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Where Do We Find More Nurses? Let’s Reframe the Question

Hiring and retention remain top priorities for hospitals even as the pandemic wanes, but the real issue is how to rewire organizational thinking to attract the next generation of nurses.

The scenes are legendary now. For close to two years following the start of COVID-19, videos of exhausted nurses pleading for more staff, more supplies and better working conditions filled our screens. Caught in a cycle of overwork and burnout, the images spoke to the state of the nursing profession today and the pressures hospitals are under to act.

To combat the issue, many hospitals resorted to stop-gap measures such as pausing elective procedures and contracting with supplemental staffing agencies that charge a premium. Both options were — are — huge financial strains that are untenable in the long run¹.

With nursing vacancy rates reaching 9.9% in 2020 and more than one-third of hospitals reporting rates over 10%², hospital managers are asking, Where do we find more nurses?

The simple answer comes from the HR hiring manual: Ramp up recruiting efforts and incentivize with signing bonuses, referral bonuses and higher pay. But the reality is not so simple — competition is fierce for a shrinking labor pool, and hiring incentives don’t necessarily equate to retention. (Some recruiting strategies that focus on creating “stickiness” with staff have shown positive results, however. For more, read FTI Consulting’s “Proactive Strategies for Nursing Staffing Challenges.”)

Given such extreme circumstances, hospital managers might consider reframing the question for strategic impact: How can we deliver care differently now to leverage support from our entire staff and create a new environment that will attract the next generation of nurses?

Determining the State of the Staff

The answer to that question starts with getting an accurate picture of current staffing demands. There’s no doubt that hospital nurses have their fingers on the pulse, but quantifying issues before diving in to make improvements that benefit everyone is critical to productive change. That’s especially so for hospitals that may be relying on outdated benchmarks and pre-pandemic data to monitor staff movement.

Conducting a thorough staffing-to-demand analysis will rule out misperceptions and expose process gaps. From there, hospitals can begin to identify improvements that can potentially lessen, and yes, even eliminate, staffing constraints.

Here is a brief look at three common functional areas that often cry out for improvement.

Roles and Responsibilities
For the past two decades, hospitals have relied on traditional management practices that bend labor cost curves in a rigid way³. These models often hold nonclinical staff to fixed roles that prevent them from stepping in to help nurses, who, with their can-do attitude, often pick up the slack in the heat of the moment for others around them.

But as the pandemic disrupted that model, an all-hands-on-deck mentality took hold, revealing a more flexible prototype.

Hospitals should grab the opportunity to redefine roles. With an eye on creating “elasticity” in the workforce — that is, identifying where to legitimately stretch duties in a safe way — hospitals can relieve some of the added burden on nurses. One specific strategy is to create internal service-level agreements that specify who fills non-clinical roles when the need arises. The goal is to allow nurses to concentrate on serving their patients and let others handle patient transport or supply runs, for example.

Established Protocols
Many legacy hospitals are operating under the same protocols they defined decades ago. Are those protocols still rooted in best practices? Certainly now is the time to consider a rewrite.

Take protocol around beds, for example. Some hospitals still block out beds for non-urgent reasons, perhaps to fill a maintenance request or patient preference. As more advanced health systems start to view all beds in a metropolitan area to distribute demand, that puts the hospital operating under the old protocol at a competitive disadvantage⁴.

By examining length-of-stay metrics and other related data to help track capacity, hospitals can get a better grasp of care models and patient flow (both in-patient and out-patient) and safely prioritize and streamline bed vacancies. That in turn can safely enable a higher nurse-to-patient ratio.

There are a number of outdated protocols ripe for review, such as specimen collection or the admissions-discharge process, which is often slow to recognize when the criteria for discharge has been met. In general, identifying the low-hanging fruit of out-of-date practices begins by reviewing the guidelines around one or two systems that have long gone unchanged.

Legacy Tech and IT
Virtually every industry was forced to reevaluate its tech suite at the start of the pandemic. For many, this happened in an operational gap. Hospitals, on the other hand, have had little time to stop and reflect on the productivity of their IT.

They should do so now. Depending on where management sees the most urgent need, a variety of tools can help unearth “hidden” capacity, improve efficiency and empower employees. Here are four examples:

Automated Scheduling. These tools are often used to increase bandwidth by automatically stacking shifts in the most efficient way, but some also allow employees to set guidelines on when and why they are scheduled. When nurses get a say in how their week looks, it means better work-life balance and, for hospitals, potentially less turnover.
Telehealth. As telehealth visits have tripled since 2018, the trend is clear⁵. Health systems now believe anywhere between 25 and 40% of health care visits could be virtual⁶. In a highly contagious pandemic, this has the added benefit of reducing spread while also reducing physical capacity demands.
Remote Monitoring. In 2020, funding for remote monitoring doubled, and 50% of providers now deem it helpful for keeping track of patient health⁷. As wearable health tech continues to improve, patients are better informed as to exactly when they do (and do not) need to come to the hospital.
EHR Interfacing. The collection and entering of patient data into the electronic health record (EHR) system remains cumbersome for many hospitals. New software or applications that interface directly between clinical equipment and the system with regulatory accuracy streamline the process.

(To read more about the above areas for improvement, read FTI Consulting’s “Staff Elasticity: Redefining Productivity and Care Models.”)

Seize the Moment

It may sound callous, but if one good thing can be said about the current circumstances that hospitals find themselves in, it’s this: The twin issues of short staffs and overwork, which were simmering long before COVID, are now on the front burner, and those on the frontlines are shouting out about it.

Delaying response is no longer an option. Unlike problems that ebb and flow on the waves of COVID-19, staffing issues are trending in one direction, as they have been for years, and demand an effort to rethink how hospitals deliver care.

The moment offers unprecedented opportunity for hospital management to gain insights and implement real, meaningful change. By collecting feedback from nurses, valuing their input and making operational changes where they can that provide relief, managers demonstrate the culture of trust and empathy that workers in all industries now expect. Competition for talent is predicted to increase across all industries, and issues of equity, fairness and inclusion are also high on many workers’ priority lists.

As the waves of Gen Z — those born roughly between 1997 and 2012 — continue to pour into the workforce, it will be vitally important for hospital managers competing for talent to align with their expectations.

Footnotes:

1: 2021 NSI National Health Care Retention & RN Staffing Report. NSI Nursing Solutions; March 2021. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf

2: Ibid.

3: “Staff Elasticity: Redefining Productivity and Care Models.” FTI Consulting, Nov. 15, 2001. https://www.fticonsulting.com/insights/articles/staff-elasticity-redefining-productivity-care-models

4: Ibid.

5: “NRC Health 2021 Healthcare Consumer Trends Report.” NRC Health. https://go.nrchealth.com/l/279972/2021-01-06/kz1c5

6: ibid.

7: “The Endless Possibilities of Wearable Technology in Healthcare.” Healthcare Information and Management Systems Society.” https://www.himss.org/resources/endless-possibilities-wearable-technology-healthcare

© Copyright 2022. The views expressed herein are those of the author(s) and not necessarily the views of FTI Consulting, Inc., its management, its subsidiaries, its affiliates, or its other professionals.

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