Wanted: nurses. Reward: $10,000.
In an era of severe nursing shortages that's only predicted to get worse, University of Missouri Health Care is offering $10,000 to any employee who refers a nurse. Their names are also entered into an annual drawing for an all-expenses-paid trip to Hawaii.
Peter Callan, MU Health's director of talent acquisition and development, said there's no limit on how many people can receive the bonus; they'll stop when the Columbia-based academic health system is fully staffed. But considering the system is expanding its emergency services and adding a psychiatric unit, that may not happen soon.
“I don't want to give the impression we're throwing money away. We still carefully watch our labor costs,” he said. “We're still doing very, very, very well in controlling costs. We think of it more on the investment standpoint.”
Paying employees to refer qualified nurses has become something of a common practice among health systems, even as many of them struggle to contain mounting labor costs. A combination of lingering, record-low unemployment and a workforce that's rapidly approaching retirement age—not to mention a healthy economy that could spur them into retiring earlier than expected—is creating a shortage of doctors, nurses and other clinicians. It's forcing health systems to spend more on labor by raising wages to keep up with competition, paying overtime, hiring contract workers and enlisting the help of staffing agencies and vendor managers.
“Right at the time that demand for healthcare professionals is rising at a pretty fast clip, the actual supply is very, very tight,” said Susan Salka, CEO of AMN Healthcare, a company that provides staffing services and workforce solutions.
In a recent survey of 101 chief financial officers and other operations executives by the consulting firm Navigant, 43% of respondents said their nursing shortages are worse or somewhat worse, while 35% said the same of both physician and mental health provider shortages. The U.S. Bureau of Labor Statistics predicted nursing will see the highest number of new jobs through 2024 of any position: 439,300.
It's a problem that's not going to let up any time soon, so Navigant's authors recommend health systems dedicate their efforts toward productivity improvement and workflow redesign. Indeed, executives who responded to Navigant's survey said that's where they plan to focus their energies over the next 12 months.
The term productivity improvement tends to get a bad rap because people assume it means squeezing more work out of the same number of employees, said Danielle Dyer, a managing director at Navigant and leader of its workforce innovation practice. On the contrary, it is about matching staffing to demand, including understanding historical volume trends and cushioning with the correct number of staff to meet those levels.
Health systems should also leverage available technology to help with tasks like creating centralized staffing pools within one site or across multiple sites to reduce reliance on premium pay, Dyer said.
When examining staffing needs, there's a tendency to focus only on clinical areas like nursing or labs, but support areas like transportation or environmental services are equally important. If not staffed appropriately, health systems can end up with nurses performing tasks like transporting patients, rather than working at the top of their licenses, Dyer said.
“Pick an area: There are both process- and technology-enabled workflow enhancements that really can be used,” she said.
There are also technological solutions that give hospitals a better understanding of the ebbs and flows of labor demand. But any time a health system adopts such a tool, it needs to provide adequate training and assess whether it's being used.
Leadership needs to ensure “that whatever the tool happens to be, it's being fully utilized,” Dyer said.
Through all this, systems should make sure they're giving front-line staff and managers the tools they need to flex, or temporarily adjust staffing levels in response to changes in demand, said Vamshi Gunukula, a director in Navigant's healthcare practice.
The concept of flex hours, while second nature for nurses, is relatively new for support services. But Gunukula said it's important that they, too, are able to make staff changes based on the fluctuations in patient loads—to ensure there are enough clean rooms, for example.
In addition to MU Health Care's nurse recruitment efforts, which include paying students who commit to working there up to $10,000 toward their loans, the health system is also focused on retention, currently boasting a first-year registered nurse retention rate of 85.5%, surpassing the national average of 83%, according to a 2017 article in the Journal of Nursing Administration.
The system abandoned annual performance reviews—which Callan said managers disliked and staff hated—and replaced them with monthly, one-on-one meetings between employees and supervisors where employees can raise issues, as well as quarterly meetings that employees schedule and determine what subjects to discuss. At the quarterly meetings, supervisors are encouraged to ask about what employees want to do in their careers, whether they want promotions or continuing education, or whether they can suggest changes, Callan said.
“It's been well-received,” he said. “They're coming up with some fantastic ideas.”
MU Health Care also implemented a one-year, in-house residency program that provides nurses who are fresh out of school with training and support to improve their competence and confidence. Part of that includes spending a week immersed in safe, simulated clinical scenarios so they can learn how to respond. It also has a trade apprenticeship program for such non-clinical positions as pipefitter, plumber and electrician—staffers who have to comply with stricter health and safety regulations when they're working in a hospital. A former cook in the health system is now training to become a pipefitter, Callan said.
Within the past six years, MU Health Care has boosted employee engagement by more than 400% according to Gallup's employee engagement survey, jumping from the 11th percentile to the 70th.
It's one thing to recruit nurses, but it's another to keep them engaged and provide an experience that will rival other companies they could work for, said Mike Koehler, MU Health Care's chief human resources officer. “How can we be the place where nurses are beating down our doors to work here?” he said.
Atlanta-based Piedmont Healthcare is turning to partnerships with colleges and universities to create a pipeline of nurses to care for its patients. Each of the system's 11 hospitals host clinical rotations with local colleges and its employees provide feedback on students.
Denise Ray, Piedmont's chief nursing officer, said the health system is increasingly losing nurses to retirement, and expects the problem to persist over the coming decade. And the number of new nurses entering the workforce is limited by the amount of faculty available to teach them.
Through partnering with schools, Piedmont hopes to convince students to stay once they graduate.
“They've already been part of the system,” Ray said. “They know the team. They've used the EHR. They really get a good feel. At the end of those they say, 'I really like it here, and I want to stay.' ”
Piedmont also is trying to increase retention by implementing a shared governance model whereby all 11 of the system's chief nursing officers meet monthly to share front-line nurses' concerns with Ray, who presents them to Piedmont's CEO.
The health system also launched a new set of initiatives designed to support nurses that includes continuing education, annual meetings and an awards program. It also places educators in every unit across all hospitals who work side-by-side with nurses once a week.
Piedmont's nurse turnover was 11.3% in the 12-month period that ended June 30, down from 17% two years earlier.
One thing's pretty clear nowadays: If you're a nurse, you're not going to have trouble finding a job, said Bryan Rayburn, who owns Interim HealthCare's Indianapolis operation. Interim has 300 offices nationwide and provides primarily acute-care nurse staffing for hospitals, schools and physician offices.
“The past two years have been unlike anything I've ever experienced with regard to the volume of needs, or the volume of requests, compared to the pool of available nurses out there,” he said. “It was just incredible.”