Luke Carignan and ASHHRA CEO Jeremy Sadlier close out October with three costs health systems already pay without naming them. Each one eats margin and morale, and each ends on a decision that sits with HR.

💵 Pay Compression Is a Fairness Problem First

Nurse.org's 2026 salary survey of 3,758 nurses: 93% say pay is not keeping up with inflation and workload, and 23% say they are underpaid compared with new hires. Mercer's 2026 planning data puts healthcare merit increases at 2.9%, tied for the lowest of any industry, while starting wages rise. Jeremy's math: a range moving 5% a year against 3% raises builds 2 points of compression every year.

HR Risk: NSI prices a bedside RN at $60,090 to replace, and 71% of nurses who left last year were past year one. The people leaving are the ones you invested in.

https://nurse.org/news/nurse-salary-survey/

🧠 The EAP Is a Phone Number, Not a Strategy

NAMI and Ipsos found 26% of employees do not know whether their employer offers an EAP at all. The ones who know face the 1-800 number, the provider list, and weeks of calls before a first appointment. Jeremy calls it a culture problem and sets the contracting standard at 24 to 72 hours to a first conversation, with charge nurses as step one, not the only step.

Action: Put guaranteed access time in the EAP contract, embed counselors on units, and tell people it exists.

https://www.nami.org/wp-content/uploads/2026/03/NAMI-Workplace-Mental-Health-Poll-February-2026_Final-PPT.pdf

📉 Budget Season Against a 1.5% Margin

Fitch puts the nonprofit hospital median operating margin at 1.5% for fiscal 2025, up from 1.1%, and calls it a likely brief operational peak before the Medicaid provisions of the One Big Beautiful Bill Act bite in 2027.

Key Takeaway: Price turnover in dollars, not points. "Spend $2 million to recover $18 million" wins where "I need $2 million for retention" loses. Jeremy goes further: workforce programs with a five-year payback belong in the capital budget, not the operating line that gets redlined every bad year.

https://www.fiercehealthcare.com/providers/fitch-2025-likely-brief-operational-peak-nonprofit-hospitals-ahead-obbba-changes

Our October Sponsors

AP3

This episode is brought to you by AP3 — the ASHHRA Preferred Partner Program.

Healthcare HR leaders are navigating rising costs, workforce shortages, and an overwhelming vendor landscape. AP3 cuts through the noise.

Managed in collaboration with Lockton and backed by ASHHRA, AP3 is a governed ecosystem of vetted, healthcare-aligned solution providers across talent acquisition, benefits administration, workforce compliance, financial wellness, and employee engagement. Every partner is rigorously vetted. Every relationship is governed. Every solution is built for healthcare.

No directories. No bidding wars. Just trusted partners proven to perform.

Visit AP3.info to learn more and get connected with a partner.

Clasp

This episode is supported by Clasp — the missing link to lasting talent.

You found two great candidates. Made two offers. One took the bigger sign-on bonus from the system across town. The other started, and was out the door six months later. That bonus is history, and now you're paying agency premiums to re-fill the role. Sound familiar?

Top health systems are done with this cycle. They've partnered with Clasp for loan-linked hiring that helps them reach candidates ahead of competitors, secure the hire with a truly differentiated offer, and retain them for multiple years by investing where it matters most: their student debt.

Clasp — the missing link to lasting talent. Visit clasp.com.

ShiftKey

This episode is brought to you by ShiftKey — empowering hospitals to deliver quality care on demand.

When census swings and acuity spikes, your team needs flexibility — not 12-week contracts, agency minimums, or exclusivity.

ShiftKey is the most powerful marketplace that gives you direct access to local, credentialed independent clinicians who are ready to work. With a presence in more than 430 markets nationwide, ShiftKey connects you with fast, quality coverage when you need it.

Post a shift. Review the professionals who request it. Choose who fits your standards. Get coverage in minutes. No long-term commitments. No hidden fees.

Start posting shifts today at ShiftKey.com.

Support the show