Gaps in the nursing workforce remain elevated, with an 18.4% hospital turnover rate for registered nurses and an RN vacancy rate of 9.9%, a recent report shows. In fact, more than half of hospitals face nurse vacancy rates of 10% or higher.
It’s a sign of the need to seriously evaluate how we are filling nursing shifts, rather than clinging to a full-time-only model for support or expecting part-time nurses to work exclusively for the hospital or health system.
The Business Case for an Expansive Approach
It would be unwise to ignore any option for closing nursing workforce gaps, especially when the qualitative and quantitative case for doing so could strengthen nurse retention and recruitment as well as patient satisfaction and revenue.
The nurse staffing shortage didn’t start with the pandemic, though COVID did exacerbate nurses’ feelings of dissatisfaction with familiar workforce challenges, from decreased time for direct patient care to rising administrative demands to the desire for greater time for professional growth. It’s an area where McKinsey & Company believes flexibility in care delivery models and operations could attract more people to nursing roles and improve nurse work-life balance, strengthening retention.
These are just some of the reasons why a pragmatic approach to solving for nurse staffing gaps—one that considers caregiver work more flexibly—is becoming an essential way for hospitals to ensure they have access to the right levels of nurse staffing, when and where they are needed.
For instance, the per diem nurse staffing market is rapidly expanding, set to reach $16.4 billion by 2033, up from $8.7 billion in 2023. When hospitals take the necessary steps so that they can lean in are willing to lean toward support from contingent or contract nurses leverage tech-enabled platforms that reimagine how nurses are assigned to shifts, allowing nurses to select specific openings rather than take on a predetermined number of shifts, our experience shows that 56% of shifts posted are filled within 24 hours of the shift start time. Moreover:
- 1 out of 4 nurses who join hospital teams as 1099 resources ultimately choose employment with that hospital.
- Filling 10% to 15% of open nursing shifts with 1099 nurse support over the course of six months not only reduced turnover rates for hospitals, but also decreased nurse vacancy rates by 27%.
For hospitals that deploy this type of staffing model, the impact of diversifying staffing pools extends beyond the initial burst of 1099 hiring. Over time, it proves essential to continued nurse staffing success. In fact, in Q2 2024, several hospitals that attempted to pull back on their use of 1099 nurses in favor of a W-2-only approach ended up paying more than three times more for nurse staffing—and went back to posting shifts through a tech-enabled platform, where needed.
There is also a rising reliance on certified nursing assistant (CNA) staffing in nursing homes—and it’s a tactic that hospitals could consider incorporating. Here’s the math: CNA support from 1099s typically saves 35% an hour when compared to staffing costs of RN only.
Tips for Building in Greater Flexibility
By expanding their viewpoint around how to meet nurse staffing needs, hospital leaders can more effectively build up their nursing work pool while generating better financial and staffing outcomes for their organization. Here are three tips for building out a more expansive approach.
Put nurses in control of determining where and when they work. By posting open shifts and allowing all available nurses to have visibility, it creates a level of flexibility that appeals to nurses who may have left full-time positions. Transparently sharing open shift needs with all parties creates an environment where the manager will have more data at the moment they need to make decisions for the organization. It enables them to be better fiduciary partners to their finance teams. The additional data is also a cost-saver for hospitals and a lever for building long-term relationships with nurses who may one day wish to take on a full-time position again.
Resist the urge to ask for an exclusivity agreement. This is an alarmist approach that threatens to put off nurses who may wish to ensure your organization is the right fit before making a regular commitment. Instead, focus on building connections with the nurses who are attracted to contract positions at your organization. When both sides sense it’s the right match, you won’t need an exclusivity agreement to keep a nurse coming back or signing up to join your team full-time.
Do your own math. Track the gains you’ve made around quality of care and patient satisfaction as well as financially by incorporating a wider mix of nurse staffing approaches. Survey contract nurses, too, to break down what works and what doesn’t in your approach to staffing. Understanding where gains are being made and where opportunities for improvement exist is vital to developing a sustainable nurse staffing approach for the long term.
About Curtis Anderson
Curtis Anderson is the CEO and founder of Nursa, which exists to put a nurse at the bedside of every patient in need. Curtis purchased a staffing agency and quickly saw there was a more efficient digital way to help nurses, facilities, and patients. Nursa’s early days were bootstrapped with personal cash. The company grew from 20,000 to 2.5MM patient hours annually in less than 36 months. Today Nursa is headquartered outside of Salt Lake City, and the entire team is passionate about making the process of care delivery more efficient for everyone. Nursa has now raised over $100M and is trusted by a growing community of more than 1,500 facilities and 100,000 nurses nationwide.
