Children’s hospitals are familiar with emergencies. But the places families rely on when their children are most in need of the best care are dealing with their own urgent issue. Workforce and staffing challenges born out of the pandemic have forever changed what work looks and feels like across many industries, including pediatric health care.
Children’s Hospitals Today explores the staffing challenges children’s hospitals are facing, specifically within nursing. Here’s a look at the big picture, the drivers affecting nursing staffing and strategies that can help organizations recruit and retain these critically important caregivers.
Linda Talley and her team saw the challenges coming. “There were signs we would be entering into a workforce shortage before the pandemic,” says Talley, M.S., RN, NE-BC, FAAN, senior vice president and chief nursing officer, Children’s National Hospital in Washington, D.C. “Throughout the pandemic, those drivers were top of mind for us.”
Drivers included nursing school enrollment numbers that fell short of the projected demand for nursing services, coupled with a shortage of faculty to teach those seeking a nursing career. Another major issue: a significant number of nurses reaching retirement age, which became a far more pressing issue with the arrival of the pandemic.
“Our retirements almost doubled in 2021,” says Christine Young, M.S.N, MBA, RN, NEA-BC, chief of hospital-based services and chief nursing officer, Akron Children’s Hospital in Ohio. “As the pandemic progressed and you’d have these surges and then periods of inactivity and then surges again, people just made the decision that if the timing was right financially for them, it was time for them to leave the workforce.”
According to the American College of Healthcare Executives 2021 Annual Survey, the No. 1 concern among hospital CEOs for the first time in 17 years is staffing. Nursing turnover in particular is on the rise for reasons ranging from early retirement and new work challenges to a desire for work-life balance and opportunities in contractual nursing.
Children’s hospitals participating in PROSPECT, the nation’s leading financial and operational comparative data set for pediatrics, report an increase in the quarterly turnover rate of more than 76% among registered nurses from the first quarter of 2019 to the third quarter of 2021.
Nancy Korom, vice president and chief nursing officer at Children’s Wisconsin, has seen high numbers in nurse turnover inside her own hospital. “I’ve been the CNO here for 24 years,” says Korom, M.S.N., RN, NEA-BC, FAAN. “This is the first time we’ve been above 10% turnover among nurses.”
Talley and Young spotlight four key factors behind the nursing shortage facing their organizations and children’s hospitals around the country.
Transitions in practice
Those who were in nursing school during the pandemic faced educational interruptions no other nursing students had faced before. “They were fast-tracked to graduation so they could be deployed more quickly onto the front line,” Talley says.
“They didn’t have a place to do clinical rotations, so they are coming to us with a knowledge deficit that we need to address. Many nursing students coming to us now have never provided direct care to a patient by virtue of the pandemic.”
Staffing is hospital CEOs’ No. 1 concern for the first time in 17 years.
Complex patient care
Talley says the pandemic has prompted more complex patient types and needs. And the stresses and pressures brought on by COVID-19 can accelerate expectations and frustrations when patients and families come into a health care facility.
“We’re seeing nurses burn out faster, new nurses especially, because they are just not prepared for the daunting task they’ve signed up for,” says Talley. “The turnover among nurses with less than two or three years of experience is where we see our highest rates.”
According to Talley, the pressures nurses have in their professional and personal lives sometimes can’t be balanced. Those nurses seek to either reduce their hours at work or to walk away from work completely—and time will tell whether they re-enter the workforce.
Young says, “The pandemic pushed that work-life balance to the forefront, where people are saying, ‘I can’t do this anymore—I have to balance my life because of the effect of everything that’s happened over the last couple of years.’”
Career and market competition
Nurses have choices now that they’ve never had before—in some cases, choices that were already there but look much more attractive considering two years of a pandemic. Case in point: travel nurse assignments, allowing nurses to take temporary jobs where there is a high demand—at a much higher rate of compensation, to the tune of hundreds of dollars an hour.
“There is the real competition that travel nurse assignments are introducing that they hadn’t before,” Talley says. “We have nurses who have said, ‘I’ll go travel for 13 weeks and take 13 weeks off, because I’ll make more money as a travel nurse working 13 weeks than if I work 26 weeks in my full-time job.’”
