To say the pandemic has dramatically changed every aspect of our lives would be gross understatement. And honestly, too much of the story has centered on anti-mask protests, the economic downfalls from business closures, people refusing to follow safety ordinances like social distancing, and a bizarre rallying cry that we just open everything back up, All of this negates the tremendous struggles that medical professionals endure on a daily basis. With unfathomable responsibilities and an interminable influx of new patients, our healthcare workers are maxed out. Travel nurses, float pools, and seasonal contract nurses are essential to filling staffing gaps across the country. But optimizing their contributions and ensuring their retention requires a best-practices staffing approach that emphasizes support, cultivates engagement, and relies on strategic planning.

Hospitals Have Already Surpassed Their Limits

Since the outbreak of the novel coronavirus (COVID-19), the U.S. healthcare system has been put to a seemingly impossible test. “As the coronavirus pandemic surges across the country,” Reed Abelson wrote in the New York Times this past November, “hospitals are facing a crisis-level shortage of beds and staff to provide adequate care for patients.”

“A record number of Americans — 90,000 — are now hospitalized with Covid, and new cases of infection had been climbing to nearly 200,000 daily,” the article continued. 

During the summer of 2020, experts had already warned of a “dark winter.” If the situation seemed dire at Thanksgiving, the following months did nothing to abate it. Citing a framework developed by the Institute for Health Metrics and Evaluation at the University of Washington, NPR reported that health officials determined hospital capacity in excess of 20% to represent “extreme stress.” The threshold gets higher for ICU capacity, in which 60% occupancy is considered “extreme stress.” 

Here’s the problem. According to the Health and Human Services (HHS) data on estimated U.S. hospital utilization, the national average for inpatient beds has climbed to 72.27%, with ICU capacity at 75.57%. That means, across the board, our hospitals have attained a dangerous and difficult-to-sustain shortage of available beds.

The average national turnover rate for nurses is typically 17% annually, with some regions reaching as high as 40%. The pandemic has had a profoundly detrimental impact on those figures. We now confront the worst nursing staffing shortage in decades, with 60% of nurses and 20% of physicians preparing to exit their professions directly because of COVID-19. Analysts project these departures to cost individual hospitals an average of $5 million in turnover per year—about $137 billion overall.

Yes, it may be a boom-time for staffing companies that specialize in nursing, but there’s a world of difference between filling an open position and keeping a sorely needed individual in that role.

Float Pools in Nursing

Float pools are pipelines of pre-qualified, credentialed, and immediately deployable nurses who travel between facilities to fill open positions or shortages. They can operate across departments (e.g. ICU, NICU, et al.) or hospital networks throughout cities. 

• Some facilities create float pools in which selected nurses transition between units as needed. This structure often results in lower attrition and higher job satisfaction. Nurses in these scenarios have access to dedicated teams, more intimate familiarity with the hospital, and the opportunity to develop greater longevity in their rapport with known patients.
• Other nurses choose to become travel nurses or locum tenens nurse practitioners, temporarily filling positions across different hospitals on behalf of a staffing agency that functions as their employer of record. The advantages here are variety, developing skills through full practice opportunities, testing out a job or hospital system, gaining more independence and flexibility in scheduling, controlling their workloads, and supplementing their incomes.
  

For staffing agencies who provide travel and temporary nurses, the work should never end at simply making the placement. In fact, it’s just the beginning.

Best Staffing Practices for Float Pools

Assignment Control

Daily travel assignments can vary wildly depending on whether nurses are supporting a single hospital or several within a network. To effectively support their nurses and the outcome of the engagement, staffing agencies must coordinate with clients and nurses to optimize the assignment.

• Work with nurses to determine their ideal schedules, including shifts, shift hours, holidays, and the dates and times they want to be on call. As staffing providers build out their float pools, they should use this information to create strategic staffing plans that ensure coverage for all client needs while satisfying the expectations and preferences of the nurses in the pool.
• Determine the type of pay best suited to the nurse and his or her assignment. You can offer traditional payrolling structures like full-time or part-time, which guarantee rates and hours each week, or per diem.
• Many hospitals encourage nurses to decline assignments if they have no comfort level with a specific unit, such as ICU or labor and delivery. In terms of maintaining patient safety and superior levels of care, this is an endorsed practice. Staffing agencies should be proactive by gathering this information upfront from their nurses and incorporate that data into staffing plans. This way, the best-matched nurse is always dispatched to a commensurate assignment without disruptions or surprises.
• When floating between hospitals, nurses may encounter new protocols or procedures. Confronting an unpredictable situation will complicate performance and satisfaction. Savvy staffing providers should take the initiative to learn as much as they can about the hospital’s demands, expectations, processes, procedures, operating environment, culture, and other relevant details. By incorporating these elements into an adaptive onboarding experience, nurses will be better prepared to hit the ground running.
  

Socialization

Without a sense or permanence, firm roots in a company culture, or a static group of colleagues, travel nursing can compromise the socialization that helps workplaces thrive. It’s not an easy situation to solve due to the nature of the arrangement. That doesn’t mean, however, that committed staffing agencies can’t try. Some nurses will form relationships within the hospitals they support. Beyond that, staffing agencies can step up their games by hosting events, forums, mentoring sessions, informal gatherings, and knowledge sharing groups within the community of nurses on their staffs. If anything, the pandemic has taught us that video conferencing and virtual hangouts can be effective substitutes when physical distancing is unavoidable.

Not only can this strategy heighten the sense of community and culture among the talent employed by the staffing agency, the diversity of perspectives can become a powerful tool for strengthening the acumen and development of nurses in the float pool.

Use Technology

As Medefis explained in a relevant blog post, “A strategic staffing plan is a health system’s way to prepare for anything the world throws at them: open shifts, Joint Commission inspections, and budget fluctuations. Health systems need to think ahead so that they have these plans in place. Float pool management is an important aspect of a strategic staffing plan, as it creates a constantly updated list of approved providers to fill open shifts.”

We believe this same process should be carried out by staffing agencies who recruit and place travel nurses. And the existing workforce technologies and management systems can help automate, streamline, and expedite comprehensive planning. The functionality of leading applicant tracking systems (ATS), vendor management systems (VMS), hiring platforms, and other human resource information systems (HRIS) can accommodate most of the requirements.

• Tracking credentials. As with any other type of license, workforce systems can store credentialing information, track compliance, and send out alerts when expiration dates approach to ensure that they are always current and accurate.
• Automating staffing plans. Most aspects of the staffing plans we previously discussed can be configured into standard workforce technologies. This would include scheduling information, available shifts, and other data vital to forecasting needs, pipelining nurses for openings or unanticipated absences, and filling gaps immediately. The more details collected by the system, the more intelligent it becomes. Such data can fuel worker satisfaction and client performance. These platforms can also track which nurses are unionized to uphold any additional regulatory rules.
• Mobile capabilities. “Mobile apps allow contingent, per diem, and any other type of worker to clock in and out in a way that works best for them,” Medefis wrote. “Hospitals can then approve these timestamps, making the process run much smoother.” Once again, most staffing and vendor management systems have built-in features to match these needs.

Caring for the Caregivers

Nurses may not make the news as much as politicians and protesters, but they have always been at the frontlines of this pandemic. Their sacrifices, obligations, and commitment to duty are nothing short of heroic. Their contributions to our welfare must continue, just as our support of their tireless efforts must not sway. Staffing agencies can’t just capitalize on the circumstances as a business win. They must embrace a hands-on, supportive, and collaborative partnership with nurses to champion their success.