How Mercy embraced a gig mindset for nursing

Mercy, a multistate health system based in Chesterfield, Mo., has harnessed an employment model usually associated with ride-share services and food delivery and applied it to nursing. 

The system saw the effects of the COVID-19 pandemic on nurses. Some workers left their local hospital jobs to take travel nursing opportunities. Nurses were also struggling with effects on their physical and mental well-being, leading some to retire early or relinquish bedside positions. That's why Mercy rolled out Mercy Works on Demand, an app and online platform that allows the health system's full and part-time nurses — and other experienced nurses in the area — to easily pick up gig shifts.

Mercy launched a pilot program at Mercy Hospital Springfield (Mo.) and, last spring, rolled out the on-demand platform across the health system. Mercy includes more than 40 hospitals and more than 40,000 employees in Missouri, Oklahoma, Arkansas and Kansas. The health system also has clinics, outpatient services and outreach ministries in Arkansas, Louisiana, Mississippi and Texas.

Since the implementation of Mercy Works on Demand systemwide, the option has been a significant draw for workers, Betty Jo Rocchio, DNP, RN, CRNA, CENP, EBP-C, senior vice president and chief nursing officer across the Mercy system, told Becker's.

"I don't know that I would have imagined it would have taken off this wildly successful, but it continues to be so popular," she said. "And when you look at what's coming out in the literature today, you can likely see why, because … it is putting more hands at the bedside. It's decreasing workload across all of nursing, and that impact to all clinical coworkers and patients. So, when our gig nurses come into Mercy, they're experiencing decreased workloads they don't get in other environments."

Dr. Rocchio also said the initiative continues to be popular because nurses can select when they work, "providing control and joy back in practice for people that might have been experiencing some burnout coming off of COVID. They're now starting to experience the joy of their profession again."

Since April, right before implementation, Mercy's fill rate — a measure that indicates the care and resources available to patients based on front-line staffing — has improved by 2 percent, achieving a target fill rate of 86 percent, according to the health system, which used the most current pay period data as of Nov. 12. Additionally, in that period, Mercy's labor per equivalent patient day (total cost to deliver care) has decreased by 12 percent, and average hourly rate (cost of resource) has decreased 10 percent. Mercy has also cut its agency spend in half. 

"We take our patient census … and it's bumped up against the number of people we have available to work, or number of nurses that we have actively scheduled on our shifts," Dr. Rocchio explained. "And your fill rate goes up as you have people scheduled to work. And you have the right ratios, meeting your patient demand. That's a really good measure of workload — how you're spreading the workload among the people you have available."

She said this flexible layer played a key role in the decision to launch Mercy's on-demand platform. For instance, a nurse who is employed by Mercy but has their primary job at another system could pick up extra shifts at Mercy. 

Overall, Mercy has hired about 1,100 gig nurses, including hundreds of nurses who worked for Mercy in some type of capacity, such as through a contract agency, and transferred into a gig role.

Dr. Rocchio praised the momentum the system has had with the new approach, including a higher retention rate, while also acknowledging challenges and additional steps ahead.

"We're going to optimize where we are today, continue to hire. But as we hire a more flexible workforce, the next body of work is turning toward the work environment and workflows to make sure that we are supporting workers in the right way," she said.  

This means ensuring all digital components of the program, including educational materials, are in place, said Dr. Rocchio.

And amid today's workforce shortages, she recommended that hospitals and health systems redesign how they view their workforce and implement approaches that provide flexibility regarding work and scheduling. 

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