Workforce retention is one of the health system's top priorities, Brace said, because the long-standing worries about America's nursing workforce are not letting up. The Bureau of Labor Statistics projected 1.09 million additional nurses will be needed by 2024. Of those, nearly 440,000 openings will come from new registered nurse positions, and 650,000 will be replacements or nurses who retire or leave the field.
In a recent report, Moody's Investors Service said an “extreme nursing shortage” will hurt not-for-profit hospitals' margins for at least the next three to four years. Efforts to recruit and retain nurses, such as sign-on bonuses and generous fringe benefits, are an increasing expense for health systems, according to the report.
Other findings from the analysis:
- The nursing shortage will have the greatest impact in Southern and Western states. In Florida, Georgia, Texas and California, populations are growing and aging while low numbers of nurses are entering the workforce.
- A shortage of nurses will hit rural hospitals the hardest because large urban hospitals generally are closer to nursing schools, can pay higher wages and offer more job opportunities for spouses.
By 2020, a full 50% of Utah's nursing workforce will be eligible for retirement, which is below the national average, said Teresa Garrett, an assistant professor at the University of Utah College of Nursing. Demographically, Utah is the youngest state in the nation, but its senior population is one of its fastest-growing segments.
“So we are very young and very old all at the same time,” Garrett said. “Those two groups require a lot of healthcare, so we have this perfect storm of things that are really going to impact the nursing workforce.”
On any given day, there are about 1,000 vacancies across the state for RNs, she said. In rural areas, the pain of having too few nurses sometimes feels more acute.
“What rural hospitals tell us is that one day, they're fine—and then one nurse takes family leave and another nurse moves out of the area and another nurse retires, and all of a sudden, they are in an absolute crisis,” Garrett said. “There is no excess capacity to fill that gap.”
At Intermountain, Brace knows that nurses are available to help fill gaps, but they are blocked by the siloed nature of current staffing practices. For example, one hospital may be desperate for nurses this week while a nearby facility cuts its nurses' hours because of a low patient census.
In its new scheduling approach, the health system will upload available shifts throughout the organization. Nurses interested in working outside their home department log onto the app, indicating where they are willing to work.
“Then the app will begin pushing shifts to them that meet not only their preferences but also their competencies, so they can accept shifts on the fly,” Brace said.
Although the pilot is initially limited to Intermountain's staff nurses in just three units, Brace foresees the day that all nurses and other clinicians click on the app as needed for opportunities.
Beyond that, the app will make it easier for its staff nurses to work in both urban and rural facilities. For example, a nurse who works at a rural hospital might find opportunities in a nearby city where he or she can develop some new skills. Or an urban nurse might go on a hiking trip in a remote part of the state while working at Intermountain's nearest facility.
“If this works the way we anticipate, they can see themselves as an Intermountain nurse and pick up shifts whenever and wherever they are qualified to pick up shifts,” Brace said.