Attracting and retaining skilled nursing staff are a crucial focus for healthcare organizations across the country, demanding substantial operational effort and financial resources. The national hospital turnover rate, currently at a notable 20.7%, highlights the magnitude of this ongoing challenge.
High turnover significantly impacts workforce morale, outlook, and well-being. A satisfied nursing workforce provides exceptional care and enhances overall hospital performance. Today’s nurse retention concern compels hospitals to spend heavily on turnover-related costs, further straining their budgets. Traditional staffing models prove inadequate in today’s healthcare environment to address the acute nursing shortage. Faced with this scenario, what can hospital leaders do?
Hospitals can course correct on this rising issue by implementing a variety of approaches, including reimagining retention strategies, taking advantage of on-demand labor, and cultivating a culture where people feel valued. These proactive measures are necessary to address the root causes of turnover and ensure a stable nursing workforce that can deliver consistent, high-quality patient care.
The problem at hand: Traditional models fall short
Historically, many hospitals (including mine) have relied heavily on traditional scheduling structures and supplemented with external agency nurses to fill staffing gaps, especially in the wake of the pandemic. Although this approach provided short-term relief, it also brought significant drawbacks. High agency fees and short-term contracts failed to foster long-term staff loyalty, and reliance on nurses unfamiliar with our hospital’s specific practices and culture led to escalating labor costs. This frequent turnover also posed challenges in maintaining consistent care standards and patient relationships.
Innovative solutions: Embracing on-demand nursing platforms
Recognizing the limitations of traditional staffing models, our health system embraced an on-demand nursing platform as part of our solution. This platform connects us directly with local nurses, bypassing costly agency intermediaries. We can post shifts on short notice, or 4 to 6 weeks ahead of time and efficiently manage the deployment of flexible resources that meet our fluctuating demands. Unlike fixed staffing models, this option offers a dynamic staffing strategy that can swiftly adjust as patient census fluctuates.
Nurses use a phone-based app or website to claim the specific shifts they want. They can plan their schedules well in advance, with some organizing their shifts a month ahead, while others prefer the spontaneity of claiming shifts just days before. Some choose to essentially work full-time at our facility through the platform, while others jump on last-minute shift additions. The platform caters to both preferences, providing a balance of predictability and flexibility to suit individual needs and lifestyles. This ease of access and control over their work schedule has made using a workforce platform a popular choice among nursing professionals.
By integrating these on-demand nurses into our core staff, we’ve cultivated a sense of belonging and continuity that benefits both patients and permanent staff alike. This direct hiring approach not only reduces costs but also enhances employee morale and job satisfaction.
Empowering through flexibility: Expanding PRN roles and regional float pools
To further enhance workforce stability and flexibility, we’ve expanded our PRN (as-needed) roles and developed regional float pools. This approach allows nurses to choose shifts that align with their schedules and personal commitments. Offering multiple PRN levels ensures that nurses have options tailored to their availability and preferences, promoting work-life balance and reducing burnout. Our focus on flexibility and autonomy empowers nurses to make informed decisions that positively impact both their professional performance and personal well-being.
Retention strategies: Dual job interviews and grassroots recruitment efforts
Central to our retention strategy is the implementation of what essentially serves as a dual job interview. This approach leverages an on-demand labor model, allowing both the nurse and our hospital to assess compatibility in a real-world setting. This enables nurses to experience our facility and work alongside our teams over time before committing to a permanent role. This extended interaction provides both parties with valuable insights into the day-to-day dynamics and culture of the workplace, ensuring a better fit and enhancing long-term retention rates.
By immersing nurses in our environment and operations, they gain firsthand experience of our organizational values and the support offered by their colleagues. Through this initiative, we’ve successfully transitioned over 100 on-demand nurses into permanent staff positions, creating a cohesive and dedicated workforce that’s aligned with our hospital’s mission and culture.
In addition to this dual job interview approach, our grassroots recruitment efforts, driven by the enthusiasm and satisfaction of our existing staff, play an important role in attracting new talent. Nurses who are happy with their work environment and experience at our hospital become natural advocates, promoting our supportive and inclusive culture to potential recruits. This positive feedback loop strengthens our recruitment efforts and reinforces our organizational culture, creating a compelling and attractive environment for new talent.
Measuring success: Clinical and financial outcomes
Since adopting on-demand platforms and flexible staffing models to create stability in our workforce, we’ve observed improvements in clinical and financial outcomes. Clinical successes include reducing infection rates for catheter-associated urinary tract infections and central line-associated bloodstream infections to zero cases, as well as achieving enhanced patient satisfaction scores. Financially, the benefits of reduced turnover translate into lowered recruitment and training costs. In the first year, we saved $85 million in workforce expenditure across our hospital system. Additionally, the improved staff culture and reduced burnout contribute to a more productive and harmonious work environment.
Looking ahead: Future directions in workforce management
As the healthcare environment evolves, the need for creative and flexible workforce solutions will only intensify. Our health system recognizes that nurses have many options when it comes to where they decide to work. Through all of these changes, we’ve strived to create an engaging environment that’s enticing and fulfilling. We’ve committed to adapting and evolving and developing sustainable models that can effectively respond to changing demands while ensuring a resilient and adaptable workforce.
Jennifer Garnica is Vice President, Patient Care Services/Chief Nursing Officer at SSM Health St. Mary’s Hospital – St. Louis
