Beyond the dollar: Hospitals embrace flexibility to retain workers

Hospitals and health systems have largely relied on competitive pay to retain employees throughout the COVID-19 pandemic. Now many organizations are going beyond financial benefits to keep staff, offering more flexibility in when and where they work. 

Competitive pay, on-site day care, housing and tuition reimbursement/assistance programs, and even covering employees' gas costs to get to work are among monetary incentives that will likely continue, but the next phase of recruitment and retention should prioritize giving employees more autonomy in their schedules, several chief nursing and medical officers told Becker's.  

"We're at a crossroads" in terms of addressing the shortage of nurses and the number of nurses who are leaving the profession altogether, said Tim Plante, MSN, RN, senior vice president and chief nursing officer of Omaha, Neb.-based CHI Health. "I think we will still have monetary incentives, but we're also going to have to look at lifestyle, balance, because the newer generation of nurses are more agile, they move around a lot quicker.

"They're looking more for growth opportunities and balance and flexibility to fit their schedules. That's just not how we have aligned our hospitals," he said. "It's [previously] been all about 12-hour shifts, and we're trying to, as a profession, to fit into the post-pandemic world. We're in the middle of change."

Becker's spoke to several leaders to discuss new flexibility strategies in place at their systems, including schedules that allow longer periods of time off, a greater emphasis on telehealth, and incentive programs that encourage greater flexibility for nurses. 

Creating flexibility for staff

CHI Health, a division of Chicago-based CommonSpirit Health, is creating flexibility for nurses in various ways. 

Mr. Plante said the health system started a program that incentivizes them to work every weekend or every other weekend for a six-month period. Nurses who opt in climb to different incentives as they work more weekends. 

The incentives are based largely on flexibility, Mr. Plante told Becker's

"For example, if a nurse is willing to work nights every weekend, their incentives would be significant. Nurses willing to shift schedules and work flexible hours will see the most incentives from this program," he said. 

Mr. Plante said the incentives are already popular with parents who don't want kids in day care. 

CHI Health, a 28-hospital system also serving southwest Iowa, North Dakota and Minnesota, is also considering opportunities for more seasoned nurses, such as those who have retired, to return virtually, Mr. Plante said. 

"We have a lot of inexperienced staff right now, which creates opportunities for mentoring," he said. "I think you can leverage that the most through virtual meetings."

For example, a more experienced nurse could be in one location and mentor 20 bedside nurses virtually. 

Mr. Plante said CHI Health already does this in the intensive care unit, where seasoned nurses in a command center watch patients and help inexperienced nurses make clinical decisions.

CHI Health also is incentivizing nurses to work in multiple areas. 

"So, if you're trained in labor and delivery and you go to ED, you will get a higher percentage of your base pay," said Mr. Plante. "Then, if you're willing to go from hospital to hospital [within the health system], that's a different rate. That gives us more flexibility to put the resources where we need them. It also offers nurses an alternative to traveling [with an external agency, while keeping their existing roles]."

Banner Behavioral Health Hospital in Scottsdale, Ariz., considers the integration of work and life in their initiatives to create workplace flexibility, according to Tyler Jones, MD, chief medical officer at Banner. 

He said the system's behavioral health division has implemented seven days on/seven days off schedules in collaboration with the physicians. This schedule allows physicians to create clear times with their families so they "can be most present during those longer stretches of time off," said Dr. Jones.

"For our physicians, they're able to schedule other things during those seven days off," he said. "They have the week day, the weekend, as part of that, so they're able to do whatever they want to do in their personal time."

Increased telehealth options also support physician flexibility and support rural health.

"This benefit offers flexibility for our physicians who can work from almost any location. For change of pace, our physicians have the opportunity to move to different units based on clinical interest and need," Dr. Jones said. 

As fewer behavioral health physicians are coming into the office, Dr. Jones said, the ability to have telehealth or flexibility options has become more important as a result of the workplace environment shifting. 

