An agency nurse costs about two-and-a-half-times more per hour than a nurse who is hired directly by the hospital. Some of this cost is accounted for in the annual budget, but at the same time, the organization recognizes the need to evaluate cost avoidance opportunities to stay fiscally on track.
But the investment has enabled Shannon to maintain its quality of care, including a four-star rating by the Centers for Medicare & Medicaid services.
"We have some of the best quality that you'll find anywhere. We're in the top decile [for CMS measures] when you compare us to hospitals across the country. From a quality perspective, there's no issues," she says.
"I think there's no question that we're going to need more physicians than we have been historically producing, but I would agree with the assessment that the solution involves developing care providers across multiple disciplines."
Bradshaw says the hope is that the international nurses will choose to stay on at Shannon once their two- to three-year contracts are complete.
"They're doing well," Bradshaw says, "and of course our goal is to retain them once we complete their contract."
To help increase the odds of retention, Shannon has created an inclusive culture that treats the international nurses just like its traditional staff nurses.
"If we have any sort of celebration or if we have an incentive that we offer, anything like that, they are eligible just like any other nurse would be. That's one of the ways to integrate them into the culture," Bradshaw says.
For example, a few months ago, an international nurse from the Caribbean won the Daisy Award for Extraordinary Nurses, a recognition that values the clinical skills and compassion of individual nurses.
Meaningful recognition programs are components of a healthy work environment, according to the American Association of Critical-Care Nurses, and research has shown that nurses nominated for the Daisy Award report lower rates of compassion fatigue.
"I'm optimistic that by the time our current contracts are done, we'll either retain those nurses or we'll have improved our local supply, which is something we're also working on," Bradshaw says.
New care models necessary
A 2017 study on behalf of the Association of American Medical Colleges predicts the U.S. will face a shortage of between 40,800 and 104,900 physicians by 2030.
However, a 2014 Institute of Medicine (now the National Academy of Medicine) report on the future of the healthcare workforce notes these projections are based on traditional healthcare delivery systems rather than newer models that include team-based care, advanced practice nurses, and physician assistants.
Spetz has a similar assessment.
"If you look at doctors only, there is a shortage coming, but if you recognize that NPs and PAs can do a lot, and I think they can do more than 25% [of the shortage differential] … there is a lot more they can do to fill the gaps," she says.
OhioHealth, the faith-based, not-for-profit health system in Columbus, has 11 hospitals, numerous ambulatory sites, and more than 200 physician offices serving a 47-county
service area in central Ohio.
"I describe a lot of the work we're doing as, ‘How do we try to get some of the work that needs to be done for our patients out of the exam room?'" says Hugh Thornhill, president of the
OhioHealth Physician Group, which employs over 700 physicians. "I'm trying to get a lot of that load off the physicians' shoulders, to have them move into a care team coaching role, plus taking care of our sickest of the sick patients."
Team-based care is essential to achieving this goal.
"More and more, our physicians are providing leadership for teams or providers that include folks from a variety of healthcare disciplines," says Bruce Vanderhoff, MD, MBA, senior vice president and chief medical officer at OhioHealth.
OhioHealth is achieving this, in part, by embracing the patient-centered medical home model. The organization has 39 primary care practices that are qualified for Comprehensive
Primary Care Plus (CPC+) under CMS.
"It is indeed a model of multidisciplinary care, but one that really enables our medical staff, our primary care physicians, to focus appropriately on their patients' care where their expertise and advanced knowledge is most needed," Vanderhoff says.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.