High labor costs continue to stress health system leaders.
In 2023, for example, the average turnover cost for one staff RN grew to $56,300, up from $52,350 in 2022. The financial stakes are high — with each 1% percent change in RN turnover estimated to cost or save the average hospital $262,500 per year. In response, healthcare leaders are looking at new ways to attract and retain the next generation of nurses.
Becker’s Healthcare and Works recently conducted a brief survey of chief nursing officers to learn more about the qualities, skills and certifications that are top of mind in their searches for future employees; the current challenges and successes that organizations are experiencing with nurse recruiting; and investments that hospitals and health systems are making to advance nurse recruitment and retention efforts.
More than three-quarters of the 115 survey respondents work at hospitals or health systems, and close to two-thirds (63.4%) work at organizations with more than 250 beds.
Please select the most accurate description of your organization.
Flexibility is an important retention tool and strategic differentiator
Interestingly, 42% of the CNOs surveyed indicated that “reducing nurse workload” was one of the top-three most difficult things to offer or change as part of their organization’s nurse retention strategy.
Although it may be difficult for hospitals and health systems to reduce nurse workloads, many recognize the value of flexibility to employees and are leveraging it in their nurse retention strategies.
More than half (60.9%) of CNOs who participated in the survey indicated that flexible work schedules and arrangements are very important to their nurse retention strategies. For 48% of respondents, “flexible work arrangements” ranked as one of the top-three most necessary changes or updates to attract and retain the younger generation of nurses.
Flexible work arrangements take a variety of forms. While the most popular option among survey participants is self-scheduling, only 31.3% of respondents said their organizations offer that to employees. Interest is strong, however; among the 68.7% of organizations that don’t offer self-scheduling, 88.7% of CNOs said they were considering technology that would allow nurses to pick their own shifts.
“Clinicians are no longer tolerating pre-pandemic working conditions, and the next generation of nurses expects flexibility. We’re starting to see hospitals optimize their current workforce by leveraging digital tools to track talent data. At Mercy, we partnered with Trusted’s Works platform to create Mercy Works On Demand.”
Betty Jo Rocchio, DNP, CRNA, CENP, Senior Vice President & Chief Nurse Executive, Mercy
Other popular types of flexible work arrangements cited by the survey participants include the ability to pick up extra shifts according to preferences, part- time work with hour requirements and the ability to work across different care settings.
What types of flexible work arrangements does your organization offer?
Self-scheduling
31.3%
Ability to pickup extra shifts, according to preferences
29.6%
Part-time work with hour requirements
28.7%
Ability to work across different care settings
28.7%
Choosing which weekends to work
26.1%
Schedules to accommodate new mothers
25.2%
Hybrid shift lengths
24.3%
Hybrid roles
23.5%
Gig work without hour requirements
23.5%
Virtual nursing
22.6%
9 a.m. to 5 p.m. schedules
22.6%
Four-day work weeks
21.7%
12-hour shifts starting at anytime
21.7%
Figure 2: Types of flexible work arrangements offered by survey respondents’ organizations
High demand for nurses with compassion, empathy, and strong communication skills
When asked to identify the most important characteristics or skills they look for in potential nursing recruits, CNO survey respondents rated compassion and empathy highest, followed by strong communication skills. CNOs prioritized these qualities above characteristics like attention to detail and clinical competence.
While many nurses may be innately compassionate and empathetic people, it’s important to keep in mind that without sufficient bandwidth on the job, it’s difficult to display these traits to patients and peers.
What are the most important characteristics or skills you look for in potential nursing recruits?
0%
10%
20%
30%
40%
50%
60%
70%
80%
Compassion and Empathy
27%
18%
25%
Strong Communication Skills
23%
26%
17%
Critical Thinking and Problem-Solving Abilities
18%
20%
17%
Attention to Detail and Clinical Competence
12%
24%
18%
Adaptability and Flexibility
19%
11%
23%
1
2
3
Figure 3: Survey respondents’ most important characteristics or skills in potential nursing recruits
Embracing technology is essential to recruit the next generation of nurses
When asked what aspect of their organization’s nurse retention strategy was most difficult to offer or change, CNOs ranked “embracing new technologies meant to alleviate burdens” as the least difficult.
When it comes to leveraging technology as a differentiator, more than one-third of CNOs (39.1%) indicated that digital recruitment platforms are an effective recruitment strategy to attract the next generation of nurses.
Nearly half (48%) of the CNO survey respondents ranked “embracing technology” as one of the top- three most necessary changes or updates to attract and retain the younger generation of nurses.
