Executive Summary
Staff engagement impacts both cost and quality outcomes in health systems. Key findings from
a survey of 76 healthcare nursing and human resources leaders include:
Voluntary nurse turnover continues to be a challenge, especially among millennials.
The two factors that have the biggest impact on nurse engagement are unsustainable and/or
unbalanced workloads and work/life balance.
The five staffing strategies that respondents feel can help boost engagement are:
- Successful and effective incentive program(s) to fill difficult shifts
- Staffing based on patient need
- Self-Scheduling
- More nurses working to top of their license
- Equitable workloads
Staff Engagement Impacts Both Cost and Quality Metrics
Healthcare is in the business of caring, and engagement from the staff that deliver and support that care is essential to the organization’s financial and clinical outcomes. As the Chief Nursing Officer at a regional medical center in Florida explains, “It is challenging to get staff to participate in cost containment when they are not engaged or are minimally engaged, as they don’t see ‘What’s in it for me?’ And, overall, I think staff still strive to do the right things for patients. That being said, I do see some individuals who are on the low end of engagement be less diligent about certain details or expectations related to patient care.”
Engagement and retainment are linked, and it’s important to promote engagement to improve retention and mitigate the costly consequences of turnover. As the AVP of Nursing Workforce Management at a health system with more than 5,000 nurses in the Gulf South describes, “Engagement is an important component for retaining staff. Although simply being engaged does not guarantee retention, it certainly is an element we must foster. Turnover has a significant impact on cost containment both in terms of cost to hire, but also in replacement staff costs, such as overtime and agency – or worse, being short staffed, which often leads to more turnover.”
How workforce management policy and practice can damage staff engagement and increase turnover
In a survey of 76 healthcare nursing and human resources executives conducted in January, 2018, respondents named unsustainable and/or unbalanced workloads (66%) and work/life balance (61%) as the two factors with the biggest impact on their voluntary nursing turnover rate.
Focusing on workforce management strategy, processes and technology can have a positive effect on providing employees with sustainable, balanced workloads and a better work/life balance. As the AVP of Nursing Workforce Management at the large health system in the Gulf South explains, “Staffing plans and actual staffing have a real impact on morale and turnover. If you are ‘fully’ staffed and employees feel overwhelmed all of the time or believe they cannot do their job well, they will leave feeling demoralized after every shift. This is a recipe for high turnover, particularly when chronic.”
The VP at Operations at a specialized medical center in California elaborates, “Few professionals are more sensitive to staffing changes as nurses. Clearly, they carry some of the heaviest workloads of all healthcare professionals. In my experience, adjusting nurse to patient ratios beyond levels that are reasonably accepted as being safe and effective for the provision of appropriate care is a bullet train to disgruntlement and lack of engagement by staff. Many employee turnover surveys show that changes to nurse to patient ratios are reflected as the ‘safe work environment’ reason for turnover. Schedules are also an important concern for many nurses, particularly millennials, as they seek optimal work-life balance.”
The processes and policies around how schedules are created and open shifts are filled have a direct connection to staff satisfaction. As a Chief Nursing Officer and Vice President of Nursing at a 5,700-employee health system in the South explains, “Staff want to feel like staffing is done with them, not to them. While our first priority is meeting patient needs, we also have an obligation to provide staff with schedule predictability and flexibility.”
Staffing Strategies that Boost Staff Engagement
Health systems are turning to staffing technology, practices and programs that allow staff to be involved and engaged in staffing and scheduling processes. A strategy that provides flexibility and collaboration is the key to increasing staff engagement.
“First, flexible scheduling is important. I think we are only beginning to understand what that means. But at its foundation, we must start with giving employees active involvement with creating their schedule. Alternative shift times is another option that might appeal to staff. These are important elements that actually cost little or nothing, but can add complexity and thus may be viewed reluctantly by leaders,” says the AVP of Nursing Workforce Management at the health system in the Gulf South.
The VP of Operations in California explains how technology supports their staffing practices, “Our use of an automated staff scheduling system allows for more transparent, consistent, and efficient staff scheduling.”
This leads to two primary outcomes:
- Ensuring that an appropriate number of competent staff are available to take care of a designated patient volume;
- Ensuring staff’s work-life balance through equitable scheduling.
So, which workforce management strategies, processes and technologies should healthcare organizations focus on if they want to improve staff engagement? The survey of healthcare nursing and HR executives revealed five initiatives to incorporate into a workforce management strategy to increase staff engagement.
