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

Featuring Jeff Battinus, VP of Talent Attraction and Selection, ChenMed, and Yaniv Shimoni, Co-Founder, Take2

Disclosure: Take2 is a sponsor of The ASHHRA Podcast.

Twenty-two years in healthcare recruiting, and Jeff Battinus says his career is changing in front of his face. He joins Bo with Take2 co-founder Yaniv Shimoni to separate real agentic AI from the version that is a sticker on an old process.

🤖 Agent or Bumper Sticker

Battinus's test is blunt. Most of the big vendors, he argues, bolted AI onto applicant tracking systems that were already stacked on top of the fax machine and the Rolodex. A real agent executes on your behalf around the clock. A wrapper hands you recommendations and waits.

Action: Peel one layer. Ask a vendor what the agent does without a human starting it.

📊 What the Interview Data Shows

Chicago Booth and Erasmus researchers ran a field experiment with 70,000 applicants. Roughly 78% chose a voice AI interview over a human recruiter, and the AI-screened candidates were likelier to get offers and still be there at 30 days. Take2 reports 57% of the applicants it interviews start outside business hours.

Key Takeaway: Candidates are voting with the clock. Nobody staffs a recruiter at 11pm.

🩺 Where the Savings Land

At Dental Care Alliance, across 141 brands, Battinus says the interview module alone returned seven figures he pushed back toward patient care. His framing throughout is access, not efficiency: unlock the constraint, get a clinician in front of a patient faster.

HR Risk: Systems moving at this pace recruit from your labor pool, and they reach the offer letter first.

⚡ What Comes Next

Take2 is building pre-boarding agents for license verification, background checks, and forms, with a personal agent assigned to each new hire. Battinus predicts recruiting is 90% automated inside five years, with the human kept for the sell and the hiring-manager relationship.

Action: His parting line is the sharpest in the episode. If talent acquisition does not do this, finance will do it for you.

Shimoni's close is the gentler version. Adoption is not required today. Curiosity is.

Enjoying the show? Subscribe to The ASHHRA Podcast on your favorite podcast platform so you never miss an episode.

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

Featuring Dominiece Hoelyfield, Lead Inclusion and Culture Consultant, Nationwide Children's Hospital

Bo opens with a question worth sitting with. The last time you walked into your workplace, did you feel like you belonged? Not tolerated, not accommodated, not represented in the right percentage on a slide. Dominiece Hoelyfield has spent a decade and a half on the difference, and she answers it as a practitioner rather than a program.

🧭 Serve the People Who Serve the People

Healthy employees deliver better care to families who arrive at their most vulnerable. That is the whole chain, and Hoelyfield puts her work at the front of it. Nationwide Children's just landed on the U.S. News Best Children's Hospitals Honor Roll for the 13th consecutive year.

**Key Takeaway:** In most communities the health system is a top-five employer, which makes its workforce a direct reflection of the community it treats.

🪟 What Belonging Actually Looks Like

New hires decide fast. BambooHR puts the window at 44 days. What fills it is unglamorous: who introduces you to stakeholders, whether policy is fair, whether anyone checks in when you are running at 40% and still expected to give 100%.

**Action:** Audit the first six weeks, not the first day. Onboarding is where belonging is won or lost.

🤫 Reading What Is Not Said

Hoelyfield runs cultural audits by handing the room the driver's seat. The group writes its own ground rules, then she asks questions and listens past the answers. The hesitation, the stutter, the shift in posture. That is where the real answer sits.

**HR Risk:** A leader who takes a call during a one-on-one has told that person they do not matter. Quiet quitting starts there.

⚖️ Discernment Over Reaction

Her closing advice, and the line of the episode: not everything needs to be addressed, but everything requires discernment. In an organization of thousands, one decision ripples, and no single decision represents every employee.

Change is consistent. Growth is optional.

Enjoying the show? Subscribe to The ASHHRA Podcast on your favorite podcast platform so you never miss an episode.

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

Luke Carignan runs this one solo and flips the format. No crisis, no warnings. Three healthcare workforce stories that went right, and three things healthcare HR can act on because of them.

🩺 Ambient AI Moved Burnout in 30 Days

Yale researchers put an ambient AI scribe in front of 263 clinicians across six health systems. Burnout fell from 51.9% to 38.8% in a month. Cognitive load dropped, after-hours charting dropped, and clinicians reported more eye contact with patients.

Action: Find out whether ambient scribing sits on your technology roadmap or in an IT queue as a physician preference item. The data makes it a workforce strategy.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2839542

🏆 165 Organizations Proved Culture Repeats

Modern Healthcare's Best Places to Work list carried 165 honorees across every size and region. Guadalupe Regional Medical Center has made it eight years running, Peterson Health six, Unity Medical Center five. Employees have to say it in an independent survey.

Key Takeaway: Community hospitals and specialty providers are on this list, so "we are too small" does not survive contact with the roster.

https://www.beckershospitalreview.com/hospital-management-administration/165-top-places-to-work-in-healthcare-2026/

🔧 Cleveland Clinic Built the Pipeline Instead of Buying It

Registered apprenticeships in pharmacy, EEG, ophthalmology and sleep medicine. Apprentice retention climbed from 75% to 95% in a single year, and the system beat its apprentice hiring goal by 50%. Healthcare apprenticeships are up 43% over five years, near 37,000 nationally.

HR Risk: At roughly $60,000 to replace one bedside RN, every retention point you leave on the table is a budget line.

https://consultqd.clevelandclinic.org/tips-to-bolster-apprenticeship-program-success

🔎 This Week's 3 Mission-Critical Moves

Put ambient scribing into the roadmap conversation. Ask your people what they would actually say in that survey. Name one thin-pipeline specialty and price out an apprenticeship.

Luke's challenge lands harder than any of it. Find one person this week and tell them out loud what they do well.

Enjoying the show? Subscribe to The ASHHRA Podcast on your favorite podcast platform so you never miss an episode.

AP3 Sponsor Read

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.

Take2 Sponsor Read

This episode is brought to you by Take2 — the AI recruiting platform built specifically for healthcare.

Hiring in healthcare is harder than ever — high-volume openings, hard-to-fill clinical roles, and recruiting teams stretched thin. Take2 changes that.

Take2's AI agents automate the work that slows recruiters down — sourcing candidates, running outreach, screening and vetting applicants, scheduling interviews, and verifying licenses and certifications. It works around the clock, syncs directly into your ATS, and gives your recruiters hours back every week so they can focus on the people, not the process. From CNAs and EVS to RNs, APPs, and physicians, Take2 helps you hire faster across every role.

Vetted through AP3. Built for healthcare. Proven to perform.

Visit take2.ai/ashhra to learn more and get started.

Support the show