Care facilities are rethinking and reorganizing the job of registered nurses.
(Bloomberg) — Hospitals, scrambling to fill vacancies after departures of nurses and other caregivers during the pandemic, are looking to new places and methods to hire help — including warehouse workers and their own non-medical staff — and creating shorter, gig-work shifts.
“Everyone realizes that we’re on the precipice of a major cliff,” said Greg Till, chief people officer at the Renton, Washington-based Providence health system, which operates 51 hospitals and 1,000 clinics in the western US. “There’s no way that we’re going to be able to build a workforce that’s large enough to take care of the population.”
The staffing crunch combined with rising costs for travel nurses, who are temporary and often paid at high rates, has prompted hospitals to rethink the job of nursing itself. Care facilities are experimenting with a combination of training programs to entice workers from other industries, reorganizing jobs to free highly trained registered nurses from paperwork and other less-skilled tasks and offering the flexibility of shorter freelance shifts.
The latter is what Josh Bersin, head of a human-resources research and consulting firm, calls the “Uberization” of health care— and part of what he and others in the field say is key to meeting the shortages that will plague the industry for years.
Openings for nurses and other health-care workers are growing more than twice as fast as the overall US job market, according to Bersin. He estimates that 42% of the nursing workforce is at or near retirement and forecasts a shortage of 2.1 million nurses — or about a third of the total needed — by 2025 as the population of older Americans continues to surge. Annual turnover for registered nurses is 22.5%, according to staffing firm NSI Nursing Solutions, Inc., with the cost to replace a bedside nurse averaging $52,350.
Till said Providence is aiming to enroll 6,000 this year in its nursing academy, which trains already-licensed nurses for practice and specialties such as behavioral health and obstetrics, from 4,700 last year. Providence has also doubled its tuition-assistance program in the past two years in an effort to train more caregivers.
Sharitah Nanono, 27, used the tuition program to move out of her job cleaning rooms at one of Providence’s California hospitals that she took when she emigrated from Uganda five years ago. In 2021, she enrolled in a five-week course for eight hours a day to become a certified nursing assistant doing jobs like checking vital signs and documenting care. “It wasn’t easy, but it was worth it in the end,’’ said Nanono, who called her experience “life changing.” Now, she’s studying to become a registered nurse.
It’s not just hospitals retraining workers for a career change to health care. Amazon.com Inc. partners with schools to train workers in health care and other fields as part of its Career Choice program, director Tammy Thieman said in an emailed statement. “Amazon’s Career Choice prepays the tuition for our hourly employees who want to take the next step in their career by learning new skills and achieving industry recognized certifications,’’ Thieman said. People who have done the program have gone on to work as nurses and in medical billing.
That’s caught the attention of Providence, which “is interested in connecting with the talent pipeline of recent healthcare graduates from Amazon Career Choice’s network of partner schools,’’ Till said.
Beyond education, Till says his chain is also “digitizing and deconstructing’’ tasks, including installing an automated scheduling system to free up nurses and doctors from non-caregiving work like record-keeping that can occupy up to 45% of their time. That’s better for nurses, he said, but it also saves money: Providence has estimated its AI-driven scheduling system will save $100 million a year.
Trinity Health, a Michigan-based Catholic system with more than 80 hospitals, is putting monitors in patient rooms that connect with a “virtual registered nurse.” And some hospitals are using “ambient listening” that records and transcribes doctor-caregiver meetings so less time is spent taking notes, said Kevin Holloran, a senior director at Fitch Ratings.
Another hospital operator, Mercy, which is based near St. Louis and operates more than 40 facilities, rolled out a system last year that allows both regular and gig employees to book shifts through a scheduling app. Betty Jo Rocchio, Mercy’s chief nursing officer, said the group began developing the app in 2019. “We thought we’d have a little extra time to add those nurses,’’ she said. But the pandemic’s arrival pushed annual turnover up to 25% at the height of cases, compared with 15% to 16% before the virus, as nurses packed up for lucrative travel engagements or simply left the field.
While the new programs bring much-needed relief, not everyone is on board. National Nurses United, the largest union for registered nurses with about 225,000 members, calls gig work a threat and part of a broader trend that’s stripped workers in numerous industries of benefits and security. While workers may be in a strong position to demand higher pay now, the new models can harm their status in the longer term.
“It is a bait and switch, just like the other Uberization models,’’ said Michelle Mahon, assistant director of nursing practice for NNU. “The more nurses they’re able to move to a contingent or precarious model, the less that they will need to pay them.’’
The union warns that gig shifts create a two-tiered system that deprives nurses of workers’ comp, paid sick days and other benefits. “They’re seeing an opportunity to reduce registered nursing care,’’ Mahon said, adding that the newer models also strip nurses of negotiating power. But Mercy says nurses also want flexibility. Since they rolled out their scheduling app last May, the percentage of jobs filled has increased by 7 percentage points to 91% and turnover has improved by a similar amount, Rocchio said. The app has helped with recruiting, too, Rocchio said. About 3,500 people have applied for the gig slots, which pay from $5 to $30 more per hour but don’t offer benefits, since the app debuted. A good portion of them are former Mercy workers. There’s one area of agreement, though — that shortages beget shortages as understaffing leads nurses to quit because they can’t properly care for patients or their own needs. “The number one reason that people are leaving us is that there’s not enough help,’’ Mercy’s Rocchio said.
That points to the need for creative solutions, Till said. “There is a national health-care workforce crisis, so we are eagerly exploring all options to increase the talent pipeline for clinical staff.”
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