Where are all the med-surg nurses?

St. Louis-based BJC HealthCare hoped to see more nurses go into medical-surgical once the COVID-19 pandemic died down and competitive pay rates for travel assignments in critical care and emergency departments stabilized. That hasn't happened. More than 70 percent of the system's agency dollars are currently being spent on nurses to work in med-surg units, Tommye Austin, PhD, RN, senior vice president and chief nursing executive at the health system, told Becker's.

When it comes to the national nursing shortage, many hospitals are feeling the effects hardest in med-surg, the areas that account for most of their beds. Before the pandemic, Cleveland Clinic Marymount Hospital in Garfield Heights, Ohio, would see more than 30 med-surg nurse hires in a single summer. "Now, however, every hospital across the country has openings that need to be filled," the hospital's CNO, Barbara Zinner, DNP, RN, said in an October blog post

Perceptions about med-surg as a specialty don't help. Often, it's considered a "stepping stone rather than a fulfilling career path," Dr. Zinner said. And it's often thought of as more strenuous than other specialties, given med-surg nursing requires a broad range of knowledge to care for patients who may each have very different conditions and needs. 

So what will it take to attract and retain more med-surg nurses?

On-the-job support & flexibility 

For one, much more additional support so nurses can, as an American Nurses Association leader recently put it, "just be nurses" and practice at the top of their license, spending less time on tasks that aren't direct patient care. A study from 2018 concluded nurses spend about 10 percent of their time on non-nursing tasks that can be delegated — a figure that has likely risen with worsening staffing shortages over the past few years. 

On this front, BJC HealthCare is looking to roll out virtual nursing in med-surg areas systemwide in 2024, based on success it has seen piloting virtual nursing at four of its facilities. Virtual nurses support med-surg nurses by assisting with the admissions process, patient education and discharge, Dr. Austin said. 

"We've also seen the virtual nurse be used as a mentoring resource because of the number of new grads we have," as new nurses who may be intimated to ask their nurse preceptor questions can call experienced virtual nurses for support, she said. 

Cleveland Clinic Marymount Hospital has leaned more heavily on patient care nursing assistants to mitigate the nurse shortage in recent years, according to Dr. Zinner. The purpose of the hospital's PCNA support program is two-fold: to better support med-surg nurses and to build a pipeline of future nurses via professional development efforts for PCNAs. 

BJC Healthcare is also looking into adopting robots and how technology can be implemented to vital sign machines and other medical equipment so that repetitive tasks can eventually be the exception, not the rule, for nurses. 

"If I'm a registered nurse working in a med-surg unit, I should be able to expect that I don't have to double document vital signs. I don't have to double document IV drips and things of that nature," Dr. Austin said. "I think there are certain things organizations should put in place so that the work environment is a lot easier." 

BJC HealthCare has also "heard loud and clear" from nursing staff that they want more scheduling flexibility. The system rolled out a flexible scheduling app earlier this year for nurses to pick up as many or as few additional hours as they like.

Address the pay gap 

One area that would be remiss not to mention is compensation. 

Increasingly, "when you talk to new graduates, their primary objective is get a couple years of experience and then go travel," Dr. Austin said. And understandably so, as the weekly average for travel nurse pay remains nearly 30 percent higher than pre-pandemic levels, according to data from Vivian Health, a national healthcare hiring marketplace. 

Overall, med-surg nurses tend to earn less than nurses in specialties like intensive care or emergency department, though it's difficult to put hard numbers on the comparison given a range of factors that play a role in salary, such as nurses' level of experience. Still, to retain experienced nurses in med-surg, any considerable gap is worth leaders' attention. 

"We're trying to work on that pay gap because … whereas an ICU nurse is focused on the technical skills of taking care of two critically ill patients, you have to have a broad range of skill sets to be able to take care of six patients at a time," Dr. Austin said. "To me, the skill sets are equivalent, but used differently to take care of different patient populations." 

Bottom line, hospitals need more med-surg nurses. Getting them — and getting them to stay — requires a range of efforts to reduce workload burden and ensure the specialty remains just as attractive as others. 


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