“Leveraging technology for staffing and scheduling decisions in healthcare settings offers numerous advantages, primarily enhancing efficiency and introducing flexibility to scheduling systems. Automated algorithms can swiftly analyze vast amounts of data to generate optimized schedules that meet staffing requirements and individual preferences.”
Brian Weirich, DHA, MHA, RN, CENP, Chief Nurse Innovation Officer, Bon Secours Mercy Health
In your organization’s nurse retention strategy, which of the following have been the most difficult to offer or change?
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Reducing nurse workload
17%
11%
14%
Reducing nurse stress and burnout
17%
5%
17%
Recognizing nurse contributions
5%
20%
13%
Offering work-life balance/flexible options
11%
11%
15%
Fostering a healthy workplace culture
14%
8%
14%
Offering career advancement opportunities
12%
13%
10%
Offering competitive compensation and benefits
9%
17%
3%
Addressing staffing shortages
6%
11%
9%
Embracing new technologies meant to alleviate burdens
10%
3%
6%
1
2
3
Figure 4: Most difficult aspects to offer/change in nurse retention strategies, per survey respondents
What changes or updates do you believe are necessary within the nursing profession to attract and retain younger generations?
0%
10%
20%
30%
40%
50%
60%
Embracing Technology
23%
10%
15%
Flexible Work Arrangements
14%
23%
11%
Focus on Diversity and Inclusion
11%
17%
19%
Enhanced Benefits Packages
16%
11%
18%
Professional Development and Career Advancement
16%
12%
14%
Emphasis on Work Environment and Culture
12%
16%
10%
Holistic Well-Being Initiatives
9%
11%
13%
1
2
3
Figure 5: Changes or updates survey respondents believe are necessary to attract and retain younger nurses
Ready to get introduced to works?
As hospitals and health systems compete to attract nursing talent, technology and flexible work arrangements are key pathways to success. Works offers an industry-pioneering workforce management platform that helps healthcare organizations bolster nurse retention through a centralized staffing model, while driving clinical cost savings.
Works drives clinical cost savings and bolsters nurse retention through flexibility and workforce optimization. With Works, clinicians move across units and hospitals and you fill more shifts with your own labor resources.
The Workforce Management Playbook: How Mercy is Empowering Nurses, Saving Premium Labor Costs + Improving Care
The Workforce Management Playbook: How Mercy is Empowering Nurses, Saving Premium Labor Costs + Improving Care
The Workforce Management Playbook: How Mercy is Empowering Nurses, Saving Premium Labor Costs + Improving Care
Learn how Mercy's partnership with Trusted Health resulted in unlocked flexibility in staffing, a 3% increase in fill rate, and 8% reduction in turnover!
Trusted Health
The Workforce Management Playbook: How Mercy is Empowering Nurses, Saving Premium Labor Costs + Improving Care
The Workforce Management Playbook: How Mercy is Empowering Nurses, Saving Premium Labor Costs + Improving Care
By Trusted Health
The demand for nurses has grown steadily since before the COVID-19 pandemic, exacerbated by an estimated 640,000 nurse retirements between 2020 and 2030.
Further, in a post-pandemic study, more than 30% of nurses reported concerns about their emotional health, citing insufficient staffing levels and its impact on their health and well-being as the main reasons for leaving the profession.
These overlapping trends are resulting in health systems losing more than 2 million years of combined nursing experience each year.
At Becker’s 11th Annual CEO + CFO Roundtable, in a session sponsored by Trusted Health, two leaders from Mercy (St. Louis) — Cheryl Matejka, CFO, and Betty Jo Rocchio, DNP, senior vice president and system chief nursing officer — discussed how the right workforce management platform can help organizations redesign their staffing models in tune with nurses’ evolving needs, while saving costs and improving operational efficiency.
In Mercy’s presentation to over roughly 100 hospital executives there were three major themes.
1. In the post-pandemic era, organizations must strive for a multi-generational staffing model redesign
Two phenomena have recently converged: The COVID-19 pandemic and generational differences in the importance that people place on their jobs. As a result, there’s a far greater emphasis on work-life balance and flexible compensation today. These preferences are more pronounced in generations Y and Z (“millennials” and “Zoomers”) than in generation X and baby boomers, but these trends are increasingly cross-cutting. “What we saw during the pandemic was that nurses left us for increased compensation — but compensation wasn’t the main driver,” Dr. Rocchio said. “Their workload for what we were paying them was the main driver. We’re noticing people are no longer tolerating what happened to them before the pandemic.” She noted that in addition to a more balanced workload, nurses want more control over their schedules. Despite these accelerating trends, many organizations’ workforce management cultures are stuck in traditionalist thinking that reflects inflexible ways of working. Changing that requires a bold new vision for redesigning the nurse staffing model.
