Nurse leaders craft 5-year plan to address staffing challenges.
Faced with a nursing shortage expected to stretch well into the next decade, CommonSpirit Health has launched a five-year strategic plan designed not only to attract and keep nurses, but to provide care in an innovative way that effectively stretches nursing resources.
"We started our five-year strategy pre-COVID," says Kathleen Sanford, DBA, RN, executive vice president and chief nursing executive (CNE) of CommonSpirit, which has about 45,000 nurses in more than 1,000 care sites across 21 states.
"We had a large meeting with nurse leaders from across the entire system and we talked about what our vision would be and about where we would be going with nursing in five years," Sanford says. "We then made a long, long list of things that we thought needed to be done to get there."
What emerged were the top three plans that CommonSpirit aggressively began implementing:
- A systemwide nursing residency for new graduates
- Establishment of an internal staffing agency
- Virtually integrated care
Sanford and other nurse leaders have good reason to get creative with nurse staffing.
With slightly more than 3 million registered nurses in the United States, demand will grow by at least 5% over the next five years, according to analyzed labor market data. In that same period, however, more than 900,000 nurses will permanently leave the profession and coupled with retirements, employers will need to hire more than 1.1 million nurses by 2026.
1. Systemwide nursing residency
"There is a very high turnover among new grads across the entire country in all healthcare systems and we're not immune to that, [where] they just leave within the first year or the second year," she says.
In questioning new graduates and other nurses, they learned that new grads don't feel that they get enough orientation and don't feel supported, Sanford says.
"They didn't feel like they had enough expertise, and it was just overwhelming to many of them to work in an acute care hospital, so we decided that it had to be a priority to help these new grads, to make sure they're prepared, that they're comfortable, and that they feel supported," she says.
The one-year residency begins this spring.
"It will be a different program than most of them probably would have gotten in other orientations or residency in that we will be (a) making sure that all preceptors are training the same way across this very large company so that we have the same expectations among our preceptors [and] (b) besides learning what you do on the unit, which is the largest part of what young nurses need to learn, we'll be having didactic courses—things that most people haven't included in their residencies," she says.
Instruction includes what new nurses should do if they're bullied, where they should go if they need support, who to see with ideas on how the company can do something better, and who to talk to if they're feeling overwhelmed.
"It's teaching them not only how to take care of patients, but how to take care of themselves and how to take care of the people around them," Sanford says.
"The second part that makes it different is because we do so much virtually at CommonSpirit Health and are moving so fast virtually, a new grad will not only have a preceptor onsite, but they will also have access to virtual preceptors," she says.
A virtual preceptor would be available when a new nurse can't get in touch with their full-time preceptor, because, for example, they don't always work the same hours.
The virtual preceptor is available to walk them through any issues or questions they may have so the new nurse always feels fully supported.
"We know that we won't be able to totally change all the turnover, but we believe we'll put a huge dent in the number of nurses that turn over during their first year," Sanford says, "and not only help them with their careers so they will have joyful, wonderful careers, but help the whole system and help the whole profession of nursing to have people that don't get lost to us who have been educated as nurses."
2. Internal staffing agency
Part of the health system's staffing strategy depended on travel and local agencies to supplement the full-time nurses as needed, Sanford says.
"Then along came COVID and this upset the applecart," she says.
Subsequently, nurses retired earlier than planned, hospitals competed for agency nurses, and agency costs were vastly rising.
"We had already put in our strategy that [an internal staffing agency] was something we needed to do before COVID started, but it made us realize that we really needed to get going a little bit faster on it," she says.
"If you have your own agency ... these are your own staff," she says. "They can keep their seniority, they can choose to travel when it works for their lives, and they can choose to be stationary somewhere when it's better for their life, so it gives your nurses more opportunity without having to leave the organization."
It benefits patients, as well, she says.
"As we standardize more of our care across this large system, it is better for the patients if the nurses who come in know the policies, know the procedures, know how we do things here, know where you go to get best practices. And that's not to denigrate the travel nurses who are not our own employees," she says. "We just think this would be better to have your own nurses have that choice and already know the system be able to come in ready to go."
The approach is a nod to Sanford's military service as a U.S. Army officer.
"I would get orders on Friday that I needed to be somewhere else on Monday," she says. "Because we were standardized and I was going from an army hospital to an army hospital, I could walk in and work and be comfortable and be competent, completely working at the top of my license because it was the same thing. So, we're going more like that."
There may be times when they must use outside staffing agencies, "but our first place to go will be to our own agency where our own staff is employed," she says.
3. Virtually integrated care
CommonSpirit is adapting virtually integrated care (VIC), an innovative virtual care program that uses videoconferencing technology and dedicated devices in each patient room, allowing the hospital's virtual nurses to assist bedside nurses by monitoring the unit from a remote digital center.
"You still have nurses in the hospital taking care of patients and touching patients," says Sanford, the architect of the model, "but you also add to that a virtual nurse who can do things virtually, [so] nurses who are onsite can concentrate on the patient and taking care of each of those individuals and not doing some of the things that could be done virtually."
Virtual nurses, for example, will handle admissions and discharges, both of which are time consuming, she says.
"That allows the staff that is onsite to concentrate on all the other things—all the other care that has to be done," Sanford says.
The model can incorporate more than the nursing staff. For example, in its growing VIC program, MercyOne Des Moines, which is part of CommonSpirit, includes pharmacists, according to Linda Goodwin, MSN, MBA, FACHE, senior vice president of clinical operations, integration, and innovation, who piloted the program inspired by Sanford's virtual care model.
"These pharmacists are taking medication reconciliation off the backs of nurses. They make sure there's no duplication of med orders, they stop a lot of errors, and they do all the patient education around new medications or diabetic education," Goodwin says. "They are a phenomenal piece of this team. It isn't just a nurse model anymore; it is a multidisciplinary model."
CommonSpirit will examine each of its markets to see what staff can be incorporated into VIC to create custom models for each hospital, Sanford says.
"In some of our other markets, they're looking at adding licensed practical nurses and more nursing assistants," she says. "It really depends on what's available in your market. The whole idea is to work as a team but to be sure that you are also using virtual nurses to do the things that don't have to be done by nurses and others on the unit."
“We believe we'll put a huge dent in the number of nurses that turn over during their first year and not only help them with their careers so they will have joyful, wonderful careers, but help the whole system and help the whole profession of nursing to have people that don't get lost to us who have been educated as nurses.”
Kathleen Sanford, DBA, RN, executive vice president and chief nursing executive, CommonSpirit Health
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.
CommonSpirit Health's five-year strategy includes a systemwide one-year residency that begins this spring.
The health system's own internal staffing agency will allow nurses to travel within the system when they want, or remain stationary.
CommonSpirit's virtual integrated care will add virtual nurses so bedside nurses can concentrate on their patients.