Amid a shortage of nurses, health systems are increasingly turning to digital health to fill gaps in scheduling.
“Nurse staffing is more of a challenge now than it’s ever been,” said Eric Humphrey, chief human resources officer at Froedtert Health in Wisconsin. “It’s always been a challenge but with the pandemic we saw a lot of nurses choose to retire, others who decided to stay at home with their kids or work part time and some who just left healthcare altogether.”
An analysis in Health Affairs from April found that the number of nurses decreased in 2021 for the first time in 18 years. And the problem could get worse. A McKinsey survey of nurses in February found that 32% are likely to leave the profession within the year.
As such, many health systems are turning to staffing agencies and travel nurses to combat the shortage. But it is an expensive option. Kaufman Hall’s survey of 900 hospitals found that median contract labor expenses went from representing 2% of hospitals’ labor expenses in February 2020 to 5% in February 2021 and 12% in February 2022.
The high cost of using staffing agencies and travel nurses has many health systems considering digital alternatives. Dr. Iman Abuzeid, CEO of San Francisco-based Incredible Health, which operates a nurse talent marketplace platform, said that human resources executives view travel nurses as a Band-Aid.
“Travel nurses are at least 3-4 times more expensive than permanent nurses,” Abuzeid said. “It’s really eating into the bottom line. Hospitals have low margins to begin with and this isn’t helping. For hospital executives, they want to figure out how to hire permanent nurses more efficiently and then retain them.”
Incredible uses algorithms to custom match nursing candidates with employers. It also automates pre-vetting procedures regarding a nurse’s credentials. All this is done to speed up the hiring process and ensure health systems can find the right candidates to fill these roles. She said hiring takes an average of 16 days through the platform, which is used by several large health systems, compared with 90 days on average via more traditional methods.
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For some health systems, digital health investment in this area isn’t just about hiring permanent nurses. Froedtert is using an app from digital health company CareRev to find local nurses who can fill shifts when needed. Humphrey said the company invested in the app before the pandemic and it has come in handy over the last two years.
“We needed to fill gaps in scheduling,” Humphrey said. “We didn’t want to overwork our nurses and have them experience burnout. Plus, with agencies, you’re signing a contract for up to 90 days. The problem we wanted to solve was how do we fill those just-in-time gaps, whether it was for paid time off or if someone calls out.”
Investing in a cloud-based platform like CareRev meant Froedtert didn’t have to implement any technology internally. The health system can use the app to find potential nurses from a local pool of registered nurses who are often retired or stay-at-home moms. This set-up provides a lot more flexibility and cost savings than use of an agency, although Humphrey does say agencies are a part of the health system’s nurse staffing strategy as well.
While travel nurses can upset the dynamics of a health system’s nursing unit because of their high compensation, those problems don’t pop up with the CareRev nurses, Humphrey said. “It has kept our full-time nurses energized and helped with burnout. We use them for upwards of 300 shifts per week,” he said.
Humphrey said that for this to work, the organization’s leaders must buy into these solutions and have a mindset that welcomes disruption. Into the future, he said that health systems will need to look at innovative ways of staffing because these challenges aren’t going away any time soon.
“We’re not going to hire our way out of this and we’re not going to pay our way out of this,” Humphrey said. “That’s not a sustainable frame of mind. Technology and other platforms for employment can help us change the way we deliver care.”
Like Froedtert, Sanford Health, a South Dakota-based health system, has invested in digital health technology to address shortages in nurse staffing. And like Froedtert, Sanford anticipated the need for the technology prior to the pandemic, said Erica DeBoer, chief nursing officer at Sanford.
“We anticipated not only were there going to be a number of retirements, but just a lack of nurses in general to take care of patients in both inpatient and ambulatory settings,” DeBoer said.
However, unlike Froedtert, Sanford is using technology to maximize the nurses it has on staff, rather than hire new ones. The health system uses an artificial intelligence tool to predict nurse staffing needs based on patient flow and scheduling. The technology was piloted and developed internally, but to scale it across the enterprise, Sanford teamed with FlexWise, a workforce optimization software company.
The Sanford tool, called Leveraging Analytics to Mobilize (LAMP), is integrated into the system’s Epic electronic health record system, which has applications for nurse scheduling, time, and attendance. With staffing levels constantly in flux, the goal with this tool is to reduce the hours spent balancing the schedule and better address patient needs. Getting the system right required a lot of collaboration with frontline nurses, DeBoer said.
“We spent an exorbitant amount of time and face-to-face conversation not only with executive leaders, but with the frontline staff, those who are managing and living the schedule,” DeBoer said. “We wanted to find out what their needs were. We had a ton of boots on the ground.”
Lunch-and-learn sessions also were held to educate and walk the affected staff through the changes. Working with the staff, DeBoer said, helped them be a part of the solution rather than push back against it. She said success in using this kind of technology to address staffing problems often comes down to creating trust between clinicians and leadership.
“Artificial intelligence can create mistrust because people are used to doing things a certain way,” DeBoer said. “Tradition is a very common theme in healthcare, especially with scheduling. But knowing what we know now and what came out of the COVID-19 pandemic, we have to work smarter. The only way we’re going to navigate our workforce challenges over the next couple of years, clinical or non-clinical, is by focusing on areas where can we make the most impact.”