Let’s take a closer look at each of these strategies:
1 – Incentive program(s) to fill difficult shifts
The Workforce Management team has seen clients successfully utilize both monetary and points-based incentive programs to successfully find staff for their difficult-to-fill shifts. Whether the incentives are monetary or non-monetary, providing staff with the ability to volunteer for the shift is a crucial part of a successful incentive program. By fostering collaboration and providing staff with motivation to work extra or hard-to-fill shifts, staff feel engaged rather than forced.
The success of non-monetary, points-based incentive programs should not be overlooked. Often, a points-based rewards program can enable the health system to move staff from high dollar-based bonus shifts while still providing creative incentives to pick up extra shifts or hard-to-fill shifts. That transition can save the organization millions of dollars.
Another great advantage of using a non-monetary rewards program is that points can be earned for requesting and/or being awarded shifts. As a result, staff are rewarded for their contribution to achieving effective staffing regardless of whether or not they are awarded the shift.
Another consideration that can be just as effective as an incentive program is self-directed floating, where staff can view and choose to work any available shifts that they are qualified to work. By providing this level of transparency, a not-for-profit community hospital in Tennessee has seen voluntary floating become an integral part of filling open shifts, with employees who voluntarily work in a non-home department filling almost 30% of in-patient nursing shifts. In addition, regular internal staff fills shifts at 26% beyond the minimum scheduling requirement, which has greatly reduced the organization’s per diem costs.
2 – Staffing based on patient need
In the past, acuity-based systems were known to be highly subjective, inconsistent and unreliable. Today, however, systems can be much more consistent and accurate, based on scientific data, practice evidence and the ability to pull information directly from a single source of truth, the electronic health record (EHR).
With a patient-centered approach, both the nurse and the patient benefit from more data-driven staffing decisions. As the Regional Chief Clinical Executive at a health system in California points out, “If we don’t have the data to demonstrate the hard work—the practice and influence we make in light of those we serve—we won’t be able to appropriately demonstrate our value contribution.”
The VP of Nursing at a 1,700-employee health system in the South shares how patient-centered staffing has increased staff satisfaction at her organization, “Nurses see how the system integrates to their assessments, so that their clinical documentation accurately impacts the workload.”
3 – Self-scheduling
A self-scheduling initiative supported by the right technology can facilitate both staff engagement and better open shift management. To be effective, the technology should provide a system of checks and balances that gives staff the ability to view and request the schedule they want to work while ensuring that patient needs and budget constraints are also accommodated.
Equally important is minimizing the amount of time that unit managers and staffing coordinators need to spend balancing and adjusting the schedule, allowing the automation to do the bulk of that work. Many organizations are utilizing self-scheduling to boost employee engagement. The Chief Nursing Officer at a regional medical center in Florida says, “On a unit where morale was an issue, engagement has increased by implementing self-scheduling.”
Self-scheduling can provide both staffing equity and flexibility. “Staffing plans were developed to improve fairness. We are trying more self-scheduling and flexibility in scheduling. This gives staff more control over schedules, which improves morale and reduces turnover,” explains the Chief Nursing Officer at a critical access acute care hospital in the Midwest.
4 – Nurses working to the top of their license
Leveraging the skills, competencies and experience of the clinicians and support staff benefits both the organization and the staff, as a 5,700-employee health system in the South has experienced. According to a Vice President of Nursing and Chief Nursing Officer at the health system, “We can track degrees, certifications and skills in our staffing and scheduling system. That helps us to better balance out the experience, the skills and the competencies of our staff. With easy access to this information, we can more easily fill our staffing needs from within our own system, not having to always engage in premium labor. That has reduced our need for travelers and agency nurses while providing our staff with opportunities to use their skills in our other hospitals.”
Her counterpart, another Vice President of Nursing and Chief Nursing Officer within the health system adds, “We encourage our nurses to gain new skill sets, and they appreciate opportunities to put those new skills to use. Nurses are lifelong learners, and many of our nurses find it attractive to be able to function in multiple areas. That mindset and ability to embrace change enables us to flex our staff across the entire organization.”
5 – Equitable workloads
Equitable nurse-patient assignments help achieve a higher likelihood for positive outcomes as a result of accurately balancing patient care needs with nurse workload and skill mix. Technology can support efforts to achieve equitable workloads.
“When staff feel like they have a heavy load, the system validates that and gives actionable items to balance the workload in real time,” explains the VP of Nursing at the 1,700-employee health system in the South.
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