Why a Texas system hasn't hired a travel nurse in 30 years

Beth Schmidt remembers the last time Fort Worth, Texas-based Cook Children's Health Care System hired a travel nurse, and it was not recently. 

"As far as travel nurses in our hospital, the last one we had was 30 years ago," Ms. Schmidt, who serves as the health system's vice president of human resources, told Becker's. "I just celebrated my 30th anniversary with Cook Children's, and I remember the last travel nurse that we had. It was about a month into my employment."

Many hospitals and health systems increased their reliance on travel nurses during the pandemic to fill vacancies. However, a number of organizations are now making efforts to decrease their dependence for financial reasons.

Cook Children's has taken a different approach that has resulted in no travel nurse hires. 

"We made a decision that we wanted our employees to take care of our patients, and we've been able to stick with that. Sometimes it was easier than other times, but we've been able to do that," said Ms. Schmidt. 

Winter Plan, a program implemented 15 to 20 years ago in Cook Children's hospitals, is not tied to the last travel nurse hired 30 years ago. However, Winter Plan allows Cook Children's to increase staffing without hiring travel nurses. Workers in the program temporarily become Cook Children's employees for four to six months to help augment the health system's nursing staff. 

"And then a couple of our other clinical areas like respiratory therapy during the winter months, they're paid, they are what we consider temporary employees," Ms. Schmidt explained. 

She said some workers participate in the program year after year, but they are paid at a higher base rate. Winter Plan employees are not eligible for benefits because of the shorter duration of their employment.

Winter Plan "has helped us staff up when [patient volume] goes up, allowed our employees to have some breathing space to allow them to take time off when they need to take time off," said Ms. Schmidt. It also "allows us to take the number of patients that we need to take when volumes increase.

"So that's been a beneficial program and I think one of the reasons that we haven't had to go to travel staffing or external staffing within the organization."

Winter Plan is only part of the larger efforts at Cook Children's to reduce turnover in the workforce. Other initiatives include six weeks of paid leave for new parents, which takes effect this summer, as well as no increase to employees' insurance premiums.

As a result of these and other initiatives, Cook Children's, which has more than 9,700 employees total, has a current turnover rate of 12%, below what it was during the pandemic and close to the pre-pandemic rate of 11.5%.

"In the past year, we staffed up our base level staffing in several of our areas, primarily nursing, in the hospital, to have enough staff for what seems to be the new normal as far as volume is concerned," Ms. Schmidt said. 

"And then we continually try to listen to what our employees need, whether that is a new benefit option, work issues, how we do things, how we don't do things. We're very much a culture of support, teamwork. Family is one of the terms we use frequently. And I think it's really a combination of all of those things and many more that allow us to have the retention that we have, attract the candidates that we attract, and have the engagement and culture that we have here at Cook Children's."

Editor's note: This article was updated at 4:40 p.m. CDT March 28.

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