Note: this article has been edited from the original.
If you’ve been reading the news at all, you know that healthcare is in a crisis. At the beginning of the pandemic, everyone celebrated nurses and frontline staff. However, nurses are now trying to draw attention to the nursing shortage crisis in their profession. While the pandemic exacerbated pre-existing labor conditions, the staffing crisis in healthcare has been building for years. A 2021 study found more than a third of nurses were suffering from burnout. Many others became ill, casualties of the viral pandemic they were fighting. While many healthcare workers are demanding more pay and safer working conditions, a theme that comes up again and again is safer staffing ratios.
From a nursing perspective, the labor market continues to tighten. In 2021, approximately one in six nurses quit their job. Hospitals are feeling the punch of the nursing shortage, with 39.8% of hospitals projecting to increase their registered nursing (RN) staff. In 2021, nearly 36% of hospitals had high vacancy rates with one in ten jobs unstaffed. All that work that isn’t handled falls onto the existing staff. It’s a vicious cycle, the nursing shortage leads to more work leading to more burnout which leads to higher turnover which leads to more of the same. Each percent increase in RN turnover costs the average hospital $270,800 a year. It takes about three months to recruit an experienced RN, so staffing issues can’t be left until the last minute. Getting ahead of the hiring needs requires more than guesswork.
Predictive analytics removes hiring guesswork
Mark Smith, Vice President of Workforce Strategy and Analytics from Providence, a comprehensive health care system serving the Western United States, knows how accurate data analysis can help with issues such as a nursing shortage.
In a recent webinar, Mark shared that healthcare uses a lot of per diem workforce to fill as needed. At Providence, he saw that this had been increasing to the point where almost 13% of their requisitions were per diem. “That might not be too bad until you also look at it and realize that our time-to-fill overall was somewhere around 45 days in aggregate, but time to fill for a per diem position was almost 120 days,” he says.
They then looked at variable shift position data. Variable shifts (also called rotating shifts) mean that instead of working a traditional eight-hour day, or a four-hour day for part-time workers, employees work longer hours in a day, but fewer days per week. Healthcare is a 24×7, 365-day operation, working days, evenings, and nights, and healthcare facilities rely on variable shifts to ensure full coverage.
But part of the hiring pressure was vacancy and turnover pressure, and variable shifts increase work-family conflict. “We were also seeing our first year turnover moving up to 39%. We were losing people as quickly as we could fill. When we went back and focused on per diem and variable, asking, ‘Is it possible that they’re part of the challenge?’ The reality was [that] per diem caregivers, who took almost 120 days to find, were leaving in less than 90 days at almost a 60% clip,” Mark explains. Variable shift workers weren’t doing much better—taking 90 days to fill yet leaving at nearly 60% within 90 days.
Mark’s data also showed an increase of people ghosting or declining offers, with the per diem and variable shift quadrants ghosting at over 25% of the time. All these data points enabled Mark’s team to go to the hiring managers and advise them to focus on the 0.5 to 0.74 caregivers—people who work half or three-quarter shifts—because talent acquisition teams could hire them fast, and the first year turnover metrics were really good for that cohort.
As a more advanced user of people data, Mark is going past merely observing the data and has moved on to using these insights to make a strategic plan. “What we’ve done with Visier and our predictive hiring initiative is moving to where we’re actually using lots of data in the background, five years of history, to see what will happen a quarter ahead to get ahead of hiring needs.”
“We’ve actually done work now with Visier where we’ve created the visuals for spans and layers. So, we know what the leader support levels look like. We know how many caregivers individuals have. We can marry that up with data that we have across history around ideal ratios. So we can begin to identify where we see that leaders may need to address their staffing in different ways.”
