Can Changing Nursing Staffing Models Make a Difference?

Understanding the reasons why nurses are leaving direct care is crucial in nurse recruitment, as it affects retention rates, future recruitment strategies, and job satisfaction. One significant factor contributing to nurse attrition may be dissatisfaction with outdated staffing models.

How can you provide safe, efficient patient care and meet the evolving needs of nurses? Innovative nurse staffing is the answer. Making a commitment to find and implement new staffing models is a great way to show current and future staff that you support their well-being and hard work.

“Organizations are being very creative with all sorts of out-of-the-box solutions,” said Carol Boston-Fleischhauer, former Managing Director and Chief Nursing Officer for Research at The Advisory Board Company.

Inspiring change

Data demonstrates an urgent need to revamp existing staffing models. According to McKinsey, about one-third of nurses plan to leave their current positions. And in an American Association of Critical Care Nurses (AACN) report of over 9,000 nurses surveyed, 24% of nurses said they have appropriate staffing more than 75% of the time. The majority of nurse leaders (92%) expect the nurse labor shortage to get worse, according to another report.

“We know that for the next decade — literally decade — it’s going to be challenging to have enough nurses for the increasing number of people that are going to need care,” said Claire Zangerle, Chief Nurse Executive at Allegheny Health Network (AHN).

Nurse leaders can consider the nursing shortage as an opportunity to abandon outdated staffing models and think differently when it comes to staffing. “The current environment in health care is providing a unique impetus to explore innovative approaches,” said Cynde Gamache, DBA, RN, NEA-BC, Vice President and Chief Nursing Officer at Southeast Georgia Health System.

Nursing staffing approaches

It’s important to consider what is causing nurses to leave. Do they want a different role or care setting? Do they require a care a more flexible schedule? Or do they just want a break from direct care? “If we did just one thing, we would not be successful,” said Zangerle.

Nurses are taking on new roles like these at Ann & Robert H. Lurie Children’s Hospital of Chicago:

  • Educational authorities (to support newer nurses on the night shift)
  • Clinical excellence mentors on cardiac care units
  • Shared inpatient and outpatient roles within a specialty (e.g., hematology/oncology, where nurses work on both inpatient units and ambulatory infusion centers)
  • Support personnel to step into roles as needed (e.g., admission and discharge nurses)
  • Asthma specialists (to educate patients prior to discharge)

“We have allowed each unit to identify what works for their team and patient population,” said Karen Richey, DNP, MBA, RN, NEA-BC, and Associate Chief Nursing Officer for Inpatient Services at Ann & Robert H. Lurie Children’s Hospital of Chicago.

Diverse solutions to staffing

Nursing leaders are breaking out of the one-size-fits-all staffing mindset. Nurses are thriving with these novel staffing models.

LPNs in acute care

Many licensed practical nurses/licensed vocational nurses (LPN/LVNs) seek jobs in post-acute care (nursing homes, skilled nursing facilities, assisted living) or ambulatory facilities. “We are partnering with local vocational schools to invite LPNs from those programs to work in acute care,” said Zangerle. The LPN/LVN scope of practice differs by state and must be considered in this model.

The relief in workload that the LPN/LVN can provide, at a minimum, includes patient care tasks, such as dressing changes and admission and discharge documentation. Zangerle explained that this approach gives RNs more time to complete their responsibilities, including assessing patients, communicating with the care team, and other critical skills.

Team-based care

The COVID-19 pandemic drew attention to the importance of cross-training nurses to work outside of their specialties to cover care needs. “Each member of the care teams needs to be fully engaged to optimize patient care and outcomes,” said Stacey Chappell, Director of Advocacy and External Communications at the American Organization for Nursing Leadership (AONL).

According to AHN, about 40% of their inpatient units have been converted to a team-based model. This uses a dedicated team of nurses to take care of a cohort of patients, allowing other nurses to cover for each other and make time for meal or bathroom breaks. “We are seeing remarkable results relative to patient safety, experience, quality — and also, notably, employee engagement and wellness,” Zangerle added.

Flexible schedules

“We have kind of gotten out of our own way in nursing and dropped some of our rigidity in scheduling,” said Zangerle. Instead of offering strictly 12-hour shifts, nurses can work four-hour blocks, eight-hour shifts, only weekends, or only nights. Another incentive: Nurses get extra pay for working off-shifts.

Hybrid positions

Hybrid roles are built with the intent to extend careers of direct care nurses who want less stress. Nurses can work part time in direct care and part time in another role (such as research nurse or care manager). “It gives them the best of both worlds. That’s been really popular with our nurses,” said Zangerle.

Internal staffing pools

In summer 2022, Southeast Georgia Health System created a Nursing Resource Pool. And as of 2023, 47 nurses have been hired into the program. “Flexibility is an expectation in this role,” Gamache said. Nurses agree to work full time in the pool for 26 weeks and are assigned to whichever hospital they’re needed at. Staffing stays consistent, while nurses get a higher pay rate, Gamache explained.

Hire nursing students as student nursing assistants

To support nursing staff, some organizations have integrated nursing students into their workforce. “This prepares them to start work as a new graduate nurse in the nurse residency program,” said Richey.

In-house staffing agencies

Boston-Fleischhauer said that this is becoming a trend for larger systems. Nurses get logistical support for travel and housing, and compensation is based on the nurse’s degree of flexibility they’re willing to accept. In-house agency staff are viewed as permanent employees, which is supportive of the system’s mission, vision, and culture. “This is in direct contrast to RNs from outside agencies assuming temporary employment at a specific institution,” said Boston-Fleischhauer.

Virtual nursing

In 2021, over 40% of nurses delivered care virtually. And AHN’s inpatient nurses collaborate with a virtual nurse through an iPad to discharge patients. Zangerle added that this same process is used to help staff nurses with certain admission duties.

Remote support can offload certain aspects of care that don’t require a physical presence. “This frees the direct care nurse to focus on physical assessment, medication administration, and mobility,” said Sarah A. Delgado, MSN, RN, ACNP, Clinical Practice Specialist at the AACN.

Collaboration can maximize success

Changing existing staffing models can be challenging. To some, it’s viewed as disruptive to professional, organizational, and cultural norms. But that’s why it’s essential to involve staff at every level. “Front-line staff involvement in model design is critical — along with investments in staff training, change management, and coaching,” Boston-Fleischhauer emphasized.

Whichever nursing staffing models you try, it’s important that nurses are involved in the process. “Provide paid time for direct care nurses to take part in or lead every step of development and implementation,” Delgado said.

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