Stretching for flexibility is critical not only to physical fitness but to the health and wellbeing of any institution or business. For example, a hospital that is inflexible in its approach to the real-world needs of its staff is going to potentially have difficulty in retaining some of its workers or attracting new ones. It has become evident in recent years that this is especially true when it comes to the hospital nursing staff. But how much flexibility is warranted?
The New Reality
Perhaps nothing else has had so dramatic an impact on the way hospitals think about staffing as the COVID-19 event. It was a game changer and paradigm shifter. Many RNs were removed from the workforce—either voluntarily or forced (due to a refusal to obtain the mandated shot)—which translated to an increasing workload borne by a decreasing workforce. This spiraling circumstance, in turn, led to the much heralded “burnout” issues experienced among the facilities’ clinical staff.
So, what we saw in the first two or three years of the 2020s was a vicious cycle. Hospitals knew they had to come up with strategies to intervene and stop the downward trend of nurse departures. What many decided on was a concerted effort to provide greater flexibility to nurses so as to ease their fatigue and secure their services over the long term.
Delineating the Approach
So, what exactly are we talking about? In order to help their nurses achieve a more amenable work-life balance and greater happiness while on the clock, hospitals have designed and offered a number of approaches. We’ve mentioned flexibility, but what specific items or areas are being flexed? And what does that look like from a practical, day-to-day perspective?
According to a recent study cited in Becker’s Clinical Leadership, hospital systems have implemented a number of flexibilities, including adding virtual nursing options or offering internal traveler and “gig programs.” According to Robin Baldauf, MSN, RN, chief nursing officer of the Bon Secours Hampton Roads market, "I think the possibilities are endless, especially with AI coming on board and the idea of virtual nursing."
According to Beckers, virtual nursing has been rising as a popular form of flexibility. Here are some examples from across the country:
- Nashville-based HCA Healthcare is increasingly hiring nurses to work from home in its virtual nursing program.
- Lawrence + Memorial Hospital in New London, CT, requires its virtual nurses to work onsite and take on bedside shifts two times a month.
- At Providence in Renton, WA, a virtual nurse program called Co-Caring, conceived by nurses, is being implemented across seven Western states. "Our facilities believe they’re achieving the right balance of work flexibility, as defined by our nurses who have implemented Co-Caring," according to Syl Trepanier, DPN, RN, chief nursing officer at Providence.
Hospitals and health systems are also offering flexibility in their schedule options. This might involve internal travel options and float schedules—to include within the same facility or among sister facilities within the market or system. There are some hospital systems even offering self-scheduling for nurses. Jared Vaughn, an RN for several years at a Baton Rouge medical center, has had the flexibility of determining his own schedule for some time now, as long as he pulls at least two regularly scheduled shifts every six weeks.
The Limits of Leniency
Critical to determining how much flexibility to grant your nurses and other clinical staff is communication. Hospital administrators may want to engage their nurses in casual or formal conversations to elicit their own ideas on appropriate schedule parameters. It’s clear that not every suggestion can be implemented by administration as chaos could ensue. But the very act of including the staff’s ideas and suggestions, as well as listening to their concerns, will have a positive effect on the caregiver’s psyche and enhance their sense of loyalty. Knowing that your institution is invested in your concerns goes a long way in keeping staff assuaged or even hopeful.
So, what are the limits of this flexibility? According to the Becker’s study, “The moment it negatively impacts patient safety or staff, it's a no-go.” Terry McDonnell, DNP, RN, senior vice president and chief nursing executive at Durham-based Duke University Health System, provided the following advice:
You have to put guardrails in, and you need to ensure that you're keeping an eye on the very core principles of the work we are trying to deliver. If it's going to erode the satisfaction and the ability of the team to come together and work effectively, you also have to deprioritize those.
The bottom line is that healthcare systems and individual hospital departments have to look at the ebb and flow of volume. Understanding and coordinating how patients are admitted and discharged against peak volume time is key to ensuring the hospital has the appropriate number of clinical workers for any given day and hour. In other words, hospital decisionmakers will need to stretch their thinking to allow for the right level of flexibility to ensure both staff happiness and patient safety.