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Travel nurses and hospital culture – Make sure they fit

By Jeff on Nov 12, 2010 in Hospital Staffing, Travel Nurses

One continual challenge of using travel nurses to meet staffing needs in your hospital is the culture fit of the nurse into your unit. This is understandable considering how short of a time they are in your hospital and how little information you have about them before they get there and vice-versa. Compare this to what you would know about a potential permanent nurse who you were able to interview in person and it is easy to see how ensuring a culture fit using a traveler RN can be a challenge.

This is an area where staffing companies should definitely always work on improving, but as a nurse manager or HR professional there are some things you can do internally as well at your hospital.

One of the simplest is to take the time to outline exactly what your culture is and communicate it to your contacts at the travel nursing companies you work with. Whether it is a page on your website or a culture manual just for travelers, the mere act of putting it together will not only help you lay out what you expect of travelers when they arrive, but will also help you see any areas that may pose a challenge for a traveler when they arrive and consequently get your brain started on simple solutions.

Finding the time to do this may not be easy, but it needs to be looked at as an investment of your time. The more effective you are at eliminating poor culture fits up front means the less time you and your travel nursing company will have to spend dealing with them as personnel issues later. Culture training needs to be part of your travel nurse orientation process.

This website has a lot of good articles, tips and tools for building a great culture so check it out.

And for a look at one of the most famous company culture icons of business check out Zappos’ culture section of their website.

Are healthcare staffing companies a haven for bad nurses? Follow-up.

By Jeff on Dec 23, 2009 in Featured, Hospital Staffing, Travel Nurses

In my last post I talked about an article in The Los Angeles Times on Sunday, Dec. 6th called, Temp Firms a Magnet for Unfit Nurses, that discussed the quality, or lack of it, of nurses working through staffing firms. My point in my last post was that the article placed a lot of the blame on the staffing agencies and not the nurses themselves or hospitals that don’t check on the agencies they work with. I also talked about research that showed that temporary nurses are as, if not more, qualified than permanent nurses. But one area I did not fully address was what could be done about it.

Well in a recent article titled “Union: Healthy Environments, Better Orientation Can Solve Temp Nurse Issue” at HealthLeadersMedia, Media Rebecca Hendren discussed the article with some nurse executives from the new National Nurses United union who brought up some great points in response to the Los Angeles article including:

Acknowledging that in some circumstances travel nurses can be a real blessing for hospitals, but focus should still be on building a stable long-term workforce
Not supporting a national nurse registry and instead letting the state associations and licensing boards handle it
Illustrates a need to focus on a healthy working environment to improve retention and recruitment of permanent nurses, which in turn will reduce the need for temporary and travel nurses
Better orientation of travel nurses is important because even a good nurse who does not know the system and procedures of her new hospital will have a hard time with little orientation
California’s nurse to patient ratio had little to do with the problem and in fact has brought more nurses back to work in the state

These points really make me think about travel nursing orientation, and the role it plays in the overall quality of healthcare provided by travel nurses and in the experience of the travel nurses themselves. Stay tuned for a post dedicated to it.

Demystifying healthcare staffing: How can hospitals make sure they are staffed appropriately in a nursing shortage?

By Jeff on Dec 04, 2009 in Demystifying healthcare staffing, Featured, Hospital Staffing

When it comes to staffing your hospital it important that you have a plan in place. You want to make sure that you have enough nurses in place to deal with things like seasonal fluctuations, the opening of new units or wings, unexpected and expected staff vacancies and illnesses just to name a few. That part you already know, the hard part is how you develop that plan.

For starters it needs to be a plan that takes of long-term and short-term staffing shortages. Like anything in life it is easier to plan for something if you know what to expect, which is why being able to look at some historical factors to predict just what your staffing needs are going to be is an important first step of creating a plan to make sure your unit always has a safe level of nurses for the number of patients you are going to have. Some factors to include in this are:

Your hospitals past census levels
Your staffing budget
Your accepted nurse to patient ratios

Conversely one thing you want to avoid is being overstaffed because it can be very costly to a hospital on a tight budget. Ultimately you want a plan that at least helps your unit break even, but even better you want it to help your hospital make money.

So when you look at staffing your hospital or unit, temporary staffing can be a good part of your staffing plan. You will often hear from the C-Level when money gets tight that temporary staff is one of the most costly budget items and easiest to get rid of, but if the use of travel nurses is part of a plan, not a quick reaction to unexpected census changes then they should not be seen as an expense, but as a revenue generator. A few factors to keep in mind when looking at the cost of temporary nurse staff as part of your staffing plan are:

How many patients are you not seeing because your nurse numbers are too low?
What is your average revenue per patient?
What percent of your FTEs are being covered by internal float pools and how long will that last?
What are average nurse turnover rates?
How much are your recruiting cost for a full-time staff?
What is your annual salary for a full-time nurse?

