If you are responsible for healthcare staffing, you know hospital staffing optimization has always been challenging, and COVID-19 made it harder. During the pandemic, healthcare staffing supply and demand volatility skyrocketed, driving higher staffing costs and spotlighting the scarcity of available providers, especially nurses. Short-staffed nursing units require remaining nurses to work overtime and undesirable shifts to cover staffing gaps, leading to higher burnout and churn rates. To keep up, hospitals are spending a fortune on contract labor and struggling to achieve safe fill rates. What is exceedingly clear is this: most hospitals are not equipped to rapidly flex up and down critical clinical staff—leading to last-minute firefighting to fill shifts and manage assignments. The solution to these challenges requires healthcare staffing innovation—in other words—creative thinking about staffing models and staffing sources. In this piece, we unpack the forces challenging healthcare leaders to rethink staffing models and illustrate how to improve healthcare hiring by deploying a more flexible workforce management strategy.

Why Healthcare Staffing Models Are Changing

Even before the pandemic hit the U.S. in early 2020, the healthcare workforce was suffering from burnout and looming shortages. Nursing school enrollment was stagnating, clinicians across roles and specialties were nearing retirement age, demand for geriatric care was growing, and turnover was pervasive. Over the past two years, these issues have persisted, becoming weightier as pandemic pressures ensued. In fact, the U.S. Bureau of Labor Statistics found that the hospital subsector’s workforce has dipped nearly 90,000 people since March of 2020.  

A recently published survey found 34% of nurses intend to leave their jobs by 2023—typically citing burnout, extensive stress, inadequate benefits, and discrimination as reasons for their departure. Further, 42% of surveyed nurses started new roles in January 2021 for the chance of an improved schedule (31%), better staffing overall (24%), and greater training opportunities (24%).  

Many of these new roles were travel assignments—an option that grew in availability and popularity throughout COVID-19 as hospitals began to rely heavily on short-term, emergency, and contract-based coverage. Nurses seized the opportunity to fill critical needs while gaining more flexibility and higher compensation, inadvertently accelerating turnover trends. As more nurses turned to travel opportunities, nurses who remained in permanent positions grew frustrated and overall expectations about what it means to be a nurse—from a scheduling and compensation perspective—shifted. All this shifting brought a clear reality to light: traditional healthcare staffing models are not the future of healthcare staffing. In reaction, healthcare leaders are rethinking the core tenets of former hiring and staffing strategies to build a more sustainable, satisfied workforce.

Ways to Improve Staffing in Healthcare: Reshaping Opportunities and Operations

Do you want to expand your candidate pipeline and float pool without breaking the budget or risking patient care standards? Start by thinking outside the rigid structure that has governed staffing and operations for decades. Instead of requiring a 100% commitment to your facility and strictly 12-hour shifts, you can significantly expand your staffing resources by being flexible with shift length and frequency. By accommodating skilled nurses who have fewer hours to offer (maybe a semi-retired nurse looking for a few shifts a month, or a parent interested in a couple days a week), you can grow your recruiting Rolodex. Offering flexible job opportunities will expand your pipeline and empower nurses of all stages, ages, and phases to join the staffing pool without fear of overwork or burnout.    

More specifically, consider reshaping:

Scheduling

Currently, scheduling is a fixed process requiring clinicians to sign up at least two months in advance. Adjusting these dates is difficult and typically falls on the shoulders of the nurses themselves to find someone who can cover their shift for any last-minute necessities or spontaneous trips. Though hospitals typically discourage nurses from making any schedule changes, hospital leadership can flex staff off when the patient census is low (and require those flexed staff members to use their own PTO). In the current employee-centric nursing labor market, this approach negatively impacts your pool or qualified candidates.  

Alternatively, you could take advantage of float pools, upskilling, and cross training your internal team, travel-at-home models, and technological advances to relieve overall burden and stress while still offering lucrative options to new and experienced nurses.  

