JOHNSON CITY, Tenn. (WJHL) — As it continues struggling with high turnover and staffing issues, Ballad Health will raise starting pay for certain nurses at its four largest and highest-turnover hospitals by 23% effective Aug. 14 — and is increasing pay at its community hospitals following “constructive feedback” after the initial announcement.

Starting registered nurses (RNs) at Johnson City Medical Center (JCMC), Holston Valley Medical Center (HVMC), Bristol Regional Medical Center (BRMC) and Johnston Memorial Hospital (JMH) will now make $56,160 a year, up from $45,760, based on standard pay with no overtime.

The starting rate increases are among changes that also include “compression increases” for existing staff nurses and support staff designed to retain appropriate gaps between experienced and new nurses, as well as a doubling of on-call pay and a doubling of the annual wage increase from 2% to 4%.

CEO Alan Levine internally announced the increase for the four larger hospitals July 26, noting Ballad’s biggest staffing challenges have consistently been for bedside nurses and in operating room (perioperative) services at those hospitals. Levine said that leads to bottlenecks at all levels of the system.

“The lack of staffing in these positions at these facilities has created significant pressure on our emergency rooms as patients wait for bed availability, delays in necessary transfers from community hospitals, and longer than usual wait times for elective surgeries,” Levine wrote in an email. “The shortages in these receiving hospitals cascades throughout the system, which creates a necessity to target these facilities as an urgent priority.”

That email also announced the on-call increase, from $1.50 an hour to $3 an hour, and the doubling of the annual rate increase to 4% (maximum, depending on review). It noted some other Ballad positions “we have identified which are appropriate for some wage adjustments.  Individuals will be notified directly as any adjustments are made.”

Just three days later, Levine sent another email saying he had heard “very helpful feedback” from staff across the system and said the targeted increase wasn’t intended to “send the wrong message to RNs in our community hospitals…”

That email still noted the worst turnover, vacancies, and use of expensive contract labor were occurring in the four large, acute-care receiving hospitals. But it acknowledged the pressure on the community hospitals as well.

“Our community hospitals are holding patients who would normally be transferred to a major receiving hospital due to the availability of the specialty services needed by the patients in the receiving hospitals. This is placing a strain on the community hospitals, their nursing and support staff, and more importantly, disrupting the continuum of care for our patients – who are the most important part of this discussion.”

New hire rates for community hospitals will increase to $24, also on Aug. 14, with “an appropriate compression adjustment” for existing staff.

Levine wrote that all the changes are part of an effort “to solve a problem that, if not solved, will harm patients and make the work of all our nursing staff in each care setting even harder than it is today.” He asked Ballad’s 13,000-odd staff to “bear with” Ballad’s leadership as it attempts to address the overall problem “systematically.”

David Campbell, an economist at Milligan University, said the increased amounts were significant.

“There’s only a nursing shortage at the current salaries,” Campbell said in reference to the national nursing shortage. “When salaries go up, that tends to work in the direction of getting rid of the shortage.

“People are drawn to where there’s pay, so markets would predict this would happen, that in a shortage salary would go up, and so you love it for the nurses that are working so hard. And then the next thing that markets would predict is that the higher salary would entice more people to enter the nursing profession, but that takes time.”

The hospitals where the $24 an hour starting pay will take effect include the following: Dickenson Community Hospital, Franklin Woods Community Hospital, Greeneville Community Hospital, Hawkins County Memorial Hospital, Hancock County Hospital, Indian Path Community Hospital, Johnson County Community Hospital, Lee County Community Hospital, Lonesome Pine Hospital, Mountain View Regional Hospital, Niswonger Children’s Hospital, Norton Community Hospital, Russell County Hospital, Smyth County Community Hospital, Sycamore Shoals Hospital, Unicoi County Hospital and Woodridge Hospital.

Levine wrote that the problem was national, but Ballad needs to discover its own solutions.

“I hope you will continue to provide the feedback to us as we navigate these very unchartered issues,” he wrote.

He pointed to additional compensation changes Ballad has made in the past couple of years.

“I hope, at a minimum, the steps we have taken – and will take in the future – to provide bonuses, withhold increases to insurance premiums, make pay adjustments and more, demonstrate you are not forgotten.”

Ballad Health currently is offering a $10,000 sign-on bonus for a limited number of nursing positions at multiple facilities. More information is available here.