In addition to the financial benefits, there is the allure of new experiences and travel to new places. Young, too, has seen many nurses at Akron Children’s take on travel nurse assignments for these reasons. “You have to be in the right family and social situation to be able to be a travel nurse, because not everyone can pick up and just go 13 weeks in different places...but for the nurses who are able to do that, the financial incentives are almost too much to overlook.”
Young says that’s something her organization, and every hospital, is struggling with across the country. “The financial incentives for travel nursing have just escalated so rapidly that it’s a financial opportunity for people to pay off student loans and pay off some other debt,” she says. “It’s hard to judge them for wanting to do that, but it certainly leaves us with a gap—and then we’re trying to refill some of the positions that they vacated with travel nurses, so then our costs are going up as well. It’s a cycle.”
Korom and her team at Children’s Wisconsin have had to pull in more travel nurses lately than they ever have before to compensate for staffing challenges. They have a creative team working to ensure they have the right number of nurses to meet the projected need, while remaining dedicated to investing in the hospital’s own nurses, she says.
Talley adds yet one more challenge to this mix: Many hospitals also are increasingly offering incentives like signing bonuses, which also attract nurses to jump to other employers, even if temporarily. It is yet another reason to rethink and reinvent not only how children’s hospitals recruit and retain nurses—but the very role and future of nursing.
1.1 million new registered nurses are needed for expansion and replacement of retirees.
“We’re looking at nurses as educators, nurses as leaders, nurses as innovators, nurses as advocates,” says Talley. “We’re looking to what that future might be and embracing the opportunity to talk to our nurses who are still here about why they want to stay—and then working with our partners in human resources to do the hard work about finding where the talent is and bringing them in.”
Easing the pain of the shortage
“I know we’re talking about the nursing staffing shortages, but the downstream effect of other staffing shortages is that the nurses typically have to do some of that work,” says Young. “When there are shortages in nutrition, in the lab or in other clinical service areas, nurses might have to deliver the trays to the patient’s room, or they might have to take the labs to the lab.”
Enter a program at Akron Children’s called Helping Hands, which is designed to maintain those critical services at their normal level so the bedside clinicians can focus on the care they need to give and not have to fill in some of those gaps, Young says.
Launched September 2021, Helping Hands is an opt-in, flexible staffing program where any current staff, clinical or non-clinical, can work additional hours in different roles to support direct and indirect patient care. Those who would like to participate in the program are matched with opportunities for assignments based on current skill sets and receive training to work across the hospital.
To ensure resources are allocated to areas with the greatest need, assignments are made daily across the health system. So far, more than 900 employees have expressed interest in being a part of the program.
Children’s Wisconsin also has adopted a Helping Hands program to offset challenges nurses were facing particularly during COVID surges—including helping to restock supplies, room patients and clean high-touch areas.
Korom and the team also worked creatively with the human resources department to bring on more nursing staff. “We rehired some of our retired nurses and brought them back on to help us,” says Staci Benz, director of human resources, Children’s Wisconsin. “Some nurses who were planning to retire stayed on in more of an as-needed role. We called it our alumni squad.”
Recruiting and retaining
Workforce development—including mentoring programs and care team wellness, including the addition of a spa-like respite room—are a big focus at Children’s National to help recruit and retain talent.
They’ve also turned the notion of the “exit interview” on its head to better understand and meet the needs of nurses. “We’re doing ‘stay’ interviews, so we can track individualized needs for staff to make progress on what is important to them and to learn what would make the difference between staying and leaving,” says Talley.
Paving the way to tomorrow
According to Young, children’s hospitals must rethink the future of nursing—and what the work environment looks like, given the transition to a work-from-home model prompted by the pandemic.
“I’m thinking futuristically but is it some sort of hybrid model where there is a virtual nurse who’s doing some of the paperwork from home and you rotate people through that?” says Young. “Maybe I work four hours a week in that role and then come into the hospital for others? We really have to think differently and creatively about how nursing care, and health care in general, is delivered.”
In the meantime, Talley says all these challenges open an exciting world of new opportunities for nurses in children’s hospitals. “This is our time, this is our calling, this is what we have been trained to do,” says Talley. “We have a nation and a world in desperate need of healing—and nurses have been and will continue to be on the front line of that work.”