For example, some health systems are rolling out an internal travel program that gives nurses the ability to gain schedule flexibility while learning new skills and experiences from working across multiple departments and sites of care. On the system side, facilities benefit from more options to leverage their internal resources and match nurses to the greatest need—ultimately improving both patient and staff experience. These internal travel programs can also repurpose the money saved from costly contract labor expenses to offer more competitive wages to internal clinicians.  

Compensation

The rapid ramp up of high-pay travel nursing slots during the pandemic exposed many nurses to a new pay grade. Base salaries—not including overtime or bonuses—rose 4% in 2021¹. On the travel nursing side, the average pay rose roughly $1,000 to $2,000 per week before the pandemic to $3,000 to $5,000 since before the pandemic². Though egregious crisis pay should be curbed (and is already showing signs of lowering in some areas), hospitals and health systems must be willing to level up pay standards for nurses throughout the industry—taking particular care to eliminate discriminatory wage gaps (e.g., gender, race) in the process. Though spending more in a time like this might seem counterintuitive, the combination of fair pay and increased flexibility will save organizations considerable time and money.

Shift Length

Since the 70s, hospitals have scheduled nurses in 12-hour shifts. This rigid perspective on nurse scheduling is antiquated. Nurses who regularly work 10-hour shifts or longer are 2.5% more likely to experience burnout and job dissatisfaction than those who work less³. Increasingly, nurses want more flexibility in shift length to preserve their mental and physical wellbeing, yet, the 12-hour shift remains largely unchanged. As demand for flexibility and competition for top nursing talent heightens, ignoring or delaying the call for change is not an option. Hospital leadership and nurses alike will benefit from a more flexible, customizable model.  

So, what does a more flexible model look like? It starts with considering not only patient volume and acuity trends, but also individual nurse skill sets, goals, and availability.  

Culture

The healthcare workforce—and the workforce in general—is increasingly led by millennials and Gen Zs. These generations have vastly different non-negotiable career requirements than those before them. They tend to value purpose over pay, opportunities to develop skills, coach-like leaders, real-time feedback, and more work-life continuity. Consider incorporating perks into your organizational culture that appeal to these values. Modern benefits that endear younger employees include loan forgiveness programs, subsidies for childcare, mental health support, and wellness stipends.

Flexibility and Control Through Technology

Another strategy to attract and retain the newest generation of talent is  to utilize recruiting and staffing technology tools that provide flexibility and control. The modern workforce is used to having more command—with the help of technology—over everyday tasks (think—Uber for getting around town, Door Dash to order food, or Airbnb for traveling). In these models, the user is in charge. This trend toward empowering, interactive  technology is spilling over into the healthcare job market as well. User-centric, visually stimulating, on-the-go technology solutions grant current team members and prospective hires more autonomy and control over their schedules while simultaneously giving you more visibility into your workforce overall.

Growth Potential

Another shift brought by younger nurses is a yearning for perpetual learning and career evolution. Nurses who feel locked into a specific role or limited in their education level or career trajectory are likely to feel unmotivated and disengaged. Consider what your leadership can do to offer interdepartmental or interfacility cross-training, research opportunities, and other educational avenues to support nurse career development. In addition, ensure nurses are able to practice at the top of their license. Doing so will not only benefit your nurse’s sense of agency as an individual; it will also foster a more engaged culture within your nursing team, drive better patient outcomes, and help assure your hospital’s ability to retain nurses.

Pipeline Cultivation

Hospitals and health systems can play powerful roles in nurturing the clinical workforce of the future. Shortages in faculty, limited training sites, and high cost of education—along with the known potential for burnout—have deterred students from pursuing clinical careers. Rather than wait and hope for change, your organization can take proactive steps to form connections and partnerships with colleges and universities, high schools, community groups, and adult education programs. Together you can build interest and highlight opportunities in the nursing field.

