Survey of nursing managers shows many are leaning on contingency staffing talent to bridge the staffing gap near-term while improving processes and adding tech over the long-term
by Intelliworx®
Nurses are the backbone of the U.S. healthcare system. Hospitals and clinics around the nation simply could not run without them. This means the role of managing a team of nurses is an important job – and one that seems to be getting harder all the time.
A recent survey of nursing leaders by the staffing firm AMN Healthcare illustrates this notion in detail. It’s among the most challenging jobs in healthcare, wrote one nursing leader in response to an open-ended question:
“It is one of the most difficult jobs in the entire hospital! You have to be a liaison between nursing, medical services, housekeeping, engineering, grounds, nutrition, social work, physical therapy, finance, supply chain, patients, their families all while keeping your bosses happy and making sure everything on their agenda is accomplished in addition to yours.”
The overall survey polled 186 nurses in late 2023. The vast majority of respondents are tenured – 69% have six years of nursing experience or more. They are also fairly senior with more than 90% holding manager titles such as nurse manager (37%), chief nursing officer (36%) and director of nursing (20%).
The top challenges facing nurses
The survey presented respondents with a list of 15 common challenges in nursing and asked them to identify the top three:
- 43% said recruitment and retention;
- 32% said staff burnout; and
- 32% said labor shortages.
It’s notable that all three of these top challenges are related to human resources and workforce management. More than 7 in 10 respondents (72%) said they feel burned out at least sometimes. Among them, almost 2 in 10 (18%) feel burned out “often” or “always.”
Nursing burnout creates a sizable challenge for healthcare organizations because, without a resolution, some might just quit. For example, nearly one in three nurses surveyed are planning to leave their current employer. This includes 17% that are looking for a new nursing job and 9% that will seek employment outside of nursing.
3 primary ways nursing leaders are addressing staffing concerns.
Across the survey, nursing leaders reported several ways they aim to address staffing shortages. All of these can be grouped into three quintessential categories in business: people, process and technology.
1. Retaining talent with recognition
The survey asked respondents what strategies they are using to retain the nurses they have on staff currently. The top three responses were:
- recognition programs (37%);
- improving the nurse-to-patient ratio (31%); and
- streamlining onboarding and orientation (31%).
It’s worth noting recognition programs don’t have to be expensive. Sometimes a compliment is the most under-used tool in a leader’s kit.
Lowering the patient ratio matters too. Many nurses take these jobs because it’s a calling – they want to help people. Indeed, our independent research of providers shows that spending more time with patients is one of the most attractive aspects of working in rural facilities.
Finally, streamlining processes like onboarding can be a real boost. As our CEO Rob Hankey wrote for Chief Healthcare Executive, healthcare can and does lose candidates to disorganized processes.
“While there are a lot of variables in talent acquisition in healthcare, the one a hospital can best influence is its process, so it’s important to smooth and streamline the recruiting process,” he wrote.
2. Augmenting staff with contingent nurses
According to the survey, 69% of nurses are part of the permanent staff in hospitals. The remainder is broken out among part-time staff (19%) and “other” sources (12%). Yet hospitals need even more help, so most use contingent nursing talent to augment staff.
Sources of contingent nursing can come from a variety of sources, including:
- 76% use a nursing float pool;
- 73% use travel nurses;
- 63% use local nurses ;
- 44% use per diem nurses;
- 17% use emergency labor stoppage nurses; and
- 14% use international nurses.
When asked why they use contingent nursing, the single most common response was to stabilize units or assist those hospital “departments with high turnover” (67%).
This only adds credence to the notion that adding contingent staff is like a temporary dressing on a wound that needs sutures. Addressing retention, as noted above, is the right priority to have at the very top of the list.
3. Investing in HR technology designed for healthcare
The survey also asked respondents how they were doing to improve the recruiting process in their organization. While building an “internal” float pool was the top answer (58%) – many of the subsequent options were related to technology.
The most common ways nursing leaders are improving recruiting processes are:
- 58% said building internal float pools;
- 48% said using virtual interview platforms;
- 47% said investing in tech tools to streamline onboarding;
- 34% said providing scheduling apps for nurses to control their own schedules;
- 33% said using online tools to expedite credentialing; and
- 31% said hiring an internal travel nurse agency.
Are these options and tools helping? The vast majority of respondents seem to think so.
For example, 91% of respondents indicated tools to streamline onboarding were of some help. Similarly, 90% said the same about platforms that expedite credentialing, which can routinely take anywhere from 1-3 months on average to complete.
It’s worth the effort
These are trying times for healthcare. Many of the challenges nurses are facing – are also prevalent across healthcare in many different job categories.
And yet it remains both a noble and essential profession. The same respondent we quoted at the beginning of this post, summed it up well when they added:
“However, with dedication and commitment, seeing positive changes in patient care and in your employees, makes it all worth it. The opportunity is one that will help you grow as a nurse, as a leader, and as a human being.”
The full report is freely available for download here: Survey of Hospital Nurse Leaders: Roles, Challenges and Workforce Solutions
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