Healthcare leaders need start viewing the nursing workforce through the lens of supply and demand in the marketplace.
There's a tendency to view nursing shortages as cyclical events that come and go. But, nurse leaders may do well to move away from a strict recruitment and retention mindset by applying a more comprehensive approach toward RN supply and demand.
"We really have to change our thinking from the nursing shortage [being a] cyclic idea to really understanding nursing supply and demand in terms of economic and non-economic factors," said Richard Ridge, PhD, MBA, RN, CENP during his presentation at AONE 2017 in Baltimore.
He is Director of Nursing Innovation at Texas Children's Hospital in Houston, TX.
Ridge acknowledged that the nursing workforce is a major concern for nurse leaders.
"Many of us spend inordinate amounts of time on this issue—developing our workforce, understanding our workforce, preparing our workforce, presenting business plans for FTEs as we move forward trying to meet the needs of our patients," he said.
Drawing on both his own experiences and those of his colleagues, Ridge developed the Relationship-based Nursing Workforce Pipeline Model as a way of assessing and planning nursing workforce needs.
"It's a model that, hopefully, you can look at and try to better conceptualize your own plans," he said. "Nothing here is presented as a recipe; it's really presented more to open up possibilities."
Three Pillars
The three theoretical underpinnings of Ridge's model are:
- Stakeholder ethics
- Systems science
- Contemporary branding
"That's really the major theoretical underpinnings of a good, effective workforce model," he said.
Stakeholder Theory
This emphasizes the need to identify all stakeholders, including primary, secondary, and tertiary parties, and understanding what makes them successful. These stakeholders can include nursing schools or even competing organizations.
"It doesn't necessarily mean you have to help them be successful, but it does mean that you have to understand how they define success," he explained.
Systems Theory
By applying systems theory, nurse leaders consider nursing workforce issues at the macro, meso (intermediate), and micro levels.
"Macro could be considered what's happening in the country, what's happening at the state level," Ridge said.
Nurse leaders need to understand the macro level data—like HRSA workforce projections and state workforce center supply and demand reports—and then consider how it affects the nursing workforce at the local level.
"What does that have to do with your hospital, your organization, your county, your city? It's the context," Ridge said. "Our plans are at the local level, but within the context of the overall."
Individual facilities are considered the meso level and the interacting departments are the micro level, Ridge explained.
"One of the big pitfalls when we don't think of systems is we end up with department level programs. Everybody's working on their own thing… and what it's called in systems theory is suboptimization," he said.
"All these little micro units, departments, might be doing a terrific job, but in the whole scheme of things, then at the meso level, your organization's level, you're really not seeing synergies, you're not seeing the outcomes that you need."
Nursing is a Brand
The third underpinning is development of a nursing brand. Many hospital and healthcare system brands market the organization's services to the community, Ridge said. But leaders also need to be mindful about marketing their organizations to prospective employees.
"When we look at brands, at many hospitals, it's really two approaches. We're marketing our services to the community and then we market our brand as an employer," he said. "Look at your own organizations and see how you're tying the two brands together."
A few years ago, when Ridge was assessing how Magnet designation and nursing was portrayed on hospital websites in New Jersey, he found that 30% of Magnet hospitals mentioned they had Magnet recognition but only 20% identified their CNOs.
Data Matters
Of course, even when taking a comprehensive approach to nursing workforce planning, nurse leaders need to assess and adjust their workforce plans based on data.
"You must have metrics that strategically support change at all levels," he said.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.