The Importance of a Nurse-Centric Staffing Model

Nurses want alternate ways to engage with employers in terms of pay, schedule, floatability, geography and technology. By implementing hiring and staffing methods that support nurses’ needs and goals, hospitals can also generate considerable benefit to their bottom line and patient outcomes.  

Estimates of the cost of nurse turnover range from $46,100 to $83,000 per replacement. Reactively hiring nurses, playing catch-up, managing short staffing issues, and managing burnout and turnover are expensive and will erode your culture. Instead, use your resources to proactively create an environment, culture, and structure that preserves nurse wellbeing and engagement, which benefits your hospital’s bottom line.  

To look at it from another angle, nearly half (47%) of nurses surveyed in 2022 believed the quality of patient care suffers from temporary staffing and turnover⁴. Organizations with minimal external travel nurse assignments are more able to cultivate a cohesive culture and improve continuity of care. Additionally, studies show that nursing units with lower levels of turnover are less likely to have severe medication errors and poor patient outcomes—and more likely to have higher patient satisfaction ratings.  

Improve Healthcare Staffing by Adapting to a Changing Landscape

Historically, staffing has been based on three influences, each with its own set of pros and cons:

• Budget: Schedules based primarily on budget may be straightforward to plan, but they operate on averages and are not well equipped for variability in actual patient care needs – leading to last-minute budget-breaking issues (either overstaffing or understaffing).
• Patient ratios: Ratio-driven staffing is based on a legislatively mandated or locally accepted best practice ratios of nurses-to-patient. This approach ensures safe fill rates but only accounts for the raw number of patients—not specific patient levels of care required—leading to a high variability in nurse workload.
• ‍Acuity: Acuity-based staffing focuses on patients’ unique care needs and each nurse’s unique skill set, credentials, and availability. The acuity-based model may be the best combination of patient-centric and nurse-centric approaches as it enables safe ratios and budget controls. However, this type of scheduling requires data-driven technology to accurately forecast patient acuity and match that with qualified nurses.

The important thing to note here is that every facility is unique. There is no silver bullet and no universal approach to improving healthcare staffing. This fact is not a reason to give up, but an encouragement to construct, test, and tweak the best healthcare staffing models for your organization.  

The future of healthcare staffing innovation is beckoning. The key to successfully innovating is taking time to understand the forces at play and building a model based on your unique needs and objectives. Technology can play a large part in gathering and consolidating organization data, workforce feedback, and national trends to devise the best way forward.  

Empowering You to Optimize your Workforce Management Strategy

If the past few years of health crises and industry volatility have taught us anything, it is that we’re better when we work together toward a common goal. Partnership is essential to accomplishing transformational change in any industry—but healthcare especially. As you set out to improve healthcare staffing, you might find that Trusted Health Works is exactly what you need to power forward.  

Works gives you one centralized, 360-degree view of your entire workforce—internal, external per diem, local, and regional float—to understand performance, spend, and trends across source pools. This enables a more flexible labor pool that you can leverage to creatively solve staffing challenges, find the best-fit nurse for any open shift, and automatically apply incentives to shifts that need the most coverage. It also empowers nurses to sign up for shifts that best meet their preferences and needs, giving them the work flexibility and choice that they seek.  

Works is a digital marketplace that enables hospitals and health systems to leverage price discovery and competition to rapidly match resources to needs across departments and facilities—without compromising nurses’ flexibility, autonomy, wellbeing, and longevity. Learn more about how Works can help your hospital build better healthcare staffing models, ensure a sustainable future for your workforce, and provide the best care to patients at https://works.trustedhealth.com.

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¹ https://www.wsj.com/articles/nurse-salaries-rise-as-demand-for-their-services-soars-during-covid-19-pandemic-11637145000

² https://www.nbcnews.com/health/health-news/u-s-hospitals-hit-nurse-staffing-crisis-pandemic-rages-n1278465

³ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608421/

⁴ https://www.fiercehealthcare.com/providers/third-nurses-plan-leave-their-jobs-2022-survey-finds