"I think those changes are driving different kinds of expectations," Dr. Jones said. 

Veronica Martin, DNP, RN, senior vice president and chief nursing executive for Houston-based St. Luke's Health, agreed with Mr. Plante that the healthcare workforce environment is evolving. This includes nurses and other clinicians.

"The workforce is different [than in the beginning of the pandemic], and we are having to evaluate and implement new models of care delivery," said Dr. Martin. "In addition, it is no surprise that our workforce has changed. As a result of that, I absolutely believe that the practice environment for nurses and other clinicians definitely has to look different. We have to find ways and opportunities to promote work-life balance for our team and retain our team members."

To address the issue, Dr. Martin is particularly focused on shared decision-making. She said this represents a concept that provides an opportunity for team members to have a voice in their practice environment. Self-scheduling is one example of shared decision-making used at her health system. It enables nurses to schedule in collaboration with their co-workers and supervisor while evaluating the needs of the organization.

St. Luke's, a 16-hospital health system that is also part of CommonSpirit Health, is considering split shifts. For example, two team members may split a shift in half based on the needs of patients and the lifestyles of the individual workers.

Advocate Aurora Health, with dual headquarters in Milwaukee and Downers Grove, Ill., has a similar job-sharing option in place.

"For example, someone nearing retirement can pair up with someone younger who wants more time at home — both going part-time for a while," said Jeffrey Bahr, MD, chief medical group officer at Advocate Aurora Health.

Such a strategy requires detailed planning, but represents one way to bolster scheduling flexibility for nurses, Dr. Martin said. 

St. Luke's is also looking at flexibility in terms of care delivery models and considering ways to prevent burnout in nursing staff. 

"We have to be nimble, we have to evaluate and reevaluate how we deliver care, and we are knee deep in doing that and trialing different models," said Dr. Martin. 

Joyce Newmyer, president of the Oregon region of Roseville, Calif-based Adventist Health and  the newly enshrined chief people officer for the system, said flexibility should come not just for clinical staff members but also for the support staff behind the medical teams. 

Since the pandemic, Ms. Newmyer said she has noticed an increased call for flexibility in the workplace that manifests itself differently depending on whether staff members are patient-facing or not. 

"In the direct patient care roles, we're seeing that a lot more nurses are going per diem and part time to manage their own schedules and their own workflow for something that works for them and their families," she said. 

The support staff roles though, she says, have changed forever. Such positions will never be assumed to be 100 percent in-person at Adventist, Ms. Newmyer told Becker's. With Adventist's offerings for remote and flexible work for nonpatient-facing roles, the system tries to create a strong culture through intentional programs and events that can strengthen bonds virtually. For instance, one team took an hour every Friday, dubbed "Friday fun time," to chat and play games over Zoom.

According to Ms. Newmyer, an important part in encouraging health organizations to embrace the shift to flexible working is getting leaders on board and in a position to listen to what workers need. 

"We're going to have to increase the leadership development activities in that space to help people understand how to lead virtual teams, how to lead hybrid teams," she said. "So it's really about open minds, listening and responding in a way that works for people.  We want to recruit and retain the very best talent, and if you're not flexible, they'll find someone who is."

Messages to executives

When it comes to providing flexible working options for staff, Mr. Plante encouraged his hospital peers to embrace shared governance and ensure staff have a voice in decisions.

Dr. Martin has a similar message: "It is important that we embrace, and think about differently, how we do our daily work, how our teams do our daily work, that we need to be nimble, we need to be open to new ideas, we need to listen to the voice of our bedside staff, and then the voice of the staff is doing the work every day.

"And that will require us to maybe change old models of care and apply new ways of thinking. This workforce wants flexibility; they want the opportunity to have a voice in the work that they do every day," she said.

She also encourages her peers to remember the value of technology and how it can help support and supplement nurses in their work.

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