How SSM Health is Tackling Staffing Challenges with W-2 On Demand Model

The W-2 on-demand staffing model is a win-win for health systems, nurses, and patients, according to this CNO.

A lot has changed in nursing in the past few years, specifically in staffing.

Healthcare has become more virtual, and flexible scheduling models have replaced more traditional ones, and it's up to CNOs to consider innovative staffing solutions to address these challenges.

According to Jennifer Garnica, vice president of nursing and chief nursing officer at SSM Health St. Mary's Hospital, St. Louis, this largely has to do with the COVID-19 pandemic.

"COVID taught us that a lot of things can be done remotely," Garnica said. "We have a lot of telehealth, we have a lot of things out there outside of just acute care in the hospital, and that's attractive to a lot of nurses."

Garnica also explained how the competitiveness of the market has increased since the pandemic, which does not help with the nursing shortage.

"Everybody needs nurses, and we're not only competing with hospitals," Garnica said, "we're competing with all of those other venues as well."

Nurses are now looking for flexible schedule options beyond just full and part time, and they are looking for strong benefits.

"That's a challenge for hospitals who traditionally had believed that your core staffing should be about 85%," Garnica said, "[with] very little contingent staffing."

Due to these changes, SSM Health is trying something different.

The W-2 on-demand model

During the pandemic, Garnica explained that SSM Health had to quickly shift to other staffing models out of necessity. The health system began using external or third-party staffing agencies, with contracted nurses who were often coming from faraway places across the country.

"They're doing their contract, [then] they're exiting, and […] although it's a short-term solution, you have a staff and a nurse at the bedside," Garnica said. "It creates some long-term challenges not only with cost, but just around longevity, loyalty, [and] sustainability for outcomes."

Enter the on-demand model.

"An on-demand model gives us the ability to adjust our staffing needs very quickly, use nurses when we need them, flex them, [and] maybe offer [them] to other areas when we don't need them," Garnica said. "It also created a lot of loyalty and longevity with local nurses."

Garnica said the health system now gets local nurses from St. Louis through their partnership with ShiftMed, and since they all work in the area and in other local markets, the nurses can build relationships with one another.

"They're helping to sort of recruit and sustain one another," Garnica said. "So, you're getting this wonderful on demand support that understands the market, they're there to support your ministry, [and] they have relationships with your own staff."

Beginning the process

Ultimately, this new model led SSM Health to convert more than 100 on-demand nurses into full-time staff, and according to Garnica, the first step in making this change was helping the nurses to understand why it was happening.

"Helping our staff understand why we were making that shift and then engaging them in the process was probably one of our biggest successes," Garnica said, "because again, they are our best recruiters."

Garnica said that leadership had many discussions with core staff, and that they provided tools to help welcome and onboard the on-demand nurses. The goal was to have the core staff build relationships and express why SSM Health St. Mary's is a good place to work, Garnica said, and to make the on-demand nurses consider what it would be like to be a permanent employee.

"We offered some unique PRN options and things that we thought would be a nice complement for those folks," Garnica said, "and I think our conversion of those nurses to onboard to our own staff, really I would credit our nursing staff. They really were our best recruiters."

Garnica attributes the decisions of many on-demand nurses to stay on full time to the core staff who made it happen, and also to the idea that the on-demand nurses get to trial the environment beforehand.

"I think there's a lot to be said for when you're being recruited from a peer," Garnica said. "It's not scary to make a leap when you get to try it out."

The on-demand model also addresses the idea of nursing being the same in every health system.

"When you have folks that get to come be a part of your culture, be a part of your hospital, and be a part of the things that you're doing in an ongoing basis […]," Garnica said, "I think it makes it a lot easier because that jump isn't scary."

Outcomes

According to Garnica, the core staff reaction to this strategy has been positive.

"They are really proud of themselves, we update them on folks that they were able to help get moved over," Garnica said. "I think there's a lot of pride and excitement in that."

The nurses also appreciate the relationships that they get to build with more local nurses, and they feel as if they are part of a staffing solution, rather than feeling like a victim of staffing challenges.

"When you're short staffed, it's really easy to fall into a victim mentality [that] feels hopeless sometimes," Garnica said, "and I think this enables them to feel like they were part of the solution."

From a financial standpoint, there are also several benefits, according to Garnica.

"I think looking at areas of turnover and retention, obviously that's a really high-cost business when you're bringing folks in and you're turning them over," Garnica said. "Anytime we can reduce that turnover rate, we're obviously going to save money."

This model also cuts down on onboarding costs, Garnica explained.

"When you have an on-demand partner whose nurse is onboarding, they've probably already been working at our hospital for months, maybe a year," Garnica said, "so that onboarding is much quicker because they're already pretty acclimated."

The health system has also saved money on external agency contracts, and in general by stabilizing their workforce.

"We've had significant improvements in HAIs, patient experience, and those areas, because we don't have such an unstable workforce anymore," Garnica said. "We treat these folks as our own, they are part of our staff, we embed them in our culture."

Garnica said there have also been overall improvements in productivity and morale among the staff.

"When you stabilize the workforce, when nurses come to work, knowing that we're doing everything we can to get support into the building for them and they've built those relationships," Garnica said, "they know that the on-demand nurses are their partners, [and] there's a lot of positive energy around that."

For CNOs who might want to consider using this strategy, Garnica recommends being open minded, and to shift mindsets to understand that the market has changed. CNOs should focus on building those relationships and partnerships, and engaging staff in decision making to help bring about change.

"You have to learn to live with staffing [looking] different than it used to," Garnica said. "There are creative options out there […]. Once you get it going, you can see a lot of really positive outcomes."