1. workforce trends and shortages

2. national trends  U.S. Bureau of Labor Statistics says about 233,000 new registered nurse jobs open each year, while only around 200,000 candidates pass the registered nurse licensing exam annually  Factors that lead to the shortage of new candidates:  Decreased funding for training  Difficult working conditions  Lack of qualified instructors  Units requiring specific experience – ICU, ED – are even harder to fill, as brand new graduates do not have the expertise http://nursing.advanceweb.com/Article/Nursing-Shortage-Expected-To-Grow-Annually-Through-2016.aspx

3. national trends  According to a study done by KPMG, 65% of respondents currently use supplemental staffing.  The average number of travel nurses used per hospital is 21 (2011)  Surveyed hospitals said that their main reasons for using travel staffing are: local nursing shortages, seasonal needs, and growth of the facility.  The average time to fill for an employed nurse is 79.7 days while the average time to fill for a travel nurse is 43 days (NSI).

4. national projections RN shortages

5. national trends  Travel Nurse Market is expected to hit 23% growth over last year by the end of 2015.  Growth expected to continue through at least 2017.

6. supplemental staff rates  Permanent nurse staff, on average, cost $98,000/year total. 11-12% of this cost is from non-productivity time (KPMG).  Travel nurses, on average, incur a much lower non- productive time and a much shorter onboard time (Tuttas, PhD, RN).  Mobility allows for easy and quick changes in staffing levels when census changes occur

7. supplemental staff rates  The hourly rate is generally higher for travel nurses, but total cost of these nurses is comparable to or lower than the total cost of permanent nurse staff.  Travel nurses are not paid PTO or other benefits and do not require a signing bonus or pension agreement.

8. current staffing models  When there is change in census, department services, expansions, vacancies, or other variables within a facility, there are limited options for staffing:  Add more patients to each nurse’s workload  Pay overtime for full-time staff  Utilize temporary staffing  Recruit and hire permanent staff  Many of these options come with increased risk or cost

9. nurse-to-patient ratios  Hanover Research found that increasing the nurse to-patient ratio has a broad impact on patient care. In the short-term, and increase in the number of RN’s can lead to the following benefits:  Reduction in adverse events  Reduction in medical errors  Reduction in length of stay (LOS) for patients  Increase in per patient day hours  Improved patient satisfaction  Lower staff turnover  Reduction in the burnout rate  Increased efficiency of nursing staff

10. nurse-to-patient ratios (continued)  Long term, hospitals can see a reduction in total cost of treatment per patient in 77-84% of cases (Nursing Economics, 2007).  For each additional patient over four per nurse, a 23% increased risk of burnout and a 15% decrease in job satisfaction is seen, according to a study by the Journal of the American Medical Association.  Each additional patient in a nurse’s workload produced a 7% increase in likelihood of failure to rescue (Aiken Group).

11. overtime  Experts believe that there are 440,000 deaths annually due to medical errors. This is equivalent to 900 fatal jumbo jet accidents. Medical error is the third leading cause of death, behind heart disease and cancer (API Healthcare).  Permanent nurse staff Overtime is not an acceptable practice as a means of bridging a staff shortage gap, according to the American Nursing Association.  Working long hours has an adverse effect on patient and nurse outcome including patient satisfaction and medical error. The Institute of Medicine suggest that nurses should not work more than 12 hours in a 24-hour period and no more than 60 hours per week to avoid errors caused by fatigue.  Medication errors are 3.7 times more likely when a nurse exceeds 40 hours in a week (Nursing Economics).

12. overtime (continued)  Longer shifts can lead to decreased patient safety and staff morale, increasing turnover and replacement costs.  The average cost to replace a nurse is $82,000 (Journal of Nursing Administration).  According to the National Sample Survey of Registered Nurses (NSSRN), 43% of RNs worked more than 40 hours per week and about 9% of RNs worked more than 60 hours per week.  Regular staff OT can increase readmissions or length of stay for patients; cause penalties under the ACA.  HRRP Survey shows that hospitals with higher nurse staffing had 25% lower odds of readmission penalties.  Having overtime levels in the 10% range can cost a 300 bed hospital an estimate of $3 million per year.

13. overtime (continued)  There is an estimated annual net savings of $11.64 million for hospitals who increase non-overtime RN hours and an annual net savings of $544,000 for hospitals decreasing overtime hours (API Healthcare). The use of strategic nurse staffing tactics to control hospital labor cost can result in significant long-term savings while also improving efficiency of the healthcare facility. Healthcare staffing services can alleviate the need for overtime.

14. seasonal changes in census  Staffing full-time employees for high levels of capacity all the time is costly  Layoffs can be detrimental to the public perception of your brand  The average cost to recruit and hire a staff nurse is $82,000 (Journal of Nursing Administration)

15. consequences  Inadequate staffing can lead or contribute to:  Staff burn-out and turn-over  Increased medication errors  Increased infection rates  Increased patient falls  Possible increase of readmissions  Decreased patient satisfaction rates

16. summary  Workforce shortages are BACK and not expected to end any time soon  Many health systems are experiencing increased in- patient census PLUS  Operating more business outside the traditional “four walls” – physician practices, ambulatory care and surgery centers, radiology procedures, rehab centers  Multi-generational workforce  Increased retirement of baby-boomers  Flexible staffing is a prime motivator for millennials  Difficult positions require experience and mixed skill sets (OR, L&D, Cath Lab, Lab, PT, Coders)

17. what’s next?  Find solutions that work for your system; knowing that:  Recruitment will be non-traditional  Retention may have a new meaning  Supplemental staffing has become a best practice  Flexibility is the new normal  Find partners and answers that work FOR you and understand your needs

18. Thank you! Sherry Kolb, RN Executive Director, Workforce Development South Carolina Hospital Association skolb@scha.org 803-744-3515