How 2 CNOs are flexing schedules to meet the needs of a changing nurse workforce

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One thing has become clear during the COVID-19 pandemic: The nursing workforce is evolving.

Take staffing, for example. The public health crisis highlighted staffing shortages, and many nurses adjusted their work schedules, worked in hospital areas outside their typical roles, and/or were deployed to other organizations as needed, based on pandemic circumstances. At the same time, nurses have juggled evolving workplace protocols, as well as home responsibilities such as child care. 

Some nurses even decided to leave their jobs amid the challenges.    

"I personally experienced my burnout after working for two years in the medical intensive care unit," Haleigh Sullivan, BSN, RN, an aesthetic nurse at Aesthetic MdR in Marina Del Rey, Calif., told Becker's in April. "Long night shifts, nights of being on call and considering getting a second job to sustain my husband and me while he pursued his MBA, all led to my decision to transition into outpatient plastic surgery."

Pandemic challenges also resulted in more focus on the well-being of nurses. It's become more important than ever to offer flexible work schedules to boost nurse satisfaction.  

Gay Landstrom, PhD, RN, chief nursing officer of Livonia, Mich.-based Trinity Health, and Tracey Moffatt, BSN, RN, chief nursing officer and vice president for quality at New Orleans-based Ochsner Health, have heard about the importance of a flexible schedule firsthand from their staffs.

Becker's recently spoke with Dr. Landstrom and Ms. Moffatt to understand how their health systems are providing flexible work models. 

Ochsner Health

At Ochsner Health, which has more than 8,000 nurses, shorter shifts are offered. Nurses have typically worked from 7 a.m. to 7 p.m. or 7 p.m. to 7 a.m. However, the health system also now considers whether some nurses want to start later in the shift — at 10 or 11 a.m. 

Ms. Moffatt said the health system evaluated data related to throughput and peak demand for patient care, and where it can create shorter or more flexible shifts, it can offer a late start or midshift assignment.

She said nurses who want to work more hours can participate in a four-week contract where they agree to an extra shift weekly outside of their normal 36 hours. The contract provides significant additional compensation. 

The health system also continues to use travel agency nurses to address staffing needs that arise.

"We're trying to address stressors from both ends: 'I'm exhausted, and I need time off' or 'I'm stressed out by the lack of family income I have, and I need to earn more money,'" Ms. Moffatt said. 

Additionally, Ochsner Health uses a systemwide float pool for nurses who are flexible and willing to work at different campuses. 

Trinity Health 

At Trinity Health, which has more than 30,000 registered nurses, a program called FirstChoice offers travel nursing career options as well as scheduling flexibility. 

The program launched about 12 years ago as nurses expressed an interest in more flexible schedules.

"Nurses, particularly in acute care hospitals, if they work full-time, they're likely working three 12-hour shifts a week. They're working every two or three weekends. These nurses, they're willing to work weekends, they're willing to work nights, but it has to match up with their personal life and the other demands on their time," said Dr. Landstrom.

She said Trinity Health saw that interest grow steadily in multiple generations of nurses, and it started to expand the FirstChoice program. 

FirstChoice now consists of two components: a national program, started in March 2020, and a component focused on regional hubs.  

"With the pandemic, we saw many nurses across the country speak about nurses leaving to take travel assignments. Maybe they had never traveled before, but the dollars that were being offered in some of the peak surge times [with travel assignments] couldn't be denied. Nurses might have school loans or there might be many reasons they were willing to leave their organization hometown and travel for the dollar," said Dr. Landstrom.

She said many nurses enjoyed the lifestyle shift they had doing travel assignments, and Trinity Health now has a structure they can come back into at the health system, in which they are treated like a travel nurse in terms of flexibility. 

As part of the structure, nurses are employed by Trinity Health and take on longer travel assignments at facilities in the U.S. These assignments could be four or eight or 13 weeks. 

Trinity Health also created hubs in each of its regions. For example, a hub for Michigan and one for Ohio. Nurses, respiratory therapists and others can work within their region, going between different regional facilities, possibly daily. 

"They're flexible, and in return we give them the flexibility they demand," Dr. Landstrom said.  

Dr. Landstrom said FirstChoice has helped to retain about 1,300 nurses in the Trinity Health network and fill critical positions during the pandemic. It has also steadily grown throughout the public health crisis, and there are now more than 300 nurses in that national travel program. 

"I believe this flexible, mobile workforce is going to be a growing percentage of the clinical workforce in any part of the country, and we're planning to that end," said Dr. Landstrom. "I think the demands of people's lives are changing what they need from their job, particularly the scheduling and where they commit their time. I think it is a permanent change. It has grown during the pandemic. It may well continue to grow."

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