2. Successfully redesigning the staffing model requires transforming 4 key elements
There are four factors that determine the success and sustainability of healthcare organizations’ workforce strategies. To bring their strategies in line with evolving worker expectations, which positively impacts vacancy fill rates and nurse satisfaction, hospitals and health systems need to redesign staffing by focusing on:
Maximizing flexibility by maintaining local and regional float pools of nurses credentialed to work in specific hospital units, as well as a pool of credentialed “gig” nurses. This layer of flexible workers supplements the organization’s core layer of full- and part-time nurses and its agency layer of external and international nurses. “This middle layer is the secret sauce and has to be designed with great precision and definitions,” Dr. Rocchio said.
Giving more choice and control over schedules and compensation by using Works technology. In automating the scheduling system across all units, equipping it with automated nurse credentialing, making it accessible to the entire available labor pool via a user-friendly platform/app and providing information about how each shift is compensated, hospitals can ensure units are safely staffed while giving nurses autonomy over when they work.
Broadening access for multiple workforce layers and generations. At Mercy, core staff members have priority access to and right of first refusal for available shifts, which then become available to the flex workforce. “During the recruitment phase, we tell job candidates: ‘If you need benefits, you’re going into the core layer. If you want maximum flexibility and don’t need benefits, you can go into either the local float pool, the regional float pool or the gig layer,’” Dr. Rocchio said. “That allows them to choose where they want to work.”
Enabling scalable technology integration with automation and artificial intelligence that pinpoints where the greatest needs are. “Before we had a technology-driven system, we were offering incentives for shifts based on whatever nurse managers thought they needed,” Dr. Rocchio said. “Today, it’s completely automated and we are using incentives to fill our hardest-to-fill shifts.”
After partnering with Trusted Health and implementing their Works platform, Mercy saw significant changes to its staffing mix, which improved flexibility and workload for workers while reducing agency spend for the organization. Before the partnership, Mercy’s staff mix comprised 67% core staff, 8% flexible staff (including local and regional float pools) and 25% agency staff. After the partnership, the mix became 69% core, 23% flex/gig and only 8% agency staff.Amid persistent staffing challenges, such shifts to the staffing mix are important because they can impact the rate at which organizations fill open shifts. When shifts cannot be filled with flexible or agency staff, the excess care burden falls on core staff; thus, one of the main benefits of increasing flex staff is to lighten the workload on permanent workers and reduce burnout and attrition. Yet, while flex staff serve a similar function to agency staff, they are less costly and generally have higher levels of commitment and familiarity with the organizations that credential them and that they repeatedly work with. “While we will always need some of the agency layer, we want to minimize that so we have nurses who are most familiar with our care model and our system works more consistently,” Ms. Matejka said.
3. Increasing flexibility and autonomy in staffing translates to cost, time + FTE savings
In fiscal year 2023, after transitioning to Trusted Health’s platform for recruiting a flexible workforce of nurses and allied health professionals, Mercy realized $30.7 million worth of savings associated with rate reductions in premium labor spend. Those savings were due to a decreased reliance on agency staff because of the availability of an alternative flexible workforce (float pools and gig workers) that became more easily discoverable through the platform. In turn, that led to a 62% reduction in agency spend and a 16% reduction in total care costs as a result of optimizing the nursing workforce. “There are a lot of workforce platforms out there, but what you should really demand is automation, such that no one is ‘touching’ things — begging staff members to come to work or trying to get them paid,” Ms. Rocchio said. “It should be an automatic flow through your systems.” At a more strategic level, automation can also act as a form of governance by ensuring fairness and transparency in pay across health systems. “If you have multiple locations, you’re going to have multiple opinions on what you should be paying per shift,” Ms. Matejka said. “Automation ensures that we don’t have rogue units that are going off and paying crazy amounts per hour.”
In addition to savings linked to pay efficiency and transparency, Mercy’s adoption of Trusted Health’s technology has also led to:
20% less time spent on staffing and scheduling tasks
An increase in the organization’s fill rate from 83% to 86%
A total of 102 equivalent FTEs saved, even as bedside FTEs increased by 3.5%
8% reduction in turnover, including a 9% reduction in first-year turnover
4% reduction in vacancy rates
“It’s an overall pretty successful effort, but it requires continuous monitoring and tweaking to sustain,” Ms. Matejka said. “We can’t let our foot off the pedal as we work to hardwire the thinking.”
