AdventHealth hired 7,000 nurses in 2 years. What happened next?

AdventHealth needed nurses post-pandemic. Quickly.

Like most health systems, the pandemic exacerbated existing nursing shortages for the Altamonte Springs, Fla.-based system's hospitals and the enterprise needed to reduce reliance on travel nurses as well as improve its nurse turnover rate. Last year Trish Celano, MSN, RN, senior vice president, associate chief clinical officer and chief nursing executive at AdventHealth, devised a strategy known as "use less, lose less, hire more" to bring on 5,000 nurses and reduce turnover.

The results?

AdventHealth hired 7,000 nurses and reduced turnover from 31% to less than 19%. The health system launched dedicated education units within local colleges of nursing to strengthen academic partnerships. It also expanded practicums and clinical rotations, and the system's team encouraged nursing leaders to become adjunct faculty at those colleges.

"We're engaging nurses and they're staying," Ms. Celano said on an episode of the "Becker's Healthcare Podcast." "It was a big deal for us to connect with all of our feeder nursing schools, making sure that we're there. We're connecting with faculty and students, opening up positions on our end for nursing students, so our nurse tech positions are allowing them to work shifts, perhaps one shift every other week, so they can get to know us and we get to know them, and they can figure out where at AdventHealth they want to land."

Ideally, the nurses will make AdventHealth their destination after graduation, she said. Because a significant number of the nurses AdventHealth hired in the last few years have been recent graduates, the system put additional support in place for them to quickly acclimate to their new roles.

"We needed to make sure they were transitioned to practice in a way that they felt good about, that they weren't just thrown into these units and suddenly having to communicate and develop working relationships with physicians that they didn't know and weren't comfortable with, and there are nuances to those relationships," Ms. Celano said.

AdventHealth is standardizing graduate nurse residencies to focus on evidence-based outcomes and provide a solid education with evaluating throughout the process so residents are well-prepared to transition into practice. The system did the same for preceptor bedside nurses.

AdventHealth is also stepping up its professional development program for experienced nurses.

"Our nursing leaders had an opportunity to really have additional support and education preparing them to lead. Now, we have assistant nurse managers and nurse managers who are running operations 24/7, and we realized that we had an opportunity to better prepare them for that role," Ms. Celano said. "Twenty-four months ago, we developed and launched nursing leadership development that was very tactical and practical for our nurse leaders so they understood what it meant to actually develop staffing and manage staffing through the day."

The program put structure around unit huddles and a variety of educational topics the nurse managers could learn about as they transitioned into their new roles as first-time leaders. The education has been especially helpful for early career nurses advancing quickly to understand how to manage their teams and schedules.

"We had a couple of things we had to do in leadership development so our nurses and assistant nurse managers who run operations 24/7, as well as our nurse managers, were prepared to effectively staff," Ms. Celano said. "They needed to understand what that meant and all of the variables involved in that. When assignments are being made for nurses, it's not just a ratio of a number of patients as it seems to be dumbed down to in the past; it's much more than a ratio."

Emerging nurse leaders have to understand how the complexity of different patients and experience level of the nurses, as well as intensity of the work, factor into appropriate assignments for each nurse.

"We needed to go back and do some level setting with nursing staffing principles and practices," Ms. Celano said. "That class for our nurse leaders really helped to get everybody on the same page. "

Their nursing engagement survey reported improvement after introducing a career pathway for nurses known as "clinical ladders" 18 months ago. Part of that program also included advancement for bedside nurses, allowing them to stay at the bedside if they desired. Among nurses participating in the clinical ladder program, turnover has been less than 5%.

Another factor in the system's retention strategy is compensation. AdventHealth aims to keep pay competitive in the market post-pandemic, especially as the average salary changed so quickly nationwide in the last two years. Ms. Celano said she went from evaluating market pay every other year to every six months. More recently, the system began evaluating market rates every quarter to stay at the forefront of local markets.


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