When you put together your staffing plan don’t just look at the immediate weigh what your nurse needs will be through the course of the year and determine the times when you will need both full-time staff and temporary (travel or per diem) staff. Not only will you be able to ease the burden on your full-time staff, plan for the temporary staff’s orientation better, help your hospital make more money and most importantly, treat more patients.

Can temporary nurse staffing help in lean hospital management?

By Jeff on Sep 18, 2009 in Featured, Hospital Staffing

A recent article in the USA Today talked about hospital CEOs’ efforts in cutting out wasteful spending to not only increase the efficiency and profitability of their hospitals but also help lower the cost of healthcare, an obviously hot topic right now.

It discussed waste in supplies and use of staff’s time and how some hospitals are reducing inefficiencies using Toyota’s lean management system and reducing costs in patient care by 25% in one example. In fact, experts weigh in and say that if all hospitals could do save similar amounts it would save $400 billion on Medicare and another $1.3 trillion on the non-Medicare side. Those are huge savings and really what industry couldn’t probably do the same by being more efficient?

It leads me to think about the role of temporary staff in running a lean hospital. Just like you wouldn’t want supplies to go to waste (like the article mentions) and would be able to save money by having supplies on demand, you wouldn’t want to be overstaffed when your patient level doesn’t call for it and conversely understaffed when your patient numbers have increased. Having nursing staff on demand could be a huge savings and, if approached right, a huge efficiency increase.

Industry research has shown that hospitals are reluctant to use contingent staffing and will usually often only use it as a last resort. And some of the reasons listed are, training and orientation, staff cohesiveness and high costs.

Those reservations are understandable, but if you approach staffing as a lean management item it may make sense to take a second look at each area of reservation and create systems to deal with each one to take advantage of the cost savings that travel nursing staff can provide instead of seeing them as obstacles to nursing and allied health staff on demand. This could help you create a better work environment for your nurses and other healthcare professionals and in turn care for your patients better. And what a competitive advantage for your hospital that would be.

This post made me think of a few more related topics so keep an eye out. And I would love to hear your thoughts too.

Refreshing nursing skills?

By Jeff on Jul 25, 2009 in Featured, Healthcare Hiring, Hospital Management, Hospital Staffing, Travel Nurses

A post and comment thread on a great blog over at the HCA West Florida Recruitment Blog brought up the point about nurses returning to the profession due to the economic recession after time away and their need to take part in “Back to Nursing” type programs to refresh their skills.

Here are some other nursing articles and resources I found on this topic:

Career Focus: Refresher Programs Help Nurses Return to Work
RN Refresher Courses at Nurse.com | Nationwide Refresher Course
Nurse Refresher.com
NurseWeek: You Can Go Home Again

One thing to keep in mind as you look to bring more permanent nurses on that are reentering the workforce, is that if it takes longer than you would like to get them going, but know that they will be worth the time investment, you may want to still look at travel or temporary nursing staff as an interim. Especially considering the quicker orientation time of a travel nurse typically. In fact a travel nurse with their wide range of backgrounds could be very useful in bringing a re-entry nurse up to speed pretty quickly.

Is this something you are seeing at your hospital as well? If so how long is it taking to get them up to speed? What are your thoughts?

How do you orient travel nurses?

By Jeff on Jul 17, 2009 in Featured, Hospital Staffing, Nursing Staff Management, Travel Nurses

One of the big concerns of nurse managers and hospital staffing managers is the length of time it takes to truly orient a new travel nurse into their hospital and unit. This is an understandable concern, if you consider you only have a temporary nurse for basically three months at your unit and if they are there, then most likely the hospital has an immediate need and getting them working as quickly as possible is crucial. The norm seems to be anywhere from a half-day to three days of orientation, whereas a permanent nurse may receive anywhere from a week to two weeks of orientation.

Because they are travel nurses coming to you through a travel nursing company you should be able to trust that the agency has qualified their skills and competency as a nurse, but there are still going to be still simple things like where are your supplies, where is the cafeteria, how is the floor organized, etc. that need ingrained quickly.

Obviously the orientation of a nurse is something that needs a delicate balance of speed and thoroughness, but there are not a lot of resources out there to help you build a quick, but effective orientation plan. At least that I could find. But, maybe we can help each other.

I would love to be able to provide some simple advice for our hospital clients (hopefully that is some of you) on how to make their orientation the most effective for them and for our travelers and I think you should be able to share with others hospital staffing and HR professionals the things that have worked for you. Handbooks? Quizzes? Mentors? Tour Guides? Puppet shows?

So if you have a second please share. If you want to be anonymous just send me an email at Jeff.Long@MedicalSolutions.com.