Over the past two years, Kearney County Hospital has added nearly 4,500 new patients, in part, because of the loss of providers in the geographic region. If they stay on pace, the organization may reach up to 360 deliveries this year. In the past, 189 deliveries a year was typical.
Anderson's advice for those who wish to replicate this model is to know your mission, identify your core values, and have a vision for the future.
"It's got to be simple and easy to understand and to articulate," he says. "If you don't know your mission, then the default mission becomes to stay open another day, and I don't know very many mission-hearted, bright medical providers or clinicians that get excited working for an organization whose goal is to stay open another day."
In turn, healthcare leaders should ask recruits what their personal mission and cores values are.
"It really is about understanding each recruit's motivations, and knowing the mission and purpose of the organization, and matching the two," he says. "If they don't match, the person is not going to stay. If they do, it's a very good thing."
International nurses fill a need
At the national level, the U.S. Department of Health & Human Services' Health Resources & Services Administration projects RN supply to exceed demand, resulting in a projected excess of about 293,800 RN FTEs in 2030.
And while Spetz thinks nursing schools will be able to keep pace with nurse supply, there are other factors influencing the nursing workforce supply.
"Overall, I think nursing is graduating the right numbers. There's a distribution problem, just like there is for physicians, and there's a skills problem," she says. "Employers are saying that new graduates don't really quite have the skills we need. We have all these experienced nurses who are leaving their jobs. We need to fill these gaps."
Texas, according to the HRSA data, is one state grappling with these issues, and by 2025 the state is expected to have an RN shortfall of 15,900 FTEs.
Shannon Medical Center in San Angelo, Texas, a town of more than 100,000 in the western part of the state, is already feeling the pinch.
During the past few years, a local university changed its nursing program from an associate's degree program to a baccalaureate degree program, significantly affecting RN supply at the 409-licensed bed organization.
"There was a lag of supply, and increased demand with retirements and everything else that's going on in healthcare at this point," says Pam Bradshaw, DNP, MBA, RN, NEA-BC, CCRN-K, chief operating officer and chief nursing officer. "If you look at my organization, the average age of a nurse is approximately 48. So as the workforce ages and we have less people coming into healthcare, you're going to end up with this imbalance somewhere. And we don't have the pipeline to backfill it. I will say it does differ based on where you live. In a rural area, it's much harder to recruit and retain than it is if you were in a metropolitan area."
New graduates often head off to larger cities such as Dallas, Austin, or San Antonio in search of big-city experience, she says.
"Realistically, from a complexity and acuity perspective, we provide that same level of care. It's the appeal of the nightlife and the restaurants and the shopping that we battle," Bradshaw says.
Around 2015, in an effort to increase RN supply, Shannon turned to international nurses on long-term contracts through staffing agencies.
"We started relatively small, with about 15," Bradshaw says. "But we quickly realized that in order to accommodate growth, because we are a growing organization, and to accommodate the lack of supply, we really needed more."
Today, 60 of Shannon's over 600 nurses—or 10%—are international nurses on long-term contracts. Additionally, 5% of the nursing workforce is short-term temporary staff.
This is by no means a low-cost solution. Bradshaw estimates the organization spends about $10 million a year on temporary labor.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.