While experts like Mark have a higher level of understanding of their staffing situation and take a long-term planning view of the nursing shortage, others in the industry have had knee-jerk reactions to the healthcare shortage. When a team of nurses decided to quit for better working conditions and more pay at a rival hospital, ThedaCare in Wisconsin responded by filing a restraining order to prevent its team from quitting. And recently, a group of Filipino nurses won a $1.56 million human trafficking lawsuit when a recruiting agency hired them for jobs in the U.S. and threatened them with high fines if they vacated their positions.
Gig economy is an imperfect solution to staffing shortages
One of the ways in which healthcare providers have been dealing with the healthcare crisis is through hiring travel nurses, who function almost as gig workers and go where they’re needed. Many nurses are switching to this type of position, in part because travel nursing pays considerably more, sometimes more than twice as much as stationary roles. Some organizations are balking at the extra cost. The American Health Care Association/National Center for Assisted Living, LeadingAge and a coalition of long-term care and senior living organizations are pressuring the government to cap pay for nurses and regulate recruiting agencies, and in some cases have succeeded, citing understaffed agencies as their driving argument.
While it’s easy to simplify these travel nurses as motivated by greed and unfairly price-gouging desperate healthcare facilities. Katherine Moseley, an RN who became a travel nurse, says this isn’t the case. “You go into travel nursing because you want to help people. People don’t go into travel nursing to make bank. It may look on paper like travel nurses are making a high hourly rate, but their recruiting agency is paying them only a fraction of that and the rest goes into overhead costs.” Our current system relies on the economies of supply and demand. But even for those healthcare organizations who happily pay whatever the market demands, the reality is that travel nursing can’t completely solve the nursing shortage problem if there aren’t enough nurses to go around.
Insightful workforce management saves lives
Safe staffing ratios are a key part of healthcare. Some ratios are determined by the healthcare organizations and others are mandated by states. For instance California mandates the ratio in an operating room can’t exceed one nurse for every one patient, while a psychiatric ward can have up to six patients for every nurse, and pediatric and emergency-room units can have up to four patients per nurse. Without adequate healthcare workers, both patients and staff suffer.
In a pooled data analysis that examined 28 studies of the association between RN staffing and patient outcomes in acute care hospitals, the results speak for themselves. Having just one more nurse on staff is literally a matter of life and death. One more nurse meant five fewer ICU deaths, five fewer medical patient deaths, six fewer surgical patient deaths and 26 fewer failure to rescue deaths.
Places hire travel nurses because they have high need, Katherine explains. “You arrive there and the nurses, if you weren’t there, would be operating at unsafe ratios. But the other side of that is when hospital systems are like ‘we’re paying these [travel] nurses too much money and because they’re here and our staff is stressed out, we’ll put the travel nurses at 1-6 [ratios] and our staff at 1-4 [ratios].” One solution Katherine suggests is to bring in non-nursing staff to help, such as runners, medics, and other ancillary roles. “It’s always better if you have people who can help a nurse. It helps with the short staffing.”
Hiring innovation with people analytics: ‘Moneyball’ for hospitals
Hiring more support staff is a solution Mark’s team have also been considering to alleviate the nursing shortage. He loves to use the baseball team in the movie (and book) “Moneyball” as an example, in which a smart General Manager used analytics to create a winning baseball team. In a time when everyone was looking for the home run hitters and the all-stars, the Moneyball idea looked at a different way to build a winning team. “From an analytics perspective, they began to uncover that you could find really good players who got on base. They didn’t hit home runs. They drew walks, they hit singles, they hustled. And so that notion for me, particularly in this crisis, is that the solution in the workforce crisis is not going to be ‘let’s go do what everyone else is doing’.” By using data and really analyzing the available skills, he can build winning teams for his healthcare facilities by using data and the insights of people analytics to find overlooked resources. Many roles don’t require a degree, only a certification, and bolstering roles such as nursing assistant, administrative assistant, phlebotomist, surgical tech, or pharmacy tech, can improve patient outcomes while reducing the burden on overworked nurses and doctors.
