Strategies to Solve the Staffing Shortage

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Keys to recruiting and retaining the best people in crisis conditions.

Between the effects of a once-in-a-generation pandemic, increased patient demand and an aging population that will soon exceed the number of nurses available, ambulatory facility leaders everywhere are facing a dire staffing crisis they’ve never seen the likes of before. In fact, the healthcare industry is facing a shortage of an astounding 200,000 to 450,000 nurses by 2025 unless action is taken. The key part of that staggering predication, of course, is the bit about “unless action is taken.” 

Leaders can’t simply react to this industrywide staffing crisis. We need to actively prepare for it and take steps to prevent the worst of the current shortage from impacting the quality care patients have come to expect from us. Combatting the staffing shortage requires leaders to tackle the problem on two main fronts that should come as no surprise: 

• Recruiting
• Retention

In other words, facilities who have fared best in today’s difficult staffing climate have found an array of successful tactics to get quality nurses into their ORs and keep them long after their initial orientation period has ended. I polled 25 trusted industry colleagues, ranging from in-the-trenches administrators to recruiters and consultants, about the “unique/unusual things that ASCs are doing to recruit/retain staff” to uncover what successful facilities do differently.

Get them in the door, and …

The reality of the situation is that good, loyal nurses are extremely hard to find. Many applicants either reply to your traditional job ads, schedule interviews and never actually show up. Or they accept the job you fast-tracked to bolster staff, only to frequently call out or send those late-Friday emails saying they won’t be in and leaving you short-staffed. 
In many cases, the traditional ways of finding candidates simply aren’t working today. Facilities that succeed in the hiring process rely on a variety of methods to find the right people. For instance, facility leaders that have formed relationships with local schools or reached out to former applicants (always keep qualified applications on file!) generally report positive results with those tactics. Recruiting requires a good deal of trial and error.

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Experts predict a shortfall of up to 400,000 nurses by 2025 unless drastic steps are taken. If you’re looking for practical recruiting and retention tips to combat the ever-present staffing crisis, sign up for “Strategies to Solve the Staffing Shortage,” a free webinar brought to you by OR Excellence Webinars by Outpatient Surgery Magazine and hosted by Ann Geier, MS, RN, CNOR(E), CASC, the chief nursing officer for Ambulatory Healthcare Strategies. The webinar will take place on April 10, 2023, at 1:00 p.m. ET. Sign up and register here: osmag.net/shortage.
—Outpatient Surgery Editors

Here are just some of the more creative recruiting approaches I’ve heard from my colleagues:

• Partnering with a staffing agency — yes, it’s costly, but the investment pays off if you gain loyal staff.
• Offering employee referrals — paying finder’s fees is a good way to create a strong team dynamic among already familiar staff.
• Soliciting the names of staff at local/regional hospitals who work 12-hour shifts.
• Reaching out to your local Chamber of Commerce.
• Creating a website that is used for recruitment-only purposes.
• Inviting potential candidates to shadow ASC/HOPD employees.
• Offering 8-, 9-, or 10-hour shifts — the key is creativity and flexibility. 
• Considering a 4-day workweek. 

When it comes to hiring, keep in mind that New RNs need extensive orientation and are more difficult to train than experienced nurses. Whenever possible, I encourage ASCs to bring in med-surg RNs who are extremely versatile and cross-train them on a variety of roles.

Another harsh reality of recruitment is that outpatient facilities — particularly smaller freestanding ASCs — simply can’t compete with the larger health systems in terms of pay. As important as money is, it often isn’t applicants’ sole motivator. Savvy facility leaders pull in strong candidates by selling the culture of ASC life and the many intangible benefits of the job. For instance, marketing is often geared toward stressing the “family work environment” of a small setting that creates a sense of unity, emphasizing that staff has a voice in the overall business decisions and hammering home the invaluable benefits of no-call, weekend or holiday scheduling.

Bottom line: In today’s staffing environment, leaders need to think outside-the-box to find the right applicants and be willing to try multiple tactics — many of which won’t ultimately pan out — to find out what works for their unique facility.

… Keep them there.

It doesn’t matter how effective your recruiting efforts are if you can’t hang onto the people you’re hiring. Retention is arguably the most crucial piece of the staffing puzzle. While some administrators and directors will lament the impossibility of retaining top nurses right now, the fact is top leaders find ways to do just that.

I firmly believe the key to retention lies in honest, open communication between staff and facility leaders. Most leaders will tell you they do this but dig a little deeper and you’ll likely find they don’t or, as is often the case, they do it but only to a certain extent. For instance, most managers will check in with new folks and ask questions like “What do you need to do your job? What’s frustrating you? What makes you happy?”  Where they fall short, however, is in the follow-through. You can’t simply ask the questions; you must also act on staff’s replies — even if you can’t get them everything they ask for.

Better bonus criteria. Another common mistake I’m seeing is the overly generous sign-on bonus. Granted, I fully understand why so many facilities are doling out these bonuses. Still, sign-on bonuses by nature entice people who are looking for upfront money and ultimately put the surgery center at a disadvantage. If the hire doesn’t work out, the employee still gets the money and the ASC is left trying to determine how to terminate the person long after they’ve proved to be a poor fit. Plus, veteran nurses may consciously or unconsciously resent the new hires for receiving a bonus for a job they’ve been doing for years without notice, much less extra compensation.

What’s more effective long-term? Retention bonuses. Instead of incentivizing people to come onboard and stay just long enough to grab that sign-on bonus, you’re sending the message that your culture is all about rewarding good, loyal workers.

Customized orientation. In a staffing crisis where facilities are dealing with constant churn, orientation often gets short shrift. That’s a mistake. A poor orientation experience is a surefire way to get a new hire to jump ship quickly.

First, make sure your preceptors are paid and paid well for their role (they’re basically doing two jobs, if not more). In terms of the actual orientation process, customization is critical. Do away with those cookie-cutter orientations except for the general training where it’s unavoidable. Before starting any orientation, ask each new hire the following two questions:

How much time each day can you typically stay interested in learning activities?

How do you prefer to be trained — handouts, “Live” or hands-on, webinars, online materials, etc.?

Then, use their response to customize the training accordingly.

Memorable mentors. Many facilities rely on some type of mentoring program to acclimate new hires, but all mentors aren’t created equal. Excellent nurses may be terrible teachers whereas competent nurse may be (and often are) excellent teachers.

“Whenever possible, I encourage ASCs to bring in med-surg RNs who are extremely versatile and cross-train them on a variety of roles.”

The key to a strong mentorship program is training your mentors to look for early warning signs that a new hire may be unhappy, a poor fit or looking to move on.

Mentors who maintain “active” communication with new hires may be the difference between a staffer who makes it through a challenging orientation and becomes a valuable part of your team and one who ultimately leaves shortly after their start date. Finally, it should go without saying: If you want to have any chance at retaining new employees, there must be a zero-tolerance policy for the old-school “OR nurses eat their young” mentality.

As difficult as the climate is right now, leaders can overcome the many challenges related to today’s staffing shortage. Remember, we’re in a long-term situation, and we must be able to plan and cope with unforeseen circumstances. That’s not an easy thing to do. We cannot only react. We need to be prepared. OSM

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