A recent study by Works & Trusted Health of more than 500 frontline nurses found a key to increasing satisfaction in the nursing field is to provide more flexibility in work arrangements, including a nurse’s ability to self-schedule the days and shift times they work.
24% of nurses surveyed said the need to schedule their life four to six weeks at a time causes significant dissatisfaction in their career and poor mental health.
THE PROBLEM
Further, from 2020 to 2021, the nursing workforce experienced the largest dip since the 1980s: The total supply of registered nurses decreased by more than 100,000. A study published in Health Affairs concluded a significant number of those 100,000 nurses were under the age of 35.
There are many converging trends contributing to strained clinical resources and nurse exits: an aging patient population, residual burnout from the COVID-19 pandemic and changing workforce preferences.
Over the past few years, workplaces at Mercy, a 50-hospital health system based in St. Louis, Missouri, have transformed into representing five generations, each with different working preferences. As a result, coworkers today are placing a far greater emphasis on work/life balance and flexible compensation.
These preferences are more pronounced for Millennials and Gen Z than Generation X and Baby Boomers, but the trends are increasingly cross-cutting.
“During the pandemic, Mercy nurses departed for increased compensation, but pay wasn’t the main driver,” said Betty Jo Rocchio, senior vice president and chief nurse executive at Mercy. “Their workload for what we were paying them was the catalyst. Clinicians are no longer tolerating pre-pandemic working conditions and they want more control over their schedules.
“The Works & Trusted Health study of frontline nurses shows one in three felt not having control over which days they work creates a significant barrier to them feeling fulfilled and sustained by their careers,” she continued. “To create a more sustainable workforce and reduce our reliance on external staffing sources, like travel nurses, Mercy wanted to offer more flexible work opportunities for our clinicians and drive administrative efficiencies while doing so.”
Mercy had tried different incentives and staffing models, but was never able to fully optimize staff, which is why it turned to vendor Works & Trusted Health to help it improve its staffing model, she added.
PROPOSAL
After meeting with Works, the Mercy team knew the company was the right one to work on a technology platform with the health system, Rocchio said.
“Our shared goal was to make our nurses’ lives easier by giving them more flexibility, and therefore more control, over their weekly schedules,” she said. “We wanted to drive workforce efficiencies, attract and retain quality talent, and decrease unnecessary labor costs. Mercy is a leader in innovation so we knew that changing this mentality would require a bold new vision for redesigning the nurse staffing model.
“On the front end, the vendor outlined that Mercy could offer our nurses scheduling flexibility in a seamless, person-centered app that would be easy to use and transparent about the shift details – length, pay, colleagues on the shift, etc.,” she continued. “The app would give both frontline nurses and clinical staff a frictionless way to pick up more shifts and reduce time spent shuffling and managing schedules.”
On the back end, the vendor provided Mercy with data and analytics captured from the software that gives Mercy better insight into how to optimize care delivery and manage clinical labor.
MEETING THE CHALLENGE
The platform was designed to enable Mercy to take stock of every workforce layer, including the health system’s core nurses, local and regional float pools, and gig nurses.
“Beyond that, we wanted to automate the way Mercy fills shifts,” Rocchio explained. “We collaborated with the vendor to identify nurses in Mercy’s recruiting pool, flag open shifts, and push available shifts to best-fit nurses based on their preferences and experience.
“When open shifts remain, our core nurse workforce use the app to pick up incentive shifts,” she continued. “We share remaining open incentive shifts with our gig and per diem workforce. Clinicians simply tap to pick up a shift and it is automatically logged in our staffing and scheduling system. This technology-powered workforce management system lowers costs, increases fill rates, and dramatically reduces the amount of time nurse managers spend trying to fill shifts.”
After much discussion and collaboration with the Works team, Mercy began the process of modernizing its procurement of long-term agency labor with two of the vendor’s programs: Works Flex and Works OnDemand.
“At every step, open communication and idea sharing were priorities to confirm that we were acutely solving the major concerns of our staffing model and keeping every stakeholder in mind – from frontline nurses to staffing managers, administrators, leadership and of course patients,” Rocchio said.
“Using Works Flex, a robust VMS tool, we were able to streamline burdensome processes, drive workflow automation, and refocus the user experience for the clinical hiring manager, a pillar of the staffing process that is so often overlooked and overworked,” she continued. “We then implemented Works OnDemand to power autonomous open shift recruitment across our 50-hospital system, enabling us to predict scheduling gaps and intelligently recruit the best-fit clinician for every open shift.”
By leveraging the vendor’s artificial intelligence engine and proprietary behavioral shift pricing algorithm, Mercy was able to identify which available clinicians were interested in which shifts, load balance shift matches, and selectively recruit to balance-fill rate and spend. All of this minimized Mercy’s reliance on an external labor source and mitigated the risk of overspending on a staffing agency.
“The AI-powered workforce management platform enabled our team to create a more flexible workforce – a combination of core workforce, regional and local float pools, and internal gig nurses – which we know boosts overall morale and limits the potential for clinician burnout,” Rocchio noted. “We’re using AI to identify the appropriate incentive premium to offer to ensure an open shift is filled without overspending.
“Within one year of implementing Mercy Works on Demand, we reduced labor costs, administrative workload and nurse turnover while supporting patient volumes and safe nurse staffing levels,” she added.
RESULTS
From the start, Mercy’s goals were threefold: to drive workforce efficiency, attract and retain quality talent, and decrease unnecessary labor costs. Through using the AI-powered workforce technology, the health system has improved operations efficiency through automation, reduced labor costs with dynamic incentive pricing, and cut down reliance on travel nurses by systemizing talent, Rocchio reported.
“One way to see how this has taken shape is to examine our staffing breakdown: before deploying the technology, our staff was 67% core staff, 8% flexible staff (including local and regional float pools), and 25% agency staff,” she explained. “After, the mix became 69% core, 23% flexible and gig staff, and only 8% agency staff.
“In 2023, by reducing our reliance on travel nurses, we were able to realize $30.7 million worth of savings associated with rate reductions in premium labor spend,” she continued. “These savings were possible due to the availability of an alternative flexible workforce, float pools and gig workers who became more easily discoverable through the platform.”
Beyond the savings, the technology platform has yielded a 20% decrease in time spent on staffing and scheduling tasks, an increase in the organization’s fill rate from 83% to 86%, and an 8% reduction in turnover, including a 9% reduction in first-year turnover, she added.
“All of this signals to us that we are not only driving savings but providing priceless flexibility to our staff that will allow them to feel more fulfilled in their careers and sustain themselves through their profession,” she said.
ADVICE FOR OTHERS
Mercy’s ability to maximize flexibility, give more choice to staff, scale the technology and meet monetary goals is due in part to its commitment to monitoring this incoming data and these outcomes daily, Rocchio advised.
“We are constantly making tweaks to sustain this level of success, and that is what I would advise any other health system leader to keep in mind: There is no one-size-fits-all solution to staffing,” she said. “It’s a delicate dance that requires continuous analysis and monitoring, beyond the tool that you’re using.
“For other healthcare leaders looking to better manage their workforce with a staffing platform, automation is a must – especially if you want to scale across multiple hospital locations,” she concluded. “Every piece of data should automatically flow through your systems to maintain fairness and transparency in paying for shifts across health systems, leading to both better margins and more flexibility for your staff.”
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