Hiring more nurses (and keeping them)
Many in the industry understand that attracting more qualified candidates means paying attention to people data and gearing recruiting messages that emphasize an organization’s differentiators. By listening to employee satisfaction data, gathering NPS metrics, and looking for resignation trends, leaders at healthcare organizations can create long-term strategies based on analytics insights rather than short term fixes that just kick the problem down the road. For example, what might look on the surface like a hiring problem could be an employee engagement problem. Pizza parties aren’t going to fix back-to-back 12 hour shifts with insufficient staffing for patient care and management who don’t provide what nurses want.
And when it comes to “what nurses want” again and again they demand safe staffing ratios. Katherine Moseley, RN, describes why she left one position shortly after taking it.
“In 2021 I was hired for a 13-week contract at a facility where many different travel nurses contracts’ had ended. The management had elected to not competitively pay the talent pool of travel nursing providers who had been working there throughout the pandemic. They had a wonderfully established staff of competent nurses who had extended their contracts over the prior two years. I came on and within two weeks of me being hired, 13 contracts lapsed. So I–one person–was hired when they knew their attrition rate was 13 more nurses. I was like ‘okay, I’m good, but I’m not 13 other people good’.”
Katherine saw the looming staffing shortage on the roster and elected not to remain, knowing she could lose her license if she stayed at a place that endangered its patients and staff. This is the kind of staffing disaster that predictive analytics can help leaders avoid.
Future-looking healthcare leaders need to innovate
Mark knows this crisis is affecting the entire industry. “As we think about diversifying our talent ecosystem this year, Visier’s new integration with EMSI Burning Glass will be very helpful because we’ll start to get timely external insights. In healthcare, over half a million workforce members in healthcare have left. So, do we have any insights externally that tell us about their comfort in returning? And if they don’t return, then does the insight tell us that there’s an overlooked talent surplus?”
In addition to looking for latent talent sources and finding ways to coax burned out healthcare workers into the hospitals again, Mark thinks thought leaders in the industry need to be looking further to combat the nursing shortage. How can employers encourage high school seniors to consider a career in the healthcare industry? College enrollment has been declining, and if students aren’t attending medical school today, that means fewer nurses and doctors to care for patients in the future. Mark believes the healthcare industry can lead by partnering with learning institutions to help clear hurdles for young people who are drawn to careers in medicine. “We have meaningful, non-degreed certified jobs that can really be attractive to start a career: as a medical assistant or a nursing assistant or a surgical tech. With our tuition reimbursement programs and with the university relationships we have, if someone at a later date wants to go to college, we can pay for that,” Mark says.
Mark, a champion of using people analytics to get good insights, thinks that a closer look at skills development will help. “How do we understand our skill sets even better so that we can begin to really target our internal development opportunities, to encourage people, to move to roles where they have a skill adjacency that results in a promotion for them? How do we look at the external data to begin to think about the overlooked alternatives, like gig workforce, that will allow us to, to meet our needs? Where do we think about redesigning jobs? Where are we going to need to add jobs in order to get it right?”
People data helps leaders listen to what nurses are saying
While healthcare workers and their employers may not agree on everything, they certainly agree that adequate staffing is crucial. Nurses and doctors have borne the brunt of the pandemic, and their mental health has been suffering as they’ve been tasked with caring for too many patients with too few resources. Using people analytics to inform workforce planning may not seem like the most exciting of tasks, but fixing the nursing shortage is literally a question of life or death. “If you care at all about people and you’re going to work every day to help save lives and help people not die, there’s a wall you hit when you realize it’s become unsafe,” Katherine says. Nurses and doctors are crying out for help, and leaders who take time to pull insights from the data will be able to respond faster and more effectively.
About the author: Catherine Cheek
Catherine “Kater” Cheek is an award-winning author with a breadth of writing experience from corporate communications to storytelling. As Senior Copywriter at Visier, she aims to highlight the human stories behind the data and showcase details that make complicated concepts easy to understand.
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