher rate.
This strategy can be challenging because schools often refuse to pay for nursing or provide poorly trained nurses. However, if you can make it work, it may allow you to focus more on finding nurses for non-school hours.
It’s a Hard Battle
Finding nurses is always hard. But it is possible. Hopefully these strategies will provide some ideas to improve your staffing.