A nonprofit, multispecialty academic medical center, Scott & White owns a dozen hospitals and 60 primary and specialty care clinics spanning central Texas in the triangle between San Antonio, Houston, and Dallas. But with many facilities in rural areas, Minnis says, in 2008 they were already struggling to find nurses. Then Scott & White began to expand its footprint and take on additional providers and payers. With the growth in patients as well as facilities came a need to staff nurses quickly. As an academic medical center operating a Level I Trauma acute care hospital, the additional challenge was to recruit experienced, high-quality candidates, says Minnis.
In recent years, many of the organization's nurses went mobile or moved closer to the cities. In 2008, more than 150 travel nurses supported the system's staffing needs, but Scott & White also maintained up to 70 staffing agreements with various vendors to help them manage the demand. Demand continued to grow, and by 2011, Scott & White faced one of the worst nurse staffing shortages in the country.
It was time to examine their overall staffing strategy, stop using stopgaps, and build lasting solutions, Minnis says.
A shift to permanent employees
"It was really important to understand where our bottlenecks were and understand the challenges we were experiencing. If you have broken processes, you're going to just keep re-creating the same holes to dig yourself out of," he says. "You really need to look at what are the challenges for recruitment, because continuing to staff with temporary staffing really is a short-term solution."